(UroToday.com) The 2025 AUA annual meeting featured a prostate cancer session and a presentation by Dr. Gal Wald discussing a multicenter comparison of retzius-sparing, hood, and standard techniques assessing recovery of urinary continence after robotic-assisted radical prostatectomy (RARP). Post-prostatectomy urinary incontinence adversely affects quality of life, but pelvic fascia sparing approaches may lead to faster and better recovery of urinary function. The anterior approach to pelvic fascia sparing approach, or hood technique, partially dissects into the space of Retzius, but preserves the detrusor apron, arcus tendineus, and puboprostatic ligaments. The posterior approach to pelvic fascia sparing approach, or retzius-sparing, avoids disruption of the retropubic space.
At the 2025 AUA annual meeting, Dr. Wald and colleagues aimed to compare continence recovery across standard, retzius sparing, and hood RARP techniques in two high volume academic centers.
This study was a retrospective review of 1,155 RARP (593 standard, 332 retzius sparing, 230 hood) procedures performed by Dr. Jim Hu at Weill Cornell and Dr. Keith Kowalczyk at Georgetown during February 2012 and May 2024. Salvage prostatectomies and pelvic fascia-sparing randomized trial patients were excluded from analysis. Functional outcomes were compared using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), and continence was defined as using 0-1 pads/day from an EPIC-CP item. Multivariable logistic regression models evaluated the return of continence at 3 and 12 months.
Hood RARP patients were more likely to be older and African American (p < 0.001), while retzius sparing RARP patients had higher BMI (p < 0.004). Baseline PSA was comparable across all groups (p = 0.628). The complete baseline characteristics are as follows:
Retzius sparing RARP improved EPIC-CP urinary incontinence scores the most at 3 months (p < 0.001), 6 months (p < 0.001) and 12 months (p < 0.001):
However, retzius sparing RARP had the most positive margins (standard 29.5%; retzius sparing 37.4%; hood 30.0%; p = 0.039):
In multivariable regression, both retzius sparing and hood had a better return of 3-month continence versus standard RARP (retzius sparing: OR 3.82, CI 2.28-6.38, p < 0.0001; hood: OR 2.39, CI 1.46-3.91, p = 0.0006). At 12-months, only retzius sparing had better continence than standard RARP (retzius sparing: OR 3.88, CI 2.08-7.24, p < 0.0001; hood: OR 1.65, CI 0.91-3.01, p = 0.10). Moreover, at 20 months, only retzius sparing had better continence than standard RARP (retzius sparing: OR 3.27, CI 1.72-6.21, p = 0.0003; hood: OR 1.63, CI 0.87-3.08, p = 0.13):
Dr. Wald concluded his presentation discussing a multicenter comparison of retzius-sparing, hood, and standard techniques assessing recovery of urinary continence after RARP with the following take home points:
- Pelvic fascia sparing approaches improve early urinary continence, although retzius sparing has higher positive margins
- A randomized controlled trial is underway to investigate oncological and functional outcomes in pelvic fascia sparing RARP versus standard RARP
Presented by: Gal Wald, MD, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2025 American Urological Association (AUA) annual meeting held in Las Vegas, NV, Saturday, April 26 - Tuesday, April 29, 2025