Patients with prior TURP undergoing robot-assisted laparoscopic radical prostatectomy have higher positive surgical margin rates.

With the incidence of robot-assisted radical prostatectomy (RALP) increasing, questions regarding the significance of margin status have arisen. Patients with a history of a prior transurethral resection of the prostate (TURP) may have a higher incidence of positive margins because of the prior surgery. We examined our IRB-approved database to determine whether patients who had undergone a prior TURP had higher rates of positive margins than patients who had no history of TURP. Between July 2003 and March 2007, six urologic surgeons in our medical group (City of Hope medical group) performed RALP on 2,041 patients. Consent to enter the database was obtained from 1,768 patients. Of these, 51 had undergone prior TURP. Patients with a history of TURP before undergoing RALP had positive margin rates of 35.3% (18 of 51) compared with 17.6% (18 of 102) of patients without a history of TURP (P = 0.015). The location of the positive margins was statistically more prevalent at the bladder neck in TURP patients (13.7 vs. 2.0%) than in non-TURP patients (Fisher's exact P value = 0.004). These two groups were statistically similar with regard to other variables examined including race, BMI, preoperative PSA, Gleason score, and pathologic stage. Patients who underwent RALP following TURP were found to have a higher positive margin rate. The positive margins were more likely to be located at the bladder neck in TURP versus non-TURP patients.