Retzius Sparing Robot-Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score Matched Analysis of 1,863 Patients

Lee, Jongsoo; Kim, Ha Yan; Goh, Hyeok Joon; Heo, Jiwoong; Almujalhem, Ahmad; Alqahtani, Ali Abdullah; Chung, Doo Yong; Chang, Kidon; Choi, Young Deuk; Rha, Koon Ho

doi:10.1097/ju.0000000000000461

Cited by 61 publications

(73 citation statements)

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“…Previous reports detailed an up to 92% immediate UC rate after using Retzius‐sparing approach [9]. After the first report [8], there was some retrospective evidence showing that the Retzius‐sparing approach is associated with a better early recovery of UC rate compared with the conventional approach [10–13]. Recently, results from two prospective randomized controlled trials (RCTs) further confirmed the advantage of the Retzius‐sparing approach, providing high‐level evidence supporting earlier recovery of UC [14,15].…”

Section: Introductionmentioning

confidence: 99%

Retzius‐sparing robot‐assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single‐blind trial with a 1‐year follow‐up

Qiu

Chen

et al. 2020

BJU International

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To evaluate the impact of Retzius-sparing robot-assisted radical prostatectomy (posterior approach) on early recovery of urinary continence (UC) compared to the conventional approach (anterior approach) for the treatment of clinically localized prostate cancer (PCa). Methods A total of 110 consecutive patients with clinically localized PCa were prospectively randomized in a 1:1 ratio to an anterior group (n = 55) or a posterior group (n = 55). The primary outcome was immediate UC, defined as freedom from any pad use within 1 week after removal of the urinary catheter. The UC rate following surgery was also calculated with Kaplan-Meier curves, and the log-rank test was used for statistical comparison. Intra-operative outcomes, pathological data and oncological outcomes, including positive surgical margin (PSM) status and biochemical recurrence-free survival (BCRFS), were also compared between the two groups. The comparison of the two approaches was also analysed in subgroups after risk stratification. Results Of the patients who underwent the posterior approach, 69.1% achieved immediate UC compared with 30.9% in the anterior group (relative risk 2.24, 95% confidence interval [CI] 1.48-3.51; P = 0.000). The relative Kaplan-Meier curves for UC during the 12-month follow-up revealed statistically better recovery in the posterior group when compared with the anterior group (hazard ratio [HR] 1.51, 95% CI 1.01-2.24; log-rank P = 0.007). No statistically significant differences were observed between the groups regarding complications (P = 0.399), PSM status (P = 0.225) or BCRFS (HR 4.80, 95% CI 0.97-23.78; log-rank P = 0.111). In sub-analyses, no significant difference between the two approaches with regard to UC recovery in patients with high-risk PCa was observed (HR 1.26, 95% CI 0.63-2.51; log-rank P = 0.415). Conclusions The Retzius-sparing approach significantly improved early recovery of UC compared to the conventional approach. Further prospective studies are needed to confirm the benefits of the Retzius-sparing approach for clinically localized PCa, especially for high-risk cases.

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Section: Introductionmentioning

confidence: 99%

Retzius‐sparing robot‐assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single‐blind trial with a 1‐year follow‐up

Qiu

Chen

et al. 2020

BJU International

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“…However, several experts are still reluctant to perform RsRARP, asserting that the technique is technically difficult with a higher risk of positive surgical margins (PSMs) compared to the standard approach [12]. Despite recent data [10,11,13] showing conflicting findings in this setting, the technique was adopted by several international centres [14]; however, there is a lack of data assessing peri‐operative outcomes improvement during the learning curve for RsRARP‐naïve surgeons. To address this, we evaluated the effect of surgical experience on peri‐operative, functional and oncological outcomes during the first 50 RsRARP cases performed by surgeons naïve to the Retzius‐sparing approach in a multi‐institutional setting.…”

