MP52-09 EARLY RETURN TO CONTINENCE, ONCOLOGICAL SAFETY AND SIGNIFICANCE OF MEMBRANOUS URETHRAL LENGTH IN ANTERIOR RETZIUS SPARING ROBOT ASSISTED RADICAL PROSTATECTOMY (RARP)

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (MP52)1 May 2024MP52-09 EARLY RETURN TO CONTINENCE, ONCOLOGICAL SAFETY AND SIGNIFICANCE OF MEMBRANOUS URETHRAL LENGTH IN ANTERIOR RETZIUS SPARING ROBOT ASSISTED RADICAL PROSTATECTOMY (RARP) Nithesh M. Ranasinha, Anthony S. Bates, Thineskrishna Anbarasan, Abhishek Sharma, Richard J. Bryant, Tom Leslie, Aaron Leiblich, Francisco Lopez, and Alastair D. Lamb Nithesh M. RanasinhaNithesh M. Ranasinha , Anthony S. BatesAnthony S. Bates , Thineskrishna AnbarasanThineskrishna Anbarasan , Abhishek SharmaAbhishek Sharma , Richard J. BryantRichard J. Bryant , Tom LeslieTom Leslie , Aaron LeiblichAaron Leiblich , Francisco LopezFrancisco Lopez , and Alastair D. LambAlastair D. Lamb View All Author Informationhttps://doi.org/10.1097/01.JU.0001008864.84854.b7.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The anterior Retzius sparing (ARS) approach to robot-assisted radical prostatectomy (RARP) preserves key structures aligned with urinary continence. Moreover, unlike posterior approach Retzius sparing surgery, ARS maintains the familiar transperitoneal anterior approach and can be modified more easily to accommodate for oncological requirements. We investigated differences in early return to continence and oncological safety between ARS and standard anterior RARP, alongside pre-operative variables. METHODS: We conducted a retrospective review of a continuously-collected, prospectively-maintained RARP database at Oxford University Hospitals NHS Trust, Oxford, UK. Patients undergoing full or modified ARS were compared to patients undergoing non-ARS standard approach RARP surgery. Multiple regression analysis assessed pre-operative variables including membranous urethral length (MUL), age, BMI, MRI PIRADs score, prostate volume, and biopsy Gleason grade group on early return to continence (defined as 0-1 pad usage per day) and oncological safety (defined as positive surgical margin (PSM) rate). ROC curve analysis was used to identify MUL cut-offs to predict 6-week continence. RESULTS: Of 508 RARPs from 14/02/2017 to 21/08/2023, 429 ARS cases were compared to 79 non-ARS standard anterior approach cases.There was no difference in baseline pre-operative variables of MUL, age, BMI, MRI PIRADS, GGG and prostate volume between ARS and non-ARS cohorts.There was an increase in 6-week continence for ARS compared to non-ARS cohorts (292/420 (70%)vs 36/74 (49%), p=0.002). There was no difference in PSM rate in ARS vs non-ARS cohorts (104/429 (25%) vs 20/79 (25%) p=0.75) (Table 1).In the ARS cohort, lower age (OR 0.92; 95%CI 0.85 – 0.99) and longer MUL (OR 1.22; 95%CI 1.09 – 1.38) were independently associated with continence at 6-weeks.ROC curve analysis for MUL identified an 80% sensitivity for 6-week continence for MUL >11.4mm in ARS cohort vs >15mm in the non-ARS cohort. CONCLUSIONS: This study highlights improved early return to continence in the ARS vs non-ARS approaches without impacting oncological safety. We identify lower age and longer MUL as independent predictive factors for early return to continence in ARS patients. Source of Funding: Nil © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e855 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nithesh M. Ranasinha More articles by this author Anthony S. Bates More articles by this author Thineskrishna Anbarasan More articles by this author Abhishek Sharma More articles by this author Richard J. Bryant More articles by this author Tom Leslie More articles by this author Aaron Leiblich More articles by this author Francisco Lopez More articles by this author Alastair D. Lamb More articles by this author Expand All Advertisement PDF downloadLoading ...