Effect of simple Retzius space preservation on urinary continence in robot-assisted radical prostatectomy: A comparison of extrafascial Retzius-sparing and extrafascial conventional techniques

This study aimed to introduce an initial technique of extrafascial Retzius-sparing robot-assisted radical prostatectomy (E-rsRARP) without nerve sparing and evaluate its functional and oncologic results with simple Retzius space preservation for intermediate- to high-risk prostate cancer (PCa) patients who have no sexual function preservation demand. This retrospective study was conducted between January 2021 and December 2022, including 78 cases of E-rsRARP and 152 cases of extrafascial conventional robot-assisted radical prostatectomy (E-cRARP). For E-rsRARP, a triangular tunnel composed of periprostatic fascia, levator ani fascia, and neurovascular bundle (NVB) could be found between the prostate and the pelvic fascia, at the 3 o'clock and 9 o'clock positions above the prostate pedicle, as the correct plane of the extrafascial technique. Neurovascular bundles were isolated thinly enough to be easily ligated with Hem-o-lok clips. Continence was defined as the absence of pad use. The complications and oncological outcomes were analyzed. Compared to the E-cRARP group, the E-rsRARP group had shorter mean surgical time ( p =0.005), less mean estimated blood loss ( p =0.014), and shorter mean catheter time ( p =0.005). No significant differences were observed in positive surgical margins or complication rates. The E-rsRARP group showed significantly better recovery of urinary continence at 0, 1, 3, 6, and 12 months postoperatively. PCa patients could have better urinary continence recovery with Retzius space preservation during the RARP, even without nerve sparing. For intermediate- to high-risk PCa patients who had no sexual function preservation demand, E-rsRARP could reach a higher early continence rate than E-cRARP.