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Can salvage Retzius-sparing robotic-assisted radical prostatectomy improve continence outcomes? A systematic review and meta-analysis study

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Abstract

Purpose

Salvage Radical Prostatectomy is challenging and associated with high rates of incontinence. The novel Retzius-sparing RARP (RS-RARP) approach has shown impressive high immediate and 1-year continence rates (> 90%) when applied as primary treatment. The purpose of this study is to evaluate the impact of salvage Retzius-sparing RARP (sRS-RARP) on continence outcomes in the salvage scenario.

Materials and methods

Using PRISMA guidelines, a systematic review and meta-analysis of articles was conducted on Medline through PubMed and on Cochrane through Central Register of Controlled Trials databases. Inclusion and exclusion criteria were used to select 17 retrospective cohort studies published until April 2023 about sRS-RARP and continence. Data were extracted independently by at least two authors. The International Prospective Register of Systematic Reviews (PROSPERO) was registered. Retrospective studies were subjected to a domain-based risk of bias assessment in accordance with the Newcastle–Ottawa quality assessment scale cohort studies (NOS). Prostate cancer patients were chosen from prospective nonrandomized or randomized sRS-RARP or sS-RARP studies that examined continence outcomes.

Results

Seventeen studies were included: 14 were retrospectives only and 3 described retrospective comparison cohorts (sRS-RARP vs sS-RARP). All the retrospective studies were of “fair” quality using the NOS. sRS-RARP may increase recovery of urinary continence after surgery compared to sS-RARP [OR 4.36, 95% CI 1.7–11.17; I2 = 46.8%; studies = 4; participants = 87].

Conclusions

sRS-RARP approach has potential to improve continence outcomes in the salvage setting.

Patient summary

sRS-RARP approach has potential to positively impact continence function on patients who underwent salvage surgery.

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Data availability

Not applicable.

Abbreviations

RS-RARP:

Retzius-sparing robotic-assisted radical prostatectomy

sRS-RARP:

Salvage Retzius-sparing RARP

PROSPERO:

International prospective register of systematic reviews

NOS:

Newcastle–Ottawa quality assessment scale cohort studies

PCa:

Prostate cancer

BMI:

Body mass index

PSA:

Prostate-specific antigen

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

OR:

Odds ratio

SMD:

Standardized mean difference

CI:

Confidence interval

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Acknowledgements

We thank Prof. Marcos Tobias-Machado, Urology Division, Centro Universitário FMABC, Santo André, São Paulo, Brazil.

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Authors and Affiliations

  1. Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil

    Igor Nunes-Silva, Alexandre Kyoshi Hidaka, Felipe Placco Araujo Glina, Renan Murata Hayashi & Sidney Glina

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  1. Igor Nunes-Silva
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  2. Alexandre Kyoshi Hidaka
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  3. Felipe Placco Araujo Glina
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Contributions

IN-S: project development, data management, data analysis, manuscript writing/editing. AKH: project development, data management, data analysis, manuscript writing/editing. FPAG: project development, data management, data analysis, manuscript writing/editing. RMH: data management, manuscript writing/editing. SG: project development, data management, data analysis, manuscript writing/editing.

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Correspondence to Renan Murata Hayashi.

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All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Research involving human participants, their data or biological material

None. This is a systematic review and meta-analysis study. The International Prospective Register of Systematic Reviews (PROSPERO) has registered the protocol for this study that includes the inclusion criteria (PROSPERO ID 425688).

Informed consent

None. This is a systematic review and meta-analysis study. The International Prospective Register of Systematic Reviews (PROSPERO) has registered the protocol for this study that includes the inclusion criteria (PROSPERO ID 425688).

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Nunes-Silva, I., Hidaka, A.K., Glina, F.P.A. et al. Can salvage Retzius-sparing robotic-assisted radical prostatectomy improve continence outcomes? A systematic review and meta-analysis study. World J Urol 41, 2311–2317 (2023). https://doi.org/10.1007/s00345-023-04505-w

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