Retzius-sparing radical prosatectomy: First 200 Australian cases

The objective of this study is to report the first multi-centred Australian series of 200 cases of Retzius-sparing radical prostatectomy (RSRP).

Between April 2017 and June 2024, 200 RSRP procedures (197 robotic, three laparoscopic) were performed separately by the authors in five centres across two Australian cities (Melbourne, Victoria and Brisbane, Queensland). Data were collected prospectively with ethics committee approval (UCH-HREC 2019.01.279) at weeks 1, 4-6, and three-monthly. Exclusion criteria included prostate size >80 cc, significant middle lobe, large anterior tumour, previous TURP or any clinical factor deemed to make RSRP unsuitable. These criteria were relaxed as experience was gained.

Median (interquartile range) age, body mass index and PSA were 65 (60-70) years, 26 (25-29) kg/m² and 5.2 (4.0-7.0) ng/mL. Low, intermediate and high D'Amico risk groups were 3.5%, 75.0% and 21.5%, respectively. Median (interquartile range) skin-to-skin operative time was 163 (125-210) min and blood loss 200 (100-350) mL. There were 17 (8.5%) Clavien-Dindo grade 1-2 complications and 8 (4%) grade 3 complications. Final pT stage was 60.5% pT2 and 39.5% pT3. The overall positive surgical margins (PSM) rate was 14.5% including 3.3% pT2 and 29.1% pT3. At 1 week post catheter removal 53.5% were pad-free, increasing to 58.5% and 65.0% at 4 and 6 weeks, then 79.5%, 84.6%, 88.2% and 91.3% at 3, 6, 9 and 12 months, respectively. When a security pad is included, 71.5% and 85.5% of men were continent at 4 and 6 weeks, then 94%, 96%, 96% and 97% at 3, 6, 9 and 12 months, respectively. Three men required a suburethral sling and one an artificial urinary sphincter. Ninety of 140 (60.4%) preoperatively potent men were potent at 12 months with or without phosphodiesterase-5 inhibitors.

RSRP provides excellent early continence and can be introduced safely with good oncological results by experienced minimally- invasive surgeons.