A meta-analysis of Retzius-sparing and hood-technique robot-assisted radical prostatectomy

doi:10.1111/bju.16847

Review

. 2025 Jul 8.

doi: 10.1111/bju.16847. Online ahead of print.

A meta-analysis of Retzius-sparing and hood-technique robot-assisted radical prostatectomy

Siyu Huang^{1

2

3

4}, David C Chen^{2

3}, Liang Qu³, Nathan Papa^{2

3}, Kirby Qin⁵, Ahmed Adam^{6

7}, Damien Bolton^{1

3}, Brian D Kelly^{2

8

9}, Declan G Murphy^{1

2}, Nathan Lawrentschuk^{1

10

2}, Marlon L Perera^{1

2

3}

Affiliations

¹ Department of Surgery, The University of Melbourne, Parkville, Vic., Australia.
² Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.
³ Department of Surgery, Austin Health, University of Melbourne, Melbourne, Vic., Australia.
⁴ Department of Urology, Grampians Health, Ballarat, Vic., Australia.
⁵ Department of Urology, Western Health, Melbourne, Vic., Australia.
⁶ Division of Urology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Department of Urology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Helen Joseph Hospital (HJH), and Rahima, Moosa Mother & Child Hospital (RMMCh), Wits Donald Gordon Medical Center, Johannesburg, South Africa.
⁸ Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia.
⁹ Department of Urology, Eastern Health, Melbourne, Vic., Australia.
¹⁰ Department of Urology, Royal Melbourne Hospital, Parkville, Vic., Australia.

PMID: 40625109
DOI: 10.1111/bju.16847

Review

A meta-analysis of Retzius-sparing and hood-technique robot-assisted radical prostatectomy

Siyu Huang et al. BJU Int. 2025.

. 2025 Jul 8.

doi: 10.1111/bju.16847. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, The University of Melbourne, Parkville, Vic., Australia.
² Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.
³ Department of Surgery, Austin Health, University of Melbourne, Melbourne, Vic., Australia.
⁴ Department of Urology, Grampians Health, Ballarat, Vic., Australia.
⁵ Department of Urology, Western Health, Melbourne, Vic., Australia.
⁶ Division of Urology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Department of Urology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Helen Joseph Hospital (HJH), and Rahima, Moosa Mother & Child Hospital (RMMCh), Wits Donald Gordon Medical Center, Johannesburg, South Africa.
⁸ Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia.
⁹ Department of Urology, Eastern Health, Melbourne, Vic., Australia.
¹⁰ Department of Urology, Royal Melbourne Hospital, Parkville, Vic., Australia.

PMID: 40625109
DOI: 10.1111/bju.16847

Abstract

Objectives: To compare Retzius-sparing (RS-) robot-assisted radical prostatectomy (RARP), hood-technique RARP and standard RARP, assessing functional, oncological and peri-operative outcomes.

Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The primary outcome was postoperative perfect continence rate (0 pad/day) at different time points over 12 months. Secondary outcomes included postoperative social continence, positive surgical margins (PSMs), biochemical recurrence at 12 months, and other peri-operative measures. A meta-analysis was conducted to assess RS-RARP vs standard RARP. A further exploratory meta-analysis was performed to compare the hood technique against standard RARP.

Results: The meta-analyses included 26 studies comparing RS-RARP vs standard RARP and four studies assessing hood-technique RARP vs standard RARP, covering a total of 5512 patients. In comparison with standard RARP, RS-RARP demonstrated a significantly higher rate of perfect continence at 0 months (risk ratio [RR] 2.28, 95% confidence interval [CI] 1.42-3.66), 1 month (RR 2.94, 95% CI 1.24-6.98), 3 months (RR 1.85, 95% CI 1.21-2.84), 6 months (RR 1.20, 95% CI 1.04-1.38) and 12 months (RR 1.30, 95% CI 1.03-1.63) after surgery. The hood technique also demonstrated a statistically favourable perfect continence outcome at 6 months post-surgery (RR 1.52, 95% CI 1.13-2.04).

Conclusions: Both RS-RARP and hood-technique RARP are associated with a higher continence rate in the early period after surgery. However, there is limited evidence to suggest significant differences between these techniques in the long term. A direct comparison between hood-technique RARP and RS-RARP as well as quality data on long-term outcomes are needed to determine which technique provides superior functional outcomes.

Keywords: Retzius‐sparing; erectile function; hood‐technique; radical prostatectomy; robotic prostatectomy; urinary function.

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References

1. Vernooij RWM, Lancee M, Cleves A, Dahm P, Bangma CH, Aben KKH. Radical prostatectomy versus deferred treatment for localised prostate cancer. Cochrane Database Syst Rev 2020; 6(6): CD006590
1. Ficarra V, Novara G, Rosen RC et al. Systematic review and meta‐analysis of studies reporting urinary continence recovery after robot‐assisted radical prostatectomy. Eur Urol 2012; 62: 405–417
1. Coughlin GD, Yaxley JW, Chambers SK et al. Robot‐assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24‐month outcomes from a randomised controlled study. Lancet Oncol 2018; 19: 1051–1060
1. Binder J, Jones J, Bentas W et al. Robot‐assisted laparoscopy in urology. Radical prostatectomy and reconstructive retroperitoneal interventions. Urologe A 2002; 41: 144–149
1. Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM. A new anatomic approach for robot‐assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 2010; 58: 457–461

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[1] Vernooij RWM, Lancee M, Cleves A, Dahm P, Bangma CH, Aben KKH. Radical prostatectomy versus deferred treatment for localised prostate cancer. Cochrane Database Syst Rev 2020; 6(6): CD006590

[2] Vernooij RWM, Lancee M, Cleves A, Dahm P, Bangma CH, Aben KKH. Radical prostatectomy versus deferred treatment for localised prostate cancer. Cochrane Database Syst Rev 2020; 6(6): CD006590

[3] Ficarra V, Novara G, Rosen RC et al. Systematic review and meta‐analysis of studies reporting urinary continence recovery after robot‐assisted radical prostatectomy. Eur Urol 2012; 62: 405–417

[4] Ficarra V, Novara G, Rosen RC et al. Systematic review and meta‐analysis of studies reporting urinary continence recovery after robot‐assisted radical prostatectomy. Eur Urol 2012; 62: 405–417

[5] Coughlin GD, Yaxley JW, Chambers SK et al. Robot‐assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24‐month outcomes from a randomised controlled study. Lancet Oncol 2018; 19: 1051–1060

[6] Coughlin GD, Yaxley JW, Chambers SK et al. Robot‐assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24‐month outcomes from a randomised controlled study. Lancet Oncol 2018; 19: 1051–1060

[7] Binder J, Jones J, Bentas W et al. Robot‐assisted laparoscopy in urology. Radical prostatectomy and reconstructive retroperitoneal interventions. Urologe A 2002; 41: 144–149

[8] Binder J, Jones J, Bentas W et al. Robot‐assisted laparoscopy in urology. Radical prostatectomy and reconstructive retroperitoneal interventions. Urologe A 2002; 41: 144–149

[9] Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM. A new anatomic approach for robot‐assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 2010; 58: 457–461

[10] Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM. A new anatomic approach for robot‐assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 2010; 58: 457–461

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A meta-analysis of Retzius-sparing and hood-technique robot-assisted radical prostatectomy

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A meta-analysis of Retzius-sparing and hood-technique robot-assisted radical prostatectomy

Authors

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Abstract

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LinkOut - more resources

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