Retzius-sparing robot-assisted radical prostatectomy is an advanced surgical technique used for the treatment of prostate cancer. This technique is designed to reduce postoperative complications, such as urinary incontinence and erectile dysfunction, by maintaining critical anatomical structures. Neurovascular bundle (NVB) preservation is crucial for maintaining erectile function and urinary continence following radical prostatectomy.

A 53-year-old man was diagnosed of prostate cancer after a prostate biopsy due to elevated serum PSA level(6.4 ng/mL). Pathology results: adenocarcinoma, Gleason score 4+3=7(2/12 cores). MRI revealed no obvious regional lymph node or distant metastasis. Initial risk stratification is unfavorable intermediate group according to NCCN Guideline. After extensive discussions with the patient regarding the potential risks and benefits, he provided consent to proceed with for the robotic-assisted radical prostatectomy.

The operative time was 2 hours and 52 minutes, with a blood loss 150 mL. Bilateral pelvic lymph nodes dissection was not performed. No obvious intraoperative or postoperative complication was noticed. Pathology revealed acinar adenocarcinoma, Gleason score: 3+4 = 7, with margin uninvolvement, bilateral seminal vesicle invasion present, pT3b. The patient exhibited good urinary continence two weeks after operation. No pad was needed. Sex rehabilitation with vacuum device was offered.

We have demonstrated out technique to perform bilateral neurovascular bundle preservation in robot-assisted Retzius-sparing radical prostatectomy. The advantages of this technique include better continence rate and may proceed with earlier sex rehabilitation.