Retzius-Sparing Robot-Assisted Radical Prostatectomy: Analysis of Functional and Oncological Outcomes

Background and Objectives: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has emerged as an alternative surgical approach designed to preserve pelvic anatomical structures involved in urinary continence. This study aimed to evaluate the perioperative, pathological, functional, and early postoperative oncological findings of RS-RARP in patients with clinically localized prostate cancer. Materials and Methods: This retrospective single-cohort study included 132 consecutive patients who underwent RS-RARP at a single institution between January 2017 and February 2020. Demographic, perioperative, pathological, functional, and postoperative oncological data were retrospectively collected. The primary functional outcome was postoperative urinary continence recovery. Pathological outcomes included final ISUP Grade Group and positive surgical margin status, while postoperative prostate-specific antigen (PSA) measurements and treatment-related oncological follow-up data were evaluated where available. Results: The median operative time was 170 min (IQR, 160-200), and the median estimated blood loss was 100 mL (IQR, 70-150). Blood transfusion was required in one patient (0.8%), and no Clavien-Dindo grade ≥ III complications were observed. Final pathological examination demonstrated ISUP Grade Group 2 disease in 64.9% of patients, and the overall positive surgical margin rate was 33.6%. The median time to both social continence (0-1 pad/day) and complete continence (0 pad/day) was 30 days. Among 130 patients with available current pad-use data, 108 (83.1%) were completely pad-free, 13 (10.0%) required one safety pad per day, and 9 (6.9%) required two or more pads per day. The median oncological follow-up was 12 months. Follow-up data were available for 131 patients; postoperative PSA measurements were available for 79 patients and last PSA measurements for 122 patients. No salvage therapy or biochemical recurrence was documented in the available clinical records. However, incomplete longitudinal PSA data precluded reliable assessment of biochemical recurrence-free survival. Conclusions: In this retrospective single-cohort study, RS-RARP was associated with low perioperative morbidity, acceptable pathological outcomes, and favorable early urinary continence recovery. However, the absence of a conventional RARP comparator group, the relatively short follow-up period, and incomplete longitudinal PSA and recurrence-related data preclude conclusions regarding comparative effectiveness and long-term oncological efficacy. Prospective multicenter comparative studies with standardized functional assessment, systematic PSA monitoring, and longer oncological follow-up are warranted.