Study shows Retzius-sparing robotic prostatectomy at MedStar Georgetown University Hospital improves patient quality of life without compromising cancer control
Patients 80% less likely to experience urinary incontinence 12 months following surgery
June 15, 2020
Washington, D.C. — Retzius-sparing robotic prostatectomy, an innovative surgical approach to treat men with prostate cancer, has shown to significantly reduce the risk of urinary incontinence, or urine leakage, and also improve patient’s quality of life without compromising oncological outcomes, according to a new study led by Keith Kowalczyk, M.D., director, Urologic Oncology at Medstar Georgetown University Hospital. Only the 3rd of its kind in the United States, this study examined data gathered from 140 radical prostatectomies performed by Dr. Kowalczyk over a 4-year period at MedStar Georgetown University Hospital.
The findings show that, in comparison to standard robotic prostatectomy, men undergoing Retzius-sparing robotic prostatectomy had higher rates of continence (98% vs. 81%), achieved continence earlier (49 vs. 64 days), and demonstrated 80% lower risk of suffering from incontinence one year following surgery. Additionally, men undergoing Retzius-sparing prostatectomy had significantly better overall quality of life one year following surgery.
Urinary incontinence and compromised quality of life following a radical prostatectomy has been a barrier to seeking appropriate care for some prostate cancer patients. “We tend to underestimate the effect that even mild urine leakage may have on patient’s quality of life and well-being following prostatectomy. That is why I decided to learn this new technique, even though it is technically very challenging. I am glad that I did because I have seen a remarkable improvement in outcomes for my patients as seen in this study,” Dr. Kowalczyk said.
Following robotic prostatectomy, most patients were able to leave the hospital less than 24 hours after surgery and resume routine activities in 1–2 weeks. Additionally, patients undergoing Robotic surgery tend to have less pain and discomfort following the surgery, translating to a minimal need for pain medications during hospitalization and no need for narcotic pain medications at home. Sean Hawkins, a patient who underwent the surgery said, “After about 3 weeks I regained all of my functions and ended up going back to work earlier than I expected, I got my life back totally.”
“Robotic surgery allows for a much more precise surgery with much easier recovery and less blood loss for the patient,” said Dr. Kowalczyk. “With Retzius-sparing robotic prostatectomy, the whole surgery is done in a very small space in the pelvis which is not accessible during traditional open surgery. This allows us to leave as much as the normal pelvic anatomy intact as possible without causing surrounding damage, which is most likely what leads to these improved outcomes.”
Medstar Georgetown University Hospital acquired the DaVinci Xi Dual Console robot in February 2020, and Dr. Kowalczyk has started performing the surgeries on this platform. The state-of-the-art surgical system offers a minimally-invasive option for patients who require a prostatectomy. The new technology uses fine instrumentation, 3-D visuals, increased magnification, and only requires a less than ½ inch incision. In addition, the DaVanci Xi platform allows improved visualization and improved movement of instrumentation. “Using the Xi platform has made this surgery much easier for me, for sure.” said Dr. Kowalczyk.
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