Effects of Retzius sparing on robot-assisted laparoscopic prostatectomy: a systematic review with meta-analysis

  • Ting-En Tai
  • Chien-Chih Wu
  • Yi-No KangEmail author
  • Jeng-Cheng WuEmail author



To comprehensively evaluate the efficacy and safety of Retzius sparing (RS) for men undergoing robot-assisted laparoscopic prostatectomy (RARP).


We searched four electronic databases and reference lists of relevant studies for eligible research published before March 11, 2019. After quality assessment, eligible studies were synthesized for relevant outcomes, including positive surgical margin (PSM), continence, incontinence, complication, console time, and hospital stay.


Two randomized clinical trials and four observational studies were included in this study. Quantitative syntheses revealed significantly higher PSM rates in RS-RARP compared with conventional RARP (c-RARP) (odds ratio [OR] 1.68, p = 0.02). Furthermore, we found significantly higher PSM rates at the anterior site in RS-RARP compared with c-RARP (OR 4.34, p = 0.03) and significantly lower incontinence rates in RS-RARP in the first month (OR 0.30, p < 0.001) and 12th month (OR 0.25, p < 0.001).


Our syntheses revealed higher PSM rates in the RS-RARP group, especially in the anterior aspect. However, RS-RARP had superior functional outcome of urinary continence and lower console time than did c-RARP with equivalent complication rates. Thus, we suggest that operators pay more attention to making clear surgical margins if the lesion is in anterior prostate when performing RS-RARP.


Prostate cancer Prostatectomy Retzius sparing Robot-assisted Laparoscopic 



Confidence interval


Conventional robot-assisted laparoscopic radical prostatectomy


Mean difference


Odds ratio


Retzius space-sparing robot-assisted laparoscopic prostatectomy


Standard deviation


Standard error



This manuscript was edited by Wallace Academic Editing.

Authors Contributions

TET conceptualized the study, screened the full text of the included studies, extracted the data, critically appraised the studies, drafted the manuscript, and approved the final manuscript; CCW interpreted the results, supervised the study, and approved the final manuscript; YNK designed the study, systematically searched the literature, screened the citations, extracted and analyzed the data, interpreted the results, drafted and critically revised the manuscript, and approved the final manuscript. JCW screened the full text of the included studies, checked the data, supervised the study, critically revised the manuscript, and approved the final manuscript.


No funding was requested for this systematic review and meta-analysis.


Ting-En Tai, Chien-Chih Wu, Yi-No Kang, and Jeng-Cheng Wu have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2019_7190_MOESM1_ESM.pdf (83 kb)
Supplementary material 1 (PDF 83 kb)
464_2019_7190_MOESM2_ESM.pdf (198 kb)
Supplementary material 2 (PDF 199b)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyTaipei Medical University HospitalTaipeiTaiwan, Republic of China
  2. 2.Department of Education and Humanities in Medicine, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan, Republic of China
  3. 3.Department of EducationTaipei Medical University HospitalTaipeiTaiwan, Republic of China
  4. 4.Institute of Health Policy and Management, College of Public HealthNational Taiwan UniversityTaipeiTaiwan, Republic of China
  5. 5.Evidence-Based Medicine CenterWan Fang Hospital, Taipei Medical UniversityTaipeiTaiwan, Republic of China
  6. 6.Department of Urology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan, Republic of China

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