[Usefulness of transurethral resection in cancer of the prostate]

We reviewed the records of 292 patients with prostatic cancer who had been submitted to transurethral resection (TUR) to elucidate the role of endoscopic surgery in the diagnosis and treatment of this condition. Re-staging TUR permits differentiation between stage A1 and A2 tumors. Of 20 patients classified as having stage A1 tumors, 4 were reclassified as A2 tumors and benefitted from subsequent radical therapy. Endoscopic surgery permitted correction of ureteral obstruction in those with advanced prostatic cancer. In 9 patients with obstructive anuria, percutaneous nephrostomy combined with TUR of the trigone and placement of a double-J catheter achieved ureteric patency; 22% of the patients were alive at 5 years. In 18 patients with obstructive anuria from prostatic cancer (4 stage C, and 14 stage D), TUR of the trigonal angle and placement of a catheter for internal diversion combined with hormone therapy (9 cases) achieved a drop in creatinine levels (9 cases) and a mean survival of 2 years. Patient quality of life was good and no hospitalization was required. TUR affords a fast and safe solution in patients with bladder obstruction from acute (33 cases; 18 stage C and 15 stage D) or chronic (219 patients with advanced prostatic adenocarcinoma, and 16 with transitional cell carcinoma of prostate) urinary retention. In 103 cases, we utilized a technique similar to that employed for resection of benign prostatic hypertrophy; vesicoureteral "funneling" was performed in 132 cases, and a urethral prosthesis was placed in 5. Our results do not corroborate the role ascribed to TUR in tumor dissemination. Of 113 patients submitted to TUR, 38% presented late metastases (mean 33 months). In 80% of the cases, TUR succeeded in eliminating bladder obstruction between 1 to 96 months (mean 21 months), with a very low operative mortality rate (0.8%) and a 44% survival rate for a mean follow-up of 3 years.