title: Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery.
abstract: OBJECTIVE
  Our objective is to clarify the effect of previous transurethral resection of the prostate (TURP) or open prostatectomy (OP) on surgical, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  Between August 1, 2009, and March 31, 2013, 380 patients underwent RARP. Of these, 25 patients had undergone surgery for primary bladder outlet obstruction (TURP, 20 patients; OP, 5 patents) (group 1). A match-paired analysis was performed to identify 36 patients without a history of prostate surgery with equivalent clinicopathologic characteristics to serve as a control group (group 2). Patients followed up for 12 months were assessed.
  
  
  RESULTS
  Both groups were similar with respect to preoperative characteristics, as mean age, body mass index, median prostate-specific antigen, prostate volume, clinical stage, the biopsy Gleason score, D'Amico risk, the American Society of Anesthesiologists (ASA) classification score, the International Prostate Symptom Score, continence, and potency status. RARP resulted in longer console and anastomotic time, as well as higher blood loss compared with surgery-naive patients. We noted a greater rate of urinary leakage (pelvic drainage, >4 d) in group 1 (12% vs 2,8%). The anastomotic stricture rate was significantly higher in group 1 (16% vs 2.8%). No difference was found in the pathologic stage, positive surgical margin, and nerve-sparing procedure between the groups. Biochemical recurrence was observed in 12% (group 1) and 11.1% (group 2) of patients, respectively. No significant difference was found in the continence and potency rates.
  
  
  CONCLUSIONS
  RARP after TURP or OP is a challenging but oncologically promising procedure with a longer console and anastomosis time, as well as higher blood loss and higher anastomotic stricture rate.
authors.affiliation: Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Tugcu
authors.affiliation: Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Arda
authors.initials: A
authors.lastname: Atar
authors.affiliation: Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Sahin
authors.affiliation: Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Kargi
authors.affiliation: Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Kamil
authors.initials: K
authors.lastname: Gokhan Seker
authors.affiliation: Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: IlkerComez
authors.affiliation: Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: IhsanTasci
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical; D003251:Constriction, Pathologic; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures; D020728:Transurethral Resection of Prostate
keywords: benign prostatic hyperplasia; outcomes; previous surgery; prostate cancer; robotics