Transvesical Versus Posterior Approach to Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Retrospective Comparison With a 12-Month Follow-Up

Abstract

ObjectivesTo assess the perioperative, functional, and oncological outcomes of transvesical robot-assisted radical prostatectomy (T-RARP) and posterior robot-assisted radical prostatectomy (P-RARP) for localized prostate cancer.Materials and MethodsWe analyzed the data of 96 patients who underwent T-RARP or P-RARP for localized prostate cancer between January 2017 and June 2019 in a retrospective fashion.ResultsNo significant differences in the baseline characteristics existed between the T-RARP and P-RARP arms. Both interventions were successfully performed without open conversion in either group. T-RARP was associated with a slightly more operative time (135.3 vs. 127.3 min) and estimated blood loss (105.2 vs. 94.2 mL) than P-RARP, but the differences were not significant (both p > 0.05). The likelihood of transfusion, ≤Grade II, and >Grade II postoperative complications, pT3a disease and positive surgical margins in the T-RARP group was comparable with that in the P-RARP group. No significant differences were noted between these two arms in terms of UC at the removal of catheter and nocturia (p = 0.750 and p = 0.684, respectively), and all included patients recovered UC at 3 months postoperatively. The median International Index of Erectile Function-5 score in both groups remains comparable before and after RARP. The patients in the T-RARP and P-RARP groups had a similar biochemical recurrence-free survival (p = 0.387).ConclusionsBoth T-RARP and P-RARP by experienced hands are feasible for well-selected patients with prostate cancer, obtaining similar outcomes in terms of perioperative results, UC and erectile function, and oncological control within short-term follow-up.

Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

“…Several pathophysiological factors may account for the occurrence of post-prostatectomy incontinence (PPI). Apart from the preoperative variables encompassing age at the time of operation, preexisting lower urinary tract symptoms, higher BMI, and bladder dysfunction, the structural damage to anatomic supporting structures and neural elements during the RP process may play a crucial part in the development of PPI ( 13 , 33 ). Given the comparability of all the preoperative variables between the two arms in our analysis, the significant differences in UC and EF recovery observed between the RARP and LRP groups in our study could be attributed to the benefits of robotic platforms in preserving membranous urethral and nerve components and allowing the reconstruction of the surrounding supporting structures.…”

“…Larger PVs are also correlated with lower risks of PSMs and extracapsular invasion, as well as favorable pathologic characteristics, all of which contribute to favorable oncologic outcomes (9,31). Moreover, the distances between the risks of PSMs and occurrences of robust clinical events were relatively remote, greatly depending upon preoperative elements such as the preoperative PSA, advanced clinical stage, and higher Gleason scores (13,24). Indeed, we found relatively low BCR rates in the RARP group (7.9%) at a median follow-up time of 36.8 months and in the LRP group (8.6%) at a median follow-up of 32.8 months, which was consistent with the low BCR rates (10.5%) following RP for PCa with a large PV (≥50 ml) at a median followup period of 36.1 months in the study reported by Mandel et al (32).…”

“…LRP has rapidly emerged as an alternative to open RP, with the advantage of reducing blood loss and length of hospital stay ( 1 , 11 ). Subsequently, with the superiority of robotic surgical platforms in providing a three-dimensional magnified visualization of the surgical field, improved dexterity, and high precision, RARP is generally considered an excellent evolution of minimally invasive surgery to address the difficulties inherent in complex laparoscopic surgery ( 12 ) and has been widely adopted for localized PCa since 2001 ( 13 – 15 ). However, given the prohibitively high cost of robotic systems and the scarcity of scientific evidence supporting the benefits of RARP over LRP, LRP is still routinely performed for localized PCa in many centers across Europe and Asia ( 16 , 17 ).…”

Independent Factors Affecting Postoperative Short-Term Urinary Continence Recovery after Robot-Assisted Radical Prostatectomy

“…The Retzius-sparing/posterior approach to RARP, a technique preserving related anatomical structures in Retzius space [ 8 ], exhibits improved short-term continence rate. However, urologists were slow to adopt the posterior approach because of the steep learning curve and specific comments regarding the uncertainties of increased positive surgical margin (PSM) [ 9 ]. Recently, our team first conducted the transvesical approach to RARP, another procedure that avoids entry to the Retzius space, in patients afflicted with localized prostate cancer (PCa) [ 9 – 11 ], thus promoting early UC recovery.…”

“…However, urologists were slow to adopt the posterior approach because of the steep learning curve and specific comments regarding the uncertainties of increased positive surgical margin (PSM) [ 9 ]. Recently, our team first conducted the transvesical approach to RARP, another procedure that avoids entry to the Retzius space, in patients afflicted with localized prostate cancer (PCa) [ 9 – 11 ], thus promoting early UC recovery. Based on the outcomes of transvesical RARP for localized PCa [ 9 – 11 ], the transvesical approach could serve as a valid alternative to RARP in selected patients, providing promising postoperative UC with compromising oncologic control for localized PCa.…”