Open AccessTrifecta results in Retzius-sparing robotic radical prostatectomy: results of a high-volume center
Author(s) -
Alberto Olivero,
Paolo Dell’Oglio,
Francesca Ambrosini,
Silvia Secco,
Michele Barbieri,
Erika Palagonia,
Grazia Napoli,
Elena Strada,
Giovanni Petralia,
Dario Trapani,
Carlo Buratto,
Marco Martiriggiano,
Antonio Galfano,
Aldo Massimo Bocciardi
Publication year - 2022
Publication title -
mini-invasive surgery
Language(s) - English
Resource type - Journals
ISSN - 2574-1225
DOI - 10.20517/2574-1225.2021.117
Subject(s) - medicine , prostatectomy , urology , confidence interval , odds ratio , logistic regression , biochemical recurrence , potency , population , urinary continence , surgery , prostate cancer , cancer , biochemistry , environmental health , in vitro , chemistry
Aim: We aimed to evaluate trifecta outcomes after Retzius-sparing robot-assisted radical prostatectomy (rs-RARP). Methods: We evaluated 1488 patients who had undergone rs-RARP at our institution from 2011 to 2019. All patients filled out questionaries for functional outcomes before surgery, and only patients with baseline continence and IIEF-5 scores of > 16 were included. Biochemical recurrence (BCR) was defined as two consecutive prostatic specific antigen levels of > 0.2 ng/mL after rs-RARP. Postoperative continence was defined as the use of no pads. Potency was defined as the ability to achieve erections for sexual intercourse, with or without phosphodiesterase-5 (PDE-5) inhibitors. A multivariable logistic regression model was performed to identify predictors of trifecta outcome. Results: In total, 1240 patients were included in the analysis. During the 24-month follow-up time, 149 patients (11.9%) harbored BCR. Urinary continence was observed in 981 patients (79.5%), while 171 (13.8%) still used a safety pad daily after 24 months. Sexual potency was reported in 643 patients (51.9%), of whom 379 (30.6%) had spontaneous erections and 264 (21.3%) used a PDE-5 inhibitor. Overall, the trifecta outcome was reached by 42.1% of the study’s population. The trifecta outcome was easily reached by younger patients and patients who underwent a full nerve-sparing (NS) prostatectomy. In the multivariable model, age [odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.84-0.90; P < 0.01] and type of NS surgery [partial NS (OR = 3.34; 95%CI: 1.01-11; P = 0.04) full NS (OR = 4.57; 95%CI: 1.86-12; P < 0.01)] resulted as independent predictors. Conclusion: rs-RARP is associated with optimal trifecta outcome rate. Age and NS technique are independent predictors of trifecta outcomes.