Retzius Sparing Research Articles

PE020 Self-removal of suprapubic catheter after retzius sparing robot-assisted radical prostatectomy: A feasibility study

PE020 Self-removal of suprapubic catheter after retzius sparing robot-assisted radical prostatectomy: A feasibility study

VJY18 Tips and tricks: Retzius sparing robot assisted radical prostatectomy

VJY18 Tips and tricks: Retzius sparing robot assisted radical prostatectomy

PE019 Evaluation of the catheter related symptoms between suprapubic and standard catheter in Retzius sparing robot-assisted radical prostatectomy

PE019 Evaluation of the catheter related symptoms between suprapubic and standard catheter in Retzius sparing robot-assisted radical prostatectomy

PJY02 Retzius sparing robotic-assisted radical prostatectomy; single center, single surgeon and our early results

PJY02 Retzius sparing robotic-assisted radical prostatectomy; single center, single surgeon and our early results

Surgical Experience and Results of Retzius Sparing Robotic Assisted Laparoscopic Radical Prostatectomy: First Report in Thailand

Objective: To evaluate the outcomes and safety of the surgical technique Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALRP), with prostatic cancer; the first report in Thailand. Material and Methods: The authors conducted a retrospective analysis from the medical records of 100 patients who underwent RS-RALRP by a single surgeon; from 1st January 2021 until 31st May 2023, at Rajavithi Hospital. The authors analyzed demographic data, clinical staging, Gleason grade group, operative time, pathologic staging, positive surgical margin rate; postoperative continence recovery and postoperative complications. Results: The median age was 71.34±6.84 years: mean total PSA was 17.16±17.55 ng/ml; with the majority in clinical T1 and T2. The mean operative time was 221.7±51.93 minutes, and the mean estimated blood loss was 312.30±264.55 ml. Of all patients, 88% did not require blood transfusion. The complication rate was 8%. The pathologic stages pT2 and pT3 or greater were 62% and 38%, respectively. Positive surgical margins (PSM) pT2 and pT3 were 14.5% and 63.2%. The postoperative continence recovery after RS-RALRP were 83%, 95%, 97%,100% and 100%: at 1, 3, 6, 9 and 12 months postoperatively, respectively. Conclusion: RS-RALRP has a potential to become the new standard for prostate cancer treatment, with improved early continence and equivalent oncologic efficacy. The limitations of this study are the small number of population, which require prospective multicenter studies.

Retzius-sparing vs. posterior urethral suspension: similar early-phase post-robotic radical prostatectomy continence outcomes.

Stress urinary incontinence (SUI) is a risk of robotic-assisted radical prostatectomy (RP) which can be a frustrating problem for both surgeons and patients. We aim to compare short-term continence outcomes between patients undergoing Retzius Sparing RP (RS-RP) and those undergoing standard RP with the inclusion of a PUS suture technique and suprapubic tube (PUS-RP). A retrospective review of 105 consecutive patients who underwent RP was performed, comparing patients who underwent RS-RP and PUS-RP. Our main outcome was pad usage as a surrogate for SUI. Patients were evaluated 4 weeks following RP and again at approximately 3 months. Continence was defined as no pad usage or up to one safety pad per day. Risk factors associated with not being continent were identified using univariate and multivariate analyses. In our cohort, 52 patients underwent RS-RP and 53 patients underwent PUS-RP. The two groups had similar patient demographics. Although not statistically significant, there was a higher rate of a positive surgical margin in the RS-RP compared to PUS-RP (25% vs 15%, p = 0.204). At one month follow-up for PUS-RP and RS-RP, there was no significant difference in the frequency of continent men (69.2% vs. 76.9%, p = 0.302). At 3-month follow-up for the two groups of patients, again, there was no significant difference in the frequency of continence for PUS-RP and RS-RP (86.2% vs 88%, p = 0.824). Patients who underwent RS-RP had similar rates of continence to those patients undergoing PUS-RP in the short-term post-operative period.

A Comprehensive Review of the Current State of Robot-assisted Laparoscopic Salvage Prostatectomy.

Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP. We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings: Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively. Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP.

Robot-assisted radical prostatectomy with Retzius-Sparing approach vs. modified Frankfurt: comparison of results at 1 year of follow-up

Robot-assisted radical prostatectomy has positioned itself as the approach of choice in the treatment of prostate cancer. To compare the outcomes of robot-assisted radical prostatectomy using the Retzius-Sparing (RS) approach against the modified Frankfurt (MF) technique. To describe the perioperative, functional and oncological outcomes of 13 patients with prostate cancer who underwent RS robotic radical prostatectomy compared to MF, evaluating pathological results, urinary continence, sexual function and oncological control in 1 year of follow-up. The average age was 64 years in RS group vs. 61 years in MF group. The values of total prostate antigen were higher in the RS group (25 ng/dl) vs. MF group (11 ng/dl). The volume of gland in RS group was 40.62 ml vs. 63.33 ml in the RS group. All patients were bilaterally neuropreserved, being statistically significant in favor of MF group (p = 0.016). Positive surgical margins were higher in R-S group (38.4%) vs. MF group (33.3%). With RS the same tendency to urinary continence is observed, with a significant difference in erectile function in favor of MF. This preliminary study shows better impact on erectile function.

Postoperative Bladder Neck to Pubic Symphysis Ratio Predictive for De Novo Overactive Bladder after Robot-Assisted Radical Prostatectomy.

The aim was to investigate the incidence and clinical predictive factors of de novo overactive bladder (OAB) after robot-assisted radical prostatectomy (RARP), including a Retzius-sparing (RS) approach, in the same period at a single institution. Of a total of 113 patients with localized prostate cancer, 81 received conventional RARP (CON-RARP) and 32 received RS-RARP at our institution. The basic characteristics data of patients and self-assessment questionnaires, including IPSS and OABSS, were obtained preoperatively and 1, 3, and 6 months after RARP. In addition, a retrospective biomarker analysis was also performed of predictive clinical parameters obtained from cystography that included a postoperative bladder neck to pubic symphysis (BNPS) ratio. Patients' basic characteristics were similar between CON-RARP and RS-RARP groups. With respect to the surgical procedure, anastomosing time was found to be significantly longer for patients in the RS-RARP compared to the CON-RARP group (p < 0.01). Compared to the CON-RARP group, the RS-RARP group showed a significantly lower postoperative BNPS and aspect ratio (p < 0.001). The incidence of de novo OAB in patients of the CON-RARP group was greater than for those in the RS-RARP group (40.7% CON-RARP vs. 25.0% RS-RARP), though this was not significant. Regarding the emergence of de novo OAB, the following were revealed in univariate analysis to be independent prognostic factors: age > 64 years (hazards ratio [HR]: 4.32, 95% confidence interval [CI]: 1.51-12.3), postoperative BNPS ratio > 0.44 (HR: 8.7, 95% CI: 6.43-54.5), postoperative aspect ratio > 1.18 (HR: 3.36, 95% CI: 1.49-7.61). Additionally, multivariate analysis identified a sole significant prognostic factor: postoperative BNPS ratio > 0.44 (HR: 13.3, 95% CI: 4.33-41.1). Our findings indicate that the postoperative BNPS ratio may be a practical predictive indicator of the emergence of de novo OAB after RARP.

Continence-Sparing Techniques in Radical Prostatectomy: A Systematic Review of Randomized Controlled Trials.

