Comparing the outcomes of Retzius-sparing versus standard robotic prostate surgery for the treatment of localized prostate cancer.

This study compared the outcomes of Retzius-sparing (RS) robotic-assisted laparoscopic prostatectomy (RALP) with standard RALP (sRALP) for the treatment of patients with localized prostate cancer (PCa). The study found that the RS-RALP approach may be associated with better urinary outcomes compared to sRALP.

Localized prostate cancer (PCa) is a form of cancer that has not spread beyond the prostate gland. PCa can be treated by surgery, radiation, or hormone therapy. Men with PCa usually have high levels of prostate-specific antigen (PSA). PSA is a protein made by the cells of the prostate gland.

Standard RALP (sRALP) is a type of prostate surgery that uses robotic hands to remove the prostate gland with more precision. Patients who undergo this surgery commonly have less blood loss and shorter hospital stays. However, patients often have urinary incontinence (UI; involuntary urine leakage) or erectile dysfunction (ED) after this procedure.

RS-RALP approaches the prostate from below rather than above as in the standard approach. This technically challenging approach preserves all of the structures located in the front and has better urinary continence (UC) rates. UC is the ability to hold urine without leaking. However, whether RS-RALP has better functional outcomes compared to sRALP is still not clear.

The authors reviewed 5 studies with a total of 502 men with PCa. Patients were treated with either RS-RALP or sRALP.

Patients treated with RS-RALP approach were 74% more likely to have better UC compared to sRALP within 1 week of treatment. After 3 months, patients treated with RS-RALP approach were 33% more likely to have better UC compared to the sRALP approach. UC and sexual function at 12 months were similar between the 2 RALP techniques.

Positive surgical margin (PSM; cancer cells left at the tumor site following surgery) might be increased with RS-RALP compared to sRALP approach. 

This study concluded that RS-RALP was associated with good continence outcomes in the short-term while having a higher risk of positive surgical margins compared to sRALP in men with localized PCa.

Most of the studies had a small number of participants and a short follow-up period. Data on long-term oncological outcomes were missing.