Section: Introductionmentioning

confidence: 99%

Retzius‐sparing robot‐assisted radical prostatectomy: early learning curve experience in three continents

et al. 2020

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Objective To assess the effect of surgical experience on peri‐operative, functional and oncological outcomes during the first 50 Retzius‐sparing robot‐assisted radical prostatectomy (RsRARP) cases performed by surgeons naïve to this novel approach. Materials and Methods We retrospectively evaluated the initial cases operated by 14 surgeons in 12 different international centres. Pre‐, peri‐ and postoperative features of the first 50 patients operated by each surgeon in all the participating centres were collected. The effect of surgical experience on peri‐operative, functional and oncological outcomes was firstly evaluated after stratification by level of surgical experience (initial [≤25 cases] and expert [>25 cases]) and after using locally weighted scatterplot smoothing to graphically explore the relationship between surgical experience and the outcomes of interest. Results We evaluated 626 patients. The median follow‐up was 13 months in the initial group and 9 months in the expert group (P = 0.002). Preoperative features overlapped between the two groups. Shorter console time (140 vs 120 min; P = 0.001) and a trend towards lower complications rates (13 vs 5.5%; P = 0.038) were observed in the expert group. The relationship between surgical experience and console time, immediate urinary continence recovery and Clavien–Dindo grade ≥2 complications was linear, without reaching a plateau, after 50 cases. Conversely, a non‐linear relationship was observed between surgical experience and positive surgical margins (PSMs). Conclusions In this first report of a multicentre experience of RsRARP during the learning curve, we found that console time, immediate urinary continence recovery and postoperative complications are optimal from the beginning and further quickly improve during the learning process, while PSM rates did not clearly improve over the first 50 cases.

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“…18 RS-RARP has been reported to achieve a better outcome with respect to early acquisition of urinary continence. [19][20][21] Although preservation of the dorsal vascular complex and endopelvic fascia was supposed to lead to a better outcome for sexual function, the recovery rate of erectile function after RS-RARP was similar to that after conventional nerve-sparing RARP in several studies (Table 1). [21][22][23][24] Transvesical RARP Desai et al first described transvesical RARP in a cadaveric study.…”

Section: Rs-rarpmentioning

confidence: 87%

“…This procedure was carried out via a transperitoneal posterior approach, leading to the preservation of neurovascular bundles, pudendal arteries and supporting structures of the prostate situated anteriorly at the prostate; for example, puboprostatic ligament 18 . RS‐RARP has been reported to achieve a better outcome with respect to early acquisition of urinary continence 19–21 . Although preservation of the dorsal vascular complex and endopelvic fascia was supposed to lead to a better outcome for sexual function, the recovery rate of erectile function after RS‐RARP was similar to that after conventional nerve‐sparing RARP in several studies (Table 1).…”

Section: Surgical Procedures For Nerve Sparingmentioning

confidence: 99%

Comprehensive approach for preserving cavernous nerves and erectile function after radical prostatectomy in the era of robotic surgery

et al. 2021

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A nerve-sparing procedure during robot-assisted radical prostatectomy has been considered one of the most important techniques for preserving postoperative genitourinary function. The reason is that adequate nerve-sparing procedures could preserve both erectile function and lower urinary tract function after surgery. When a nerve-sparing procedure is carried out, the cavernous nerves themselves cannot be visualized, despite the magnified viewing field during robot-assisted radical prostatectomy. Thus, nerve-sparing procedures have been considered challenging operations, even now. However, because not all surgeons have carried out a sufficient number of nerve-sparing procedures, the development of new nerve-sparing procedures or new methods for mapping the cavernous nerves is required. Recently, various new operative techniques, for example, Retzius-sparing robot-assisted radical prostatectomy, transvesical robot-assisted radical prostatectomy and retrograde release of neurovascular bundle technique during robot-assisted radical prostatectomy, have been developed. In addition, new surgical devices, for example, biological/bioengineering solutions for cavernous nerve protection and devices for identifying the cavernous nerves during radical prostatectomy, have developed to preserve the cavernous nerves. In contrast, limitations or problems in preserving cavernous nerves and postoperative erectile function have become apparent. In particular, the recovery rate of erectile function, the positive surgical margin rate at the site of nerve-sparing and the indications for nerve sparing have become obvious with the accumulation of much evidence. Furthermore, predictive factors for postoperative erectile function after nerve-sparing procedures have also been clarified. In this article, the importance of a comprehensive approach for early recovery of erectile function in the robot-assisted radical prostatectomy era is discussed.

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Retzius Sparing Robot-Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score Matched Analysis of 1,863 Patients

Cited by 61 publications

References 0 publications

Retzius‐sparing robot‐assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single‐blind trial with a 1‐year follow‐up

Retzius‐sparing robot‐assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single‐blind trial with a 1‐year follow‐up

Retzius‐sparing robot‐assisted radical prostatectomy: early learning curve experience in three continents

Comprehensive approach for preserving cavernous nerves and erectile function after radical prostatectomy in the era of robotic surgery

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