Simultaneous surgery for NMIBC and BOO: evaluating surgical safety to oncological benefit.

BACKGROUND: Current evidence demonstrates that simultaneous surgical management of bladder cancer (BCa) and bladder outlet obstruction (BOO) is oncologically safe, despite well-known concerns. This systematic review and meta-analysis primarily evaluates oncological outcomes of concurrent transurethral resection of bladder tumor (TURBT) and BOO surgery compared to TURBT alone or staged treatments; perioperative safety is descriptively summarized. METHODS: A systematic search of PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted from January 2000 to March 2026. Included were NMIBC and BOO surgical studies comparing simultaneous versus staged/control management. Pooled RR and HR were estimated using a random-effects model. Methodological quality was assessed using RoB 2 and ROBINS-I. Publication bias was assessed using funnel plots and Egger's weighted regression test. RESULTS: Ten studies involved 1401 patients. Compared to the control group, simultaneous surgery was significantly associated with a reduced bladder tumor recurrence risk (pooled RR: 0.80; 95% CI: 0.70-0.91; P=0.001), with low heterogeneity (I²=7%). There were no significant differences in disease progression to stage ≥T2 (RR: 0.74; P=0.22), site-specific recurrence in the bladder neck and prostatic fossa (RR: 0.75; P=0.45). Time-to-recurrence analysis demonstrated similar oncological timeframes for both methods (pooled HR: 1.22; P=0.13). Cohorts are mostly retrospective, randomized controlled trials are limited, and surgical methods vary. CONCLUSIONS: Our analysis demonstrates that simultaneous surgery is not only oncologically safe but also appears to be associated with a lower risk of recurrence. Reducing obstruction may improve bladder dynamics and lower urothelial exposure to urine carcinogens, suggesting that, alongside its established surgical safety, this approach should also be considered for its potential oncological benefits.