Impact of graded detrusor preservation on continence in Retzius-Sparing Robotic-Assisted Prostatectomy

To evaluate the influence of detrusor apron preservation on continence in Retzius-sparing Robotic assisted radical prostatectomy (RS-RARP).

A prospective study was carried out on patients who underwent RS-RARP at our institute from January 2019 to June 2022. We aimed to identify potential factors that could affect continence, including age, BMI, ISUP Grade Group, bladder neck sparing, fascial plane of dissection, and degree of preservation of the detrusor apron. The detrusor preservation was graded from 0 to 3, where grade 0 the detrusor apron is sacrificed and grade 3 it is complete preservation.

The study included 311 patients. There was a significant correlation between the degree of detrusor preservation and continence at three months, with significance escalating with greater detrusor preservation. The OR for grade 1, grade 2 and grade 3 stood at 3.84 (p = 0.026), 9.83 (p < 0.001) and 16.06 (p = 0.03) respectively. This correlation in the three groups at six months was 29.38 (p < 0.001), 26.57 (p < 0.001), and 17.29 (p = 0.005) respectively, showing an even stronger association with continence recovery. The OR for detrusor apron preservation at 12 months was 21.89 (p = 0.003), 14.21 (p = 0.006), and 6.31 (p = 0.105) respectively. We observed that the association between detrusor apron preservation persisted at 12 months, although the odds ratios (OR) were diminished compared to the six-month periods.

The study emphasizes the critical role of the detrusor apron in achieving both early and superior continence rates. Sacrificing the detrusor apron was associated with delayed continence recovery and an increased incidence of incontinence. To achieve good continence with reduced incidence of margin positivity detrusor can be preserved in a graded manner.