The Advantage Of Robotic Radical Prostatectomy With Preserving Retzius Gap In Patients With Prominent Mid-lobe Protrusion

Purpose:To evaluate the potential advantage of RS-RARP for prostate cancer patients with significant PML over RARP.Methods:we retrospectively included consecutive patients with significant PML who underwent RARP or RS-RARP performed by the same surgeon in our center between April 2016 and September 2018.All patients underwent pelvic mpMRI.PML was measured from T2-weighted midsagittal images.All pathologic images were interpreted by a dedicated genitourinary pathologist.The Basic information,perioperative outcomes,rate of positive surgical margin and urinary continence were analysed.Results:The P value of age,BMI,PML,prostate volume,preoperative PSA level,clinic GS,clinic stage,diabetes,hypertension,ECOG score and IPSS score were all less than 0.05.Postoperative PSA level were all less than 0.2 ng/ml.The total operative time in two groups were 197.95(54.60)mins vs 164.34(33.43),P=0.002.And the time for bladder neck were 28.74(5.91)mins vs 25.95(6.29),P=0.048.Patients kept catheter for 13.79(2.81)days and 12.32(2.65)days in two groups,P=0.020.These two groups had equivalent overall positive surgical margin(25.6%vs 18.4%,P=0.445)and positive base surgical margin(2.6%vs 0.0%,P=0.320).Patients had great significance in urinary continence at 1 week and 1 month(28.2%vs 52.6%,P=0.029;41.0%vs 68.4%,P=0.016),while they did not show any significance at 3 months and 6 months(56.4%vs 76.3%,P=0.065;71.8%vs 78.9%,P=0.467).Discussion:The basic information was same in both groups.It ensured consistency of two groups.There were significant differences between two groups in total operative time and the time for bladder neck.So,we can affirm the advantage of RS-RARP for prostate cancer patients with significant PML over RARP.Besides,RS-RARP can improve early urinary continence at 1 week and 1 month without a higher positive surgical margin rate and urinary infection rate.Conclusion:RS-RARP can improve early urinary continence with a well positive surgical margin control,and had advantages on total operative time and the time for bladder neck for prostate cancer patients with significant PML over RARP.