Robotic surgical arm delicately preserving the Retzius space during a prostatectomy

Retzius-Sparing Prostatectomy: Is It Really a Game-Changer?

Beau Callahan in Health & Wellness December 2025 • 3 min read.

"Explore the evolution of prostate cancer surgery, comparing the Retzius-sparing approach (RS-RARP) to standard RARP and uncover the facts about continence, oncological safety, and long-term outcomes."

In the realm of prostate cancer (PCa) treatment, the introduction of robotic surgery has paved the way for numerous surgical innovations aimed at enhancing postoperative functional outcomes while maintaining oncological safety. Among these advancements, Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has garnered attention for its potential to improve urinary continence recovery.

The Retzius space, located between the pubic bone and the bladder, plays a crucial role in urinary control. RS-RARP involves preserving this space during surgery, which proponents believe leads to faster continence recovery compared to standard RARP techniques. The standard approach often involves disturbing this space, potentially leading to a longer recovery period for urinary control.

This article explores the nuances of RS-RARP, comparing it to standard RARP in terms of continence rates, oncological outcomes, and long-term results. We aim to provide a comprehensive overview, drawing from recent studies and expert opinions, to help you understand whether RS-RARP truly represents a significant advancement in prostate cancer surgery.

Retzius-Sparing Prostatectomy: How Does It Improve Continence?

Robotic surgical arm delicately preserving the Retzius space during a prostatectomy

The primary appeal of RS-RARP lies in its potential to expedite urinary continence recovery. This benefit stems from several anatomical factors preserved by the technique:

Intact Retzius Space: By keeping the Retzius space undisturbed, the bladder's natural support structures remain intact.
No Bladder Dropping: The urinary bladder is not displaced during the procedure.
Preservation of Endopelvic Fascia: The endopelvic fascia and puboprostatic ligaments, which are critical for urethral support, are maintained.
Minimal Urethral Tissue Distortion: RS-RARP minimizes disruption to the tissues supporting the urethra.

The anatomical benefits of RS-RARP contribute to reduced bladder neck descent, a factor associated with improved continence.

Several studies have reported promising early continence rates with RS-RARP. One study noted that continence rates (no pad/safety pad) reached 90% to 96% at one week and one year, respectively, post-surgery. Another group reported a 70% continence rate at one month after RS-RARP.

RS-RARP: Weighing the Benefits and Long-Term Outcomes

Retzius-sparing prostatectomy presents a promising avenue for enhanced early urinary continence recovery following prostate cancer surgery. While early results appear favorable, continued research and long-term data are essential to fully understand its oncological safety and lasting impact on patient outcomes. Patients considering prostate cancer surgery should engage in thorough discussions with their surgeons to determine the most appropriate approach based on individual factors and the latest evidence.

About this Article -

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Everything You Need To Know

What is Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and how does it differ from standard RARP?

RS-RARP is a surgical technique used in prostate cancer treatment that aims to improve urinary continence recovery after surgery. Unlike standard RARP, the RS-RARP approach preserves the Retzius space, the area between the pubic bone and the bladder. This preservation is believed to lead to faster continence recovery because it keeps the bladder's natural support structures intact, avoids bladder dropping, maintains the endopelvic fascia and puboprostatic ligaments, and minimizes disruption to the tissues supporting the urethra. Standard RARP often disturbs the Retzius space, potentially leading to a longer recovery period for urinary control.

How does preserving the Retzius space contribute to better urinary continence after Retzius-sparing prostatectomy?

Preserving the Retzius space during RS-RARP contributes to better urinary continence because it maintains several crucial anatomical structures. These include keeping the bladder's natural support structures, preventing the bladder from dropping, maintaining the endopelvic fascia and puboprostatic ligaments (critical for urethral support), and minimizing disruption to the tissues that support the urethra. By keeping these structures intact, RS-RARP reduces bladder neck descent, which is associated with improved continence.

What are the reported continence rates after RS-RARP compared to standard RARP?

Several studies have shown promising early continence rates with RS-RARP. One study indicated that continence rates (defined as no pad or safety pad use) reached 90% to 96% at one week and one year post-surgery, respectively. Another study reported a 70% continence rate at one month after RS-RARP. While the specific continence rates for standard RARP are not detailed in the provided context, the key advantage of RS-RARP lies in its potential for faster and improved continence recovery compared to standard techniques.

Besides continence, what other factors should patients consider when evaluating RS-RARP?

While the primary benefit of RS-RARP is enhanced early urinary continence recovery, patients should also consider oncological safety and long-term outcomes. It's crucial to discuss these aspects with their surgeons to ensure that the surgical approach chosen is the most appropriate for their individual circumstances. The long-term data is still developing. Comprehensive understanding of the cancer's specifics, overall health, and potential risks and benefits is essential.

Why is it important for patients to have thorough discussions with their surgeons regarding RS-RARP?

It is important for patients to have thorough discussions with their surgeons regarding RS-RARP because the decision about prostate cancer surgery is highly individual. These discussions should cover several key aspects. First, patients should understand the potential benefits of RS-RARP, particularly the improved early continence rates. Second, patients need to have a clear understanding of the potential drawbacks, including any possible impact on oncological safety or other long-term outcomes. Third, surgeons can explain how RS-RARP fits into the latest evidence and how it compares to alternative approaches, such as standard RARP. Finally, surgeons can assess individual factors such as cancer stage, overall health, and patient preferences to determine if RS-RARP is the most suitable option.