1
|
Lu H, Yu C, Yu X, Yang D, Yu S, Xia L, Lin Y, Yang B, Wu Y, Li G. Effects of Bony Pelvic and Prostate Dimensions on Surgical Difficulty of Robot-Assisted Radical Prostatectomy: An Original Study and Meta-analysis. Ann Surg Oncol 2024; 31:8405-8420. [PMID: 39080137 DOI: 10.1245/s10434-024-15769-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/25/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Due to the deep location of the prostate within the pelvic cavity, procedures of robot-assisted radical prostatectomy (RARP) might be challenged by the prostate size and the limited pelvic cavity space. This study aimed to investigate the roles of bony pelvic and prostate dimensions in RARP procedures by an original study coupled with a meta-analysis. METHODS In the original study, patients undergoing multiport RARP between 2021 and 2022 were consecutively assessed. The associations of anatomic features with operative time (OT), estimated blood loss (EBL), and positive surgical margin (PSM) were evaluated using linear and logistic regression analyses as well as restricted cubic spline (RCS) analysis. Based on machine-learning algorithms, this study established predictive models for surgical difficulty and interpreted the model using SHapley Additive exPlanation (SHAP). In the meta-analysis, three databases were searched for eligible studies. Quantitative syntheses were subsequently performed. RESULTS Overall, 219 patients were enrolled in the original study. Prostate volume (PV) and the prostate volume-to-pelvic cavity index (PCI) ratio (PV-to-PCI ratio) were significantly associated with longer OT (P < 0.05). In the RCS models, U-shaped associations were observed between the prostate anteroposterior diameter (PAD) and OT, and between the prostate height (PH) and EBL, and an L-shaped association was observed between the anteroposterior diameter of the pelvic inlet (API) and EBL. The XGBoost model was superior to the logistic regression model in predicting prolonged OT. The meta-analysis demonstrated that greater PV was significantly associated with longer OT (β = 0.20; 95% confidence interval [CI] 0.12-0.27; odds ratio [OR] = 1.05; 95% CI 1.00-1.11), and a smaller PV could increase the risk of PSM (OR = 0.82; 95% CI 0.77-0.88). CONCLUSIONS A large prostate within a narrow and deep pelvis might suggest increased surgical difficulty of RARP. The size of the pelvic inlet also had a great impact on RARP. For PAD and PH, there seemed to be an optimal range with the lowest surgical difficulty. Machine-learning models based on the XGBoost algorithm could be successfully applied to predict the surgical difficulty of RARP.
Collapse
Affiliation(s)
- Haohua Lu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenhao Yu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaojing Yu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dexin Yang
- Department of Toxicology of School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shicheng Yu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liqun Xia
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yudong Lin
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bowen Yang
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yihua Wu
- Department of Toxicology of School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| |
Collapse
|
2
|
Chierigo F, Caviglia A, Cellini V, Tappero S, Aigner M, Palagonia E, Olivero A, Secco S, Bocciardi AM, Dell'Oglio P, Galfano A. Retzius sparing robot-assisted radical prostatectomy: optimizing functional results. World J Urol 2024; 42:385. [PMID: 38916624 DOI: 10.1007/s00345-024-05066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/14/2024] [Indexed: 06/26/2024] Open
Abstract
PURPOSE The aim of this study is to critically evaluate the existing body of evidence regarding the efficacy of Retzius-sparing radical prostatectomy (RS-RARP) in achieving improved functional outcomes. Moreover, we explored possible strategies to further optimize functional outcomes. METHODS Following PRISMA guidelines, a systematic review (PROSPERO ID CRD42024539915) was performed on 9th September 2023 on PubMed, Scopus, and Web of Science. Only original articles in the English language reporting functional outcomes after RS-RARP were included. RESULTS Overall, the search string yielded 99 results on PubMed, 122 on Scopus, and 120 on Web Of Science. After duplicate exclusion, initial screening and eligibility evaluation, a total of 47 studies were included in the qualitative analysis, corresponding to a cohort of 13.196 patients. All studies reported continence recovery. RS-RARP appeared to achieve better and faster continence recovery compared to S-RARP. However, it should be noted that continence definition was heterogeneous and not based on validated condition-specific questionnaires. Seven (15%) studies provided for any sort of rehabilitation for urinary incontinence after RS-RARP. 22 studies analyzed potency recovery rates, showing no difference between RS-RARP and S-RARP. The evaluation of this outcome poses a great challenge due to the lack of standardized assessment tools and reporting methods. Only two studies reported on the consistent use of post-operative PDE5i as penile rehabilitation. CONCLUSIONS The current review highlights the satisfactory functional results of Retzius-sparing robot assisted radical prostatectomy, which holds true irrespective of disease stage and prostate volume, with promising results even in patients previously treated for BPH or in the salvage setting. How can we optimize those results? The answer does not probably lie in further refinement of the surgical technique, but in giving greater attention to patient counselling and rehabilitation strategies in order to minimize regret and maximize satisfaction.
