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Retzius-sparing - Best surgical technique for RARP?

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User
Posted 21 Nov 2017 at 14:09

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.

User
Posted 21 Nov 2017 at 14:09

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.

User
Posted 21 Nov 2017 at 18:03

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

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User
Posted 21 Nov 2017 at 18:03

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 Nov 2017 at 09:15
Hello

Could this have been avoided by undertaking traditional open surgery ?

User
Posted 22 Nov 2017 at 23:54

Very interesting

Thanks for sharing

User
Posted 23 Nov 2017 at 01:16
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

User
Posted 25 Jun 2018 at 15:34

Originally Posted by: Online Community Member

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.

I have only one experience of a urethral catheter which was inserted and removed under general anaesthetic during my template prostate biopsy, yet it still caused me to piss razor blades and blood for two days.

In contrast, my supra-pubic catheter fitted after my prostatectomy, where the pipework from the bladder emerges just above the penis, and is plumbed into a shin-pad style urine leg-bag, was nothing more than a minor inconvenience, and involved no pain at all.

I was more or less continent from my penis the moment the supra-pubic catheter was removed after ten days, with a total absence of razor blades and today, I am still completely continent, just three weeks to the day after my op.

Go, supra-pubic, I say, although I realise this is an additional technical complication for surgeons who just want to do their best and remove as much cancer that they can for their patients. But if they are low-volume urological surgeons doing all sorts of other urological procedures, they are unlikely to achieve the skill levels required to do any such thing.

I think of cataract “production line“ surgery in Cuba, where one nurse anaesthetises the patient, then on to the incision maker, the lens remover, the lens installer, and then the stitcher-upper. None are doctors, but they are world experts in their particular field, with fantastic outcomes overall.

I wonder if this will ever apply to prostate surgery in the future, and I expect a robot will do it more or less autonomously in due course.

https://www.santishealth.org/prostate-cancer-information-centre/an-introduction-to-the-use-of-catheters-radical-prostatectomy/

Edited by member 26 Jun 2018 at 11:33  | Reason: Not specified

 
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