Early Experience with Salvage Retzius-sparing Robotic-assisted Radical Prostatectomy: Oncologic and Functional Outcomes

Urology. 2021 Mar:149:117-121. doi: 10.1016/j.urology.2020.12.029. Epub 2021 Jan 5.

Abstract

Objective: To report on feasibility, safety, and continence outcomes using the Retzius-sparing approach in the salvage setting (sRS-RARP).

Materials and methods: A total of 26 patients underwent robotic salvage prostatectomy at our institution from January 2012 to May 2020 by a single surgeon (RM). Twenty patients underwent sRS-RARP and 6 underwent the standard approach (sRARP). Pre-, intra-, and postoperative outcomes were compared between these groups with emphasis on continence and oncologic safety.

Results: Patients had comparable preoperative characteristics with no significant difference in age, race, prostate-specific antigen level, and Gleason score. Most patients underwent primary external beam radiation therapy (69.2%). Median time to biochemical failure was 7.9 years (IQR 6.1-13.4). sRS-RARP required less console time (141.5 vs 199.5.0 minutes, P = .008) and less blood loss (50.0 mL vs 100.0 mL, P = .045) compared to sRARP. Postoperative course was uneventful with a median hospital stay of 1 day. Median catheterization time was 14.0 days (IQR 11.5-17). Patients undergoing sRS-RARP had better immediate (25.0% vs 0.0%, P < .001), 3 month (80.0% vs 0%, P < .001), and 12 month continence rates (100% vs 44%, P = .0384) compared to sRARP patients. Likewise, median time to continence was significantly shorter for sRS-RARP patients (90.0 vs 270.0 days, P = .0095). Biochemical recurrence rate was 20.0% in the sRS-RARP group and 33.3% in the sRARP group (P = .60).

Conclusion: Early experience suggests that sRS-RARP is feasible, oncologically safe, and may offer improved continence compared to the sRARP approach.

MeSH terms

  • Aged
  • Feasibility Studies
  • Humans
  • Male
  • Middle Aged
  • Neoadjuvant Therapy / methods
  • Organ Sparing Treatments / adverse effects
  • Organ Sparing Treatments / methods
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Prostate / pathology
  • Prostate / surgery
  • Prostatectomy / adverse effects*
  • Prostatectomy / methods
  • Prostatic Neoplasms / therapy*
  • Radiotherapy, Adjuvant / methods
  • Retrospective Studies
  • Robotic Surgical Procedures / adverse effects*
  • Robotic Surgical Procedures / methods
  • Salvage Therapy / adverse effects
  • Salvage Therapy / methods
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Urinary Catheterization / statistics & numerical data
  • Urinary Incontinence / diagnosis
  • Urinary Incontinence / epidemiology*
  • Urinary Incontinence / etiology
  • Urinary Incontinence / therapy