Comparing the outcomes of transvesical or posterior robot-assisted radical prostatectomy for localized prostate cancer.

This study compared 2 approaches of robot-assisted radical prostatectomy (RARP) for the treatment of localized prostate cancer (PCa). The authors concluded that both transvesical (T) and posterior (P) approaches had similar results in these patients.

Localized prostate cancer (PCa) is cancer that is confined to the prostate gland. Radical prostatectomy (RP) is a surgical option in which the prostate and surrounding tissues are removed. RARP is a surgical method that uses robotic hands for the surgical removal or the prostate. Variations in RARP techniques include transvesical RARP (T-RARP; approach of the prostate from above, through the bladder) and the “Retzius-sparing” or posterior approach (P-RARP; approaches the prostate from below).

Both techniques involve nerve-sparing dissection. As a result, complications such as urinary incontinence (leakage) and erectile dysfunction are expected to be reduced. However, there is a need to assess the functional outcomes of these two surgical techniques in patients with low-risk localized PCa.

This study involved 96 patients with localized PCa. Of these, 44 patients underwent T-RARP and 52 patients were treated by P-RARP. The average follow-up period was 12 months.

T-RARP had a slightly longer surgical time (135.3 minutes) compared to P-RARP (127.3 minutes). T-RARP also had a slightly higher blood loss during surgery (105.2 ml vs 94.2 ml) compared to P-RARP.

Urinary continence (the ability to hold urine) was achieved immediately after surgery in 90.9% of the T-RARP group and 88.5% of the P-RARP group. No patients in either group had urinary blockage symptoms after 12 months. No differences in erectile function were reported between groups ar 3 and 12 months after surgery. 

PCa recurrence was also similar between groups after 12 months. 

The study concluded that T-RARP and P-RARP led to similar outcomes in the short term in patients with localized PCa.

The study had a short follow-up period. The study was based on medical records. Patients were not randomly assigned to the groups. Further studies are needed.