Retzius-sparing Retroperitoneal Laparoscopic Radical Prostatectomy (RSR-LRP): A Novel Technique With Favorable Functional and Oncological Outcomes - A Single-surgeon Experience of 186 Consecutive Cases

Abstract

Background/aim: Retzius-sparing radical prostatectomy has demonstrated superior early continence recovery compared to standard approaches in robotic series. We present the first large series of retzius-sparing retroperitoneal laparoscopic radical prostatectomy (RSR-LRP), a novel technique combining the benefits of the Retzius-sparing approach with extraperitoneal access.

Patients and methods: Between February 2022 and November 2025, 186 consecutive patients underwent RSR-LRP by a single surgeon. The technique involves a purely extraperitoneal approach using five trocars, intrafascial dissection without electrocautery near the neurovascular bundle, and complete closure of the Retzius space. Continence was assessed at 2 and 6 months using a 4-point scale (0=no pads, 1=safety pad, 2=one pad/day, 3=≥2 pads/day). Erectile function was evaluated as percentage of preoperative erection quality.

Results: Mean follow-up was 21.9 months (range=2.4-46.7 months). Clinical staging: 84.4% cT2, 5.4% cT3. Pathological staging: 71.5% pT2, 18.3% pT3a, 10.2% pT3b. At two months, complete continence (0 pads) was achieved in 55.7%, with social continence (≤1 pad/day) in 94.3%. At six months, complete continence reached 94.4% with 99.4% social continence. PSA nadir <0.1 ng/ml was achieved in 86.6% of patients with available data. Positive surgical margin rate was 25.3% overall, with 75% of positive margins ≤3 mm. Of patients with erectile function data, 96% reported any erection recovery and 31% achieved erection ≥75% sufficient for intercourse.

Conclusion: RSR-LRP demonstrates excellent functional outcomes with rapid continence recovery, comparable to reported robotic Retzius-sparing series. This technique offers a viable alternative for centers without robotic platforms, achieving favorable oncological control in locally advanced disease.

Keywords: Prostate cancer; Retzius-sparing; continence; extraperitoneal; laparoscopy; radical prostatectomy.