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

doi:10.21203/rs.3.rs-4914193/v1

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

https://doi.org/10.21203/rs.3.rs-4914193/v1

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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).

Prostate cancer

Radical prostatectomy

Prostate volume

Continence

Nowadays, prostate cancer has become one of the most common malignant tumors [1]. Robot-assisted radical prostatectomy (RARP) is the standard of treatment for localized prostate cancer. Compared with traditional open and laparoscopic surgery, it has obvious advantages in the control of tumor, the potency and the continence. There are several approaches to RARP, such as the traditional anterior approach, posterior approach, extraperitoneal approach and so on [2].

In 2006, El-Hakim et al. [3] first reported on the effect of prostate volume on RARP, demonstrating that console time and estimated blood loss (EBL) were significantly increased in patients with large prostates. Since then, several studies have been conducted to investigate whether prostate volume affects RARP [4–8]. Most of these findings are from studies using the traditional anterior approach or extraperitoneal approach. In comparison, the posterior approach has a smaller surgical space, making it more complex in cases of large prostate cancer.

In 2010, Galfano et al. [9] first reported on Retzius-sparing robot-assisted radical prostatectomy. This method provides better continence outcomes compared to traditional operations, but it comes with a long learning curve and operates within a narrow space. We have further improved upon this method: our surgery does not open the Retzius space and enables the retrograde release of the neurovascular bundle (NVB) and ventral prostatic fascia along the prostatic envelope without using Hem-o-lok (RNRS-RARP) [10]. This modification has resulted in increased continence and a reduced surgical learning curve. As a result, this study aimed to retrospectively analyze the effect of prostate volume on RNRS-RARP, specifically focusing on perioperative outcomes, short-term oncology outcomes, and continence. The goal was to investigate whether prostate volume affects short-term continence and to identify risk factors that impact short-term continence. Additionally, a clinically relevant nomogram was established to predict short-term continence.

2.1 Collection of Clinical Information

We conducted a retrospective analysis of 298 patients with prostate cancer who underwent RNRS-RARP at the Second Hospital of Tianjin Medical University from October 2021 to September 2023. The study excluded patients with preoperative absence of prostate MRI, incomplete clinical data, and loss of follow-up. The patients were divided into three groups based on the pathological weight of the prostate: group 1 (≤ 30g, n = 75), group 2 (30-50g, n = 142), and group 3 (≥ 50g, n = 81). Clinical data including age, body mass index (BMI), prostate-specific antigen (PSA) levels, pathological prostate volume, use of preoperative medication, clinical T stage, and biopsy Gleason score were collected. Similarly, perioperative data such as console time, anatomical time for prostate and seminal vesicle dissection, anastomosis time, EBL, Length of stay (LOS), duration of catheterization, transfusion rate, and early postoperative complications were collected and analyzed. Postoperative outcomes in terms of pathological stage, postoperative Gleason score, positive surgical margin (PSM), continence (defined as not need pad), and biochemical recurrence (BCR) (two consecutive PSA levels > 0.2 ng/mL) were also analyzed.

2.2 Surgical technique

All patients underwent RNRS-RARP, a modified posterior approach optimized by our center. The bladder was pulled to expose the Douglas’space. The peritoneum at the anterior surface of the pouch of Douglas was incisedVas deferens and seminal vesicles were isolated at the dorsal side without being incised. Blunt dissection was performed at the 6 o'clock position of the prostate to locate and open the Denonvilliers fascia. The next,the 30°lens was turned upwards, and the Denonvilliers fascia was separated along the posterior plane of the prostate until reaching the prostate apex. The apex of the prostate was completely freed.The NVB were retrogradely released in close proximity to the prostate capsule, and the prostate lateral pedicle was dissected Blunt dissection and precise electrocoagulation were primarily employed during this process, without hem-o-lok clips. The vas deferens was incised, and the seminal vesicle was isolated. Blunt dissection was continued along the prostate layer to expose the vesicoprostatic junction, after which the bladder neck was sectioned his step was performed as close to the prostate as possible while ensuring oncological safety.Dissection of the surrounding structures was carried out along the anterior periprostatic fascia. During this process, the Retzius space was not opened, and the dorsal venous complex (DVC) was not ligated.The apex of the prostate was completed isolated, and the urethra was incised. The urethral stump was preserved to the maximum extent possible.The prostate was removed, and a vesicourethral anastomosis was performed Following the completion of the anastomosis, posterior reconstruction was carried out at 6 o’clock position. Subsequent closure of the peritoneum[10]. Postoperatively, all patients were fitted with drainage and urinary tubes, with the latter typically removed two weeks after surgery.

