Retzius-sparing radical prosatectomy: First 200 Australian cases

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Radical prostatectomy is a primary treatment for localized prostate cancer.
• Retzius-sparing radical prostatectomy (RSRP) is a technique aiming to preserve neurovascular bundles and improve functional outcomes.
• Data on multi-centre Australian RSRP series are limited.

Purpose of the Study:

• To report the first multi-centred Australian series of 200 Retzius-sparing radical prostatectomy (RSRP) cases.
• To evaluate the safety, oncological results, and functional outcomes (continence and potency) of RSRP.
• To assess the feasibility of introducing RSRP in a multi-centre setting.

Main Methods:

• Prospective data collection from 200 RSRP procedures (197 robotic, 3 laparoscopic) across five Australian centres (April 2017 - June 2024).
• Patients assessed at 1 week, 4-6 weeks, and then 3-monthly post-operatively.
• Exclusion criteria were initially strict but relaxed with increasing experience.

Main Results:

• Median operative time was 163 minutes with a median blood loss of 200 mL.
• Clavien-Dindo grade 1-2 complications occurred in 8.5% and grade 3 in 4%.
• Urinary continence rates (pad-free) reached 91.3% at 12 months; potency was preserved in 60.4% of preoperatively potent men at 12 months.

Conclusions:

• Retzius-sparing radical prostatectomy (RSRP) provides excellent early urinary continence.
• RSRP can be safely introduced by experienced minimally invasive surgeons.
• The procedure yields good oncological results, supporting its role in prostate cancer management.