Collapse
Affiliation(s)
- Francesco Chierigo
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Caviglia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valerio Cellini
- Department of General Surgery and Surgical Specialties, Azienda Ospedaliera "S. Maria" of Terni, Terni, Italy
| | - Stefano Tappero
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Michael Aigner
- Department of Urology, Südtiroler Sanitätsbetrieb, Azienda Sanitaria dell'Alto Adige, Krankenhaus Brixen, Ospedale di Bressanone, Brixen, Italy
| | - Erika Palagonia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| |
Collapse
|
3
|
Investigating the mechanism underlying urinary continence using dynamic MRI after Retzius-sparing robot-assisted radical prostatectomy. Sci Rep 2022; 12:3975. [PMID: 35273228 PMCID: PMC8913653 DOI: 10.1038/s41598-022-07800-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) exhibits better postoperative urinary continence than conventional RARP (C-RARP) via the anterior approach. However, the reasons behind this are unknown. Herein, early postoperative urinary incontinence and anatomical differences of 51 propensity score-matched C-RARP and RS-RARP cases were compared. Dynamic magnetic resonance imaging (MRI) was performed before and after surgery to examine the pelvic anatomical changes under abdominal pressure. The median urine loss ratios in the early postoperative period after C-RARP and RS-RARP were 11.0% and 1.0%, respectively. Postoperative MRI revealed that the anterior bladder wall was fixed in a higher position after RS-RARP compared with its position after C-RARP. Dynamic MRI after C-RARP showed that cephalocaudal compression of the bladder while applying abdominal pressure caused the membranous urethra to expand and the urine to flow out. After RS-RARP, the rectum moved forward during abdominal pressure, and the membranous urethra was compressed by closure from behind. This is the first study using dynamic MRI to reveal the importance of high attachment of the anterior bladder wall for the urethral closure mechanism during abdominal pressure. RS-RARP, which can completely preserve this mechanism, is less likely to cause stress urinary incontinence compared with C-RARP.
Collapse
|
4
|
Yee CH, Liu AQ, Chiu PKF, Teoh JYC, Hou SSM, Ng CF. A propensity score-matching study on retzius-sparing robotic-assisted radical prostatectomy: Evidence of continence advantage in the early learning curve. Asian J Surg 2021; 45:1403-1407. [PMID: 34690053 DOI: 10.1016/j.asjsur.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/07/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the outcome of retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) compared with conventional RARP in the early learning curve. METHODS Consecutive patients with prostate cancer who underwent RS-RARP were included to compare against conventional RARP of the same period. Propensity-score matching was performed based on age, prostate size, nerve-sparing approach, and final pathological risk categories. All patients were re-admitted to undergo trial without Foley catheter from post-operative day 7-10. Clinical follow-up was performed with monitoring of continence (day 0, 3 months, and the latest continence during the study period) and surveillance of PSA level. RESULTS Between July 2017 and August 2019, 24 consecutive patients received RS-RARP in our centre. Propensity score matching was performed with the best matched 24 controls receiving conventional RARP. Overall median follow-up duration was 15.5 months. A majority of the patients belonged to the intermediate-risk group, with most of them harbouring pT2 disease (RS-RARP: 87.5%; conventional RARP: 79.2%). More patients in RS-RARP group achieved day-0 continence (33.3% vs 0%, p = 0.002) and 3-month continence (66.7% vs 12.5%, p = 0.001). During the whole study period, more RS-RARP achieved continence with 0 pad (91.7% vs 66.7%, p = 0.033). The mean months to continence is shorter in RS-RARP group (4.0 months vs 13.6 months, p = 0.002). No statistically significant differences between the two groups with respect to surgical margins, post-operative PSA detection, and the use of adjuvant radiotherapy. CONCLUSIONS RS-RARP showed better continence rates when compared to conventional RARP even during the learning curve phase.