2.3 Statistical analysis

The statistical analysis was conducted using Statistical Package for Social Science 25.0 (SPSS 25.0, IBM Corp). Continuous data were presented as median and interquartile range (IQR), while disaggregated data were expressed as quantities and percentages. The Pearson chi-square test was used to compare disaggregated data, and the Kruskal-Wallis test was used for nonparametric continuous data analysis across the three groups. Univariate and multivariate logistic regression analyses were performed to explore the relationship between independent predictors and immediate continence in the study population. The independent predictors identified in the study were used to develop a nomogram. The construction of the nomogram was carried out using the R software (version 4.2.2, http://www.r-project.org). The receiver operator characteristic (ROC) curves were used to evaluate the discriminative performance of the nomogram, and the areas under the curve (AUC) statistic were calculated to evaluate the predictive accuracy. Parameters with a P value < 0.05 was considered statistically significant and all P values were bilateral.

3.1 Baseline information

A total of 298 patients underwent surgery, and their clinical characteristics were presented in Table 1. The median (IQR) prostate volume for the three groups was 25.5 (21.9–27.8), 39.5 (34.5–43.8), and 61.7 (54.9–76.9). The p values for age, PSA, BMI, and Gleason scores among the groups were all less than 0.05, indicating a statistically significant difference among the groups. There was also a statistically significant difference in the number of patients who used neoadjuvant therapy before surgery (p < 0.001). However, there was no statistical difference in clinical T stage (p = 0.223). Among these patients, 56 patients received neoadjuvant therapy while 242 did not. The clinical characteristics are summarized in Supplementary Table 1A,1B.

Table 1

Preoperative patient chrarcteristics of study sujects
Characteristics	≤ 30	30–50	≥ 50	p-Value
Number of subjects	75	142	81
Median age at diagnosis, years	67 (63–71)	68 (64–71)	70(67–75)	0.001
Median PSA at diagnosis, ng/mL	4.31 (0.07–9.99)	10.29(5.94–18.01)	13.98(7.93–25.60)	< 0.001
BMI, kg/m2	24.22(22.32–26.04)	25.26(23.34–26.57)	25.21(23.67–27.68)	0.041
Median Pathological prostate weight, g	25.5 (21.9–27.8)	39.5 (34.5–43.8)	61.7(54.9–76.9)	< 0.001
Gleason score, n (%)
≤ 7	31(41.3%)	86(60.6%)	45(55.6%)	0.025
> 7	44(58.7%)	56(39.4%)	36(44.4%)	0.025
Clinical T stage, n (%)
<T3	63(84.0%)	130(91.5%)	73(90.1%)	0.223
≥T3	12(16.0%)	12(8.5%)	8(9.8%)	0.223
Neoadjuvant therapy, n (%)
Yes	33(44.0%)	17(12.0%)	6(7.4%)	< 0.001
No	42(56.0%)	125(88.0%)	75(92.6%)	< 0.001
PSA, prostate-specific antigen; BMI, body mass index;

3.2 Perioperative outcome

The perioperative data of the patients were retrospectively collected and presented in Table 2. The patients' console time, anatomical time, and anastomosis time increased with the increase of prostate volume, and all were statistically different (p < 0.001). In the three groups, 0, 1, and 1 patients received intraoperative blood transfusion. There were no significant differences in the degree of reduction of hemoglobin and EBL. Similarly, there were no significant differences between the duration of catheterization and the LOS among the three groups. The postoperative complications were recorded, and there was no statistical difference. Among them, one patient developed postoperative acute pulmonary embolism, two patients developed COVID-19 respiratory failure after surgery, and one patient developed renal failure. Subgroup analyses of perioperative outcomes were performed, and the same trend was observed in the non-neoadjuvant group, as detailed in Supplementary Table 2A. Compared with non-neoadjuvant therapy patients, patients treated with neoadjuvant therapy had an increase in console time, anatomical time, and anastomosis time, and there were significant statistical differences among all groups (p < 0.05). The number of patients receiving intraoperative blood transfusion in the three groups was 0, 1, and 1. The changes in hemoglobin and EBL increased with the increase of prostate volume, and the difference was statistically significant. There was no statistical difference in the duration of catheterization, but there was a statistical difference in the LOS of patients, as shown in Supplementary Table 2B.