Background: Numerous continence-sparing radical prostatectomy techniques have been developed to enhance postoperative early continence (EC) recovery; however, evidence regarding the best approach remains controversial. The objectives are to provide a critical appraisal of various prostatectomy techniques, based on the evidence of quality-assessed randomized control trials (RCTs); to summarize the immediate continence and the EC reported; and to propose a new standardization for continence outcomes reporting. Methods: Data acquired from five medical registries were reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Evidence from published, English, full-text RCTs reporting postoperative urinary continence outcomes within 6 months from surgery was included. The heterogeneity of surgical techniques and continence definitions did not allow a meta-analysis. All RCTs were critically appraised, and quality assessed. Results: In total, 39 RCTs were included: 19 of 39 studies were low-quality RCTs, presenting small cohort, monocentric, or single-surgeon data. The best RCT-supported evidence is in favor of robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) and of the Retzius-sparing (RS) technique over the traditional prostatectomy. Other techniques such as bladder neck and puboprostatic ligament (PPL) preservation, posterior reconstruction with or without combination of anterior suspension technique, and nerve-sparing (NS) approach seem to enhance EC. Oppositely, the endopelvic fascia preservation, bladder neck mucosa eversion/plication/slings, and the selective ligature of dorsal venous complex (DVC) were not significantly associated with EC improvements. RCTs are lacking on pubovesical complex-sparing, seminal vesicle preservation, anterior reconstruction of the puboprostatic collar, musculofascial reconstruction, and DVC suspension to the periosteum of the pubic bone techniques. Conclusions: RARP and RS have high-quality evidence supporting their ability to enhance postoperative EC recovery. NS, bladder neck, and PPL preservation may contribute to better EC recovery, although the evidence level is low. Further multicenter RCTs are needed to establish the optimal combination of standard surgical techniques. A new continence outcome-reporting standardization was proposed.

VE54 - Retzius sparing robot-assisted radical prostatectomy after urolift - technical challenges

VE54 - Retzius sparing robot-assisted radical prostatectomy after urolift - technical challenges

PD27-10 AN INTERMEDIATE-TERM ONCOLOGICAL ASSESSMENT COMPARING THE RETZIUS-SPARING ROBOT ASSISTED RADICAL PROSTATECTOMY TO THE STANDARD APPROACH IN A RANDOMIZED CONTROL COHORT

You have accessJournal of UrologyCME1 Apr 2023PD27-10 AN INTERMEDIATE-TERM ONCOLOGICAL ASSESSMENT COMPARING THE RETZIUS-SPARING ROBOT ASSISTED RADICAL PROSTATECTOMY TO THE STANDARD APPROACH IN A RANDOMIZED CONTROL COHORT Mohit Butaney, Ghassan Barayan, Deepansh Dalela, Sohrab Arora, Alison Levy, Firas Abdollah, James Peabody, Craig Rogers, Mani Menon, and Wooju Jeong Mohit ButaneyMohit Butaney More articles by this author , Ghassan BarayanGhassan Barayan More articles by this author , Deepansh DalelaDeepansh Dalela More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Alison LevyAlison Levy More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , James PeabodyJames Peabody More articles by this author , Craig RogersCraig Rogers More articles by this author , Mani MenonMani Menon More articles by this author , and Wooju JeongWooju Jeong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003305.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retzius sparing prostatectomy is promoted with the early continence result, but criticized for higher positive surgical margin. The long-term oncological outcome is still unknown. In this study, we aimed to compare the intermediate-term oncologic outcomes of these two approaches in a patient cohort treated as part of a randomized controlled trial. METHODS: A total of 120 patients were previously randomized equally to receive retzius sparing (RS-RARP) versus standard robotic assisted laparoscopic radical prostatectomy (S-RARP) between January 2015 to April 2016. Baseline, surgical, and pathological characteristics as well as oncologic outcomes were assessed. The analysis was done based on the treatment received. RESULTS: Sixty-three patients underwent S-RARP while 57 patients underwent RS-RARP. There was no statistically significant difference in the baseline nor surgical characteristics. The median follow up was 71.24 (IQR 59.75 - 75.75). There were more pathological T3 diseases in RS-RARP. There was no significant difference in the positive margin status nor the biochemical recurrence rate among both groups. After S-RARP and RS-RARP, 6 and 10 patients had biochemical recurrence and the 5 years biochemical recurrence free survival were 91% and 85%, respectively. (p=0.21). CONCLUSIONS: In this cohort, there was no difference in biochemical recurrence in the patients who received either technique. Further multi-institutional studies with a larger sample size and longer follow-up are required. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e745 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohit Butaney More articles by this author Ghassan Barayan More articles by this author Deepansh Dalela More articles by this author Sohrab Arora More articles by this author Alison Levy More articles by this author Firas Abdollah More articles by this author James Peabody More articles by this author Craig Rogers More articles by this author Mani Menon More articles by this author Wooju Jeong More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of single-port and multi-port Retzius-sparing robot-assisted laparoscopic prostatectomy.