Collapse
Affiliation(s)
- Chi Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Alex Q Liu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Peter K F Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Simon S M Hou
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chi Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
5
|
Kishore TA, Kuriakose MJ, Raveendran V, Ramaprasad MK. The impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis. Indian J Urol 2021; 37:140-146. [PMID: 34103796 PMCID: PMC8173943 DOI: 10.4103/iju.iju_414_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/17/2021] [Accepted: 02/13/2021] [Indexed: 11/11/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- T A Kishore
- Department of Urology, Aster Medcity, Cochin, Kerala, India
| | | | | | - M K Ramaprasad
- Department of Urology, Aster Medcity, Cochin, Kerala, India
| |
Collapse
|
6
|
Xu D, Yang Z, Qi J, Mundhenk J, Zanker P, Schwentner C, Lei Y. Early urinary continence recovery following retzius-sparing robotic-assistant radical prostatectomy with suprapubic catheter: a short-term follow-up outcome. World J Urol 2021; 39:3251-3257. [PMID: 33638659 DOI: 10.1007/s00345-021-03643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/19/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the recovery of early urinary continence in patients with prostate cancer using a suprapubic catheter during Retzius-sparing robotic-assistant laparoscopic prostatectomy. PATIENTS AND METHODS From January 2018 to January 2019, 223 patients diagnosed with prostate cancer who underwent Retzius-sparing robotic-assistant laparoscopic prostatectomy in Diakonie Klinikum Stuttgart were involved in our study. From January 2018 to June 2018, patients (112 cases) only had an indwelling urinary catheter during Retzius-sparing robotic-assistant laparoscopic prostatectomy, while from July 2018 to January 2019, patients (111 cases) were offered an extra suprapubic catheter during operation. The recovery of early urinary continence of patients was mainly investigated one month later. RESULTS The overall early urinary continence rate was 81.61%. Patients with suprapubic catheter had better urinary control results, compared to patients with only indwelling urinary catheter (87.39% vs 75.89%, p = 0.027). In addition, International Prostate Symptom Score and irritative subscore in patients with good urinary control were significantly lower than that in patients with urinary incontinence. Suprapubic catheter insertion (OR 0.395; 95% CI 0.190-0.821) and advanced pathological tumor stage (T3a-T4) (OR 2.061; 95% CI 1.008-4.217) were two independent influencing factors for early urinary continence recovery in patients who underwent Retzius-sparing robotic-assistant laparoscopic prostatectomy through multivariate logistic regression analysis. CONCLUSION Suprapubic catheter insertion may be helpful for early urinary continence recovery in patients with Retzius-sparing Robotic-assistant laparoscopic prostatectomy. Advanced pathological tumor stage (T3a-T4) before Retzius-sparing robotic-assistant laparoscopic prostatectomy might be associated with poor urinary control.