Table 2

Perioperative outcomes and postoperative complications of the subjects
Characteristics	≤ 30	30–50	≥ 50	p-Value
Number of subjects	75	142	81
Console time, mins	65(55–82)	70(60–90)	90(65–120)	< 0.001
Anatomical time, mins	45(35–60)	50(40–60)	60(45–80)	< 0.001
Anastomosis time, mins	20(15–25)	20(15–25)	27(20–35)	< 0.001
Estimated blood loss, ml	95(80–110)	90(75–110)	100(80–145)	0.057
Blood transfusion, n (%)	0(0%)	1(0.7%)	1(1.2%)	0.639
Length of stay, days	8(7–8)	8(7–8)	8(7-8.5)	0.312
Duration of catheterization, days	4(4–5)	4(4–5)	4(4–5)	0.389
Reduction of hemoglobin, g/L	14.0(8.0–21.0)	17.0(10.0–23.0)	18.0(12.0–23.0)	0.055
Complications, n (%)	3(4%)	4(2.8%)	7(8.6%)	0.134
I	2	2	3
II	1	1	1
IV	0	1	3

3.3 Pathological outcome

There were no significant differences in pathological stage, overall PSM rate, and BCR rate among the three groups. However, a significant difference was observed in Gleason score. The 24-hour immediate continence of the three groups showed a statistically significant difference and decreased with an increase in prostate volume (p = 0.041). However, no significant differences were found in continence at 1 month and 3 months (Table 3). Subsequently, relevant subgroup analyses were conducted. Among patients who did not receive neoadjuvant therapy, there were no statistically significant differences in pathological stage, Gleason score, BCR, 1 month continence, and 3 months continence. However, there were statistical differences in 24-hour immediate continence among the three groups. For patients who received neoadjuvant therapy, there was no statistically significant difference in 24-hour immediate continence. Nevertheless, a trend was observed where a larger prostate volume was associated with lower 24-hour immediate continence. The detailed findings are presented in Supplementary Table 3A and S3B.

Table 3

Oncology outcome and urine continence of the study subjects
Characteristics	≤ 30	30–50	≥ 50	p-Value
Number of subjects	75	142	81
Pathological Gleason score, n (%)
≤ 7	39(52%)	104(73.2%)	56(69.1%)	0.006
> 7	36(48%)	38(26.8%)	25(30.9%)	0.006
Pathological T stage, n (%)
<T3	61(81.3%)	108(76.1%)	62(76.5%)	0.656
≥T3	14(18.7%)	34(23.9%)	19(23.5%)	0.656
PSM, n (%)
total	21(28.0%)	49(34.5%)	19(23.5%)	0.205
<pT3	14/61(23.0%)	28/108(25.9%)	6/62(9.7%)	0.038
≥pT3	7/14(50.0%)	21/34(61.8%)	13/19(68.4%)	0.560
Urinary continence, n (%)
24hours	60(80.0%)	110(77.5%)	52(64.2%)	0.041
1 month	68(90.7%)	128(90.1%)	67(83%)	0.192
3 months	70(93.3%)	134(94.3%)	71(87.7%)	0.181
BCR at 6 months follow-up, n (%)	3(4.0%)	6(4.2%)	3(3.7%)	0.982
PSM, positive surgical margin; BCR, biochemical recurrence

We found that immediate urine continence was different for different prostate volume. So the logistic regression analysis was conducted to investigate the factors influencing 24-hour immediate continence. Univariate logistic regression analysis indicated that prostate volume, age, preoperative PSA, clinical T stage, Gleason score, console time, anatomical time and anastomosis time were the risk predictors for predicting 24-hour immediate continence. After evaluating the clinical significance of the predictors and excluding collinearity, prostate volume, age, preoperative PSA, clinical T stage, Gleason score, anatomical time, and anastomosis time were included in the multivariate logistic regression analysis. The results of the multivariate logistic regression analysis showed that prostate volume (OR = 0.982, p = 0.029), age (OR = 0.898, p = 0.000), and clinical T stage (OR = 0.314, p = 0.008) were independent predictors for 24-hour immediate continence (Table 4). Subsequently, a prediction model was constructed and these predictors were used to construct a nomogram. The relevant AUC value was calculated to evaluate the predictive performance, resulting in an AUC of 0.751 (Fig. 1).

