For functional outcomes, we emphasized two key areas: urinary continence and sexual health. We used validated PROMs, such as the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), the International Index of Erectile Function, and the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire. These tools helped us gather subjective data on incontinence and sexual function directly from patients during each phase of recovery.
For urinary function, we found that rsRALP offered clear advantages, showing earlier and more sustained recovery of continence. Our data demonstrated that patients undergoing rsRALP reported better continence scores at 1, 3, and 12 months postoperatively. This improvement was particularly important since urinary incontinence significantly affected patient's quality of life after prostate surgery. By preserving the Retzius space, rsRALP appeared to minimize disruption to surrounding structures, which likely accounted for this benefit. Even at 24 months, patients treated with rsRALP still reported better urinary function compared to those who underwent sRALP.
Sexual function recovery, however, was more nuanced. While we observed a modest early advantage with rsRALP in terms of sexual function at 1 and 3 months, by the 12-month and 24-month follow-ups, the difference between the two approaches diminished. Our findings suggested that bilateral nerve-sparing played a crucial role in long-term sexual recovery, regardless of the surgical approach.
Oncologically, we examined the rate of positive surgical margins (PSM), an important predictor of cancer recurrence. We found that overall PSM rates were comparable between rsRALP and sRALP, but there were differences in specific subgroups. In patients with organ-confined disease (pT2 tumors), we noticed a higher likelihood of anterior PSM in those undergoing rsRALP. The length and extent of PSM in these patients also tended to be greater in rsRALP cases. Despite these differences, we did not find a significant impact on 5-year biochemical recurrence (BCR) rates between the two approaches.
Ultimately, our study demonstrated the functional benefits of rsRALP, particularly in urinary continence recovery, while also highlighting the importance of careful patient selection to optimize oncological outcomes.
Written by:
- Romain Diamand, MD, Professor, Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
- Grégoire Assenmacher, MD, Department of Urology, Europe Hospitals, Ste-Elisabeth, Brussels, Belgium