Collapse
Affiliation(s)
- Ding Xu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Urology, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Zhongqing Yang
- Department of Urology, Xiangya Hospital of Central South University, Changsha, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jens Mundhenk
- Department of Urology, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Patrick Zanker
- Department of Urology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Ye Lei
- Department of Urology, Xiangya Hospital of Central South University, Changsha, China. .,Department of Urology, Diakonie Klinikum Stuttgart, Stuttgart, Germany.
| |
Collapse
|
7
|
Qian J, Fu Y, Wu X, Xu L, Zhang M, Zhang Q, Rosenberg JE, Xu L, Qiu X, Guo H. Impact of protruded median lobe on perioperative, urinary continence and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy. Transl Androl Urol 2021; 10:538-547. [PMID: 33718056 PMCID: PMC7947452 DOI: 10.21037/tau-20-1229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To investigate the effect of protruded median lobe (PML) on the perioperative, oncological, and urinary continence (UC) outcomes among patients underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods 231 consecutive patients who had undergone RS-RARP were collected and analyzed. Patients were divided into three groups based on the PML degree: PML<5 mm (n=99); 5≤ PML <10 mm (n=91); PML ≥10 mm (n=41). The perioperative outcomes, short-term oncological, and UC outcomes were compared among the three groups. Those outcomes were also compared in patients with significant PML (>10 mm) who underwent the traditional or Retzius-sparing RARP. Results The median PML was significantly associated age (P<0.001) and prostate volume (P<0.001). Perioperative characteristics including console time, estimated blood loss (EBL), intraoperative transfusion rate, and complications were not statistically different among the three groups (P=0.647, 0.574, 0.231, 0.661, respectively). The rate of positive surgical margin (PSM) were not significantly different in the three groups (P=0.065). No significant difference regarding UC and biochemical recurrence (BCR) at 12-month follow-up was observed in the three groups (P>0.05). Comparison between the two approaches in men with significant PML showed better recovery of UC (HR =1.83, 95% CI: 1.117-3.01, log-rank P=0.002) and similar BCR (log-rank P=0.072) after RS-RARP. Conclusions RS-RARP is an oncologically and functionally equivalent approach for patients with PML. Compared with the traditional approach, RS-RARP offers benefits regarding UC for cases with significant PML.
Collapse
Affiliation(s)
- Jiajun Qian
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Yao Fu
- Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiao Wu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Liu Xu
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Mengjie Zhang
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Qing Zhang
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China.,Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | | | - Linfeng Xu
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Xuefeng Qiu
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| |
Collapse
|
8
|
Yılmaz K, Özsoy Ç, Ölçücü MT, Aksaray EE, Okuducu Y, Ateş M. Is Retzius-sparing robot-assisted laparoscopic radical prostatectomy effective in early continence? A single-center experience of the first 50 patients. Turk J Urol 2020; 47:125-130. [PMID: 33226325 DOI: 10.5152/tud.2020.20411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we aimed to present the perioperative and postoperative outcomes and early continence rates of the first 50 patients who underwent Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) in our clinic for prostate adenocarcinoma. MATERIAL AND METHODS Between December 2018 and December 2019, 50 patients who underwent RS-RALP by 2 surgeons in our clinic were enrolled in the study. Preoperative, perioperative, and postoperative clinical data were analyzed retrospectively. Procedure-specific complications were graded according to the Clavien-Dindo classification. The continence status of the patients was recorded in the 1st week, 1st month, and 3rd month after catheter removal. Zero pads or 1 safety pad per day was accepted as total continence. RESULTS The mean age of the patients was 66.6 (57-75) years. According to the D'Amico classification, 36% of patients were at low risk, 48% at intermediate risk, and 16% at high risk. Bilateral or unilateral nerve-sparing procedure was performed in 76% of the patients. There were no intraoperative complications. A total of 9 (18%) patients had a postoperative complication (7 with grade 1, 1 with grade 2, and 1 with grade 3 complications). Whereas 32% of the patients had an extraprostatic extension, 22% had seminal vesicle invasion. The overall positive surgical margin rate was 26%. At 1 week, 1 month, and 3 months after surgery, 64%, 80%, and 92% of men who underwent RS-RALP were continent, respectively. CONCLUSION Our study showed that this new surgical technique can be a safe and feasible method because high rates of early continence were achieved in the patients who underwent RS-RALP without increasing the risk of complications.
