Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae

Abstract

Background Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) has improved urinary function compared with standard robotic-assisted radical prostatectomy (S-RARP). As RS-RARP spares the dorsal vascular complex, pelvic fascia, and anterior abdominal fascia, it may also lower the incidence of “neglected” postprostatectomy sequelae such as penile shortening, Peyronie’s disease, and inguinal hernias. Objective To determine whether there are patient-perceived differences in penile shortening, Peyronie’s disease, and inguinal hernia rates among men undergoing RS-RARP versus S-RARP. Design, setting, and participants Researchers uninvolved in clinical care and blinded to surgical approach surveyed 60 RS-RARP versus 57 S-RARP men with validated patient-reported items to assess penile shortening, Peyronie’s disease, and inguinal hernia sequelae following surgery. Intervention RS-RARP versus S-RARP. Outcome measurements and statistical analysis Univariate differences between the two cohorts were analyzed using Student t test. Logistic regression was used to analyze variables associated with postoperative penile shortening. Cox proportional hazards models were used to assess the risk of developing Peyronie’s disease and inguinal hernia postoperatively. Results and limitations RS-RARP was associated with less patient-reported penile shortening (41.7% vs 64.9%, p = 0.012), Peyronie’s disease (0% vs 8.7%, p = 0.020), and inguinal hernia (0.0% vs 13.0%, p = 0.004). In adjusted analyses, RS-RARP (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.09–0.63, p = 0.004) was associated with lower odds of penile shortening, while a higher body mass index was associated with increased odds of penile shortening (OR 1.13, 95% CI 1.01–1.26, p = 0.037). RS-RARP was not associated with a decreased risk of Peyronie’s disease on Cox proportion hazard model; however, these models are limited due to a limited number of events in our cohort. Limitations include retrospective design, patient-reported outcomes, and small cohorts. Conclusions RS-RARP is associated with less patient-reported penile shortening and may decrease the risk of Peyronie’s disease and postoperative inguinal hernia development. These new findings add to research, showing improved urinary continence and quality of life following RS-RARP; however, a prospective study is needed to validate these findings. Patient summary Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) is an evolving surgical technique for prostate cancer treatment, which has shown improved postoperative urinary control compared with the standard technique, likely due to preservation of natural pelvic anatomy...

Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

“…To our knowledge, our meta-analysis is the most up-to-date and comprehensive. Due to the inclusion of several recent high-quality works of literature (19)(20)(21)(22)(23)(24), we have obtained some more stable results in some outcome indicators that were different from the previous meta-analyses (18,29,30).…”

“…Of the 14 studies, four were RCTs ( 11 , 12 , 16 , 20 ) and the rest were observational controlled studies ( 13 – 15 , 17 , 19 , 21 – 24 , 28 ). Among them, Dalela ( 16 ) and Menon ( 12 ) were from the same randomized controlled study, and Egan ( 24 ) and Kowalczyk ( 23 ) were from the same prospective cohort study. The baseline data of the studies included in our meta-analysis are shown in Table 1 .…”

“…A total of nine studies ( 11 – 13 , 15 , 17 , 19 , 20 , 22 , 24 ) reported postoperative complications, and three studies ( 20 , 23 , 28 ) reported postoperative hernia incidence. Results of the meta-analysis showed that although there was no significant difference in postoperative complications between the two surgical procedures (OR = 0.88, 95% CI: 0.59–1.32, P = 0.54, I 2 = 16%) ( Figure 8 ), the incidence of postoperative hernia in the RS-RARP group was significantly lower than that in the c-RARP group (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001, I 2 = 14%) ( Figure 9 ).…”

“…Due to the small sample size of the previous studies and the few references included in the previous meta-analyses, the safety and efficacy of RS-RARP compared with c-RARP are not clear at present. Several new studies have been published in 2020, which may yield new results and new outcome indicators (19)(20)(21)(22)(23)(24). Our study aims to systematically compare the clinical, oncological, and functional outcomes of RS-RARP and c-RARP through meta-analysis, to obtain reliable results and provide a basis for future studies and clinical guidance.…”

Orphaned Side-effects After Robot-assisted Radical Prostatectomy: Is the Retzius-sparing Approach Superior to the Standard Approach or Are the Data Just Not Mature Enough?

“…In volume 22 of European Urology Open Science , Kowalczyk et al [1] report interesting new data comparing the novel Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) to the standard RARP (S-RARP) approach. In their retrospectively assessed institutional series of 60 RS-RARP and 57 S-RARP procedures performed by a single surgeon, they observed varying rates of “orphaned” postoperative adverse sequelae of RP, such as inguinal hernias, Peyronie’s disease, and penile shortening.…”