Comparison of retzius-sparing versus standard robot-assisted radical prostatectomy for prostate cancer

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Prostate cancer (PCa) is the second most commonly diagnosed cancer and the greatest number of deaths are due to lung, prostate and colorectal cancer in men.1 Radical prostatectomy is the most common and widely accepted surgical method for men with PCa. Although the main aim is the eradication of cancer, preserving the urinary function and sexual health became more important secondary outcomes as a result of technical improvements in surgery.

Urinary incontinence after surgery causes an impaired quality of life. Metanalysis show that nearly 30% of the patients had urinary incontinence however surgeons’ experience in robotic surgery has improved and continence rates increased to 75%–90% after robotic surgery in 12 months.2, 3 However, early continence is still a remarkable issue.

Age, obesity, comorbidities and anatomical measurement (Membranous urethral length and prostate axis angle) preoperatively with magnetic resonance imaging (MRI) are reported parameters to maintain early continence after surgery.4 Technical changes in the preservation of the membranous urethral length and the neurovascular supply, reconstruction of urethral and urethrovesical support, neurovascular bundles sparing and finally posterior robot-assisted radical prostatectomy are described to achieve continence after prostatectomy.5 Galfano et al described their Retzius-sparing technique (posterior robot-assisted radical prostatectomy) and they extended their series and found the continence rate was nearly 90% in the first week after catheter removal.6, 7 Based on these veri, we performed Retzius sparing robot-assisted radical prostatectomy (Rs-RARP) to our patients who had low and intermediate-risk, if possible.

In this study, we aimed to compare the first year oncological and functional outcomes of Retzius‐sparing robot‐assisted radical prostatectomy (Rs-RARP) and standard RARP robot‐assisted radical prostatectomy (RARP) in patients with PCa.

Materials and methods

After the approval of our institutional ethics committee (Reg. No.:12) retrospective analysis was performed with prospectively collected veri for 88 patients with PCa between April 2018–April 2019. Forty-six patients who underwent Rs-RARP and 42 patients who underwent standard RARP who had a en az one-year follow-up were included. All surgeries were performed by a single experienced robotic surgeon.


Patients’ demographics are given in Table 1. There were no significant differences in the median age, BMI and preoperative The Sexual Health Inventory for Men (SHIM) score between groups. The European Association of Urology (EAU) prostate cancer risk classification was also similar (p = 0.25). Preoperative ISUP grade group did not differ between groups. Preoperative median PSA value (median PSA, Rs-RARP: 5.7 vs. RARP: 7.45, p = 0.12) was also similar but the prostate volume (mean prostate


The main purpose of radical prostatectomy is the eradication of cancer meanwhile, if possible, preserving the continence and potency has become more important, recently. In the current study, we compared the functional and oncological outcomes of patients who underwent Rs-RARP or RARP procedures. We found shorter catheter removal time, higher continence rates and faster recovery of continence in Rs-RARP group compared to the RARP group at the end of the first month. No biochemical recurrence


Rs-RARP is a feasible technique compared to standard RARP in terms of oncological and functional outcomes in the short-to midterm follow-up. Rs-RARP clearly provides an early return of the continence. However, no significant difference in overall continence rates was observed in the first-year follow-up.

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