RS-RARP confers better continence outcomes than conventional RARP

In prostate cancer patients, retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) yields better continence outcomes compared with conventional RARP, a recent study has found.

The study included 24 consecutive prostate cancer patients who had undergone RS-RARP and were followed-up for a median of 15.5 months to assess the primary outcome of postoperative continence, defined as either the use of <1 or 0–1 incontinence pad per day. Participants were propensity score-matched to 24 controls who received conventional RARP.

Continence was significantly better in the RS-RARP group, such that 91.7 percent of patients needed 0 incontinence pads as opposed to 66.7 percent in the conventional RARP group (p=0.033). The overall need for ≤1 pad was likewise greater in the RS-RARP group but did not achieve significance vs conventional RARP (95.8 percent vs 87.5 percent; p=0.296).

RS-RARP also led to significant improvements in other continence outcomes. For instance, the mean time to achieve continence of 0 pads was significantly shorter in RS-RARP vs conventional RARP (4.0±5.6 vs 13.6±13.2 months; p=0.002), as was the time to continence of ≤1 pad (3.0±5.2 vs 9.2±12.6 months; p=0.033).

Moreover, 33 percent of RS-RARP patients achieved day 0 continence, as opposed to 0 percent of conventional RARP comparators (p=0.002).

Such advantages in continence outcomes did not come at the expense of oncologic efficacy such that postoperative surgical margins, detectable levels of prostate-specific antigen, and the use of adjuvant radiotherapy were all statistically comparable between RS-RARP and conventional RARP groups.  

“Robotic prostatectomy surgeons can safely consider adopting this technique even though a learning phase is needed to switch from RS-RARP to conventional RARP,” the researchers said.