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Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates

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Abstract

Background

Post-prostatectomy urinary incontinence is an adverse event leading to significant distress. Our aim was to evaluate immediate urinary continence (UC) recovery in a single-surgeon prospective randomized comparative study between the traditional robot-assisted laparoscopic radical prostatectomy (TR-RALP) and the Retzius-sparing RALP (RS-RALP), for the treatment of the clinically localized prostate cancer (PCa).

Methods

102 consecutive PCa patients were prospectively randomized to TR-RALP (57) or RS-RALP (45). Postoperative continence was defined as patient-reported absence of leakage or use of 0 pads/day. The immediate continence rate and 95% confidence interval (CI 95%) were calculated for each treatment. Univariable and multivariate logistic regressions were used to assess predictors of immediate continence following RALP. Continence rates from 1 to 6 months were calculated by Kaplan–Meier curves; log-rank test was used for the curve comparison. Two analyses were performed, considering a per-protocol (PP) population regarding all randomized patients that received nerve-sparing RALP and an Intention-To-Treat (ITT) population regarding all randomized patients that received RALP.

Results

In the PP analysis, the rates of immediate continence were 12/40 (30%) (CI 95% 17–47%) for the TR-RALP and 20/39 (51.3%) (CI 95% 35–68%) for the RS-RALP (p = 0.05). In the ITT analysis, the corresponding rates were 12/57 (21%) (CI 95% 11–34%) for the TR-RALP and 23/45 (51%) (CI 95% 36–66%) for the RS-RALP (p = 0.001). Median time to continence was 21 days for the TR-RALP and 1 day for RS-RALP, respectively (p = 0.02). The relative Kaplan–Meier curves regarding continence resulted statistically different when compared with the log rank test (p = 0.02). In the multivariate analysis, lower age and the Retzius-sparing approach were significantly associated to earlier continence recovery.

Conclusions

The Retzius-sparing approach significantly reduces time to continence following RALP. Further studies are required to confirm the reproducibility of our results and investigate the role of the RS-RALP as an additional “protective” factor for postoperative continence in the elderly population.

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References

  1. Cambio AJ, Evans CP (2006) Minimising postoperative incontinence following radical prostatectomy: considerations and evidence. Eur Urol 50(5):903–913 (discussion 913)

    Article  Google Scholar 

  2. Freire MP, Weinberg AC, Lei Y, Soukup JR, Lipsitz SR, Prasad SM, Korkes F, Lin T, Hu JC (2009) Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol 56(6):972–980

    Article  Google Scholar 

  3. Tan HJ, Xiong S, Laviana AA, Chuang RJ, Treat E, Walsh PC, Hu JC.. Tan HJ, Xiong S, Laviana AA, Chuang RJ, Treat E, Walsh PC, Hu JC (2016) Technique and outcomes of bladder neck intussusception during robot-assisted laparoscopic prostatectomy: a parallel comparative trial. Urol Oncol 34(12):529.e1–529.e7

    Article  Google Scholar 

  4. John H, Hauri D (2000) Seminal vesicle-sparing radical prostatectomy: a novel concept to restore early urinary continence. Urology 55(6):820–824

    Article  CAS  Google Scholar 

  5. Rocco B, Gregori A, Stener S, Santoro L, Bozzola A, Galli S, Knez R, Scieri F, Scaburri A, Gaboardi F (2007) Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy. Eur Urol 51(4):996–1003

    Article  Google Scholar 

  6. Tewari AK, Bigelow K, Rao S, Takenaka A, El-Tabi N, Te A, Vaughan ED (2007) Anatomic restoration technique of continence mechanism and preservation of puboprostatic collar: a novel modification to achieve early urinary continence in men undergoing robotic prostatectomy. Urology 69(4):726–731

    Article  Google Scholar 

  7. Patel VR, Coelho RF, Palmer KJ, Rocco B (2009) Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 56(3):472–478

    Article  Google Scholar 

  8. van der Poel HG, de Blok W, Joshi N, van Muilekom E (2009) Preservation of lateral prostatic fascia is associated with urine continence after robotic-assisted prostatectomy. Eur Urol 55(4):892–900

    Article  Google Scholar 

  9. Asimakopoulos AD, Annino F, D’Orazio A, Pereira CF, Mugnier C, Hoepffner JL, Piechaud T, Gaston R (2010) Complete periprostatic anatomy preservation during robot-assisted laparoscopic radical prostatectomy (RALP): the new pubovesical complex-sparing technique. Eur Urol 58(3):407–417

    Article  Google Scholar 

  10. Porpiglia F, Fiori C, Grande S, Morra I, Scarpa RM (2009) Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status. Eur Urol 55(6):1377–1383

    Article  Google Scholar 

  11. Coelho RF, Chauhan S, Palmer KJ, Rocco B, Patel MB, Patel VR (2009) Robotic-assisted radical prostatectomy: a review of current outcomes. BJU Int 104(10):1428–1435

