A Comparative Analysis of the Functional Outcomes Between Retzius-Sparing and Conventional Robot-Assisted Radical...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted radical prostatectomy (RARP) is the leading surgical method globally for prostate cancer.
• Despite advancements, functional impairments like urinary incontinence and sexual dysfunction remain significant concerns post-RARP.
• Retzius-sparing RARP (RS-RARP) aims to preserve the Retzius space, with emerging evidence suggesting benefits, but comprehensive functional outcome data are limited.

Purpose of the Study:

• To compare the functional outcomes, specifically urinary continence and sexual function, between Retzius-sparing RARP (RS-RARP) and conventional RARP (C-RARP).
• To evaluate the impact of RS-RARP on bowel and hormonal functions.
• To assess sexual function preservation in nerve-sparing procedures using RS-RARP versus C-RARP.

Main Methods:

• Retrospective analysis of 132 patients undergoing RARP between January 2020 and July 2021.
• Comparison of functional outcomes between the RS-RARP (n=49) and conventional RARP (C-RARP) (n=83) groups using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire.
• Specific comparison of sexual function outcomes in patients who underwent nerve-sparing procedures.

Main Results:

• RS-RARP demonstrated significantly better preservation of urinary continence (p < 0.01) and sexual function (p = 0.03) at 12 months postoperatively compared to C-RARP.
• No significant differences were found in bowel or hormonal function domains between the two surgical approaches.
• Even in nerve-sparing cases, RS-RARP showed significantly higher EPIC scores for functional outcomes at 12 months (p < 0.01) compared to C-RARP.

Conclusions:

• RS-RARP shows a potential advantage in preserving both urinary continence and sexual function following radical prostatectomy.
• The technique may offer superior functional recovery compared to conventional RARP, particularly in nerve-sparing procedures.
• Further research may be warranted to explore the oncological implications, such as surgical margins, associated with RS-RARP.