Incontinence

I know many new members come on this board to research surgery, active surveillance and Radiation treatments after their diagnosis. This post is for those that can consider surgery in their research and decision making. In some cases their disease, age, comorbidities, or other factors have already ruled surgery out. I am also only addressing only one side effect and that is a significant side effect as it is written about often regarding the frustrations and struggles regaining continence. I read often the one year mark to regain it, the constant daily kegels, and the necessity of the obvious pads. ALL of this is significantly accurate in regards to the standard Robotic Assisted Laparoscopic Prostatectomy which most surgeons will be performing. I read recently a comment the “luckier ones” get their continence back sooner than a year and that maybe is true with most of the surgeries. I don’t consider myself a luckier one, I consider myself the standard patient of a surgeon performing the Retzius sparing technique. I think when one is just coming on the board and reading these comments it is certainly a factor in their concern naturally over surgery, that is why I feel it is important to share the documented studies regarding the Retzius Sparing technique regarding RALP’s. Most surgeons are not trained in this and their is certainly a learning curve for surgeons in this technique that does not cut the Puboprostatic ligament holding the bladder in place, the standard common, most often RALP cuts the ligament. If you go in for a surgery consultation and have not researched the procedure the surgeon will perform it’s probably a 90%+ a standard RALP and he knows no different and probably is very proficient and good at it. Just remember all the continence recovery time it could take under this technique versus the newer Retzius technique which is not some experimental new technique. It is advancement in prostate surgery. Like regular RALP you do need a experienced skilled surgeon in Retzius RALP. Retzius RALP in many cases has immediate continence or 70% to 90% in weeks, not months. Overall studies will show by a year regular RALP has caught up, but why wait months or a year struggling with pads, pullups and kegels if not necessary. Are all patients good candidates for this this surgery, i.e. large prostate versus small prostate, obese versus non obese, age. I don’t know but the surgeon should. I personally know of three patients from my surgeon with in essence immediate continence (within days) . Most Centers of Excellence have one surgeon likely performing this technique but they typically have multiple surgeons performing regular RALP’s and most patients just go to the surgeon they are referred to even at the COE and who will perform the standard RALP no questions asked. Studies listed below have shown within weeks of Retzius-sparing robotic prostate removal, 70% to 91% of patients achieve almost total urinary continence. This technique yields significantly faster recovery of bladder control compared to conventional methods. Early continence rates and recovery milestones for the Retzius-sparing approach include: At 1 Week (Post-Catheter): Studies show 71% to 91.2% of patients are continent (using zero pads or just one security liner).At 4 to 6 Weeks: Continence rates climb to between 81% and 90%.At 12 Weeks: Studies observe up to 96% to 100% of patients regaining almost total control. Research published in BJU International indicates that by avoiding dissection in the Retzius space, the surgery preserves crucial anterior support structures and nerves, leading to this early return of bladder control.

The studies that support this Retzius-sparing vs. standard robot-assisted radical prostatectomy for clinically localised prostate cancer:

a comparative study
Vincenzo Ficarra et al. Prostate Cancer Prostatic Dis. 2023 Sep. from NIHHome / Vol 9, No 6 (December 27, 2020) / Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy

Review Article on Surgery for Urologic Cancers
Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy
Ahmet Urkmez, Weranja Ranasinghe, John W. Davis
Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Journal of UrologyAdult Urology1 Jan 2020
Retzius Sparing Robot-Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score Matched Analysis of 1,863 Patients

I just wanted to share this information for the new members coming on board or members currently on AS that things are changing and not to be discouraged by concerns over what many have seen in the past as the inevitable struggles they must face and accept after surgery. Will there be others that don’t have the rosy experience that this seems to paint, probably so, but it is a technique that every new patient should consider, evaluate and review in their research in deciding surgery.