Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: The UK experience

Objective: The purpose of this study was to investigate urinary continence four weeks following Retzius-sparing robot-assisted radical prostatectomy. Patients and methods: Forty patients with T2-T3 prostate cancer underwent Retzius-sparing-robot-assisted radical prostatectomy and their results were compared with those from the 40 patients having robot-assisted radical prostatectomy done by the same surgeon immediately prior to the adoption of Retzius-sparing-robot-assisted radical prostatectomy. Results: Patients in the two groups had similar age, body mass index, prostate specific antigen, biopsy Gleason sum, clinical stage, d'Amico risk profile, blood loss, prostate weight and post-operative hospital stay. Median operating time (200 (interquartile range=155-266) vs 223 (interquartile range=100-238) min; p=0.05) and catheterisation (8 (interquartile range=8-8) vs 14 (interquartile range=14-14) days; p<0.0001) were shorter in the Retzius-sparing group, many of whom had suprapubic catheters inserted. The overall complication rate was lower in Retzius-sparing patients (2.5% vs 8.0%; p=0.36). Positive surgical margin rates were similar for Retzius-sparing and non-Retzius-sparing patients and decreased with greater experience with the Retzius-sparing technique: 16.7% vs 7.7% for pT2 (p=0.65) and 31.8% vs 14.3% for pT3 (p=0.44). Initial prostate specific antigen was <0.1 ng/ml in 97.5% and 100%, respectively (p=1.00). At four weeks post-operation 0, 1 and 2 pads/day were needed in the Retzius-sparing group in 90.0%, 7.5% and 2.5% of patients, compared to 37.5% (p<0.0001), 32.5% (p=0.01) and 30% (p=0.002) of men having conventional surgery. Conclusion: Retzius-sparing-robot-assisted radical prostatectomy is faster than the anterior approach to the prostate, allows a shorter catheterisation time and produces dramatically better continence results at four weeks with 90% of patients being pad-free and 97.5% of patients needing 0-1 pads/day.