What are the indications for combining Transurethral Resection of Bladder Tumor (TURBT) with Transurethral Resection of the Prostate (TURP)?

Indications for Combining TURBT with TURP

The primary indication for combining Transurethral Resection of Bladder Tumor (TURBT) with Transurethral Resection of the Prostate (TURP) is in patients with confirmed urothelial carcinoma of the prostate with ductal/acini or prostatic urethra involvement. 1

Primary Indications

1. Urothelial carcinoma involving the prostate:

   • Prostatic ductal/acini involvement
   • Prostatic urethral involvement
   • Requires postsurgical intraprostatic BCG therapy after the procedure 1

2. Coexisting bladder cancer and symptomatic BPH:

   • Patients with non-muscle invasive bladder cancer (NMIBC) and concurrent symptomatic benign prostatic hyperplasia 2, 3
   • Particularly beneficial for patients with bladder tumors located near the bladder neck or prostatic urethra

Clinical Benefits of Combined Procedure

Oncological Benefits

• Reduced overall recurrence rates compared to TURBT alone 3, 4
• Significantly lower recurrence rates at the bladder neck/prostatic fossa (3% vs 55%) 3
• No increase in progression rates or adverse oncological outcomes 2, 3

Urological Benefits

• Improved maximal urinary flow rate (Qmax) 2, 4
• Better International Prostate Symptom Score (IPSS) at 12 months post-procedure 2
• Enhanced quality of life for patients with both conditions 2

Patient Selection Criteria

Optimal candidates for combined TURBT+TURP include:

• Age ≤75 years 2
• First diagnosis of bladder cancer up to 4 cm 2
• Prostate volume ≤80 ml 2
• Patients with bladder cancer and significant lower urinary tract symptoms due to BPH

Contraindications and Cautions

• Fertility concerns: The procedure causes retrograde ejaculation in approximately 65.4% of patients 5
• For younger men concerned about fertility, consider alternative approaches:
  • Transurethral Incision of the Prostate (TUIP) for prostates ≤30g (only 18.2% risk of retrograde ejaculation) 5
  • Modified TURP techniques with selective resection 5

Procedural Considerations

• Combined procedure requires longer operative time than TURBT alone 3
• No significant difference in length of hospital stay 3
• Similar complication rates, including major complications (Clavien-Dindo Grade ≥III) 3

Follow-up Management

• Standard bladder cancer surveillance protocols should be followed
• Consider intravesical therapy based on pathological findings
• For patients with urothelial carcinoma of the prostate, postsurgical intraprostatic BCG is recommended 1

The combined TURBT+TURP approach appears to be oncologically safe and may improve quality of life outcomes in appropriately selected patients with concurrent bladder cancer and symptomatic BPH. The procedure may even provide a protective effect against recurrence at the bladder neck and prostatic fossa 3.