Retzius-Sparing Versus Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis of Functional and Oncological Outcomes

<jats:p>Background and Objectives: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has emerged as an alternative to the conventional anterior approach, aiming to preserve pelvic anatomical structures responsible for urinary continence while maintaining oncological safety. This study evaluated the perioperative, pathological, functional, and early oncological outcomes of RS-RARP in patients with clinically localized prostate cancer. Methods: This retrospective cohort study included 132 consecutive patients who underwent RS-RARP at a single institution. Demographic, perioperative, pathological, functional, and oncological data were retrospectively collected. Primary functional outcomes included postoperative urinary continence recovery, while pathological findings, positive surgical margins (PSMs), and postoperative prostate-specific antigen (PSA) levels were evaluated as oncological outcomes. Results: The median operative time was 170 min (IQR, 160–200), with a median estimated blood loss of 100 mL (IQR, 70–150). Blood transfusion was required in one patient (0.8%), and no Clavien–Dindo grade ≥III complications occurred. Pathological examination demonstrated ISUP Grade Group 2 disease in 64.9% of patients, while the overall PSM rate was 33.6%. The median time to both social continence (0–1 pad/day) and complete continence (0 pad/day) was 30 days. At final follow-up, 82.4% of patients achieved complete pad-free continence, 9.9% required one safety pad daily, and 6.9% required two or more pads. Median follow-up was 12 months. Postoperative PSA remained undetectable (&amp;lt;0.2 ng/mL) in all patients with available follow-up, and no patient required salvage therapy. Conclusions: RS-RARP is a safe and effective surgical approach associated with low perioperative morbidity, acceptable pathological outcomes, rapid urinary continence recovery, and encouraging short-term oncological control. These findings support the functional advantages of the Retzius-sparing technique without compromising early oncological outcomes; however, prospective multicenter studies with longer follow-up are needed to confirm long-term efficacy.</jats:p>