Pelvic fascia-sparing (Retzius-sparing) tecniche for RP ?

Posted by kurthmiller @kurthmiller, 1 day ago

I am scheduled for RP soon, and have been trying to understand likely trajectory of overall recovery - and incontinence in particular - post surgery. In doing my research I learned that some (maybe all?) Mayo facilities / physicians use a surgical technique called 'pelvic fascia-sparing (Retzius-sparing)' surgery - which appears to provide a much faster path to recovery of urinary continence (although it sounds like the jury is still out on long-term oncologic outcomes associated with this approach). I don't know if this approach is appropriate for all cases or not (e.g. Gleason score, location of the tumor(s), etc. may be factors). Does anyone have any experience with this, and if so - can you shed light on how the post-surgery process went, and which facilities or physicians utilize this technique? I am pursuing this question with my provider team, but would love to get fellow patient perspectives on this as well. Thanks in advance for any thoughts or perspectives.

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wheel1 | @wheel1 | 1 day ago

I know three people myself one of those that have undergone this new technique. One of the other two, Mozir is also on this site. I don’t know of limitations or qualifications for this, but their could certainly be health considerations, metastatic involvement, large prostate, or other reasons a person is not a good candidate. Nothing came up eith me. I was Gleason 8 at the time, downgraded to unfavorable 7(4+3) after surgery. Studies have shown quicker recovery of continence, although longer term at 6 month to 1 year review seems to have brought regular robotic prostatectomies to same degree. I know that I had immediate continence the day my catheter was removed. I believe Mozir has indicated little leakage immediately, gone by day 4. Other person I know almost immediately. I was told afterwards to not do kegels, although prior to surgery as part of his protocol I was sent to a therapist to learn about kegels. Mozir might chime in on his procedure. I also had single port, discharged the same day as my surgery, and my tissue and lymph nodes immediately sent to pathology for inking while I was on the table to see everything was negative. The procedure was done in Southern California. You are certainly in good hands with Mayo.

rom82826 | @rom82826 | 1 day ago

Thanks for the quick reply wheel1 - very helpful and much appreciated!

psychometric | @psychometric | 1 day ago

Dr. John Ward at MD Anderson uses a Retzius-sparing technique, although he does not do PLND because in his opinion the risks outweigh the rewards. I really liked Dr. Ward and it was an angonizing decision not to travel back down to Houston for my surgery. Dr. Christopher Weight at Cleveland Clinic (who did my RARP last June) does a similar technique although one of his fellows told me they don't like to use that term. Tumor location can be more or less favorable to Retzius-sparing because of how the surgeon (robot) accesses the prostate.

keywest19 | @keywest19 | 23 hours ago

Look up "hood technique" and "Rocco stitch" my Mayo surgeon used these and I had no incontinence. I believe the hood technique is a form of pelvic fascia preserving. I trusted my surgeon to do what was best based on my tumor and overall anatomy. He can do all the techniques