Early urinary continence recovery after extraperitoneal Retzius-space-sparing robot-assisted radical prostatectomy: a single-center retrospective cohort study
This single-center retrospective cohort study demonstrates that extraperitoneal Retzius-space-sparing robot-assisted radical prostatectomy significantly accelerates early urinary continence recovery at one and three months postoperatively compared to conventional surgery, likely due to the preservation of a longer membranous urethral length.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For men facing the removal of a cancerous prostate, the surgery itself is often a success in stopping the disease, but the path to a normal life afterward can be complicated by a different kind of challenge: the ability to control urine. The body relies on a complex system of muscles and connective tissues to keep the bladder closed, much like a door held shut by a sturdy frame and a tight seal. When surgeons remove the prostate, they must navigate around these delicate structures. If the supporting tissues are cut or disturbed too much, the "door" may not close properly, leading to leakage. In recent years, medical teams have developed new ways to perform this operation that try to leave those supporting structures untouched, hoping to help patients regain control of their bladder faster.
A team of surgeons at Shandong Provincial Hospital in China recently put one of these newer approaches to the test. They compared two methods of robot-assisted surgery for removing the prostate. The first method, known as the conventional approach, involves clearing away fatty tissue and cutting through specific ligaments and layers of fascia to reach the prostate from the front. The second method, called the Retzius-space-sparing technique, takes a different route. Instead of cutting through the front supports, the surgeon works within the extraperitoneal space using a transvesical, posteriorly directed dissection to reach the prostate. This allows the surgeon to leave the front-facing support structures—the ligaments and connective tissues that hold the urethra in place—completely intact. The researchers wanted to know if preserving these structures actually helped men stop leaking urine sooner after surgery.
The study looked at 263 men who underwent the procedure between January 2024 and December 2025, all operated on by the same senior surgeon. Of these, 198 men received the conventional surgery, while 65 men received the Retzius-space-sparing technique. The researchers measured how quickly the men achieved "social continence," a standard definition meaning they needed no more than one protective pad per day. They checked this status within 24 hours of removing the catheter, and again at one, three, and six months after the operation. They also carefully measured the length of the membranous urethra, a specific segment of the tube that carries urine, because a longer length is known to be a strong predictor of better bladder control.
The results showed a clear difference in the early weeks following surgery. Men who had the Retzius-space-sparing procedure regained control significantly faster. At one month after the operation, about 81.5 percent of the men in the sparing group were continent, compared to roughly 60 percent of those in the conventional group. By the three-month mark, the gap remained wide, with 93.8 percent of the sparing group continent versus 73.7 percent of the conventional group. The researchers confirmed that this advantage held true even after accounting for other factors like the patient's age, body mass, and the length of their urethra. The men who had the tissue-sparing surgery were more than three times as likely to be continent at one month and more than five times as likely to be continent at three months compared to those who had the standard surgery.
However, the story changes as time goes on. By six months after the surgery, the difference between the two groups had disappeared. In both groups, more than 95 percent of the men had regained full control, suggesting that while the new technique offers a much faster recovery, the conventional method eventually catches up for most patients. The study also noted that the men in the tissue-sparing group had slightly longer membranous urethras on average, which likely contributed to their better outcomes, but the benefit of the new technique remained strong even when the researchers adjusted for this anatomical difference.
The researchers are careful to note that their findings come from a single center and one surgeon, so the results might look different in other hands or settings. They also point out that the study was retrospective, meaning they looked back at records rather than randomly assigning patients to one group or the other, which can introduce subtle biases. Despite these limitations, the data provides a compelling picture of how preserving the body's natural support structures can speed up the return to a normal life. For men facing this surgery, the choice of technique appears to offer a significant head start in the race to regain bladder control, even if the final destination is the same for most.
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