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Retzius-sparing robotic radical prostatectomy yields better outcomes vs anterior method

05 Jan 2018

Compared with the anterior approach to the prostate, Retzius-sparing-robot-assisted radical prostatectomy is faster, allows a shorter catheterization time, and delivers better continence results at 4 weeks, with most patients being pad-free or needing just a single pad a day, a recent study has shown.

Age, body mass index, prostate-specific antigen, biopsy Gleason sum, clinical stage, d’Amico risk profile, blood loss, prostate weight, and postoperative hospital stay were similar across patients in the two groups.

Patients in the Retzium-sparing group had shorter median operating time (200 min; interquartile range [IQR], 155‒266 vs 223 min; IQR, 100‒238; p=0.05) and catheterization (8 days; IQR, 8‒8 vs 14 days; IQR, 14‒14; p<0.0001), of whom many had suprapubic catheters inserted. Retzius-sparing patients also had lower overall complication rate (2.5 vs 8.0 percent; p=0.36).

Patients in the two groups had similar positive surgical margin rates, which decreased with greater experience with the Retzius-sparing technique (for pT2: 16.7 vs 7.7 percent; p=0.65; for pT3: 31.8 vs 14.3 percent; p=0.44). Initial prostate-specific antigen was <0.1 ng/ml in 97.5 and 100 percent, respectively (p=1.00).

In the Retzius-sparing group, zero, one, and two pads per day were needed in 90.0, 7.5, and 2.5 percent of patients at 4 weeks postoperation, as compared with 37.5 (p<0.0001), 32.5 (p=0.01), and 30 percent (p=0.002) of men having conventional surgery.

A total of 40 patients with T2‒T3 prostate cancer underwent Retzius-sparing-robot-assisted radical prostatectomy. The authors compared the results with those from the 40 patients having robot-assisted radical prostatectomy done by the same surgeon immediately prior to the adoption of the Retzius-sparing technique.

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