In most cases, bladder tumors are diagnosed in patients with either absolute (retention, recurrent hematuria, etc.) or relative indications for BPO surgery (worsening of LUTS despite medical therapy). In some cases, bladder tumors are incidentally detected during elective transurethral surgery for BPO. It is estimated that approximately 6% of patients diagnosed with NMIBC will have simultaneous BPO. Specifically, BPO prevalence among men over the age of 50 years is 50–75% over the age of 70 years, 80% on average are impacted and over the age of 80 years, prevalence is almost 90%. Accordingly, benign prostatic obstruction (BPO), highly prevalent among elderly men, impairs quality of life and is surgically managed, in most cases, by endoscopic transurethral prostate surgery. Patients diagnosed with NMIBC have a 5-year recurrence risk of 31–78% and a 5-year progression risk of 0.8–45%, depending on tumors stage and grade, adding a significant burden for both patients and healthcare system resources. Conclusion: Concomitant endoscopic BPO surgery and TURBT are oncologically safe and improve LUTS-related quality of life.īladder cancer, with worldwide age-standardized incidence rates of (per 100,000 person/y) 9.0 for men and 2.2 for women, diagnosed in 75% of cases as non-muscle-invasive bladder cancer (NMIBC), is managed by transurethral resection of bladder tumors (TURBT) and adjuvant intravesical immunotherapy or chemotherapy, depending on patient and tumor characteristics. Concomitant surgery improved lower urinary tract symptoms. The level of evidence was estimated as low for all outcomes. Subgroup analyses based on tumor grade, number of tumors, and utilization of single-instillation chemotherapy post-TURBT did not detect any significant differences in overall bladder tumor recurrence. Similarly, no significant differences were observed in recurrences located at the bladder neck and/or prostatic urethra (OR: 1.06, 95% CI: 0.76–1.47, I 2 = 0%), time to first recurrence (WMD: −0.2 months, 95% Cl: −2.2–1.8, I 2 = 48%), and progression rate (OR: 1.05, 95% CI: 0.67–1.64, I 2 = 0%). Across studies with good methodological quality, no statistically significant differences were demonstrated regarding overall bladder tumors recurrence rates between concomitant endoscopic BPO surgery and TURBT versus TURBT alone (OR: 0.81, 95% CI: 0.60–1.09, I 2 = 42%). Results: Three randomized and twelve retrospective observational studies with 2421 participants were included. Accordingly, we undertook multiple subgroups and sensitivity analyses (PROSPERO: CRD42020173363). We performed a random-effects meta-analysis of odds ratios (ORs) or weighted mean differences (WMD) to compare concomitant TURBT and BPO surgery versus TURBT alone in terms of recurrence and progression rates. Methods: We searched the PubMed, Cochrane Library, EMBASE, Scopus, and databases and sources of grey literature published before June 2021 for relevant studies. Aim: The aim of this study was assess the effect of concomitant TURBT and endoscopic BPO surgery on oncological safety and patient quality of life via systematic review and meta-analysis. Transurethral resection of bladder tumors (TURBT) and endoscopic surgery for benign prostatic obstruction in the same setting are avoided by many surgeons due to concerns for tumor cell seeding and recurrences in the prostatic urethra. Background: Lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO) and bladder tumors may co-exist, especially among elderly patients.
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