Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy.
World J Urol. 2024 Jun 25;42(1):385. doi: 10.1007/s00345-024-05066-2.
The aim of this study is to critically evaluate the existing body of evidence regarding the efficacy of Retzius-sparing radical prostatectomy (RS-RARP) in achieving improved functional outcomes. Moreover, we explored possible strategies to further optimize functional outcomes.
Following PRISMA guidelines, a systematic review (PROSPERO ID CRD42024539915) was performed on 9th September 2023 on PubMed, Scopus, and Web of Science. Only original articles in the English language reporting functional outcomes after RS-RARP were included.
Overall, the search string yielded 99 results on PubMed, 122 on Scopus, and 120 on Web Of Science. After duplicate exclusion, initial screening and eligibility evaluation, a total of 47 studies were included in the qualitative analysis, corresponding to a cohort of 13.196 patients. All studies reported continence recovery. RS-RARP appeared to achieve better and faster continence recovery compared to S-RARP. However, it should be noted that continence definition was heterogeneous and not based on validated condition-specific questionnaires. Seven (15%) studies provided for any sort of rehabilitation for urinary incontinence after RS-RARP. 22 studies analyzed potency recovery rates, showing no difference between RS-RARP and S-RARP. The evaluation of this outcome poses a great challenge due to the lack of standardized assessment tools and reporting methods. Only two studies reported on the consistent use of post-operative PDE5i as penile rehabilitation.
The current review highlights the satisfactory functional results of Retzius-sparing robot assisted radical prostatectomy, which holds true irrespective of disease stage and prostate volume, with promising results even in patients previously treated for BPH or in the salvage setting. How can we optimize those results? The answer does not probably lie in further refinement of the surgical technique, but in giving greater attention to patient counselling and rehabilitation strategies in order to minimize regret and maximize satisfaction.
本研究旨在批判性地评估保留耻骨后间隙的前列腺根治性切除术（RS-RARP）在改善功能结果方面的现有证据，并探讨进一步优化功能结果的可能策略。
根据 PRISMA 指南，于 2023 年 9 月 9 日在 PubMed、Scopus 和 Web of Science 上进行了系统评价（PROSPERO ID CRD42024539915）。仅纳入报道 RS-RARP 后功能结果的原始英文文章。
总体而言，在 PubMed 上搜索到 99 项结果，在 Scopus 上搜索到 122 项结果，在 Web of Science 上搜索到 120 项结果。经过重复排除、初步筛选和资格评估，共有 47 项研究纳入定性分析，对应 13196 例患者。所有研究均报告了控尿恢复情况。RS-RARP 似乎比 S-RARP 更快、更好地恢复控尿。然而，需要注意的是，控尿定义存在异质性，且未基于验证的特定疾病问卷。7 项（15%）研究为 RS-RARP 后尿失禁提供了任何形式的康复治疗。22 项研究分析了勃起功能恢复率，结果显示 RS-RARP 与 S-RARP 之间无差异。由于缺乏标准化评估工具和报告方法，对该结果的评估具有很大的挑战性。只有两项研究报告了术后持续使用 PDE5i 作为阴茎康复治疗。
本综述强调了保留耻骨后间隙的机器人辅助前列腺根治性切除术的满意的功能结果，这一结果适用于疾病阶段和前列腺体积，甚至在之前接受过 BPH 治疗或挽救性治疗的患者中也有很好的结果。我们如何优化这些结果？答案可能不在于进一步改进手术技术，而在于更加关注患者咨询和康复策略，以尽量减少遗憾并最大限度地提高满意度。
