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Surgical Endoscopy

, Volume 33, Issue 7, pp 2187–2196 | Cite as

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

  • Anastasios D. AsimakopoulosEmail author
  • Luca Topazio
  • Michele De Angelis
  • Enrico Finazzi Agrò
  • Antonio Luigi Pastore
  • Andrea Fuschi
  • Filippo Annino
Article

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.

Keywords

Prostate cancer Randomized controlled trial Retzius Robot-assisted radical prostatectomy Urinary continence 

Notes

Compliance with ethical standards

Disclosures

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.

Supplementary material

464_2018_6499_MOESM1_ESM.doc (418 kb)
Supplementary material 1 (DOC 418 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Anastasios D. Asimakopoulos
    • 1
    • 2
    Email author
  • Luca Topazio
    • 1
  • Michele De Angelis
    • 1
  • Enrico Finazzi Agrò
    • 2
  • Antonio Luigi Pastore
    • 3
  • Andrea Fuschi
    • 1
    • 3
  • Filippo Annino
    • 1
  1. 1.Department of UrologyUsl Toscana Sud Est, San Donato HospitalArezzoItaly
  2. 2.Department of Experimental Medicine and Surgery, UOC of UrologyUniversity of Rome Tor VergataRomeItaly
  3. 3.Department of Medico-Surgical Sciences and Biotechnologies, Urology UnitSapienza University of RomeLatinaItaly

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