Retzius-sparing versus modified anatomical structures preserving and retzius repairing robotic-assisted radical prostatectomy: A prospective randomized comparison on functional outcomes with a 1-year follow-up

Objectives; To compare the short-term and 1-yr follow-up functional outcomes of modified anatomical structures preserving and retzius-repairing robot-assisted radical prostatectomy (APR-RARP) compared with retzius-sparing (RS) RARP. Methods; 80 consecutive patients aged 40-75 yr with low-intermediate risk prostat cancer (PCa) were prospectively randomized to APR-RARP or RS-RARP. Urinary continence (UC) recovery rates were evaluated from catheter removal up to 1 yr follow-up. Postoperative UC was defined as 0 pads/one security pad per day. UC recovery rates from catheter removal to 1 yr were calculated by Kaplan-Meier curve; log-rank test was used for the curve comparison. Postoperative potency was evaluated at 3 and 12 months after surgeries. Perioperative complications, positive surgical margin (PSM), and biochemical recurrence rates represent secondary outcomes reported in the study. Results; At the catheter removal, 1, 3, 6 and 12 months after surgery, 52.5% (CI% 95% 37.6-67), 82.5% (CI% 95% 70.8-94), 95% (CI% 95% 88.3-99.1), 97.5% (CI% 95% 92.5-99.9) and 97.5% (CI% 95% 92.5-99.9) of men undergoing the APR-RARP were continent (0 pads/one security pad per day), compared with 61.5% (CI% 95% 46.5-76.6), 89.7% (CI% 95% 80.3-98.1), 97.5% (CI% 95% 92.6-99.9), 97.5% (CI% 95% 92.6-99.9) and 97.5% (CI% 95% 92.6-99.9) undergoing the RS-RARP, respectively, and the Kaplan Meier curve showed no statistically significant difference for both technique at any time point (log-rank p = 0.556). The median (95% confidence interval [CI]) time to UC recovery was 9.8 (5.2-14.4) days for the APR-RARP versus 6.7 (3.2-10.2) days for the RS-RARP group. Potency rates were similar in both groups at 3 and 12 months after surgeries. The two compared approaches, in terms of rate of complications, PSM were similar. Conclusions; Surgeons can achieve functional results comparable to the retzius-sparing technique with the modified reconstructive anterior approach, without changing the surgical technique they are used to.