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Retzius-sparing - Best surgical technique for RARP?

User
Posted 21 November 2017 14:09:31(UTC)

I have recently undergone a Robot Assisted Radical Prostatectomy (RARP) using the conventional surgical approach, which results in having a urethral catheter in-dwelling for 7 to 10 days.

Not only did I find this very uncomfortable I also found it’s removal difficult and painful. In addition, I had to have a cystogram prior to the catheter removal to check the water-tightness of the anastomosis between my bladder and urethra. This required saline solution to be ‘pumped’ up the catheter to fill my bladder under pressure to check for leaks before the urologist would agree to have the catheter removed. Not particularly pleasant.

I wondered if there was a RARP surgical technique that would have avoided these catheter complications, and I was surprised to discover the following articles by Professor Christopher Eden

https://www.santishealth.org/prostate-cancer-information-centre/an-introduction-to-retzius-sparing-radical-prostatectomy/

and

https://www.santishealth.org/prostate-cancer-information-centre/retzius-sparing-radical-prostatectomy-one-year-on/

In these, Professor Eden describes the anatomical region known as the “Cave of Retzius” and a alternative surgical approach (developed by Professor Aldo Bocciardi) which spares this region compared to the conventional RARP surgical approach. Not only does this avoid having to use a urethral catheter in most cases (and subsequent cystogram checks) he and others advocate that it provides much improved continence and potency results with an equivalent level of cancer control for a range of PCa stages.

See:-

http://www.europeanurology.com/article/S0302-2838(17)30339-1/fulltext

for controlled trial results.

Professor Eden carried out the first Retzuis-sparing RARP in the UK in 2016, and strongly advocates its wider adoption throughout the UK by suitably skilled and trained urologists.

I wish I had known about this prior to my discussions with my urologist before electing to have a conventional anterior RARP. I would have liked to have checked if the Retzuis-sparing approach was available/suitable, as I would almost certainly have chosen that option.

Perhaps others can use this information to make a more informed decision about electing for the RARP option if offered to treat their PCa.

Thanked 1 time
User
Posted 21 November 2017 18:03:47(UTC)

Most men find the catheter tolerable and I suspect few would opt for a suprapubic catheter if they could avoid it. You could have asked about a perineal prostatectomy but a catheter would still be needed.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 22 November 2017 09:15:56(UTC)
Hello
Could this have been avoided by undertaking traditional open surgery ?
User
Posted 22 November 2017 23:54:21(UTC)

Very interesting

Thanks for sharing

User
Posted 23 November 2017 01:16:53(UTC)
Originally Posted by: Online Community Member
Hello
Could this have been avoided by undertaking traditional open surgery ?


Hi Harry, no - open RP also requires a catheter. It is because the urethra runs right through the middle of the prostate so when that is removed, there are two raw ends of the urethra to join back together. The catheter is used while the join is healing.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


 
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