Multicentric comparative analysis of Retzius versus Retzius sparing robotic assisted simple prostatectomy in the management of large prostate glands

Abstract

Aim

Robot-assisted simple prostatectomy (RASP) is a minimally invasive alternative to open simple prostatectomy in the management of patients with large prostate glands suffering from moderate-to-severe lower urinary tract symptoms (LUTS). Our study aimed to evaluate two transvesical robotic approaches in order to compare functional outcomes and postoperative complications.

Materials and methods

Clinical data from 111 consecutive patients from three tertiary robotic centers were retrospectively collected. Patients were divided into two groups depending on the surgical approach: 58 Retzius sparing and 53 Retzius approach RASP. We evaluated peri-operative outcomes (operating time, blood loss, transfusion rate, length of hospital stay), as well as intra-operative and early complications using a Clavien Dindo scale. Fisher’s exact test, chi-square test and Mann–Whitney U test were applied for statistical analyses. A p-value <0.05 was considered statistically significant.

Results

Neither subgroup differed significantly in age (p = 0.104), Charlson comorbidity index (p = 0.088) or prostate volume (p = 0.507), total IPSS score (0.763) and Q_max (p = 0.651). Total complication rates were lower for the Retzius approach subgroup (19 vs 11.9%) without reaching statistical significance in multivariate analysis (HR = 1.21, 95% CI = 0.17 − 8.44, p = 0.84). No significant differences based on IPSS total score and Q_max could be observed between the two subgroups during follow-up.

Conclusions

Both RASP approaches provide similar results in terms of functional outcomes and present a good safety profile in the management of large prostatic adenomas. Larger trials are needed in order to establish the indications for each robotic technique.

Keywords:

• Robotic assisted simple prostatectomy
• large prostate
• LUTS
• Retzius approach
• Retzius sparing

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The present study is a retrospective one; for this type of study formal consent is not required.

Author contributions

Study conception and design: Surcel, Labanaris, Zugor. Sinescu, Gandaglia, A. Kretschmer, Mirvald

Acquisition of data: Najjar, Labanaris, Zugor, Kajaia, Heidegger, Kretschmer, Mirvald

Analysis and interpretation of data: Surcel, Labanaris, Heidegger, Gandaglia, Kretschmer, C. Mirvald

Drafting of manuscript: Surcel, Najjar, Labanaris, Kajaia, Heidegger, Sinescu, Gandaglia, Kretschmer, Mirvald

Critical revision: Surcel, Zugor, Heidegger, Sinescu, Gandaglia, Kretschmer, Mirvald

Disclosure statement

No potential conflict of interest was reported by the author(s).