A propensity score-matching study on retzius-sparing robotic-assisted radical prostatectomy: Evidence of continence advantage on the early learning curve

Abstract

To investigate the outcome of retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) compared with conventional RARP in the early learning curve. Consecutive patients with prostate cancer who underwent RS-RARP were included to compare against conventional RARP of the same period. Propensity-score matching was performed based on age, prostate size, nerve-sparing approach, and final pathological risk categories. All patients were re-admitted to undergo trial without Foley catheter from post-operative day 7-10. Clinical follow-up was performed with monitoring of continence (day 0, 3 months, and the latest continence during the study period) and surveillance of PSA level. Between July 2017 and August 2019, 24 consecutive patients received RS-RARP in our centre. Propensity score matching was performed with the best matched 24 controls receiving conventional RARP. Overall median follow-up duration was 15.5 months. A majority of the patients belonged to the intermediate-risk group, with most of them harbouring pT2 disease (RS-RARP: 87.5%; conventional RARP: 79.2%). More patients in RS-RARP group achieved day-0 continence (33.3% vs 0%, p=0.002) and 3-month continence (66.7% vs 12.5%, p=0.001). During the whole study period, more RS-RARP achieved continence with 0 pad (91.7% vs 66.7%, p=0.033). The mean months to continence is shorter in RS-RARP group (4.0 months vs 13.6 months, p=0.002). No statistically significant differences between the two groups with respect to surgical margins, post-operative PSA detection, and the use of adjuvant radiotherapy. RS-RARP showed better continence rates when compared to conventional RARP even during the learning curve phase.