Clinical and morphological assessment of the results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of Retzius-sparing technique


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective: To compare the perioperative, functional, clinical and morphological results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of the Retzius-sparing technique. Materials and methods: A prospective analysis was performed of two groups of patients (n=54) who underwent nerve-sparing robot-assisted radical prostatectomy (period from 2017 to 2018). The first group included 29 patients who underwent nerve-sparing robot-assisted radical prostatectomy with Retzius-sparing technique, the second - 25 patients operated on according to the standard method of bilateral nerve-sparing radical prostatectomy. All patients were comparable in baseline characteristics. In all cases, patients had histologically verified localized prostate cancer pT2a-2c. Results: In cases with use Retzius-sparing technique there is no statistically significant difference in the operation time (243.60 min vs 236.64 min, in groups 1 and 2, p>0.05) and intraoperative blood loss (131.20 ml vs 122.57 ml , in groups 1 and 2, p>0.05). Regarding the dynamics of the urinary continence recovery, the Retzius-sparing technique demonstrates advantages in speed and frequency at all follow-up periods (54.13% vs 41.81%; 68.12% vs 59.21%; 94.15% vs 90 , 63%; 98.54% vs 97.12%; 98.62% vs 97.31%; 98.83% vs 97.82% - in one week after removal of the urethral catheter, 1, 3, 6, 9, and 12 months in the first and second group, respectively). The frequency of erectile function recovery after 12 months was 82.17% and 71.14% in the first and second groups, respectively. Conclusions: Retzius-sparing robot-assisted prostatectomy superior to standard operation in the speed and timing of recovery of urine continence and erectile function.

Full Text

Restricted Access

About the authors

E. N Golubtsova

Russian Medical Academy of Continuous Professional Education; S.P. Botkin’s State Clinical Hospital

Email: engolubtsova@yandex.ru
Ph.D., assistant of the Department of Urology and Surgical Andrology

E. I Veliev

Russian Medical Academy of Continuous Professional Education; S.P. Botkin’s State Clinical Hospital

Email: veliev@urotop.ru
Ph.D., MD, professor, professor at the Department of Urology and Surgical Andrology; Head of the Department of Urology

E. A Sokolov

Russian Medical Academy of Continuous Professional Education; S.P. Botkin’s State Clinical Hospital

Email: sokolov.yegor@yandex.ru
Ph.D., assistant of the Department of Urology and Surgical Andrology

O. V Paklina

S.P. Botkin’s State Clinical Hospital

Email: botkinhospital@zdrav.mos.ru
Ph.D., MD, Department of Pathology, chief researcher of the Laboratory of electronic microscopy of FGBU “SMRC Vishnevskyi A.V.” of the Ministry of Health of the Russia

