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Retzius-Sparing Robotic Radical Prostatectomy

A robotic radical prostatectomy technique performed via a posterior, transperitoneal approach that preserves the anterior pelvic structures (Retzius space, dorsal venous complex, puboprostatic ligaments) to improve early urinary continence after surgery for localized prostate cancer.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Retzius-Sparing Robotic Radical Prostatectomy?

Retzius-sparing robotic radical prostatectomy (RS-RARP) is performed via a posterior, transperitoneal approach: the prostate is approached through the pouch of Douglas, between the rectum and seminal vesicles, without disturbing the anterior pelvic anatomy.

Preserved structures include the Retzius space, the dorsal venous complex, the puboprostatic ligaments, the endopelvic fascia, and the bladder anterior wall, all of which contribute to urinary continence and pelvic floor stability.

Compared with anterior or standard approaches, RS-RARP has been shown in randomized trials to improve early urinary continence (immediate to 3 months) without compromising oncologic outcomes (positive margin rates, biochemical recurrence) when performed by experienced robotic surgeons.

Symptoms

Localized prostate cancer (clinical stage T1c to T2) confirmed on biopsy with intermediate or high-risk features that are candidates for surgical management
Patient preference for surgical over radiotherapy management
PSA level less than 20 ng/mL with negative metastatic work-up
Higher Gleason grade with anatomically organ-confined disease on multiparametric MRI
Younger patients in whom rapid continence recovery is a priority

Risk Factors

Large prostate volume greater than 80 mL (relative technical difficulty)
Prior pelvic surgery or radiotherapy with significant adhesions
Severe obesity (BMI greater than 40) limiting docking angles
High clinical stage (cT3) with extracapsular extension
Active inflammatory bowel disease or significant rectal pathology

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Newly diagnosed localized prostate cancer with intermediate or high-risk features — referral to robotic prostate surgery center
  • Multidisciplinary urologic oncology consultation for shared decision-making between surgery and radiotherapy
  • Postoperative new-onset urinary incontinence persisting beyond 12 months — pelvic floor physiotherapy or referral for sling or sphincter implantation
  • Postoperative biochemical recurrence (PSA above 0.2 ng/mL on two consecutive measurements) — restaging imaging and salvage therapy planning
  • Severe early postoperative complications (urinary retention, hematuria, pelvic hematoma) requiring inpatient assessment

Treatment Methods

01
Multidisciplinary prostate cancer team review with multiparametric MRI, prostate biopsy, and risk stratification
02
Robotic posterior, transperitoneal dissection through the pouch of Douglas with preservation of seminal vesicles and Denonvilliers fascia as oncologically appropriate
03
Preservation of the Retzius space, the dorsal venous complex, and the puboprostatic ligaments to support urinary continence
04
Vesicourethral anastomosis with running barbed sutures and selective neurovascular bundle preservation depending on oncologic risk
05
Postoperative pelvic floor rehabilitation, structured PSA follow-up, and adjuvant or salvage therapy in patients with high-risk pathology or biochemical recurrence

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.