Dissemination of robotic surgical technology for robot-assisted laparoscopic prostatectomy (RALP) has yielded advancements including the Retzius-sparing (RS) approach and the single-port (SP) platform. The safety and feasibility of each individual advancement have been evaluated, yet there is a lack of literature comparing SP RS-RALP to conventional multi-port (MP) RS-RALP. All patients who underwent RS-RALP at our institution between January 2019 and February 2021 were retrospectively reviewed. Data regarding baseline patient and tumor characteristics, operative characteristics, and surgical outcomes were collected and analyzed using the Fisher's exact test and two-tailed unpaired t tests. 62 patients were evaluated: 31 received SP RS-RALP and 31 received MP RS-RALP. Differences in patient age, BMI, and initial PSA were not observed. Lower median lymph node yield (SP: 4 vs MP: 12, p < 0.01), lower estimated blood loss (SP: 111.2 vs. MP 157.8mL, p < 0.01), shorter operative time (SP: 207.7 vs. MP: 255.9min, p < 0.01) and decreased length of stay (SP: 0.39 vs. MP: 1.23days, p < 0.01) were observed in the SP RS-RALP cohort. No differences in positive surgical margins, complications, or biochemical recurrence rates were observed. SP RS-RALP is non-inferior to MP RS-RALP in terms of both perioperative and early oncologic outcomes. Despite the small sample size, the SP platform is a safe and feasible option for RS-RALP and confers potential benefits in the form of shorter operative time and reduced length of stay.

PE16 - Retzius sparing robot-assisted radical prostatectomy in patients with previous BPH-surgery: Analyses of perioperative, functional and oncological outcomes

PE16 - Retzius sparing robot-assisted radical prostatectomy in patients with previous BPH-surgery: Analyses of perioperative, functional and oncological outcomes

SC231 - Retzius sparing robot-assisted radical prostatectomy in patients with previous BPH-surgery: evaluation of perioperative, functional and oncological outcomes

SC231 - Retzius sparing robot-assisted radical prostatectomy in patients with previous BPH-surgery: evaluation of perioperative, functional and oncological outcomes

Impact of Pelvic Anatomical Changes Caused by Radical Prostatectomy.

Simple SummaryAfter radical prostatectomy, the pelvic anatomy is altered such that the postoperative structure differs from the preoperative one, resulting in a variety of complications. In this review, the complications and mechanisms of pelvic anatomical changes associated with radical prostatectomy, as well as countermeasures, are outlined. An analysis of the anatomical mechanisms that cause complications after radical prostatectomy using imaging and other modalities is in progress. In addition, many surgical techniques that ensure the prevention of postoperative complications have been reported, and their usefulness has been evaluated. The preservation of as much periprostatic tissue and periprostatic structures as possible may lead to favorable postoperative functions, as long as the cancer condition permits.During radical prostatectomy, the prostate is removed along with the seminal vesicles, and the urinary tract is reconstructed by dropping the bladder onto the pelvic floor and suturing the bladder and urethra together. This process causes damage to the pelvic floor and postoperative complications due to the anatomical changes in the pelvic floor caused by the vesicourethral anastomosis. Urinary incontinence and erectile dysfunction are major complications that impair patients’ quality of life after radical prostatectomy. In addition, the shortening of the penis and the increased prevalence of inguinal hernia have been reported. Since these postoperative complications subsequently affect patients’ quality of life, their reduction is a matter of great interest, and procedural innovations such as nerve-sparing techniques, Retzius space preservation, and inguinal hernia prophylaxis have been developed. It is clear that nerve sparing is useful for preserving the erectile function, and nerve sparing, urethral length preservation, and Retzius sparing are useful for urinary continence. The evaluation of pre- and postoperative imaging to observe changes in pelvic anatomy is also beginning to clarify why these techniques are useful. Changes in pelvic anatomy after radical prostatectomy are inevitable and, therefore, postoperative complications cannot be completely eliminated; however, preserving as much of the tissue and structure around the prostate as possible, to the extent that prostate cancer control is not compromised, may help reduce the prevalence of postoperative complications.