G. V Knyshinsky

S.P. Botkin’s State Clinical Hospital

Email: botkinhospital@zdrav.mos.ru
pathologist at the Department of Pathology

References

  1. Злокачественные новообразования в России в 2018 г. (заболеваемость и смертность). Под ред. Д.А.Каприна В.В. Старинского, Г.В. Петровой. М.: МНИОИ им. П.А. Герцена - филиал ВГБУ «НМИЦ радиологии» Минздрава России, 2019 г. 250 с.
  2. Checcucci E., Amparore D., De Luca S., Autorino R., Fiori C., Porpiglia F., Precision prostate cancer surgery: an overview of new technologies and techniques. Minerva Urol Nefrol. Minerva Urol Nefrol 2019;71(5):487-501. doi: 10.23736/S0393-2249.19.03365-4.
  3. Gu X., Araki M., Wong C. Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP). Minim Invasive Ther Allied Technol. 2015 ;24(6) :364-371. doi: 10.3109/13645706.2015.1027711.
  4. Sridhar A.N., Abozaid M, Rajan P., Sooriakumaran P., Shaw G., Nathan S., Kelly J.D., Briggs T.P. Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer. Curr Urol Rep. 2017;18(9):71.doi: 10.1007/s11934-017-0717-4.
  5. Porpiglia F., Bertolo R., Manfredi M., De Luca S., Checcucci E., Morra I., Passera R., Fiori C. Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence. Eur Urol. 2016;69(3):485-495. Doi: 10.1016/j. eururo.2015.08.005.
  6. 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: 974-980. Doi: 10.1016/j. eururo.2013.06.046.
  7. Galfano A., Panarello D., Secco S., Di Trapani D., Barbieri M., Napoli G., Strada E., Petralia G., Bocciardi A.M. 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):408-413. doi: 10.23736/S0393-2249.18.03069-2.
  8. Соколов Е.А., Велиев Е.И., Богданов А.Б., Велиев Р.А., Гончарук Д.А. Онкологическая безопасность нервосберегающей техники радикальной простатэктомии: оценка патоморфологических результатов и безрецидивной выживаемости. Урология. 2020; 2:60-64). Doi: https: //dx.doi.org/10.18565/ urology.2020.2.60-64
  9. Велиев Е.И., Соколов Е.А., Лоран О.Б. Сравнительный анализ частоты позитивных хирургических краев у пациентов, перенесших роботассистированную или позадилонную радикальную простатэктомию по поводу рака предстательной железы. Урология. 2015; 4:44-47
  10. Autorino R., Porpiglia F., Dasgupta P., Rassweiler J., Catto J.W., Hampton L.J., et al. Precision surgery and genitourinary cancers. Eur J. Surg Oncol. 2017;43(5):893-908. doi: 10.1016/j.ejso.2017.02.005.
  11. Соколов Е.А., Велиев Е.И., Велиев Р.А. Современный взгляд на нервосберегающую технику радикальной простатэктомии. Онкоурология 2019;15(3):17- 27). doi: 10.17650/1726-9776-2019-15-3-17-27.
  12. Dalela D., Jeong W., Prasad M.A., Sood A., Abdollah F., 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;72:677-685. Doi: 10.1016/j. eururo.2017.04.029.
  13. Menon M., Dalela D., Jamil M., Diaz M., Tallman C., et al. Functional recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: an evidence-based analysis comparing the Retzius sparing and standard approaches. J. Urol 2018;199:1210-1217. doi: 10.1016/j.juro.2017.11.115.
  14. Sayyid R.K., Simpson W.G., Lu C., Terris M.K., Klaassen Z., et al. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: a safe surgical technique with superior continence outcomes. J. Endourol 2017;31:1244- 1250. doi: 10.1089/end.2017.0490.
  15. Asimakopoulos A.D., Topazio L., De Angelis M., Agro E.F., Pastore A.L., et al. Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates. Surg Endosc 2019;33:2187-2196. doi: 10.1007/s00464-018-6499-z.
  16. Lim S.K.,, Kim K.H., Shin T.Y. et al. Current status of robot-assisted laparoscopic radical prostatectomy:how does it compare with other surgical approaches? Int J. Urol 2013;20:271-284. Doi: 10.1111/j. 1442-2042.2012.03193.x.
  17. Galfano A., 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;64:974-980. Doi: 10.1016/j. eururo.2013.06.046.
  18. Lim S.K., Kim K.H., Shin T.Y., et al. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int. 2014; 114(2):236-244. Doi: 10.1111/ bju.12705.
  19. Велиев Е.И., Голубцова Е.Н., Котов С. В. Динамика восстановления удержания мочи у пациентов после радикальной позадилонной нервосберегающей простатэктомии. Онкоурология. 2011;2:64-68
  20. Sammon J.D., Trinh Q.D., Sukumar S., Diaz M., Simone A., et al. Long-term follow-up of patients undergoing percutaneous suprapubic tube drainage after robotassisted radical prostatectomy (RARP). BJU Int 2012;110:580- 585. doi: 10.1111/j.1464-410X.2011.10786.x.
  21. Nikhil Vasdev, Samita Agarwal, Bhavan P. Rai, Arany Soosainathan, Gregory Shaw, Sebastian Chang, Venkat Prasad, Gowrie Mohan-S, James M. Adshead. Intraoperative Frozen Section of the Prostate Reduces the Risk of Positive Margin Whilst Ensuring Nerve Sparing in Patients with Intermediate and High-Risk Prostate Cancer Undergoing Robotic Radical Prostatectomy: First Reported UK Series. Curr Urol. 2016;9(2): 93-103. doi: 10.1159/000442860.
  22. Соколов Е.А., Велиев Е.И., Паклина О.В., Кнышинский Г.В. Интраоперационное гистологическое исследование замороженных срезов участков предстательной железы, прилегающих к сосудисто-нервному пучку: первичный опыт применения при робот-ассистированной радикальной простатэктомии. Вестник современной клинической медицины. 2019;12(6):66-71). doi: 10.20969/VSKM.2019.12(6).66-71.
  23. Carlos Arroyo, Alberto Martini, Joanna Wang, Ashutosh K. Tewari Anatomical, surgical and technical factors influencing continence after radical prostatectomy. Ther Adv Urol. 2019;11:1756287218813787. doi: 10.1177/1756287218813787. eCollection 2019 Jan-Dec.
  24. Ashwin N. Sridhar, Mohammed Abozaid, Prabhakar Rajan, Prasanna Sooriakumaran, Greg Shaw, Senthil Nathan, John D. Kelly, Tim P. Briggs Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer. Curr Urol Rep. 2017;18(9):71-79. doi: 10.1007/s11934-017-0717-4.
  25. Ganzer R., Blana A., Gaumann A. et al. Topographical anatomy of periprostatic and capsular nerves: quantifcation and computerized planimetry. Eur Urol 2008;54:353-361. doi: 10.1016/j.eururo.2008.04.018.
  26. Walz J., Burnett AL., Costello AJ. et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy.EurUrol2010;57:179-192. Doi: 10.1016/j. eururo.2009.11.009.
  27. Costello A.J., Dowdle B. W., Namdarian B., et al. Immunohistochemical study of the cavernous nerves in the periprostatic region. BJU International 2010;107:1210-1215. doi: 10.1111/j.1464-410X.2010.09711.x.
  28. Tewari A.K., Ali A., Ghareeb G. et al. Improving time to continence after robot-assisted laparoscopic prostatectomy:augmentation of the total anatomic reconstruction technique by adding dynamic detrusor cuff trigonoplasty and suprapubic tube placement. J Endourol. 2012;26:1546- 1552. doi: 10.1089/end.2012.0544.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies