Clinical and morphological rationale for urinary continence recovery after robot-assisted nervesparing radical prostatectomy

Golubtsova E.N., Knyshinskiy G.V., Veliev E.I., Tomilov A.A., Sokolov E.A.

1) Moscow Urologic Center, S.P. Botkin’s State Clinical Hospital, Moscow, Russia; 2) Russian Medical Academy of Continuing Professional Education, Moscow, Russia; 3) Moscow S.P. Botkin Hospital, Moscow, Russia

Objective. To compare the functional, clinical and morphological results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of the Retzius-sparing technique. To justify the differences in the rate and quality of urinary continence recovery based on the results of morphological examination.
Materials and methods. A prospective and retrospective 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, while the second group consisted of 113 patients who underwent standard nerve-sparing robot-assisted radical prostatectomy. The mean age in groups 1 and 2 was 59,95±6,63 and 59,88±6,23 years, respectively (p=0,928). 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); the IIEF-5 score was 22,91±3,43 and 23,12±4,26 in groups 1 and 2, respectively (p=0,466). No statistically significant differences were observed between the groups 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, 52,18% of patients were fully continent; in the second group, 34,53% of patients were continent (p=0,019). One month after catheter removal, urine was fully retained by 67,14% and 58,18% of patients in groups 1 and 2, respectively (p=0,002). At three months, 93,82% and 89,17% of patients were continent (p=0,105), and at six months, 98,21% and 96,84% of operated patients were continent (p=0,426). After 12 months of follow-up, urine was fully retained by 98,53% and 97,17% of patients (p=0,326). Morphological examination following standard nerve-sparing radical prostatectomy reveals a minimal number of nerve fibers per unit area in the prostatic fascia. In contrast, when using the partial preservation of the Retzius space technique, nerve fibers are not detected in the prostatic fascia.
Conclusions: Nerve-sparing robot-assisted radical prostatectomy using a modified technique for preservation of the Retzius space demonstrates advantages in the rate of urinary continence recovery within the first three months after urethral catheter removal compared to the standard procedure. According to morphological data, this technique allows for the preservation of vascular-neural and ligamentous-fascial structures involved in maintaining continence.

Keywords

About the Authors

Corresponding author: E.N. Golubtsova – Ph.D., associate professor at the Department of Urology and Surgical Andrology of Russian Medical Academy of Continuing Professional Education. Urologist at the Moscow Urologic Center of S.P. Botkin State Clinical Hospital, Moscow, Russia e-mail: engolubtsova@yandex.ru

Similar Articles