Continence-Sparing Techniques in Radical Prostatectomy: A Systematic Review of Randomized Controlled Trials.

Area of Science:

• Urology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Numerous radical prostatectomy techniques aim to improve early continence (EC) recovery post-surgery.
• Evidence supporting the optimal technique for enhanced EC remains controversial and requires critical appraisal.
• Standardization of continence outcome reporting is needed for comparative analysis.

Purpose of the Study:

• To critically appraise randomized control trials (RCTs) on prostatectomy techniques for EC recovery.
• To summarize reported immediate and early continence outcomes.
• To propose a standardized framework for reporting continence outcomes.

Main Methods:

• Systematic review adhering to PRISMA standards, analyzing data from five medical registries.
• Inclusion of English, full-text RCTs reporting postoperative urinary continence outcomes within 6 months.
• Critical appraisal and quality assessment of all included RCTs; meta-analysis was precluded by heterogeneity.

Main Results:

• 39 RCTs were included; 19 were low-quality. High-quality evidence supports robot-assisted radical prostatectomy (RARP) over laparoscopic radical prostatectomy (LRP) and Retzius-sparing (RS) over traditional techniques for EC.
• Nerve-sparing (NS) approach, bladder neck, and puboprostatic ligament (PPL) preservation show potential for EC enhancement, albeit with low-level evidence.
• Endopelvic fascia preservation, bladder neck modifications, and selective dorsal venous complex (DVC) ligature did not significantly improve EC.

Conclusions:

• RARP and RS techniques demonstrate high-quality evidence for enhancing postoperative EC recovery.
• NS, bladder neck, and PPL preservation may contribute to better EC, requiring further investigation.
• Multicenter RCTs are essential to determine optimal surgical technique combinations, alongside a proposed new standardization for continence outcome reporting.