Journal article
A Pragmatic Randomized Controlled Trial Examining the Impact of the Retzius-sparing Approach on Early Urinary Continence Recovery After Robot-assisted Radical Prostatectomy
European urology, Vol.72(5), pp.677-685
11/01/2017
DOI: 10.1016/j.eururo.2017.04.029
PMID: 28483330
Abstract
Retzius-sparing (posterior) robot-assisted radical prostatectomy (RARP) may expedite postoperative urinary continence recovery.
To compare the short-term (≤3 mo) urinary continence (UC), urinary function (UF), and UF-related bother outcomes of posterior RARP compared with standard anterior approach RARP.
A total of 120 patients aged 40–75 yr with low–intermediate-risk prostate cancer (per the National Comprehensive Cancer Network guidelines) underwent primary RARP at a tertiary care institution.
Eligible men were randomized to receive either posterior (n=60) or anterior (n=60) RARP.
Primary outcome was UC (defined as 0 pads/one security liner per day) 1 week after catheter removal. Secondary outcomes were short-term (≤3 mo) UC recovery, and UF and UF-related bother scores (measured by the International Prostate Symptom Score [IPSS] and IPSS quality-of-life scores, respectively) assessed at 1 and 2 wk, and 1 and 3 mo following catheter removal. Continence outcomes were objectively verified using 24-hr pad weights. UC recovery was analyzed using Kaplan–Meier method and Cox proportional hazards regression; UF and UF-related bother outcomes were compared using linear generalized estimating equations (GEEs). Perioperative complications, positive surgical margin, and biochemical recurrence-free survival (BCRFS) represent secondary outcomes reported in the study.
Compared with 48% in the anterior arm, 71% men undergoing posterior RARP were continent 1 wk after catheter removal (p=0.01); corresponding median 24-h pad weights were 25 and 5g (p=0.001). Median time to continence in posterior versus anterior RARP was 2 and 8 d postcatheter removal, respectively (log-rank p=0.02); results were confirmed on multivariable regression analyses. GEE analyses showed that UF-related bother (but not UF) scores were significantly lower in the posterior versus anterior RARP group at 1 wk, 2 wk, and 1 mo on GEE analyses. Incidence of postoperative complications (12% anterior vs 18% posterior) and probability of BCRFS (0.91 vs 0.91) were comparable in the two arms.
In this single-center randomized study, the Retzius-sparing approach of RARP resulted in earlier recovery of UC and lower UF-related bother compared with standard RARP. These results require long-term validation and reproduction by other centers, as well as studies on men with high-risk localized disease.
In our hands, men with low–intermediate-risk prostate cancer undergoing Retzius-sparing robot-assisted radical prostatectomy (RARP) had earlier recovery of urinary continence and lower urinary function-related bother than those undergoing standard RARP.
We conducted a randomized controlled trial comparing the short-term (≤3 mo) urinary outcomes of patients undergoing posterior (Retzius-sparing) approach of robot-assisted radical prostatectomy (RARP) with those undergoing the standard (anterior) approach. We noted that patients in the posterior RARP arm had superior continence outcomes at 1 wk, 2 wk, 1 mo, and 3 mo, along with favorable urinary function-related bother scores.
Details
- Title: Subtitle
- A Pragmatic Randomized Controlled Trial Examining the Impact of the Retzius-sparing Approach on Early Urinary Continence Recovery After Robot-assisted Radical Prostatectomy
- Creators
- Deepansh Dalela - Henry Ford Health SystemWooju Jeong - Henry Ford Health SystemMadhu-Ashni Prasad - Henry Ford Health SystemAkshay Sood - Henry Ford Health SystemFiras Abdollah - Henry Ford Health SystemMireya Diaz - Henry Ford Health SystemPatrick Karabon - Henry Ford Health SystemJesse Sammon - Henry Ford Health SystemMarcus Jamil - Henry Ford Health SystemBrad Baize - Henry Ford Health SystemAndrea Simone - Henry Ford Health SystemMani Menon - Henry Ford Health System
- Resource Type
- Journal article
- Publication Details
- European urology, Vol.72(5), pp.677-685
- DOI
- 10.1016/j.eururo.2017.04.029
- PMID
- 28483330
- NLM abbreviation
- Eur Urol
- ISSN
- 0302-2838
- eISSN
- 1873-7560
- Publisher
- Elsevier B.V
- Number of pages
- 9
- Language
- English
- Date published
- 11/01/2017
- Academic Unit
- Urology
- Record Identifier
- 9984949182202771
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