Table 4

Univariate logistic regression and multivariate logistic regression analysis of immediate continence
Variable	Univariate analysis		Multivariate analysis
Variable	OR (95% Cl)	p-Value	OR (95% Cl)	p-Value
Prostate volume	0.977(0.965–0.989)	< 0.001	0.982(0.967–0.998)	0.029
BMI	1.044(0.957–1.139)	0.333
Age	0.873(0.828–0.920)	< 0.001	0.898(0.849–0.950)	< 0.001
Median preoperative PSA	0.982(0.968–0.996)	0.014	0.996(0.980–1.012)	0.596
Clinical T stage
<T3	0.251(0.119–0.534)	< 0.001	0.314(0.133–0.737)	0.008
≥T3	0.251(0.119–0.534)	< 0.001	0.314(0.133–0.737)	0.008
Gleason score
≤ 7	0.445(0.261–0.757)	0.003	0.595(0.320–1.107)	0.101
> 7	0.445(0.261–0.757)	0.003	0.595(0.320–1.107)	0.101
Console time	0.986(0.978–0.994)	0.001
Anatomical time	0.98(0.968–0.992)	0.001	0.999(0.983–1.016)	0.943
Anastomosis time	0.969(0.946–0.992)	0.010	0.988(0.957–1.019)	0.436
Estimated blood loss	0.998(0.994–1.001)	0.177
Reduction of hemoglobin	0.979(0.955–1.004)	0.105
BMI, body mass index; PSA, prostate-specific antigen;

With the advancement in detection methods for prostate cancer, there has been a steady increase in the number of diagnosed patients each year [11]. Multiple studies have illustrated the viability of various approaches to RARP for larger prostate volumes [12–16]. However, the influence of prostate volume on RARP surgery and tumor outcomes remains a topic of debate. In this study, we examined the impact of prostate volume on perioperative outcomes, short-term continence, and related oncology outcomes in patients undergoing RNRS-RNRP. Our findings demonstrated that prostate volume can influence various outcome measures, including console time, EBL, and 24-hour immediate continence. Furthermore, we discovered that prostate volume was an independent risk factor for 24-hour immediate continence.

In this retrospective study, postoperative pathology was examined in relation to prostate volume, revealing that patients with larger prostates tended to be older and have higher PSA levels. This is consistent with the trend of most studies [4, 17]. The association between benign prostatic hyperplasia and elevated PSA levels can explain this trend [18]. A higher number of patients with a Gleason score > 7 were observed in the ≤ 30 group (p = 0.025), likely due to a larger proportion of patients in this group receiving neoadjuvant therapy (p < 0.001), leading to a reduction in prostate volume. The subsequent findings revealed that among patients who did not receive neoadjuvant therapy, larger prostates were associated with older age and higher PSA levels.

In this study, the console time was 65, 70, and 90 mins (p = 0.000), and the console time increased gradually with the increase of prostate volume. At the same time, the anatomical time and anastomosis time also showed a gradual increase and exhibited statistical significance. In our previous study, we conducted an overall comparison between this procedure and the traditional posterior approach and found a significant reduction in operation time. Studies have confirmed that prostate volume is an independent risk factor affecting the perioperative period, indicating that a larger prostate volume will prolong the console time [19, 20]. This study recorded perioperative data for varying prostate volumes and observed variations in console time corresponding to these different prostate volumes. In a study by Santok et al. [21], the console times for groups with prostate volumes of < 40, 40–60, and > 60 undergoing posterior approach surgery were reported as 93, 92, and 100 minutes. Bocciardi et al. [7] reported that as prostate volume increased, the corresponding console times for the three groups were 90, 100, and 100 mins. Our cohort has reduced surgical time by comparison. We observed that an increased prostate volume led to higher EBL, although this difference was not statistically significant. Furthermore, there were no statistically significant variances in transfusion rates, LOS and duration of catheterization. Additionally, it was found that increased prostate volume didn’t lead to a rise in perioperative complications (p = 0.134). Kim et al. [5] reported that differences in estimated blood loss by prostate volume, but no difference in transfusion. Santok et al. [21] reported that the EBL and blood transfusion were different with different prostate volume. Our study demonstrates that surgeons dealing with large prostates may increase the console time of operation without excessive perioperative complications.

