The impact of prostate volume on Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle

Abstract

OBJECTIVE: Robot-assisted radical prostatectomy (RARP) has emerged as a primary treatment modality for localized prostate cancer. In this context, we report a novel surgical technique termed Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle (RNRS-RARP). This study aims to assess the perioperative, oncological, and functional outcomes of RNRS-RARP across varying prostate volumes. METHODS: A retrospective analysis was conducted on clinical data retrieved from 298 patients who underwent RNRS-RARP from October 2021 to September 2023. Patients were stratified into three groups based on pathological prostate weight: ≤ 30 g, 30-50 g, and ≥ 50 g. Comparative analyses were performed on perioperative and postoperative oncological and functional outcomes among the three groups to discern variations. Separate analyses were performed for patients who received neoadjuvant therapy and those who did not. Additionally, independent predictors of immediate continence following RNRS-RARP were investigated. RESULTS: Patients with larger prostate volumes were significantly older and have higher body mass index and prostate-specific antigen (PSA) (all p < 0.05). Larger prostate volumes exhibited prolonged median console time (65 vs. 70 vs. 90 min, p < 0.01) and increased median estimated blood loss (95 vs. 90 vs. 100 ml). There were no significant differences in duration of catheterization, length of stay, postoperative complications, positive surgical margin, PSA recurrence after 6 months, 1 month and 3 months continence. Immediate continence worsened with increasing prostate volume (80.0% vs. 77.5% vs. 64.2%, p = 0.04). Prostate volume (OR = 0.98; 95% Cl: 0.97-0.99; p = 0.03), age (OR = 0.90; 95% Cl: 0.86-0.95; p < 0.01), and clinical T stage (OR = 0.31; 95% Cl: 0.13-0.74; p = 0.01) were independent risk factors for immediate continence, with an area under the curve of 0.75 in the predictive model. CONCLUSION: RNRS-RARP can be safely performed regardless of prostate volume. As prostate volume increases, both console time and estimated blood loss tend to rise. However, the oncological outcomes and complication rates remained similar. Immediate continence was significantly lower with larger prostate volume, which also emerged as an independent predictor. CLINICAL TRIAL REGISTRATION: The clinical trial registration number is ChiCTR2200066350 (December1, 2022).