A meta-analysis of Retzius-sparing and hood-technique robot-assisted radical prostatectomy

To compare Retzius-sparing (RS-) robot-assisted radical prostatectomy (RARP), hood-technique RARP and standard RARP, assessing functional, oncological and peri-operative outcomes.

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The primary outcome was postoperative perfect continence rate (0 pad/day) at different time points over 12 months. Secondary outcomes included postoperative social continence, positive surgical margins (PSMs), biochemical recurrence at 12 months, and other peri-operative measures. A meta-analysis was conducted to assess RS-RARP vs standard RARP. A further exploratory meta-analysis was performed to compare the hood technique against standard RARP.

The meta-analyses included 26 studies comparing RS-RARP vs standard RARP and four studies assessing hood-technique RARP vs standard RARP, covering a total of 5512 patients. In comparison with standard RARP, RS-RARP demonstrated a significantly higher rate of perfect continence at 0 months (risk ratio [RR] 2.28, 95% confidence interval [CI] 1.42-3.66), 1 month (RR 2.94, 95% CI 1.24-6.98), 3 months (RR 1.85, 95% CI 1.21-2.84), 6 months (RR 1.20, 95% CI 1.04-1.38) and 12 months (RR 1.30, 95% CI 1.03-1.63) after surgery. The hood technique also demonstrated a statistically favourable perfect continence outcome at 6 months post-surgery (RR 1.52, 95% CI 1.13-2.04).

Both RS-RARP and hood-technique RARP are associated with a higher continence rate in the early period after surgery. However, there is limited evidence to suggest significant differences between these techniques in the long term. A direct comparison between hood-technique RARP and RS-RARP as well as quality data on long-term outcomes are needed to determine which technique provides superior functional outcomes.