Retzius-Sparing Robot-Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Matched Analysis of 1,863 Patients.

Abstract

PURPOSE\nWe aimed to compare the early continence recovery after surgical treatment of prostate cancer between Retzius-sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy.\n\n\nMATERIALS AND METHODS\nRobot-assisted radical prostatectomy was performed by a single surgeon in 1,863 cases between October 2005 and May 2018. Conventional and Retzius-sparing robot-assisted radical prostatectomy were performed in 1,150 and 713 cases, respectively. To compare the continence outcome between groups, propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate-specific antigen, biopsy Gleason grade group, clinical T stage, prostate volume on trans-rectal ultrasound, International Prostate Symptom Score, International Prostate Symptom Score quality of life score, and International Index of Erectile Function-5 score. Assessment of continence was calculated by pad count every month after the surgery until the sixth month and was converted to binary outcome.\n\n\nRESULTS\nAfter propensity score matching, 609 cases in each group were matched with no significant difference of all 9 variables. Kaplan-Meier curve analysis revealed that Retzius-sparing robot-assisted radical prostatectomy had significantly better continence recovery rate than did conventional robot-assisted radical prostatectomy during the 6-month study period (p<0.001).\n\n\nCONCLUSION\nBased on the propensity score matched with multiple variables and large case series, Retzius-sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy, which achieves better early continence recovery, short operation time, and early recovery compared to conventional robot-assisted radical prostatectomy.