Retzius-sparing prostatectomy is a treatment to eradicate prostate cancer and allow a return to normal life more effectively than after a typical robotic prostatectomy.
How does Retzius-sparing prostatectomy work?
It is a key-hole, computer-assisted procedure to treat prostate cancer with a significant advantage over the traditional robotic prostatectomy. The pivotal difference is that the prostate is reached by going behind rather than in front of the bladder.
Under a general anaesthetic, key-hole incisions are made and narrow instruments placed inside the body. Using robotic assistance, the nerves that give erections are released very carefully from the prostate. Then, the prostate is separated from the bladder and urethra. To further improve bladder control, more urethra is retrieved from inside the prostate.
The prostate is sent for analysis during the operation to see if there is cancer on the edges particularly where the nerves for erections are located. Usually, there is no cancer, so no action is needed. However, if cancer is present, then the surgeon can remove more tissue to avoid leaving cancer behind.
The bladder and urethra are joined up. A catheter is placed through the lower tummy area and this is called a suprapubic catheter.
- Physical activity after surgery can occur with good bladder control because the bladder is largely untouched and more urethra is kept
- Erections, if normal before, can be achieved more reliably than the standard approach. Better erections are possible because the nerves are preserved more consistently since they are seen directly and early during the procedure at an easier point to release.
- Follow up after treatment is much easier compared to focal therapy or partial ablation or radiotherapy since only the PSA needs to be followed unlike other treatments that also need multiple MRI scans and repeated prostate biopsies
- As the prostate is removed, there is no chance of persistence or recurrence of disease in the prostate unlike other treatments that keep the prostate. However, if there is unknown cancer outside the prostate that will still need therapy like all treatments for prostate cancer
- A catheter through the lower belly, which is called a suprapubic catheter, is much more comfortable that a catheter through the penis
Men with localised prostate cancer
Most men stay one or two nights in hospital. The suprapubic catheter is removed seven to ten days later. You should take at least two weeks off and preferably a month. Most of the improvement occurs in the first few weeks, but improvement continues to occur over several months