Re: challenging the dogma of simultaneous resection of bladder tumor and benign prostate
Letter to the Editor

Re: challenging the dogma of simultaneous resection of bladder tumor and benign prostate

Daniele Castellani, Marco Dellabella

Department of Urology, IRCCS-INRCA, Ancona, Italy

Correspondence to: Daniele Castellani. Department of Urology, IRCCS-INRCA, via della Montagnola 81, 60127 Ancona, Italy. Email: d.castellani@inrca.it.

Provenance: This is an invited article commissioned by Section Editor Xiao Li (Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China).

Response to: Tsivian M, Tsivian A. Challenging the dogma of simultaneous resection of bladder tumor and benign prostate. Transl Androl Urol 2018;7:S756-7.


Submitted Jan 15, 2019. Accepted for publication Jan 23, 2019.

doi: 10.21037/tau.2019.01.14


Doctors Tsivian and Tsivian commented on the results of our randomized clinical trial, evaluating oncological and functional outcomes of simultaneous transurethral prostate (TURP) and bladder tumor resection (TURBT) in men with concomitant benign prostatic hyperplasia (BPH) with surgical indication (1). First of all, we would like to thank them for their insightful editorial comment which was recently published in this journal (2). Our reply may perhaps clarify some of the concerns raised in their editorial. We agree with Doctors Tsivian and Tsivian that the lack of blindness surgery after the randomization may be a bias. However, this could have been an unethical step of the trial and, anyway, most of the men in Group 2 would have understood what surgery they had undergone considering the improvement of their lower urinary tract symptoms (LUTS) and flow rate during follow-up. Intravesical chemo/immunotherapy was administered after surgery according to European Association of Urology (EAU) risk of recurrence (3) in 26 patients in Group 1 and in 27 in Group 2, with no statistical difference between the groups; this was reported in results and in Table 2. Therefore, adjuvant instillation influenced equally bladder cancer recurrence. Concomitant TURP and TURBT have become our standard strategy when indicated. The results of our study (1) and previous retrospective data (4-7) should, nowadays, reassure urologists to offer concomitant TURP and TURBT in order to improve quality of life of their patients. Moreover, this approach has been demonstrated to be time and consequently cost-saving (8). Time has come to defeat the dogma (9).


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

  1. Dellabella M, Branchi A, Gasparri L, et al. Oncological safety and quality of life in men undergoing simultaneous transurethral resection of bladder tumor and prostate: results from a randomized controlled trial. World J Urol 2018;36:1629-34. [Crossref] [PubMed]
  2. Tsivian M, Tsivian A. Challenging the dogma of simultaneous resection of bladder tumor and benign prostate. Transl Androl Urol 2018;7:S756-7. [Crossref] [PubMed]
  3. Babjuk M, Oosterlinck W, Sylvester R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2008;54:303-14. [Crossref] [PubMed]
  4. Li S, Zeng XT, Ruan XL, et al. Simultaneous transurethral resection of bladder cancer and prostate may reduce recurrence rates: A systematic review and meta-analysis. Exp Ther Med 2012;4:685-92. [Crossref] [PubMed]
  5. Luo S, Lin Y, Zhang W. Does simultaneous transurethral resection of bladder tumor and prostate affect the recurrence of bladder tumor? A meta-analysis. J Endourol 2011;25:291-6. [Crossref] [PubMed]
  6. Picozzi SC, Ricci C, Gaeta M, et al. Is it oncologically safe performing simultaneous transurethral resection of the bladder and prostate? A meta-analysis on 1,234 patients. Int Urol Nephrol 2012;44:1325-33. [Crossref] [PubMed]
  7. Singh V, Sinha RJ, Sankhwar SN. Outcome of simultaneous transurethral resection of bladder tumor and transurethral resection of the prostate in comparison with the procedures in two separate sittings in patients with bladder tumor and urodynamically proven bladder outflow obstruction. J Endourol 2009;23:2007-11. [Crossref] [PubMed]
  8. Tsivian A, Shtricker A, Sidi AA. Simultaneous transurethral resection of bladder tumor and benign prostatic hyperplasia: hazardous or a safe timesaver? J Urol 2003;170:2241-3. [Crossref] [PubMed]
  9. Kiefer JH. Bladder tumor recurrence in the urethra: a warning. J Urol 1953;69:652-6. [Crossref] [PubMed]
Cite this article as: Castellani D, Dellabella M. Re: challenging the dogma of simultaneous resection of bladder tumor and benign prostate. Transl Androl Urol 2019;8(Suppl 1):S119-S120. doi: 10.21037/tau.2019.01.14