A comparative analysis of robotic prostatectomy techniques post TURP/HOLEP: retzius-sparing vs. non-retzius approaches: evaluation of perioperative, functional, and oncological outcomes.

Purpose: We evaluated the perioperative, functional, and oncological outcomes of Retzius-sparing and conventional non-Retzius-sparing robotic radical prostatectomy (RS-RARP and NRS-RARP) in the patients with a prior history of transurethral resection and enucleation of prostate (Post TURP/HOLEP).

Methods: A total of 47 patients who had at least completed one year of follow-up after robotic radical prostatectomy and had a prior TURP/HOLEP were included in this retrospective analysis. The clinico-demographic data, perioperative parameters such as mean operating time, blood loss, mean hospital stay, complications as per Clavien-Dindo grading, and readmission were evaluated. Continence, potency, and biochemical recurrence were assessed to check the functional and oncological outcomes.

Results: There was no significant difference in mean age, body mass index (BMI), co-morbidities, D-Amico risk stratification, preoperative PSA level and positive cores in TRUS-guided biopsy. The console time and blood loss were significantly less in the RS-RARP group (91.6 ± 24.2 vs. 128.9 ± 38.7 min vs. 110.3 ± 57.5 vs. 152.9 ± 64.9 ml, p = 0.0002 and p = 0.02, respectively). The complication rate, mean postoperative catheter duration, lymph nodes, readmission rates, final histopathology, and invasion status were similar in both groups. Continence achieved at 1,3,6,9 and 12-month follow-up was significantly more in the RS-RARP group (90% vs. 64.7% at 12-month; p = 0.01). The potency rates in nerve-sparing cases at 6-month and 1-year follow-ups were similar. Margin positivity rates and Biochemical recurrence were comparable and statistically insignificant in both groups.

Conclusion: Retzius-sparing RARP had less console time, less intraoperative blood loss and better continence recovery in both immediate and at 12-month follow-up. The potency, biochemical recurrence and margin status in both approaches were similar.