Retzius-Sparing vs Modified Anatomical Structure Preserving and Retzius-Repairing Robotic-Assisted Radical Prostatectomy: A Prospective Randomized Comparison on Functional Outcomes with a 1-Year Follow-Up

Abstract

Objectives: To compare the short-term and 1-year follow-up functional outcomes of modified anatomical structure preserving and Retzius-repairing robot-assisted radical prostatectomy (APR-RARP) compared with Retzius-sparing (RS) RARP. Methods: Eighty consecutive patients 40-75 years of age with low-intermediate risk prostate cancer were prospectively randomized to APR-RARP or RS-RARP. Urinary continence (UC) recovery rates were evaluated from catheter removal up to 1 year follow-up. Postoperative UC was defined as 0 pads/one security pad per day. UC recovery rates from catheter removal to 1 year were calculated by Kaplan-Meier curve; log-rank test was used for the curve comparison. Postoperative potency was evaluated at 3 and 12 months after surgeries. Perioperative complications, positive surgical margin (PSM), and biochemical recurrence rates represent secondary outcomes reported in the study. Results: At the catheter removal, 1, 3, 6, and 12 months after operation, 52.5% (confidence interval [CI] 95%: 37.6-67), 82.5% (CI 95%: 70.8-94), 95% (CI 95%: 88.3-99.1), 97.5% (CI 95%: 92.5-99.9), and 97.5% (CI 95%: 92.5-99.9) of men undergoing the APR-RARP were continent (0 pads/one security pad per day), compared with 61.5% (CI 95%: 46.5-76.6), 89.7% (CI 95%: 80.3-98.1), 97.5% (CI 95%: 92.6-99.9), 97.5% (CI 95%: 92.6-99.9), and 97.5% (CI 95%: 92.6-99.9) undergoing the RS-RARP, respectively, and the Kaplan Meier curve showed no statistically significant difference for both technique at any time point (log-rank p = 0.556). The median (95% CI) time to UC recovery was 9.8 (5.2-14.4) days for the APR-RARP vs 6.7 (3.2-10.2) days for the RS-RARP group. Potency rates were similar in both groups at 3 and 12 months after surgeries. The two compared approaches; in terms of rate of complications, PSM was similar. Conclusions: Surgeons can achieve functional results comparable to the RS technique with the modified reconstructive anterior approach, without changing the surgical technique they are used to.

Keywords: Retzius sparing; anatomical reconstruction; prostate cancer; randomized controlled trial; robot-assisted radical prostatectomy; urinary continence.