Retzius-sparing Robotic-assisted Radical Prostatectomy Facilitates Early Continence Regardless of Neurovascular Bundle Sparing

Abstract

Background/Aim: Retzius-sparing robotic-assisted radical prostatectomy (RARP) has had better results in early continence rate and comparable oncological safety compared to the retropubic approach. However, the role the neurovascular bundle (NVB) sparing plays in the rate of early continence after catheter removal remains unclear. In this study, we sought to compare the early continence rate between Retzius-sparing RARP and the retropubic approach RARP to assess whether NVB sparing affects the continence rate in patients with prostate cancer. Patients and Methods: This was a retrospective case series of 133 patients who underwent RARP from 2004 to 2017. 92 patients underwent retropubic RARP and 41 patents underwent Retzius-sparing RARP. All procedures were performed by a single surgical team in a single institution. Baseline patient characteristics were recorded and analyzed. Continence results and oncological outcomes were compared between the two groups. Continence outcome of Retzius-sparing RARP with NVB sparing was also analyzed. Results: No differences in age, prostate size, pathology T stage, PSA, and NVB sparing were found between the two groups. The oncological results including surgical margin and biochemical recurrence rate at one year showed no difference between the two groups. With respect to immediate continence results, the Retzius-sparing group showed a better continence result compared to the retropubic approach (75.6% vs. 26.1 %, respectively, p<0.001) after catheter removal. However, there was no difference between the two groups after 6 months. Furthermore, no significant difference in immediate continence result was found in the Retzius-sparing group between patients with NVB sparing (75 %) and those without (75 % vs. 78%, respectively, p=1.00). Conclusion: Retzius-sparing RARP may provide a better immediate continent result compared to retropubic RARP. In Retzius-sparing RARP, NVB sparing did not enhance immediate continence after the operation.

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

“…After reading through the full text of 24 articles, a total of 14 studies including 3,129 participants were finally included in our meta-analysis ( 11 – 17 , 19 – 24 , 28 ). 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.…”

“…Biochemical recurrence data were reported in four studies ( 12 , 21 , 24 , 28 ), and meta-analysis using a random-effects model showed no significant difference in the rate of 1-year-biochemical recurrence between the two surgical procedures (OR = 0.87, 95% CI: 0.35–2.18, P = 0.77, I 2 = 69%) ( Figure 10 ).…”

“…Eight studies (13,14,17,(19)(20)(21)(22)24) reported the difference in estimated blood loss between RS-RARP and c-RARP. Due to the high heterogeneity (I 2 = 85%), the meta-analysis results using the random-effects model showed that there was no significant difference in estimated blood loss between RS-RARP and c-RARP (MD = −14.27, 95% CI: −72.89 to 44.36, P = 0.63) (Figure 3).…”

“…Ten studies (11,(13)(14)(15)(16)(17)(19)(20)(21)(22) reported data on early urine continence (≤1 month), and the random-effects model results showed that RS-RARP was significantly better than c-RARP in early urine continence (OR = 5.72, 95% CI: 3.56-9.19, P < 0.001, I 2 = 68%) (Figure 7).…”

“…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.…”