Leakage of urine after prostate cancer surgery is one of men's biggest concerns. Most men regain good bladder control over the months after surgery, but the speed of recovery varies. Retzius-sparing robotic prostatectomy is a technique designed to help some men regain continence sooner by changing the route the surgeon takes to reach the prostate.
What the Retzius space is
The Retzius space is the area between the pubic bone and the front of the bladder. It contains fat, blood vessels and supporting tissues, including ligaments that help hold the bladder and urethra in position.
In a standard robotic prostatectomy, the surgeon opens this space to reach the front of the prostate. The bladder is moved backwards, and the supporting structures at the front are divided.
How the Retzius-sparing approach differs
In a Retzius-sparing operation, the surgeon reaches the prostate from behind, through a space between the bladder and the rectum. The structures at the front, including the supporting ligaments and the network of blood vessels, are left largely undisturbed.
The prostate is then removed from behind, and the bladder is joined to the urethra from the same direction. This is technically more demanding, as the working space is smaller and the view is different from a standard operation. Surgeons who perform it regularly have usually trained specifically in the technique.
Possible benefits
Research suggests that Retzius-sparing surgery may offer:
- Earlier continence: many studies report that more men are dry, or nearly dry, in the first weeks and months after surgery compared with the standard approach.
- Similar cancer control: for suitable men, studies have generally shown similar cancer outcomes.
- Preservation of anatomy: supporting structures that may help continence are kept.
Over the longer term, at around a year after surgery, the difference in continence between the two approaches tends to become smaller, as most men improve whichever technique is used. For men who need to return to work or an active lifestyle quickly, earlier continence can still make a real difference to daily life.
Possible drawbacks
There are some considerations:
- Margins: some studies have found a slightly higher rate of positive margins at the front of the prostate, especially for tumours in that area. This is why careful selection matters.
- Technical difficulty: the technique has a learning curve and is not offered everywhere.
- Not suitable for every man: it may be harder in men with very large prostates, a large middle lobe or previous surgery.
Who may be suitable
The approach may be considered for men with:
- cancer confined to the prostate
- tumours not located mainly at the front of the gland
- a prostate of suitable size
MRI helps identify where the cancer sits and whether the technique is appropriate. Our guide to how MRI helps plan your prostatectomy explains this.
Combining with nerve-sparing
Retzius-sparing surgery addresses continence, while nerve-sparing focuses on erections. The two can be combined. Our articles on nerve-sparing robotic prostatectomy and the SAFE technique explain approaches to protecting the nerves.
Recovery
Recovery is similar to a standard robotic prostatectomy. Most men go home after one or two nights, with a catheter for one to two weeks. Pelvic floor exercises remain important. Our step-by-step pelvic floor guide explains how to do them.
Questions to ask
- Is the Retzius-sparing approach suitable for my cancer?
- How many of these operations have you performed?
- How would it affect my chance of a clear margin?
- What continence recovery would you expect for me?
Prostate Cancer UK has information on continence after surgery, and the British Association of Urological Surgeons publishes patient leaflets on prostatectomy.
The best approach depends on your cancer and anatomy. Professor Prokar Dasgupta can discuss the surgical options that suit you at The London Clinic. Please contact the clinic to arrange a consultation.