Retzius-sparing robot-assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single-blind trial with a 1-year follow-up.

To evaluate the impact of Retzius-sparing robot-assisted radical prostatectomy (posterior approach) on early recovery of urinary continence (UC) compared to the conventional approach (anterior approach) for the treatment of clinically localized prostate cancer (PCa).

110 consecutive patients with clinically localized PCa were prospectively randomized in a 1:1 ratio to anterior group (n = 55) or posterior group (n = 55). The primary outcome was immediate UC defined as freedom from any pad use within 1 week after removal of urinary catheter. UC rate following surgery was also calculated with Kaplan-Meier curves and log-rank test was used for the statistical comparison. Intraoperative outcomes, pathologic data and oncologic outcome including positive surgical margin (PSM) and biochemical recurrence-free survival (BCRFS) were also compared between the two groups. The comparison of the two approaches was also analyzed in subgroups by risk stratification.

69.1% of men who underwent posterior approach achieved immediate UC compared with 30.9% in the anterior group (RR = 2.24, 95% CI: 1.48 - 3.51, p = 0.000). The relative Kaplan-Meier curves regarding UC during 12-month follow-up revealed statistically better recovery of posterior approach when compared with anterior approach (HR = 1.51, 95% CI: 1.01 - 2.24, log-rank p = 0.007). No statistically significant differences were observed between the groups regarding complications (p = 0.399), PSM (p = 0.225), and BCRFS (HR = 4.80, 95% CI: 0.97 - 23.78, log-rank p = 0.111). In subanalyses, no significant difference regarding continence recovery in high-risk patients was observed between the two approaches (HR = 1.26; 95% CI: 0.63 - 2.51, log rank p = 0.415).

The Retzius-sparing approach significantly improved early recovery of UC compared to the conventional approach. Further prospective studies are needed to confirm the benefits of Retzius-sparing approach for clinically localized prostate cancer, especially for high-risk cases.

BJU international. 2020 Aug 02 [Epub ahead of print]

Xuefeng Qiu, Youjian Li, Mengxia Chen, Linfeng Xu, Suhan Guo, Giancarlo Marra, Joel Elliot Rosenberg, Haoxin Ma, Xiaogong Li, Hongqian Guo

Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, 210008, China., School of Artificial Intelligence, Nanjing University, Nanjing, 210008, China., Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy., University of Minnesota Medical School, Minneapolis, Minnesota, United States.

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