Collapse
Affiliation(s)
- Kayhan Yılmaz
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Çağatay Özsoy
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mahmut Taha Ölçücü
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Eren Erdi Aksaray
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Yahya Okuducu
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| |
Collapse
|
9
|
Algarra R, Salas T, García S, Arance I, Sánchez de la Muela P. Retzius-sparing robot-assisted radical prostatectomy: Perioperative and immediate continence outcomes of an initial series. Actas Urol Esp 2020; 44:542-548. [PMID: 32536428 DOI: 10.1016/j.acuro.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/18/2019] [Accepted: 02/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this work is to present initial perioperative, immediate continence and oncological results in a series of 25 prostate cancer patients treated with Retzius-sparing robot-assisted radical prostatectomy. MATERIAL AND METHODS We retrospectively analyzed a series of 25 patients treated with Retzius-sparing robot-assisted radical prostatectomy for cT1-T2b prostate cancer between 2018-2019. The 5 stages of surgery are described. We make a descriptive statistic of our initial series and its outcomes in terms of immediate continence, defined as the use of 0 pad/diapers or 1 safety pad/diaper every 24 hours, one week after catheter removal. RESULTS Median follow-up, 6 months (3-18). Median PSA, 6.1 ng/ml (4-14.3). All surgeries were performed through a posterior intrafascial approach, and bilateral nerve-sparing was carried out in 84% of the cases. Affected surgical margins were present in 28%, being the apex the most frequent site of affectation. Surgical complications: 1 (4%) patient required transfusion of blood products in the immediate postoperative period. Mean hospital stay was 48 hours. Functional outcomes: 80% of the patients present immediate continence. 80% of continent patients do not require the use of any safety pads/diapers. Oncological outcomes: 84% are free of biochemical-progression in a median follow-up of 6 months. CONCLUSIONS Initial functional results in terms of immediate continence are very satisfactory in patients who have undergone Retzius-sparing robot-assisted radical prostatectomy without negative impact on prognosis.
Collapse
Affiliation(s)
- R Algarra
- Adjunto de Urología de Centro de Cirugía Robótica, Hospital Vithas Nuestra Señora de América, Madrid, España.
| | - T Salas
- Diplomada universitaria en Enfermería, Hospital Vithas Nuestra Señora de América, Madrid, España
| | - S García
- Diplomada universitaria en Enfermería, Hospital Vithas Nuestra Señora de América, Madrid, España
| | - I Arance
- Adjunto de Urología de Centro de Cirugía Robótica, Hospital Vithas Nuestra Señora de América, Madrid, España
| | - P Sánchez de la Muela
- Jefe de Centro de Cirugía Robótica, Hospital Vithas Nuestra Señora de América, Madrid, España
| |
Collapse
|
10
|
Jiang YL, Zheng GF, Jiang ZP, Zhen-Li, Zhou XL, Zhou J, Ye CH, Wang KE. Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis. BMC Urol 2020; 20:114. [PMID: 32746829 PMCID: PMC7398331 DOI: 10.1186/s12894-020-00685-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background To compare the postoperative continence and clinical outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) with non-RS RALP for patients with prostate cancer. Methods We searched PUBMED, EMBASE and the Cochrane Central Register from 1999 to 2019 for studies comparing RS-RALP to non-RS RALP for the treatment of prostate cancer. We used RevMan 5.2 to pool the data. Results A total of seven studies involving 1620 patients were included in our meta-analysis. No significant difference was found in positive surgical margins (PSM), bilateral nerve-sparing, postoperative hernia, complications, blood loss, or operative time. Postoperative continence was better with RS-RALP compared with non-RS RALP (OR = 1.02, OR: 2.86, 95% CI 1.94–4.20, p < 0.05). Conclusions RS-RALP had a better recovery of postoperative continence than non-RS RALP. The perioperative outcomes were comparable for the two methods.
