Objectives: To advance robotic radical prostatectomy, we developed a novel anterior approach that uses a peritoneal incision created between the umbilical ligaments to develop the Retzius space and thus spares vessels that surround the bladder and prostate, with the space being closed after prostatectomy and vesicourethral anastomosis. This approach may improve continence recovery. We investigated continence recovery following the novel anterior approach compared to after the conventional anterior approach.
Methods: We retrospectively reviewed 516 patients who underwent robotic radical prostatectomy from January 2019 to July 2023. We compared continence recovery following our novel anterior approach (N = 282) to that after conventional anterior approach (N = 234), and we compared the oncological outcomes and safety profiles of the two groups.
Results: Patient demographics did not differ significantly between the two groups. Continence recovery in patients undergoing the novel anterior approach was significantly better than that of patients treated via the conventional approach (hazard ratio: 1.651, 95% confidence interval: 1.325-2.057, p < 0.0001). Use of the novel anterior approach in addition to nerve sparing and preservation of the detrusor apron independently predicted continence, and the mixture of these three techniques afforded excellent continence recovery (1- and 2-year total continence rate of 81.1% and 93.7%). Neither the biochemical recurrence-free survival nor the complication rate differed significantly between the two groups.
Conclusion: Our novel anterior approach may improve continence recovery compared to the conventional anterior approach, without compromising the oncological outcomes. Prospective comparative studies are necessary to confirm the benefits of this approach.
Keywords: Retzius space; continence; reconstruction; robotic radical prostatectomy; superficial vein.
© 2024 The Japanese Urological Association.