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The Retizius-sparing (RS) approach to prostatectomy has several proposed advantages over the conventional retropubic approach. This includes reduced post-prostatectomy stress urinary incontinence rates and better preservation of potency.1,2,3 While a smaller workspace may render this technique more technically challenging, this approach provides an advantage beyond functional outcome in certain clinical situations. We present two scenarios where Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) provided additional versatility that was translated into a more desired clinical outcome.
The first case was a 76-year-old renal transplant patient diagnosed with intermediate-risk prostate cancer. His well-functioning low-lying graft kidney in the left lower quadrant was in close relation to the prostate gland, precluding either conventional retropubic prostatectomy or radiotherapy as a treatment option. RS-RARP was performed for the patient, yielding satisfactory oncological and functional outcomes. The second case was a 61-year-old patient who had a rectal tumour with suspected prostate invasion on MRI. After neoadjuvant chemotherapy and radiotherapy, robotic en-bloc abdominal-perineal resection of the rectum, using a Retzius-sparing prostatectomy technique, was performed to save the patient from total exenteration and double stomata. A modified RS-RARP was adopted to keep the surgical plane between the rectum and prostate. Both procedures were uneventful.
In conclusion, the Retzius-sparing approach is a versatile technique which helps the surgeon to conduct a prostatectomy when special anatomical considerations are at play.
References
Dalela D, Jeong W, Prasad MA, et al. 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. 2017;72(5):677–85. https://doi.org/10.1016/j.eururo.2017.04.029.
Galfano A, Di Trapani D, Sozzi F, et al. 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. 2013;64(6):974–80. https://doi.org/10.1016/j.eururo.2013.06.046.
Lim SK, Kim KH, Shin TY, et al. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: Combining the best of retropubic and perineal approaches. BJU Int. 2014;114(2):236–44. https://doi.org/10.1111/bju.12705.
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Yee, C.H., Yu, S.J.A., Ho, MF. et al. Versatility of Retzius-Sparing Prostatectomy: Its Application in Renal Transplant Patient and En-bloc Abdominal-Perineal Resection. Ann Surg Oncol 29, 1486–1487 (2022). https://doi.org/10.1245/s10434-021-10804-6
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DOI: https://doi.org/10.1245/s10434-021-10804-6