EURURO Vol. 72 No. 5

Platinum Priority – Editorial

Referring to the article published on pp. 677–685 of this issue

Will Retzius-sparing Prostatectomy Be the Future of Prostate

Cancer Surgery?

Antonio Galfano

Silvia Secco, Aldo Massimo Bocciardi

Urology Unit, Niguarda Hospital, Milan, Italy

In this month’s issue of European Urology, Dalela et al

report a randomized clinical trial (RCT) that compares early

continence in standard robot-assisted radical prostatec-

tomy (RARP) and in Retzius-sparing prostatectomy (RSP).

The features of this study are peculiar and deserve

attention: the authors call it a ‘‘pragmatic’’ RCT, and in our

opinion, this is the case. Indeed, it has been conducted

using the most robust and severe methodology. It satisfies

the internationally recognized CONSORT guidelines;

it has been registered in a worldwide-known database

(clinicaltrials.gov). It is a single-surgeon study; the results

were evaluated by an independent third party, using an

objective method (pad weight); outcome assessment was

blinded to the procedure; and the surgical team had no

access to outcome files.

The Retzius-sparing approach resulted in statistically

and clinically significant advantages as regards immediate

continence recovery, whatever parameter was considered:

rate of no-pad patients, number of pads, weight of pads,

urinary bother, and urinary function questionnaires.

available at

journal homepage:

[(Fig._1)TD$FIG]

Fig. 1 – Urinary continence recovery in 600 patients with >1 yr follow-up. (A) Overall, 84% of patients are continent (no pad/safety pad) 1 wk after

surgery. (B) Stratifying for nerve-sparing status, more than 70% of non–nerve-sparing patients are continent 1 wk after surgery. NS = nerve sparing.

DOI of original article:

* Corresponding author. Department of Urology, Niguarda Hospital, Piazza dell’Ospedale Maggiore, 3, 20162 Milan, Italy. Tel. +39 02 6444 7896;

Fax: +39 02 6444 4882.

E-mail address:

(A. Galfano).

0302-2838/