LAUSR

PURPOSE To elucidate factors contributing to early urinary continence recovery after retzius-sparing robot-assisted radical prostatectomy (RS-RARP) by evaluating postoperative pelvic anatomical features between RS-RARP and conventional RARP (CON-RARP). MATERIALS AND METHODS We retrospectively examined 50 men who underwent RS-RARP (n=25; the RS-RARP group) and CON-RARP (n=25; the CON-RARP group) between October 2017 and June 2018. Perioperative outcomes and postoperative urinary continence were assessed in both groups. Anatomical features including the bladder neck-to-pubic symphysis ratio (determined from cystograms) and membranous urethral length (MUL) (determined from magnetic resonance imaging) were evaluated. RESULT The daily urinary incontinence rate at discharge was significantly lower in the RS-RARP group than in the CON-RARP group [0.046 (range: 0.014-0.160) vs 0.357 (range: 0.139-0.616), P<0.001]. Postoperative urinary continence at 1, 3, 6, and 12 months was 80%, 92%, 96%, and 96% in the RS-RARP group and 24%, 40%, 68%, and 84% in the CON-RARP group, respectively (P<0.001). The urgency scores in the international prostate symptom score (IPSS) questionnaire at one and three months were significantly lower in the RS-RARP than in the CON-RARP group (P=0.028 and 0.033, respectively). The quality of life (QOL) indices were more significantly improved in the RS-RARP group than in the CON-RARP group one month (P=0.027) and three months (P=0.045) postoperatively. Receiver operating characteristic analysis revealed that a postoperative MUL of 12.1 mm [area under the curve: 0.852] was the optimal cut-off value predictive of continence recovery after one month. Multivariate analysis demonstrated that RS-RARP [odds ratio (OR): 23.6; P<0.001] and prostate volume (OR: 0.926; P=0.049) were the independent factors of a longer MUL. CONCLUSIONS RS-RARP results in an early continence recovery and a better urgency score in the IPSS by suppressing the descent of the bladder and maintaining a long MUL. RS-RARP may contribute to a better QOL recovery after RARP.