Retzius sparing robotic assisted radical prostatectomy vs. conventional robotic assisted radical prostatectomy: a systematic review and meta-analysis

Phukan, Chandan; McLean, Andrew; Nambiar, Arjun; Mukherjee, Ankur; Somani, Bhaskar K.; Krishnamoorthy, Rajagopal; Sridhar, Ashwin; Rajan, Prabhakar; Sooriakumaran, Prasanna; Prasad, Bhavan

doi:10.1007/s00345-019-02798-4

Cited by 51 publications

(49 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite promising UC outcomes, oncological safety remains a concern with regard to the Retzius-sparing approach because of the higher PSM rate [23][24][25], especially for highrisk cases. We found no significant differences for overall PSM rates and also for sub-analysis of low-to intermediaterisk or high-risk cases (Table S1).…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…Auch der 2010 publizierte laparoskopische "Retzius-Sparing"-Ansatz mit Erhalt der paravesikalen Strukturen zielt darauf ab, durch Veränderung des Zugangswegs via Douglas-Raum Verletzungen der endopelvinen Faszie und der anterior der Prostata gelegenen Strukturen zu vermeiden [31]. Für diese Modifikation der roboterassistierten radikalen Prostatektomie wurden vielversprechende funktionelle Ergebnisse nach 12 Monaten demonstriert [32].…”

Section: Intraoperative Parameterunclassified

Prä-, intra- und postoperative Einflussfaktoren funktioneller Einschränkungen nach radikaler Prostatektomie

Krausewitz

Ritter

2020

Aktuelle Urol

View full text Add to dashboard Cite

ZusammenfassungDer Erhalt von Kontinenz und Erektionsfähigkeit ist für die Lebensqualität nach radikaler Prostatektomie von entscheidender Bedeutung. Dieser Artikel gibt einen Überblick über präoperative Risikostratifizierung sowie intra- und postoperative Faktoren, die die funktionellen Ergebnisse nach radikaler Prostatektomie maßgeblich beeinflussen.Alter, präoperativ bestehende Sexualfunktion, Prostatavolumen, Body Mass Index und Komorbiditäten gelten laut Studienlage als valide Prädiktoren der funktionellen Ergebnisse nach einer Prostatektomie. Während die Operationsmethode selbst keinen Einfluss zu haben scheint, wirken sich das intraoperative Vorgehen in Form nervenschonender Techniken und Umfang der Beckenbodenrekonstruktion sowie die Erfahrung des Operateurs signifikant auf die postoperative Potenz und Kontinenz aus. Im Rahmen der Rehabilitationsmaßnahmen werden dem Beckenbodentraining und der PDE-5-Inhibitor-Therapie Schlüsselrollen zur Wiedererlangung der erektilen Funktion und Harnkontrolle zugeschrieben.Zusammenfassend können zahlreiche Therapiemodifikationen dazu beitragen, funktionelle Ergebnisse und damit auch die Lebensqualität der Patienten nach einer Prostatektomie zu verbessern. Eine sorgfältige präoperative Patientenselektion durch den Urologen sowie der Eingang besserer anatomischer Kenntnisse der nervalen und faszialen periprostatischen Strukturen in das operative Vorgehen sind dabei entscheidende Einflussfaktoren.

show abstract

“…Some investigators have advised against performing RS-RARP if the tumor involves the anterior region [28]. On the other hand Genes, et al and others also did not ind signi icant differences between the two groups [28,30,[40][41][42][43]. Moreover, one might argue that this difference in PSM rate might be also related to the learning curve associated with the RS approach.…”

Section: Best Literature Datamentioning

confidence: 99%

“…Phukan, et al showed that short term biochemical free survival appears to be similar between the two approaches [40,44,47], but according to Eden, et al it is impossible given the limited follow-up to comment biochemical recurrence rates [38].…”

Section: Biochemical Recurrence (Bcr): Mukherjee Et Al Andmentioning

confidence: 99%

“…Additionally, other papers reported that in comparison to the conventional anterior approach, RS-RARP promoted a signi icantly faster and higher overall continence recovery immediately after the surgery, at 10 days, 1-2 weeks, 4 weeks, 3, 6 and 12 months after surgery [14,28,34,42,48], and the International Prostate Symptom Score (IPSS) at 3 months after surgery signi icantly favored the RS group [28]. In contrast, according to Phukan, et al RS-RARP did not alter 6 and12month continence rates [40], and a randomized controlled trial concluded that men undergoing C-RARP still reached similar levels of continence at 90 days and beyond [44].…”

Section: Biochemical Recurrence (Bcr): Mukherjee Et Al Andmentioning

confidence: 99%

See 1 more Smart Citation

“Maximum Preservation Radical Prostatectomy”: Oncological, functional and other contemporary aspects of Retzius Sparing Robotic Assisted Radical Prostatectomy

Tobias-Machado¹,

Sarmento²,

Nunes‐Silva³

et al. 2020

Arch Cancer Sci Ther

View full text Add to dashboard Cite

Retzius sparing robotic assisted radical prostatectomy vs. conventional robotic assisted radical prostatectomy: a systematic review and meta-analysis

Cited by 51 publications

References 25 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

Prä-, intra- und postoperative Einflussfaktoren funktioneller Einschränkungen nach radikaler Prostatektomie

“Maximum Preservation Radical Prostatectomy”: Oncological, functional and other contemporary aspects of Retzius Sparing Robotic Assisted Radical Prostatectomy

Contact Info

Product

Resources

About