Collapse
Affiliation(s)
- Yu-Li Jiang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Gao-Feng Zheng
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Ze-Peng Jiang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Zhen-Li
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Xie-Lai Zhou
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Jin Zhou
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Chun-Hua Ye
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Kang-Er Wang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.
| |
Collapse
|
11
|
Retzius sparing robotic assisted radical prostatectomy vs. conventional robotic assisted radical prostatectomy: a systematic review and meta-analysis. World J Urol 2019; 38:1123-1134. [PMID: 31089802 DOI: 10.1007/s00345-019-02798-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/30/2019] [Indexed: 01/02/2023] Open
Abstract
CONTEXT Retzius sparing robotic assisted radical prostatectomy appears to have better continence rates when compared to conventional robotic assisted radical prostatectomy, however, concern with high positive surgical margin rates exist. OBJECTIVE To systematically evaluate evidence comparing functional and oncological outcomes of retzius sparing robotic assisted radical prostatectomy and conventional robotic assisted radical prostatectomy. EVIDENCE ACQUISITION The systematic review was performed in accordance with the Cochrane guidelines and the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Bibliographic databases searched were PubMed/MEDLINE, Cochrane central register of controlled trials-CENTRAL (in The Cochrane library-issue 1, 2018). We used the GRADE approach to assess the quality of the evidence. EVIDENCE SYNTHESIS The search retrieved 137 references through electronic searches of various databases. Six were included in the review. RS-RALP was associated with better early continence rates (≤ 1 month) (moderate quality evidence) (RR 1.72, 95% CI 1.27, 2.32, p 0.0005) and at 3 months (low quality evidence) (RR 1.39, 95% CI 1.03, 1.88, p 0.03). Time to continence recovery, number of pads used and pad weight are better with RS-RALP. Based on very low quality evidence, RS-RALP did not alter 6 and 12 months continence rates. Based on very low quality evidence, RS-RALP did not alter T2 positive margin rates (RR 1.67, 95% CI 0.91, 3.06, p 0.10) and T3 positive margin rates (RR 1.08, 95% CI 0.68, 1.70, p = 0.75). Short-term biochemical free survival appears to be similar between the two approaches. Based on low-quality evidence, RS-RALP did not alter overall and major complication rates. CONCLUSIONS RS-RARP appears to have earlier continence recovery when compared to Con-RARP which does not come at a significant oncologic cost. Whilst there was a trend towards higher PSM rates with RS-RALP, this did not achieve statistical significance. Furthermore this trend appeared to be less pronounced with T3 disease, where the PSM rates are almost similar.
Collapse
|
12
|
Predictors for immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy: a case-control study. Int Urol Nephrol 2019; 51:825-830. [PMID: 30929223 DOI: 10.1007/s11255-018-02071-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We evaluated urinary continence in a series of consecutive patients who underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) to identify the preoperative predictors of the return to immediate urinary continence. METHODS 110 consecutive patients who underwent RS-RARP for clinically localized prostate cancer were retrospectively collected. Patients reported freedom from using safety pad (0 pad/day) within 7 days after removal of urinary catheter were defined as immediate urinary continent. RESULTS A total of 85 patients (77.27%) were immediate urinary continent after RS-RARP. Patients with immediate urinary continence were significantly younger (66.92 ± 5.73 vs. 69.68 ± 4.99 years, p = 0.031) than those who were incontinent. Furthermore, the prostate volume was significantly smaller (30.90 vs. 44.60 ml, p = 0.001) and preoperative international prostate symptom score (IPSS) was significantly lower (Mild 76.5% vs. 24.0%, Moderate 20.0% vs. 32.0%, and Severe 3.5% vs. 44.0%, p = 0.000) in patients with immediate urinary continence compared with those who were not. On univariable regression analysis, patient's age (OR 0.907, p = 0.035), prostate volume (OR 0.935, p = 0.000), moderate (OR 0.196, p = 0.007), and severe IPSS (OR 0.025, p = 0.000) (compared with mild IPSS) were independent adverse predictors of immediate urinary continence. On multivariable analysis, prostate volume (OR 0.955, p = 0.032) and severe preoperative IPSS (OR 0.044, p = 0.000) (compared with mild IPSS) were independent adverse predictors of immediate urinary continence after RS-RARP. CONCLUSIONS RS-RARP hastens the recovery of urinary continence after surgery. Prostate volume and severe preoperative IPSS were independent adverse predictors of the return to immediate urinary continence.
