Introduction

Retzius-sparing (posterior or &[prime]Bocciardi&[prime] approach) of robot-assisted radical prostatectomy (RARP) has been recently suggested as a feasible alternative to the standard (anterior or &[prime]Menon&[prime] approach) RARP. We compared urinary continence (UC), sexual function (SF), oncological outcomes, and postoperative complications over a short term (~1-year) follow up for patients undergoing posterior vs. anterior approach RARP in a randomized trial.

Methods

120 patients with low-intermediate risk prostate cancer (PCa) undergoing RARP by a single surgeon were randomized to posterior (n=60) or anterior RARP (n=60). Recovery of SF was defined as a) erections sufficient for penetrative intercourse (ESI), and b) Sexual Health Inventory for Men (SHIM) score≥ 17. UC recovery was defined as use of 0 pad/one security pad per day. Both UC and SF recovery data were collected by an independent third party (MUSIC registry) using validated patient-reported questionnaires. Oncologic outcomes consisted of positive surgical margins (PSM) and short term (~1 year) biochemical recurrence-free survival (BCRFS).

Results

There were no significant differences in UC at 6- or 12-months post-RARP (98.4% in posterior vs. 95% in anterior RARP) or urinary function scores in the two arms (figure 1). Amongst preoperatively potent men (SHIM≥ 17), 72.4% in anterior and 83.7% in posterior RARP group were able to have ESI one year after surgery (p=0.6); 46.2% and 59.2% had regained SHIM≥ 17 by the same time point (figure 2). There were no significant differences in the incidence of PSM (25% in posterior vs. 13.3% in anterior RARP), BCRFS (91.5% vs. 94.4% respectively) or postoperative complications over a median follow-up of 13.5 months.

Conclusions

In this randomized trial of patients with low-intermediate risk PCa, UC, SF, postoperative complications, and BCR rates were comparable at 12 months in patients undergoing &[prime]Bocciardi&[prime] vs. &[prime]Menon&[prime] approach RARP.

Funding

none