A systematic review of outcomes after prostatectomy in patients with an ileal pouch-anal anastomosis.

Prostate cancer is the fourth most frequently diagnosed malignancy worldwide. Since the inception of ileal pouch-anal anastomoses (IPAA) in 1978, the clinical situation of prostate cancer in the setting of an IPAA has arisen. We aimed to examine and synthesize the literature on oncologic, urologic and pouch outcomes after prostatectomy in patients with a pre-existing IPAA. We performed a systematic review according to PRISMA guidelines, searching MEDLINE, EMBASE, Scopus, PubMed, and Google Scholar for studies published from inception to June 2025. Studies not written in English or unable to be accessed were excluded. Descriptive statistics were performed on patient demographics, surgical details, characteristics of prostate cancer, and treatment outcomes. Eight retrospective studies were included, consisting of 93 male patients with a median follow-up of 9 months (range 1-174 months) postprostatectomy. Prostate cancer grade group 2 disease was most common. Prostatic adhesions and scarring were frequently encountered during surgery. Normal pouch function was preserved in 83.9% (78/93) of patients following prostatectomy and pouch failure occurred in 5.4% of cases postoperatively (5/93). Erectile function and urinary continence were preserved in 62.5% (10/16) and 88.2% (30/34) of patients respectively at the time of last follow-up. Most patients did not experience biochemical recurrence of prostate cancer (92.5%; 62/67). Prostatectomy can be considered when deciding to treat patients with a pre-existing IPAA who develop prostate cancer. There remains a need for prospective research to provide additional evidence on the effectiveness and safety of prostatectomies in this unique population.