Faculty Collaboration Database

Comparative Outcomes of Salvage Retzius-Sparing versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series. J Urol 2021 Nov;206(5):1184-1191

Date

06/29/2021

Pubmed ID

34181471

DOI

10.1097/JU.0000000000001939

Scopus ID

2-s2.0-85117928904 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

PURPOSE: Salvage radical prostatectomy is rare due to the risk of postoperative complications. We compare salvage Retzius-sparing robotic assisted radical prostatectomy (SRS-RARP) with salvage standard robotic assisted radical prostatectomy (SS-RARP).

MATERIALS AND METHODS: A total of 72 patients across 9 centers were identified (40 SRS-RARP vs 32 SS-RARP). Demographics, perioperative data, and pathological and functional outcomes were compared using Student's t-test and ANOVA. Cox proportional hazard models and Kaplan-Meier curves were constructed to assess risk of incontinence and time to continence. Linear regression models were constructed to investigate postoperative pad use and console time.

RESULTS: Median followup was 23 vs 36 months for SRS-RARP vs SS-RARP. Console time and estimated blood loss favored SRS-RARP. There were no differences in complication rates or oncologic outcomes. SRS-RARP had improved continence (78.4% vs 43.8%, p <0.001 for 0-1 pad, 54.1% vs 6.3%, p <0.001 for 0 pad), lower pads per day (0.57 vs 2.03, p <0.001), and earlier return to continence (median 47 vs 180 days, p=0.008). SRS-RARP was associated with decreased incontinence defined as >0-1 pad (HR 0.28, 95% CI 0.10-0.79, p=0.016), although not when defined as >0 pad (HR 0.56, 95% CI 0.31-1.01, p=0.053). On adjusted analysis SRS-RARP was associated with decreased pads per day. Lymph node dissection and primary treatment with stereotactic body radiation therapy were associated with longer console time.

CONCLUSIONS: SRS-RARP is a feasible salvage option with significantly improved urinary function outcomes. This may warrant increased utilization of SRS-RARP to manage men who fail nonsurgical primary treatment for prostate cancer.

Author List

Kowalczyk KJ, Madi RH, Eden CG, Sooriakumaran P, Fransis K, Raskin Y, Joniau S, Johnson S, Jacobsohn K, Galfano A, Bocciardi AM, Hwang J, Kim IY, Hu JC

Author

Scott C. Johnson MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Feasibility Studies
Humans
Incontinence Pads
Male
Middle Aged
Organ Sparing Treatments
Postoperative Complications
Prostate
Prostatectomy
Prostatic Neoplasms
Retrospective Studies
Risk Assessment
Robotic Surgical Procedures
Salvage Therapy
Time Factors
Treatment Outcome
Urinary Incontinence