Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is a surgical technique that preserves the retropubic space by accessing the prostate through Douglas pouch. This approach has attracted increasing attention for its potential to enhance early recovery of urinary continence. We aim to report the initial perioperative and oncological outcomes, results in a cohort of 50 patients with prostate cancer who underwent RS-RARP.

Retrospective data were collected from September 2023 to March 2025, including 50 patients who treated with RS-RARP for localized prostate cancer. The operations were performed by a single surgeons. Perioperative characteristics, intraoperative variables, early oncological and functional outcomes were assessed.

The median age of the 50 patients was 69 years [64–72], with a median prostate volume of 40 mL [31–50.5] and median preoperative PSA level of 9.5 ng/mL [6.4–14.1]. Most patients were categorized as either favorable or unfavorable intermediate risk (34% and 36%, respectively). The median console and operative times were 130 minutes [110–150] and 198 minutes [177–227], respectively. Median estimated blood loss was 300 mL [150–412.5]. Final pathology revealed 88% of patients had Gleason grade group 2 or 3, with 38% presenting with extraprostatic extension (26% pT3a, 12% pT3b). Positive surgical margins were identified in 28% of patients, and lymph node involvement was found in 3 patients (6%). At 1 month postoperatively, there is 1 patient (2%) showing PSA > 0.2 ng/mL. Median PSA (post operative 1 month) was 0.014 ng/mL [0–0.03]. The 1-month incontinence rate was 26%, defined as using >1 pad/day.

Our preliminary experience with Retzius-sparing robot-assisted radical prostatectomy demonstrates highly satisfactory immediate continence outcomes, without compromising oncological prognosis. Further studies are warranted to evaluate long-term functional and oncological outcomes.