Urinary incontinence is a common complication of conventional robot-assisted radical prostatectomy (RARP). Retzius-sparing RARP is performed through the pouch of Douglas to avoid destroying the pelvic fascia and the prostate’s anatomical structures. It has shown early favourable results in terms of continence compared to conventional techniques. This study (a meta-analysis), aimed to evaluate these differences in continence and sexual function between Retzius-sparing and conventional RARP) in the treatment of prostate cancer. Inclusion criteria included studies that directly compared both techniques and were published in English. Of 1002 records searched, 11 studies were identified to meet the inclusion criteria. Only two studies were randomised controlled studies. Continence was assessed immediately after catheter removal and at one, three, six and twelve months postoperatively. In the Retzius-sparing RARP group, recovery rates were significant better with 65.92%, 52.84%, 87.19%, 90.70% and 91.24%, respectively continent after surgery. In the C-RARP group, these values were 43.00%, 18.92%, 52.78%, 75% and 83.89%, respectively. Two studies reported sexual function recovery after RARP, but no statistically significant difference was found between either technique at any time point. No statistical differences were found between either technique in secondary outcomes such as operation time, intraoperative blood loss, length of stay, positive margin rate and complications. A funnel plot demonstrated a low probability of publication bias. This study (Level 1a evidence) demonstrates that Retzius-sparing has shown to be superior in postoperative continence recovery compared to standard techniques. The learning curve of RS-RARP may influence surgeon uptake and its effectiveness.
Is Retzius-sparing prostatectomy the way forward?
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