Introduction

Retzius-sparing (posterior) robot-assisted radical prostatectomy (RARP) may expedite urinary continence (UC) recovery. We compared the short-term (≤3 months) UC, urinary function (UF) and UF-related bother outcomes of posterior RARP compared to standard approach (anterior) RARP in a randomized controlled trial (RCT).

Methods

120 patients aged 40-75 with low-intermediate risk prostate cancer (PCa) undergoing primary RARP by a single surgeon were randomized 1:1 to posterior (n=60) or anterior RARP (n=60). Primary outcome was UC (defined as 0 pad/one security liner per day and verified using 24-hour pad weights) 1 week after catheter removal. Secondary outcomes were time to UC recovery, UF and UF-related bother scores (measured by the International Prostatic Symptom Score (IPSS) and IPSS-Quality-of-Life scores respectively) assessed at 1 week, 2 weeks, 1 and 3 months following catheter removal. UC recovery was analyzed using Kaplan-Meier method and Cox proportional hazards regression. Linear generalized estimating equations (GEE) were used to compare UF and UF-related bother scores.

Results

Median age of the cohort was 61 years. 75.8% harbored intermediate-risk PCa. 71.2% in the posterior vs. 48.3% in the anterior arm were continent 1-week post-catheter removal (p=0.01); corresponding median 24-hour pad weights were 5 and 25 gm respectively (p=0.001). Posterior RARP showed faster UC recovery (figure 1); 94.9% in posterior vs. 85.8% in anterior RARP arms were continent at 3 months (p=0.018), and findings were confirmed on multivariable regression analyses. Urinary bother scores were significantly lower in the posterior vs. anterior RARP group at 1,2 and 4 weeks on GEE analyses (figure 2). _x000D_

Conclusions

This single-center RCT shows that in the hands of an experienced surgeon, Retzius-sparing approach of RARP resulted in earlier recovery of UC and lower UF-related bother than standard RARP in patients with low-intermediate risk PCa

Funding

none