Retzius-sparing Robotic Radical Prostatectomy for Surgeons in the Learning Curve: A Propensity Score–matching Analysis

Olivero, Alberto; Galfano, Antonio; Piccinelli, Mattia Luca; Secco, Silvia; Trapani, Dario; Petralia, Giovanni; Strada, E.; Barbieri, Michele; Napoli, Grazia; Bocciardi, Aldo Massimo

doi:10.1016/j.euf.2020.03.002

Cited by 23 publications

(23 citation statements)

References 21 publications

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“…[ 20 ] They have reported excellent continence rate at 1 year and also subsequent to the radiotherapy. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

“…conducted a retrospective propensity score-matched analysis between the experienced and the young surgeons who are in their learning curve. [ 21 ] They found that with adequate training an inexperienced surgeon can also perform RS-RARP with good oncological efficacy and functional outcomes. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

“…Some of the studies previously performed on this subject have performed a propensity matched analysis. [ 11 21 ] Lack of the propensity matching of the cohorts could be considered as another limitation of our study. Also, our study lacks a long-term follow-up in terms of oncological and functional outcome regarding RS-RARP.…”

Section: Discussionmentioning

confidence: 99%

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The impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis

et al. 2021

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Introduction: To assess the outcomes of Retzius sparing robotic-assisted radical prostatectomy (RS-RARP) in comparison with the conventional RARP. Materials and Methods: A retrospective analysis of 320 cases of RARP, performed from 2014 April to 2019 April, was performed. The predictor variables included age, body mass index, clinical stage, prostate-specific antigen, Gleason score category in biopsy, D'Amico risk category, presence of the median lobe, prior transurethral resection of the prostate, and the ability to perform the RS-RARP. The outcome variables included console time, blood loss, blood transfusion, nerve sparing, bladder neck sparing, positive surgical margins (PSM), number and the site of PSMs, extracapsular invasion, seminal vesicle involvement, complications, continence, erectile function, biochemical recurrence, and adjuvant treatment. Regression analysis was performed using the linear regression for the continuous variables and binary logistic regression for the categorical variables with two levels. Results: Three hundred and twenty patients underwent radical prostatectomy from 2014 April to 2019 April. We started the RS-RARP program in December 2016. Twenty-three patients who did not meet the inclusion criteria were excluded and a total of 297 patients were studied. Multivariate analysis demonstrated that RS-RARP was a strong positive independent predictor for continence recovery at 3 months, 6 months, and 12 months. RS-RARP was an independent predictor of reduced console time and increased probability of bladder neck sparing. RS-RARP was also independently associated with increased PSM in the posterolateral, anterolateral, and the apical regions. Conclusion: RS-RARP has better continence rates up to 12 months compared with the conventional approach, but is associated with increased PSM at certain locations.

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“…[ 20 ] They have reported excellent continence rate at 1 year and also subsequent to the radiotherapy. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis

et al. 2021

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“…RS-RARP is a novel and promising surgical approach; however, with new techniques, published series are relatively small and follow-up is limited. A recent survey indicated that it is limited to 30 centers worldwide [19] . Similarly, our major limitation is the small sample size and limited follow-up.…”

Section: Discussionmentioning

confidence: 99%

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

Kowalczyk

Davis

O’Neill

et al. 2020

European Urology Open Science

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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...

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“…The technological advances have allowed better anatomical understanding and knowledge of radical prostatectomy, allowing modi ications to the operative technique and bringing undeniable bene its. Although RS-RARP approach problably require proctoration to achieve pro icience, recent paper show that it has proven to be safe and feasible during the learning curve period [51]. As a new technical alternative, long-term oncological outcomes remain unclear and the surgeon must pay attention to own surgical margins and compare with videotapes to improve personal results.…”

Section: Other Caractheristics Of Rs-rarpmentioning

confidence: 99%

“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

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Retzius-sparing Robotic Radical Prostatectomy for Surgeons in the Learning Curve: A Propensity Score–matching Analysis

Cited by 23 publications

References 21 publications

The impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis

The impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis

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

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

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