Prostate cancer is a common cancer in men, and surgical removal of the prostate, a prostatectomy, is a standard treatment option. Surgical techniques have continually evolved to minimize side effects and improve outcomes. The Retzius-sparing prostatectomy is a refined approach designed to reduce common post-operative complications, preserving quality of life after surgery.
Understanding the Retzius Sparing Approach
The “Retzius space” is the anatomical area in front of the prostate gland and behind the pubic bone. In traditional prostatectomy procedures, surgeons typically enter this anterior space to access and remove the prostate. The Retzius-sparing approach avoids entry into this region. Instead, the surgeon approaches the prostate from below, or a posterior direction, preserving the delicate structures within the Retzius space.
This minimally invasive technique is commonly performed using robotic-assisted laparoscopic prostatectomy (RALP). Small incisions are made in the abdomen for surgical instruments and a camera attached to robotic arms. The robotic system provides enhanced precision, magnification, and 3D visualization, allowing the surgeon to carefully remove the prostate while leaving anterior anatomical structures, including the puboprostatic ligaments, intact. This preservation differs from conventional methods, where these structures are often divided.
Advantages for Patient Recovery
The Retzius-sparing technique offers functional benefits for patient recovery, primarily early urinary continence and erectile function. Patients undergoing this procedure show significantly higher rates of early continence recovery compared to conventional prostatectomy. Studies indicate that 91.2% of patients achieved urinary continence within one week after catheter removal, compared to 54.3% in the standard approach. Another study reported 98% continence rates for Retzius-sparing patients versus 81% for standard robotic prostatectomy patients after 12 months, with continence achieved earlier, around 49 days versus 64 days.
This improved continence is attributed to the reduced trauma to the muscles and nerves that control bladder function, as the Retzius space, containing structures like the puboprostatic ligaments and external urinary sphincter, is largely undisturbed. These preserved attachments help stabilize the urethra and bladder neck, contributing to better bladder control post-surgery. While early potency recovery might not show immediate significant differences, some studies suggest improved erectile function at six months post-surgery. The preservation of nerves and blood vessels in this anatomical region is thought to contribute to better erectile outcomes, though more research is ongoing to confirm long-term sexual function benefits.
Who is a Candidate
Patient selection for Retzius-sparing prostatectomy is a considered process, considering factors related to prostate cancer and overall patient health. This approach is generally suitable for individuals with localized prostate cancer, often those with lower to intermediate-risk tumors. Factors like tumor size, location, and aggressiveness (determined by Gleason score and PSA levels) play a role in candidacy.
While some surgeons may prefer this technique for non-anterior tumor locations or those without large median lobes, recent evidence suggests it can be feasible and safe even in some higher-risk settings. Not all patients are suitable candidates, and the decision also involves patient-specific factors, such as individual anatomy and overall health status. A thorough discussion with an experienced surgeon is necessary to determine if it is the appropriate treatment option.
What to Expect After Surgery
Following a Retzius-sparing prostatectomy, patients can anticipate a prompt initial recovery. The typical hospital stay is short, often one to two days. Patients will have a urinary catheter in place for about one to two weeks to allow the surgical site to heal. Some studies suggest a suprapubic catheter, placed directly into the bladder through the abdomen, may be more comfortable than a urethral catheter for some patients.
Patients are encouraged to begin walking and light activity soon after surgery to aid recovery. Adherence to post-operative care instructions, including prescribed medications and pelvic floor exercises, is important for optimizing functional outcomes, especially for urinary control. Follow-up appointments monitor recovery, assess continence and erectile function, and track prostate-specific antigen (PSA) levels to ensure cancer control. While individual recovery timelines vary, many patients experience significant improvements in urinary control within weeks to a few months.