    Article  Google Scholar 

  12. Krupski TL, Saigal CS, Litwin MS (2003) Variation in continence and potency by definition. J Urol 170(4 Pt 1):1291–1294

    Article  Google Scholar 

  13. Galfano A, Di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M, Ascione A, Gambacorta M, Bocciardi AM (2013) Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥ 1 year of follow-up. Eur Urol 64(6):974–980

    Article  Google Scholar 

  14. Donovan JL, Peters TJ, Abrams P, Brookes ST, de la Rosette JJ, Schäfer W (2000) Scoring the short form ICSmaleSF questionnaire. J Urol 164:1948–1955

    Article  CAS  Google Scholar 

  15. Asimakopoulos AD, Miano R, Galfano A, Bocciardi AM, Vespasiani G, Spera E, Gaston R (2015) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: critical appraisal of the anatomic landmarks for a complete intrafascial approach. Clin Anat 28(7):896–902

    Article  Google Scholar 

  16. Schulz KF, Altman DG, Moher D, for the CONSORT Group. (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Ann Int Med 152:726–732

    Article  Google Scholar 

  17. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55(5):1037–1063

    Article  Google Scholar 

  18. Heesakkers J, Farag F, Bauer RM, Sandhu J, De Ridder D, Stenzl A (2017) Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol 71(6):936–944

    Article  Google Scholar 

  19. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358(12):1250–1261

    Article  CAS  Google Scholar 

  20. Prabhu V, Sivarajan G, Taksler GB, Laze J, Lepor H (2014) Long-term continence outcomes in men undergoing radical prostatectomy for clinically localized prostate cancer. Eur Urol 65(1):52–57

    Article  Google Scholar 

  21. Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, Blazeby JM, Peters TJ, Holding P, Bonnington S, Lennon T, Bradshaw L, Cooper D, Herbert P, Howson J, Jones A, Lyons N, Salter E, Thompson P, Tidball S, Blaikie J, Gray C, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Kockelbergh R, Kynaston H, Paul A, Powell P, Prescott S, Rosario DJ, Rowe E, Davis M, Turner EL, Martin RM, Neal DE, ProtecT Study Group* (2016) Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 375(15):1425–1437

    Article  CAS  Google Scholar 

  22. Barry MJ, Gallagher PM, Skinner JS, Fowler FJ Jr (2012) Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of medicare-age men. J Clin Oncol 30(5):513–518

    Article  Google Scholar 

  23. Yanagida T, Koguchi T, Hata J, Yabe M, Sato Y, Akaihata H, Kawashima Y, Kataoka M, Ogawa S, Kumagai S, Kumagai K, Haga N, Kushida N, Ishibashi K, Aikawa K, Kojima Y (2014) Current techniques to improve outcomes for early return of urinary continence following robot-assisted radical prostatectomy. Fukushima J Med Sci 60(1):1–13

    Article  Google Scholar 

  24. Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM (2010) A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 58(3):457–461

    Article  Google Scholar 

  25. Dalela D, Jeong W, Prasad MA, Sood A, Abdollah F, Diaz M, Karabon P, Sammon J, Jamil M, Baize B, Simone A, Menon M (2017) A pragmatic randomized controlled trial examining the Impact of the Retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 72(5):677–685

    Article  Google Scholar 

  26. Mandel P, Graefen M, Michl U, Huland H, Tilki D (2015) The effect of age on functional outcomes after radical prostatectomy. Urol Oncol 33(5):203.e11–203.e18

    Article  Google Scholar 

  27. Menon M, Dalela D, Jamil M, Diaz M, Tallman C, Abdollah F, Sood A, Lehtola L, Miller D, Jeong W (2018) Functional recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: an evidence-based analysis comparing the Retzius sparing and standard approaches. J Urol 199(5):1210–1217

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy

    Anastasios D. Asimakopoulos, Luca Topazio, Michele De Angelis, Andrea Fuschi & Filippo Annino

  2. Department of Experimental Medicine and Surgery, UOC of Urology, University of Rome Tor Vergata, Rome, Italy

    Anastasios D. Asimakopoulos & Enrico Finazzi Agrò

  3. Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy

    Antonio Luigi Pastore & Andrea Fuschi

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  1. Anastasios D. Asimakopoulos
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  2. Luca Topazio
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  3. Michele De Angelis
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  4. Enrico Finazzi Agrò
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Correspondence to Anastasios D. Asimakopoulos.

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Dr Asimakopoulos Anastasios, Dr Topazio Luca, Dr De Angelis Michele, Dr Finazzi Agrò Enrico, Dr Antonio Lugi Pastore, Dr Andrea Fuschi and Dr Annino Filippo have no conflicts of interest or financial ties to disclose.

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Asimakopoulos, A.D., Topazio, L., De Angelis, M. et al. Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates. Surg Endosc 33, 2187–2196 (2019). https://doi.org/10.1007/s00464-018-6499-z

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