Retzius-sparing versus standard robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer.

Retzius-sparing Robot-assisted Radical Prostatectomy in High-risk Prostate Cancer Patients: Results from a Large Single-institution Series

“…According to the European Association of Urology (EAU) guidelines, radical prostatectomy with extended pelvic lymph node dissection is a reasonable option in selected high-risk PCa patients, as part of potential multimodal therapy [1] . Among different surgical approaches, Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been considered a valid surgical treatment option for PCa patients [1] , [3] , [4] , [5] , [6] , [7] . However, differently from the anterior robot-assisted radical prostatectomy (RARP) and retropubic open prostatectomy, clinicians are sceptic regarding a possible role of the posterior approach (ie, RS-RARP) in the high-risk PCa setting, given the lack of high-level evidence on this subset of patients and a concern that RS-RARP may confer an increased positive surgical margin (PSM) rate [1] , [6] .…”

“…Among different surgical approaches, Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been considered a valid surgical treatment option for PCa patients [1] , [3] , [4] , [5] , [6] , [7] . However, differently from the anterior robot-assisted radical prostatectomy (RARP) and retropubic open prostatectomy, clinicians are sceptic regarding a possible role of the posterior approach (ie, RS-RARP) in the high-risk PCa setting, given the lack of high-level evidence on this subset of patients and a concern that RS-RARP may confer an increased positive surgical margin (PSM) rate [1] , [6] . The majority of the available studies on RS-RARP focused exclusively on low- and intermediate-risk PCa [1] , [3] , [4] , [6] , [8] , [9] , [10] .…”

“…However, differently from the anterior robot-assisted radical prostatectomy (RARP) and retropubic open prostatectomy, clinicians are sceptic regarding a possible role of the posterior approach (ie, RS-RARP) in the high-risk PCa setting, given the lack of high-level evidence on this subset of patients and a concern that RS-RARP may confer an increased positive surgical margin (PSM) rate [1] , [6] . The majority of the available studies on RS-RARP focused exclusively on low- and intermediate-risk PCa [1] , [3] , [4] , [6] , [8] , [9] , [10] . High-risk PCa patients are generally under-represented, and their oncological and functional outcomes are generally clustered with those with less aggressive disease [7] , [11] , [12] , [13] , [14] .…”

Radical Prostatectomy: Sequelae in the Course of Time

“…Further research focuses not only on the primary technique of RP (open vs. laparoscopic vs. robotic), but also on the exact surgical approach. A recently published Cochrane Review analyzed the standard RARP approach dissecting the socalled space of Retzius anterior to the bladder compared to the Retzius-sparing or posterior approach where the Retzius is left intact (65). Accordingly, the Retzius-sparing approach may improve early continence up to 6 month and improve early urinary quality of life but ultimately results in similar continence outcomes at 12 month (65).…”

“…A recently published Cochrane Review analyzed the standard RARP approach dissecting the socalled space of Retzius anterior to the bladder compared to the Retzius-sparing or posterior approach where the Retzius is left intact (65). Accordingly, the Retzius-sparing approach may improve early continence up to 6 month and improve early urinary quality of life but ultimately results in similar continence outcomes at 12 month (65). Several other surgical techniques like for example anatomic bladder neck preservation (66), posterior reconstruction ("Rocco" stitch) (67,68), the periurethral suspension stitch ("Patel" stitch) (69), total anatomical reconstruction (70) and suture ligation with suspension of the dorsal venous complex (71) improve early urinary continence, but outcome data beyond 12 month are mostly lacking.…”