Collapse
|
13
|
Galfano A, Panarello D, Secco S, Di Trapani D, Barbieri M, Napoli G, Strada E, Petralia G, Bocciardi AM. Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy? MINERVA UROL NEFROL 2018; 70:408-413. [DOI: 10.23736/s0393-2249.18.03069-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Chang KD, Abdel Raheem A, Choi YD, Chung BH, Rha KH. Retzius-sparing robot-assisted radical prostatectomy using the Revo-i robotic surgical system: surgical technique and results of the first human trial. BJU Int 2018; 122:441-448. [PMID: 29645348 DOI: 10.1111/bju.14245] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the safety and proficiency of the Revo-i® robotic platform (Meere Company Inc.) in the treatment of prostate cancer (PCa). PATIENTS AND METHODS A prospective study was carried out on 17 patients with clinically localized PCa treated between 17 August 2016 and 23 February 2017 at our urology department using the Revo-i. Patients underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). The primary objective was to describe the RS-RARP step-by-step surgical technique using the Revo-i. In addition, the safety of the Revo-i was assessed according to intra-operative and the postoperative complications within 30 days of surgery. Early oncological outcomes were also assessed according to surgical margin status and biochemical recurrence (BCR). Continence was defined as use of no or only one pad. Surgeons' satisfaction with the Revo-i was assessed using the Likert scale. RESULTS All surgeries were completed successfully, with no conversion to open or laparoscopic surgery. The median patient age was 72 years. The median docking time, console time, urethrovesical anastomosis time and estimated blood loss were 8 min, 92 min, 26 min and 200 mL, respectively. One patient was transfused intra-operatively as a result of blood loss of 1 500 mL. Postoperatively, two patients received blood transfusion, and there were no other serious/major complications. The median hospital stay was 4 days. At 3 months, four patients had positive surgical margins, one patient had BCR, and 15 patients were continent. Most of surgeons were satisfied with the Revo-i performance. CONCLUSIONS The first human study for the treatment of patients with localized PCa using the Revo-i robotic surgical system was carried out successfully. The peri-operative, early oncological and continence outcomes are encouraging. Further prospective studies are warranted to support our preliminary results.
Collapse
Affiliation(s)
- Ki Don Chang
- Department of Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Urology, Urological Science Institute, Yonsei Wonju University College of Medicine, Wonju, Korea
| | - Ali Abdel Raheem
- Department of Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Urology, Tanta University Medical School, Tanta, Egypt
| | - Young Deuk Choi
- Department of Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Kaouk J, Garisto J, Bertolo R. Different approaches to the prostate: The upcoming role of a purpose-built single-port robotic system. Arab J Urol 2018; 16:302-306. [PMID: 30147958 PMCID: PMC6105340 DOI: 10.1016/j.aju.2018.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 03/27/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023] Open
Abstract
With the aim of minimising the patient’s postoperative pain, expediting recovery and improving cosmesis, the idea of performing a laparoscopic procedure through a single abdominal incision was introduced. In the present report, we describe five different access routes to the prostate that may be at the surgeon’s disposal with the potential of decreasing patient’s perioperative morbidity. Robotic radical prostatectomy has been refined and became a standard of care in surgery for localised prostate cancer. The advent of single-port robotic surgery has prompted the re-discovery of different access routes to the prostate and ideally all of them are feasible. The potential for avoiding the abdominal cavity will decrease the surgical morbidity and minimise the surgical dissection. In the near future, each of the described approaches could be chosen on the basis of the patient’s preoperative comorbidities, body habitus, anatomy, and disease characteristics and location.
