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

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, oncologic, 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: ≤30g, 30-50g, and ≥50g. Comparative analyses were performed on perioperative and postoperative tumor and functional outcomes among the three groups to discern variations. Relevant analyses were conducted separately for patients who received neoadjuvant therapy and those who did not. Additionally, independent predictors influencing immediate continence following RNRS-RARP were investigated. Results: Firstly, an association was observed between larger prostate volume and advanced patient age, elevated prostate-specific antigen levels, and higher body mass index. Secondly, patients with larger prostate volume exhibited prolonged console time and increased estimated blood loss, but it will not increase the duration of catheterization and the length of hospital stay and postoperative complications. Finally, immediate continence worsened with increasing prostate volume, and the areas under the curve of the predictive model based on prostate volume, age, and preoperative T stage was 0.751. Conclusion: RNRS-RARP is an improvement on the posterior approach for RARP. It leads to better continence outcomes and can be done with any volume of prostate. However, larger prostate volume was associated with prolonged console time and inferior immediate continence, with prostate volume identified as an independent predictor of immediate continence following RNRS-RARP. Clinical trial registration: The clinical trial registration number is ChiCTR2200066350 (December1, 2022).