Introduction. Radical prostatectomy, while providing satisfactory rates of recurrence-free and cancer-specific survival, remains one of the main radical treatment modalities for patients with prostate cancer. No less important is ensuring satisfactory functional results of the operation, including urinary continence. The incidence of incontinence after surgical intervention remains relatively high. This circumstance necessitates the development of surgical techniques that can improve the operation and ensure rapid recovery of urinary continence.
Objective. Compare the rate and quality of urinary continence recovery after nerve-sparing robot-assisted radical prostatectomy: with partial preservation of the Retzius space and lateral reconstruction of the urethrovesical anastomosis versus the standard technique.
Material and methods. A analysis was conducted on two groups of patients (n=223) who underwent nerve-sparing robot-assisted radical prostatectomy between 2013 and 2023. The first group included 110 patients who underwent nerve-sparing robot-assisted radical prostatectomy with partial preservation of the Retzius space and lateral reconstruction of the urethrovesical anastomosis, and the second group included 113 patients who underwent standard nerve-sparing robot-assisted radical prostatectomy. The mean age was 59.95±6.63 and
59.88±6.23 years (p=0.928) in groups 1 and 2, respectively. Body mass index was 27.46±3.38 and 27.02±3.41 (p=0.399); PSA level was 8.13 (5.2–10) and 7.67 (5.1–9) ng/ml (p=0.508), and the IIEF-5 score was 22.91±3.43 and 23.12±4.26 (p=0.466) in groups 1 and 2, respectively. The groups did not differ significantly before surgery.
Results. One week after urethral catheter removal in the group of patients who underwent nerve-sparing robot-assisted radical prostatectomy with partial preservation of the Retzius space and lateral reconstruction of the urethrovesical anastomosis, 52.18% of patients were completely continent; in the group of patients who underwent standard robot-assisted radical prostatectomy with bilateral nerve-sparing technique, 34.53% of patients were completely continent (p=0.019). One month after urethral catheter removal, 67.14% and 58.18% of patients in groups 1 and 2, respectively, were completely continent (p=0.002). At three months, 93.82% and 89.17% of patients were completely continent (p=0.105). At six months, complete urinary continence was achieved in 98.21% and 96.84% of operated patients (p=0.426). At the 12-month follow-up, 98.53% and 97.17% of patients were continent (p=0.326).
Conclusion. The technique with preservation of the structures of the Retzius space and lateral reconstruction of the urethrovesical anastomosis demonstrates advantages in the speed and rate of urinary continence recovery.