There was no significant difference in postoperative T stage among the groups, but a significant difference was observed in postoperative pathological Gleason score. The proportion of patients with a Gleason score of ≤ 7 in the small prostate group was 52%, which was lower than the 69.1% observed in the large prostate group. This difference can be attributed to the fact that some patients in the small prostate group had received neoadjuvant therapy before surgery. In the subgroup analysis, no statistically significant differences were found in T stage and Gleason score among patients with different prostate volumes who had not received neoadjuvant therapy. The overall PSM rate of all patients was 29.8%, and the PSM rates of patients in the three groups were 28.0%,34.5% and 23.5% (p = 0.205). The > 50 group had a lower PSM rate compared to the < 30 group, which is consistent with other studies [17, 21]. However, the PSM rate of our large volume was slightly higher than that reported by other studies, which was 14.3% reported by Wang et al. and 19% reported by Stolzenburg et al. [22, 23]. In this study, the posterior approach optimized by our center was used for surgery, which was similar to the PSM rate of conventional posterior approaches reported in the literature (24%). All is higher than that of traditional RARP (15.2%)[20]. The BCR reported in this study was 4.0%, 4.2%, and 3.7%, respectively (p = 0.982), which proved that prostate volume was not related to BCR, probably due to the short follow-up time and small sample size. It has been reported that increasing prostate volume can reduce BCR in patients [24], and Patel et al. [25] recently reported that prostate volume can affects the BCR.

After Galfano et al. [9] reported the posterior approach with Retzius preservation, numerous studies have been conducted on its efficacy and outcomes. The posterior approach maximally preserves the Retzius space and bladder neck. In 2013, he reported the recovery of continence in 200 cases using the posterior approach. The continence rate of patients within 1 week was 92%, 90%(using one pad ≤ 1 piece/24h), and the proportion decreased to 76% when defined as 0 piece/24h[26]. Several studies have reported that the posterior approach leads to better continence outcomes compared to the anterior approach [27–30].

In 2020, Guo et al. [27] reported a study including all high-risk patients. Out of 55 cases, the continence rate within 1 week was 69.1% for the posterior approach, while it was 30.9% for the anterior approach (defined as not using any pad/24h for 1 week). Dalela et al. [31] reported that among low and medium-risk patients, 71% of patients who underwent the posterior approach achieved continence (defined as using 0–1 pad per day) after 1 week of catheter removal. In comparison, only 48% of patients who underwent the anterior approach achieved continence under the same criteria. Additionally, when continence was defined as not using any pads, 42% of patients who underwent the posterior approach achieved continence. Galfano et al. [7] discovered a variation in immediate continence rates among patients with different prostate volumes who underwent surgery using the posterior approach. In the < 40, 40–60, > 60 groups, immediate continence rates (defined as the use of ≤ 1 pad /24h for 1 week) were 88.2%, 89.5%, 81.3%, and there were statistical differences (p < 0.05). Our study observed a similar trend and achieved favorable continence outcomes. Immediate continence in our study was defined as not using any pads for a full 24-hour period, with rates of 80%, 77.5%, and 64.2% in the three groups.

Through univariate and multivariate logistic regression analysis, our study found that prostate volume was a significant protective factor for immediate continence after RNRS-RNRP (OR < 1). In addition, age and preoperative T stage were also independent risk factors for immediate continence. We combined them to establish a clinical prediction model and construct a related nomogram to predict immediate continence. The AUC value of the nomogram was calculated to be 0.751, indicating its potential clinical value.

This study has certain limitations that should be acknowledged. Firstly, the follow-up period was relatively short, and thus, only short-term outcomes were evaluated. Secondly, our assessment of continence relied on outpatient follow-up visits or telephone interviews, potentially introducing some degree of inaccuracy. Finally, it was a single-center study with a relatively small sample size. To address these limitations and ensure the reliability and generality of the results, a multi-center, large-sample, prospective study is necessary to validate our results.