Retzius-Sparing vs Modified Anatomical Structure Preserving and Retzius-Repairing Robotic-Assisted Radical Prostatectomy: A Prospective Randomized Comparison on Functional Outcomes with a 1-Year Follow-Up.

Objectives: To compare the short-term and 1-year follow-up functional outcomes of modified anatomical structure preserving and Retzius-repairing robot-assisted radical prostatectomy (APR-RARP) compared with Retzius-sparing (RS) RARP. Methods: Eighty consecutive patients 40-75 years of age with low-intermediate risk prostate cancer were prospectively randomized to APR-RARP or RS-RARP. Urinary continence (UC) recovery rates were evaluated from catheter removal up to 1 year follow-up. Postoperative UC was defined as 0 pads/one security pad per day. UC recovery rates from catheter removal to 1 year were calculated by Kaplan-Meier curve; log-rank test was used for the curve comparison. Postoperative potency was evaluated at 3 and 12 months after surgeries. Perioperative complications, positive surgical margin (PSM), and biochemical recurrence rates represent secondary outcomes reported in the study. Results: At the catheter removal, 1, 3, 6, and 12 months after operation, 52.5% (confidence interval [CI] 95%: 37.6-67), 82.5% (CI 95%: 70.8-94), 95% (CI 95%: 88.3-99.1), 97.5% (CI 95%: 92.5-99.9), and 97.5% (CI 95%: 92.5-99.9) of men undergoing the APR-RARP were continent (0 pads/one security pad per day), compared with 61.5% (CI 95%: 46.5-76.6), 89.7% (CI 95%: 80.3-98.1), 97.5% (CI 95%: 92.6-99.9), 97.5% (CI 95%: 92.6-99.9), and 97.5% (CI 95%: 92.6-99.9) undergoing the RS-RARP, respectively, and the Kaplan Meier curve showed no statistically significant difference for both technique at any time point (log-rank p = 0.556). The median (95% CI) time to UC recovery was 9.8 (5.2-14.4) days for the APR-RARP vs 6.7 (3.2-10.2) days for the RS-RARP group. Potency rates were similar in both groups at 3 and 12 months after surgeries. The two compared approaches; in terms of rate of complications, PSM was similar. Conclusions: Surgeons can achieve functional results comparable to the RS technique with the modified reconstructive anterior approach, without changing the surgical technique they are used to.

V07-06 RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY IN HIGH-RISK PROSTATE CANCER PATIENTS

