Radical prostatectomy is an acceptable treatment for men with prostate cancer. Although the main purpose is the eradication of cancer, preserving the continence are become an important secondary outcome especially by the technical improvements in surgery. Technical changes in the preservation of the membranous urethral length, reconstruction of urethral and urethrovesical support, nerve-sparing surgery and finally posterior robot-assisted radical prostatectomy are described to maintain continence after prostatectomy. This study aims to compare Retzius‐sparing robot‐assisted radical prostatectomy (Rs‐RARP) vs standard robot‐assisted radical prostatectomy (RARP) in terms of continence after prostatectomy.

We prospectively collected the data from 92 patients who underwent robotic radical prostatectomy in our clinic by a single surgeon. We compared oncological data and continence rates of 46 patients who underwent Rs‐RARP with 46 patients who underwent RARP who had at least a one‐year follow‐up. Continence was defined as the absence of urinary incontinence with no leakage after surgery. Patients were assessed with PSA, pathology and for continence and potency after the first month of the surgery. Patients were also assessed bi‐monthly with PSA  and continence situation.

There were no significant differences in the mean age, mean BMI, preop SHIM score between groups. EAU prostate cancer risk classification was also similar. Preoperative median PSA value, prostate volume and the estimated blood loss are lower, catheter removal time is significantly shorter and in Rs‐RARP group(Table 1). One month after surgery, 41 patients (%89) were continent (use no pads) in Rs‐RARP group while 26 patients (%56) were continent in RARP group and it's statistically highly significant(p = 0.001)(Table 1). Patients in RS‐RARP group achieved faster recovery of urinary continence (Log‐rank, p = 0.001)(Figure 1). After a one‐year follow‐up, there were no differences in the continence rates and potency between two groups. 43 patients %93) were continent in Rs‐RARP group, 41 patients (%89) were continent in the RARP group. Potency rates were 38.7% in Rs‐RARP vs 36.6% in RARP respectively. No biochemical recurrence was observed in two groups after one‐year follow‐up.

Retzius sparing surgery for robot-assisted radical prostatectomy is providing early recovery continence. Early continence is an important issue for the patients perspective. In the retzius-sparing surgery group, some patients had to experience continence at catheter removal time. Although in the twelfth-month follow-up, two types of surgery method have similar continence rates, retzius sparing group has nearly continent in the third month after surgery.

Rs-RARP is a feasible technique compared to standard RARP in terms of oncological and functional outcomes in the short-to midterm follow-up. Rs-RARP clearly provides an early return of the continence. However, no significant difference in overall continence rates was observed in the first-year follow-up.