In conclusion, our study suggests that RNRS-RARP can be performed irrespective of prostate volume and all achieved good immediate continence. However, larger prostate volumes were associated with longer operation times and poorer immediate continence outcomes. Notably, the impact of prostate volume on continence tends to diminish over time. Prostate volume was identified as an independent risk factor for immediate urinary continence following RNRS-RARP.

RARP: Robot-assisted radical prostatectomy

RNRS-RARP:Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle

EBL:Estimated blood loss

NVB:Neurovascular bundle

BMI:Body mass index

PSA:Prostate-specific antigen

LOS: Length of stay

PSM:Positive surgical margin

BCR: Biochemical recurrence

AUC: Areas under the curve

ROC: receiver operator characteristic

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was approved by the Ethical Review Board of the Second Hospital of Tianjin Medical University ([2022] No. (046)) and carried out in accordance with the principles outlined in the Declaration of Helsinki. Informed consent was obtained from each patient in this study.

Patient consent statement: Informed consent was obtained from all subjects involved in the study.

Consent for publication：Not applicable.

Data availability statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Conflict of interest disclosure: The authors declare no conflict of interest.

Funding statement: This research was funded by the central government guides the construction of scientific and technological innovation bases for local scientific and technological development funds [grant numbers 22ZYJDSY00010] and the Urinary talent incubation project of the Second Hospital of Tianjin Medical University [grant numbers 2023ZDSYS06].

Author contributions: LY and LZH designed the study and were major contributors to the writing of the manuscript. WZ,SY,YZ,HH,WZY,FZN,WSM were the main participants in the surgery and helped collect the data. NYJ and WY supervised and reviewed the manuscript.All authors read and approved the final manuscript.

Acknowledgments: We would like to thank the researchers, study participants and Beckman for their supports and contributions.

