Retzius-sparing Robotic-assisted Radical Prostatectomy Associated with Less Bladder Neck Descent and Better Early Continence Outcome.

Background/Aim: We attempted to evaluate the association of early continence outcome of Retzius-sparing robotic assisted radical prostatectomy (RARP) and bladder neck descent with postoperative cystography. Patients and Methods: From November 2014 to December 2015, 30 patients with prostate cancer who received Retzius-sparing LRP/RARP were compared to 30 patients that received retropubic approach RARP with propensity score matching analysis. Cystogram was used to evaluate the bladder neck descent using the bladder neck to pubic symphysis (BNPS) ratio and the continence state was evaluated. Results: A total 60 patients were included 30 of which had received Retzius-sparing and 30 the retropubic approach, using propensity score matching analysis. There was no difference in age, prostate size, pathology T stage and PSA among groups. BNPS ratio is significantly low in the Retzius-sparing group (0.25 +/- 0.10 vs. 0.46 +/- 0.14, p=0.000). Early continence was improved in the Retzius-sparing group and early continence within the first week was 73.3% compared to 26.7% (p=0.000), but no difference was seen at one year (100.0% vs. 93.30%, p=0.150). The independent risk factors affecting post-operative continence were age and approach. The association between less bladder neck descent as BNP ratio and continence was also confirmed (HR=0.048, 95% CI=0.005-0.420, p=0.006). Conclusion: With the advantage of more normal pelvic anatomy preserved in Retzius-sparing RARP, it was associated with less bladder neck descent and better early continence outcome. Age was also an independent risk factor for postoperative continence.