You have accessJournal of UrologyCME1 May 2022V07-06 RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY IN HIGH-RISK PROSTATE CANCER PATIENTS Paolo Dell'Oglio, Stefano Tappero, Mattia Longoni, Carlo Buratto, Pietro Scilipoti, Silvia Secco, Alberto Olivero, Michele Barbieri, Erika Palagonia, Giancarlo Napoli, Elena Strada, Giovanni Petralia, Dario Di Trapani, Angelo Vanzulli, Aldo Massimo Bocciardi, and Antonio Galfano Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Stefano TapperoStefano Tappero More articles by this author , Mattia LongoniMattia Longoni More articles by this author , Carlo BurattoCarlo Buratto More articles by this author , Pietro ScilipotiPietro Scilipoti More articles by this author , Silvia SeccoSilvia Secco More articles by this author , Alberto OliveroAlberto Olivero More articles by this author , Michele BarbieriMichele Barbieri More articles by this author , Erika PalagoniaErika Palagonia More articles by this author , Giancarlo NapoliGiancarlo Napoli More articles by this author , Elena StradaElena Strada More articles by this author , Giovanni PetraliaGiovanni Petralia More articles by this author , Dario Di TrapaniDario Di Trapani More articles by this author , Angelo VanzulliAngelo Vanzulli More articles by this author , Aldo Massimo BocciardiAldo Massimo Bocciardi More articles by this author , and Antonio GalfanoAntonio Galfano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retzius-sparing (RS) robot assisted radical prostatectomy is a valid surgical treatment option for prostate cancer (PCa) patients. However, there is a lack of evidence on the feasibility of this approach in high-risk (HR) PCa patients. In this video we describe our RS-RARP technique for HRPCa patients. METHODS: We present the case of a 66 year-old patient with PSA of 13.8 ng/ml, cT3 on the left side at DRE, an MRI showing 16 mm PIRADS 5 on the left lobe and an ISUP 4 grade PCa at biopsy (17/21 cores). No distant metastases were found at total body CT and bone scan. Left extrafascial and interfascial right nerve sparing RS with extended lymph node dissection was performed with a four-arm da Vinci Si Surgical System at a high volume centre. After incision of the parietal peritoneum at the anterior surface of the Douglas pouch, dissection of the vasa deferentia, isolation of the seminal vesicles, the Denonvillier’s fascia is medially incised starting from an extrafascial layer and pushed upwards with the posterior surface of the prostate. The dissection is carried out forward to the prostatic apex. On the left side part of the perirectal fat is also pushed upwards with the specimen. Once isolated the posterior aspect of the prostate, a wide left extrafascial plane is carried out laterally to the levator ani fascia. A right unilateral inter-fascial nerve sparing is performed in a standard fashion. The bladder neck is dissected, the anterior surface of the gland is isolated, the Santorini plexus is partially resected. Finally, the apex is isolated from the urethra and the latter is incised. RESULTS: Operative time and estimated blood loss were 185 min and 150 ml. No intraoperative complications occurred. Final pathology revealed a ISUP 4 grade, pT3aN0R0. The patient was discharged on POD 2 and the suprapubic catheter was removed on POD 7. Follow-up period was uneventful and at 8 months from surgery PSA was undetectable and the urinary continence (UC) fully recovered. 340 HRPCa patients were treated with this technique at our centre. Final pathology reported 9.4% focal and 19.4% extended positive surgical margins. Median follow-up was 47 months. At 4 years of follow-up, BCR-free and additional treatment-free survival were 64 and 57%. The 2-year UC and erectile function recovery were respectively 85% and 50%. CONCLUSIONS: RS in HR-PCa patients is safe and allows optimal intra- peri- and postoperative, oncologic and functional outcomes. RS should be considered a valid surgical treatment option for HRPCa patients in expert hands. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e660 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paolo Dell'Oglio More articles by this author Stefano Tappero More articles by this author Mattia Longoni More articles by this author Carlo Buratto More articles by this author Pietro Scilipoti More articles by this author Silvia Secco More articles by this author Alberto Olivero More articles by this author Michele Barbieri More articles by this author Erika Palagonia More articles by this author Giancarlo Napoli More articles by this author Elena Strada More articles by this author Giovanni Petralia More articles by this author Dario Di Trapani More articles by this author Angelo Vanzulli More articles by this author Aldo Massimo Bocciardi More articles by this author Antonio Galfano More articles by this author Expand All Advertisement PDF downloadLoading ...