Siegel RL,Giaquinto AN,Jemal A. Cancer statistics, 2024. CA Cancer J Clin.2024; 74 (1): 12-49.
Menon M,Tewari A,Peabody J. Vattikuti Institute Prostatectomy: Technique. J Urol. 2003; 169 (6): 2289-2292.
El‐Hakim A,Leung RA,Richstone LEE, et al. Athermal Robotic Technique of prostatectomy in patients with large prostate glands (>75 g): technique and initial results. BJU Int.2006; 98 (1): 47-49.
Farzat M,Rosenbauer J,Tanislav C, et al. Prostate Volume Influence on Postoperative Outcomes for Patients Undergoing RARP: A Monocentric Serial Analysis of 500 Cases. J Clin Med.2023; 12 (7).
Kim MS,Jang WS,Chung DY, et al. Effect of prostate gland weight on the surgical and oncological outcomes of extraperitoneal robot-assisted radical prostatectomy. BMC Urol.2019; 19 (1).
Labanaris AP,Zugor V,Witt JH. Robot-Assisted Radical Prostatectomy in Patients with a Pathologic Prostate Specimen Weight ≥100 Grams versus ≤50 Grams: Surgical, Oncologic and Short-Term Functional Outcomes. Urol Int.2013; 90 (1): 24-30.
Galfano A,Panarello D,Secco S, et al. Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy? Minerva Urol Nefrol.2018; 70 (4).
Hirasawa Y,Ohno Y,Nakashima J, et al. Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy. Surg Endosc.2015; 30 (9): 3702-3708.
Galfano A,Ascione A,Grimaldi S, et al. A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery. Eur Urol.2010; 58 (3): 457-461.
Wang Y,Liu Z,Huang H, et al. Hem-o-lok-free and Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle. Current Urology 2022; 16 (2): 114-115.
Farha MW,Salami SS. Biomarkers for prostate cancer detection and risk stratification. Ther Adv Urol. 2022; 14.
Takahiro Yasui1* KT, Satoshi Kurokawa1, Atsushi Okada1, Kentaro Mizuno1, Yukihiro Umemoto1, Noriyasu Kawai1, Shoichi Sasaki1, Yutaro Hayashi1, Yoshiyuki Kojima2 and Kenjiro Kohri1. Impact of prostate weight on perioperative outcomes of robot-assisted laparoscopic prostatectomy with a posterior approach to the seminal vesicl.BMC Urol.2014.
Ted A. Skolarus1, Ryan C. Hedgepeth1,2, Sean Zhang2, Alon Z. Weizer1, Jeffrey S.,Montgomery1 DCM, 2, David P. Wood Jr.1, and Brent K. Hollenbeck. Does robotic technology mitigate the challenges of large prostate size? Urology. 2010.
Boczko J,Erturk E,Golijanin D, et al. Impact of Prostate Size in Robot-Assisted Radical Prostatectomy. J Endourol.2007; 21 (2): 184-188.
Yoshiaki Kawamura TU, Tatsuya Umemoto, Nobuyuki Nakajima, Masahiro Nitta, Masanori Hasegawa, Sunao Shoji,,Miyajima A. Robot-assisted radical prostatectomy in a patient with prostate cancer complicated by benign prostate hypertrophy with middle lobe hypertrophy. J Surg Case Rep.2024.
Tugcu V,Simsek A,Yigitbasi I, et al. Robotic perineal radical prostatectomy with high prostate volume. Arch Ital Urol Androl. 2018; 90 (1).
Stankovic M,Wolff L. The Impact of Prostate Volume in Open Radical Prostatectomy: A Single Centre Experience. Clin Genitourin Cancer.2024; 22 (1): 7-13.
M Kojima PT, R J Babaian. Influence of noncancerous prostatic tissue volume on prostate-specific antigen. Urology.1998.
Wenzel M,Preisser F,Theissen LH, et al. The Effect of Adverse Patient Characteristics on Perioperative Outcomes in Open and Robot-Assisted Radical Prostatectomy. Front Surg. 2020; 7.
Checcucci E,Veccia A,Fiori C, et al. Retzius‐sparing robot‐assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes. BJU Int.2019; 125 (1): 8-16.
Santok GDR,Abdel Raheem A,Kim LHC, et al. Perioperative and short‐term outcomes of Retzius‐sparing robot‐assisted laparoscopic radical prostatectomy stratified by gland size. BJU Int.2016; 119 (1): 135-141.
Deng W,Liu X,Liu W, et al. Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups. Front Oncol.2021; 11.
Stolzenburg J-U,Holze S,Neuhaus P, et al. Robotic-assisted Versus Laparoscopic Surgery: Outcomes from the First Multicentre, Randomised, Patient-blinded Controlled Trial in Radical Prostatectomy (LAP-01). Eur Urol.2021; 79 (6): 750-759.
T A Stamey CMY, J E McNeal, B M Sigal, I M Johnstone. Prostate cancer is highly predictable: a prognostic equation based on all morphological variables in radical prostatectomy specimens. J Urol.2000.
Jaber AR,Moschovas MC,Saikali S, et al. Impact of Prostate Size on the Functional and Oncological Outcomes of Robot-assisted Radical Prostatectomy. Eur Urol Focus.2024.
Galfano A,Di Trapani D,Sozzi F, et al. Beyond the Learning Curve of the Retzius-sparing Approach for Robot-assisted Laparoscopic Radical Prostatectomy: Oncologic and Functional Results of the First 200 Patients with ≥1 Year of Follow-up. Eur Urol.2013; 64 (6): 974-980.
Qiu X,Li Y,Chen M, et al. Retzius‐sparing robot‐assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single‐blind trial with a 1‐year follow‐up. BJU Int.2020; 126 (5): 633-640.
Kominsky HD,Awad MA,Farhi J, et al. Retzius-sparing vs. posterior urethral suspension: similar early-phase post-robotic radical prostatectomy continence outcomes. J Robot Surg. 2024; 18 (1).
Qian J,Fu Y,Marra G, et al. Modified Retzius-sparing robot-assisted radical prostatectomy for cases with anterior tumor: a propensity score-matched analysis. World J Urol.2024; 42 (1).
Asimakopoulos AD,Topazio L,De Angelis M, et al. Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates. Surg Endosc. 2018; 33 (7): 2187-2196.
Dalela D,Jeong W,Prasad M-A, et al. A Pragmatic Randomized Controlled Trial Examining the Impact of the Retzius-sparing Approach on Early Urinary Continence Recovery After Robot-assisted Radical Prostatectomy. Eur Urol.2017; 72 (5): 677-685.

No competing interests reported.

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

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Abstract

Figures

1. Introduction

2. Methods

2.1 Collection of Clinical Information

2.2 Surgical technique

2.3 Statistical analysis

3. Results

3.1 Baseline information

3.2 Perioperative outcome

3.3 Pathological outcome

4. Discussion

5. Conclusion

Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1