Collapse
Affiliation(s)
- Jihad Kaouk
- Corresponding author at: Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH 44195, USA.
| | | | | |
Collapse
|
16
|
Dirie NI, Pokhrel G, Guan W, Mumin MA, Yang J, Masau JF, Hu H, Wang S. Is Retzius-sparing robot-assisted radical prostatectomy associated with better functional and oncological outcomes? Literature review and meta-analysis. Asian J Urol 2018; 6:174-182. [PMID: 31061804 PMCID: PMC6488752 DOI: 10.1016/j.ajur.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/29/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the efficiency, safety and clinical outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in comparison with the standard RARP. Methods A systematic search from Web of Science, PubMed, EMBase, Cochrane Library and Google Scholar was performed using the terms “Retzius-sparing”, “Bocciardi approach” and “robot-assisted radical prostatectomy”. Video articles and abstract papers for academic conferences were excluded. Meta-analysis of interested outcomes such as positive surgical margins (PSMs) and continence recovery was undertaken. A comprehensive literature review of all studies regarding Retzius-sparing (RS) approach was conducted and summarized. Results From 2010 to 2017, 11 original articles about RS-RARP approach were retrieved. Of that, only four studies comparing the RS-RARP approach to the conventional RARP were comparable for meta-analysis. Faster overall continence recovery within 1 month after the surgery was noted in the RS group (61% vs. 43%; p = 0.004). PSMs of pT2 and pT3 stages were not significantly different between the groups (10.0% vs. 7.4%; p = 0.39 and 13.1% vs. 9.5%, p = 0.56, respectively). Of all the studies, only one reported sexual recovery outcomes after RS treatment in which 40% of the participants achieved sexual intercourse within the first month. Conclusion Though more technically demanding than the conventional RARP, the RS technique is a safe and feasible approach. This meta-analysis and literature review indicates that RS technique, as opposed to the conventional approach, is associated with a faster continence recovery while PSMs were comparable between the two groups. The limitations of observational studies and the small data in our meta-analysis may prevent an ultimate conclusion. Future well-designed RCTs are needed to validate and confirm our findings.
Collapse
Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mukhtar Adan Mumin
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jackson Ferdinand Masau
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Corresponding author.
| |
Collapse
|
17
|
Retzius space reconstruction following transperitoneal laparoscopic robot-assisted radical prostatectomy: does it have any added value? J Robot Surg 2017; 12:475-479. [PMID: 29181778 DOI: 10.1007/s11701-017-0768-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/19/2017] [Indexed: 12/31/2022]
Abstract
Retzius space sparing (RSS) during laparoscopic robot-assisted radical prostatectomy (RALP) has been offered as an approach that reduces perioperative complications and enables faster gaining of full urinary continence due to bladder anatomy preservation. Retro and transperitoneal techniques have been proposed, whereby RSS has been implemented. We sought to explore whether Retzius space reconstruction (RSR) following transperitoneal RALP will be an advantageous step as well. A prospective registry database of 102 consecutive transperitoneal RALP cases performed by a single surgeon was reviewed. The Retzius space had been opened by dissecting the bladder away from the anterior abdominal wall to the level of both internal rings. In the last 51 cases (RSR group), the peritoneal layer had been sutured back, thus repositioning the bladder back to the anterior abdominal wall and reconstructing the Retzius space. Perioperative factors were analyzed and compared between the two groups. Demographic and perioperative data did not differ between the two groups. RSR group demonstrated shorter length of stay (LOS) compared with the control group (p = 0.01), as well as faster urinary continence recovery (i.e., 0 pads) (p = 0.01). Moreover, lower numbers of Clavien-Dindo class 3 complications and 12 mm port-site hernias (p = 0.03) were seen in the RSR group compared with the control group. RSR following transperitoneal RALP is a simple and efficient step that potentially reduces early and late post-operative complications, shortens LOS and accelerates full urinary continence.
Collapse
|
18
|
Eden CG, Moschonas D, Soares R. Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: The UK experience. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817706635] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
| | | | - Ricardo Soares
- Department of Urology, The Royal Surrey County Hospital, Guildford, UK
| |
Collapse
|