V07-05 HOW WE SURVIVED OUR FIRST 50 RETZIUS SPARING PROSTATECTOMIES: TIPS AND PITFALLS OF ROUNDING THE LEARNING CURVE

You have accessJournal of UrologyCME1 May 2022V07-05 HOW WE SURVIVED OUR FIRST 50 RETZIUS SPARING PROSTATECTOMIES: TIPS AND PITFALLS OF ROUNDING THE LEARNING CURVE Ben Schurhamer, Daniel Lee, and Phil Mucksavage Ben SchurhamerBen Schurhamer More articles by this author , Daniel LeeDaniel Lee More articles by this author , and Phil MucksavagePhil Mucksavage More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retzius sparing prostatectomy has grown in utilization since its publication in 2010 by Galfano et al. Preliminary reports suggest earlier return of urinary continence with equivalent erectile function. The surgery learning curve is steep and has been reported to require 30-40 operations to obtain mild proficiency. We attempted to identify easy modifications and tips to flatten the learning curve. METHODS: We illustrate surgical tips to include delayed seminal vesicle dissection, improved peritoneum incision, ureteral identification and bladder neck tagging. We found that delayed seminal vesicle dissection is an easy reproducible tool to allow for posterior dissection with no need for additional support sutures. RESULTS: This video safely shows posterior dissection of the seminal vesicles and vas deferens and improved bladder neck marking techniques. CONCLUSIONS: Our modifications have provided safe alternatives to continue to improve outcomes with retzius sparing prostatectomy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e660 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ben Schurhamer More articles by this author Daniel Lee More articles by this author Phil Mucksavage More articles by this author Expand All Advertisement PDF DownloadLoading ...

V07-11 VARYING APPROACHES TO THE PROSTATE APEX TO OPTIMIZE URETHRAL STABILITY AND EARLY CONTINENCE RECOVERY AFTER ROBOTIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 May 2022V07-11 VARYING APPROACHES TO THE PROSTATE APEX TO OPTIMIZE URETHRAL STABILITY AND EARLY CONTINENCE RECOVERY AFTER ROBOTIC RADICAL PROSTATECTOMY Claudia Mercader, J. Francisco Lopez, Nitesh Ranasinha, Mutie Raslan, Ruth McPherson, Richard Bell, Tom Leslie, Richard Bryant, Freddie Hamdy, Alastair, and Lamb Claudia MercaderClaudia Mercader More articles by this author , J. Francisco LopezJ. Francisco Lopez More articles by this author , Nitesh RanasinhaNitesh Ranasinha More articles by this author , Mutie RaslanMutie Raslan More articles by this author , Ruth McPhersonRuth McPherson More articles by this author , Richard BellRichard Bell More articles by this author , Tom LeslieTom Leslie More articles by this author , Richard BryantRichard Bryant More articles by this author , Freddie HamdyFreddie Hamdy More articles by this author , AlastairAlastair More articles by this author , and Lamb Lamb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pre-operative membranous urethral length (MUL) is a well-known non-modifiable factor predicting continence recovery after surgery, but there are also refinements in surgical techniques to optimize early continence after robotic-assisted radical prostatectomy (RARP). These include modifications in apical dissection to maximize urethral length and maximizing preservation of periurethral structures responsible for urethral stability. METHODS: We reviewed data of patients who underwent RARP between January 2018 and October 2021. MUL, anterior Retzius sparing approach and continence (pads) 6-weeks after surgery were recorded. We present five surgical scenarios often encountered while planning the apical dissection in RARP: non urethral preservation, half-supported full or non-full-length urethral preservation, full length unstable urethra, full length stable urethra and full-length stable preservation in the context of unusual apical anatomy. All patients consented to data storage and video-recording. RESULTS: Following on from the video footage of this surgical scenarios, we present 342 patients for quantitative analysis. Those patients with a MUL >10 mm had 9.7 increased chance of being completely dry at 6-weeks (OR 9.7 CI 95% 2.2–42.1). Those patients with a MUL >10 mm who also had anterior Retzius sparing their chances increased by a further 4.3 (OR 4.3 IC 95% 2.1–8.8). CONCLUSIONS: The apical approach in a RARP can be planned and tailored for each case depending on both patients and tumour anatomy to optimize urethral stability post-RARP and early continence recovery. We advocate both preservation of urethral length and those structures responsible for urethral stability. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e662 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claudia Mercader More articles by this author J. Francisco Lopez More articles by this author Nitesh Ranasinha More articles by this author Mutie Raslan More articles by this author Ruth McPherson More articles by this author Richard Bell More articles by this author Tom Leslie More articles by this author Richard Bryant More articles by this author Freddie Hamdy More articles by this author Alastair More articles by this author Lamb More articles by this author Expand All Advertisement PDF downloadLoading ...