title: Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches.
abstract: OBJECTIVE
  To compare the early peri-operative, oncological and continence outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RALP) with those of conventional RALP.
  
  
  METHODS
  Data from 50 patients who underwent Retzius-sparing RALP and who had at least 6 months of follow-up were prospectively collected and compared with a database of patients who underwent conventional RALP. Propensity-score matching was performed using seven preoperative variables, and postoperative variables were compared between the groups.
  
  
  RESULTS
  A total of 581 patients who had undergone RALP were evaluated in the present study. Although preoperative characteristics were different before propensity-score matching, these differences were resolved after matching. There were no significant differences in mean length of hospital stay, estimated blood loss, intra- and postoperative complication rates, pathological stage of disease, Gleason scores, tumour volumes and positive surgical margins between the conventional RALP and Retzius-sparing RALP groups. Console time was shorter for Retzius-sparing RALP. Recovery of early continence (defined as 0 pads used) at 4 weeks after RALP was significantly better in the Retzius-sparing RALP group than in the conventional RALP group.
  
  
  CONCLUSIONS
  The present results suggest that Retzius-sparing RALP, although technically more demanding, was as feasible and effective as conventional RALP, and also led to a shorter operating time and faster recovery of early continence. Retzius-sparing RALP was also reproducible and achievable in all cases.
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea; Department of Urology, Changi General Hospital, Singapore.
authors.forename: Sey Kiat
authors.initials: SK
authors.lastname: Lim
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Shin
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments; D010502:Perineum / Q000601:surgery; D011467:Prostate / Q000294:innervation; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D020127:Recovery of Function; D015203:Reproducibility of Results; D012371:Robotics; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery
keywords: continence; nerve-sparing; perineal; prostate cancer; prostatectomy