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Retzius-sparing Robotic Prostatectomy

If you’re facing a prostate cancer diagnosis, you may be considering surgical options that offer effective cancer control while preserving your quality of life. Retzius-sparing robotic prostatectomy represents a refined surgical approach designed to remove the prostate while protecting important anatomical structures that support urinary continence and sexual function. This technique, performed using robotic assistance, modifies the traditional surgical approach to potentially improve functional outcomes while maintaining cancer control. Dr Tan Teck Wei is among a handful of urologists in the region proficient in this technique, and was the earliest doctor to perform this surgery in Tan Tock Seng Hospital, and in the private hospitals in Singapore.

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Dr Tan Teck Wei

MBBS|DFD (CAW)|MRCS|MMed (Surgery)|FAMS (Urology)

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TTW robotic Retzius-sparing Robotic Prostatectomy
Overview Candidate Techniques Process Recovery Benefits Risks Considerations FAQ
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Overview
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Techniques
Process
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Benefits
Risks
Considerations
FAQ

What is Retzius-sparing Robotic Prostatectomy?

Retzius-sparing robotic prostatectomy is a minimally invasive surgical technique for removing the prostate gland in men with localised prostate cancer. Unlike conventional robotic prostatectomy, which approaches the prostate through the space of Retzius (the area between the pubic bone and bladder), this technique preserves this anatomical space by approaching the prostate from behind, via the narrow space between the bladder and rectum.

The procedure utilises robotic surgical systems to provide enhanced precision and visualisation during surgery. By preserving the space of Retzius and the supporting structures of the bladder, including important ligaments and fascia, this approach aims to maintain the natural anatomical relationships that support bladder control and sexual function. The prostate, along with the seminal vesicles and surrounding tissue containing cancer, is completely removed while minimising disruption to its surrounding structures.

This surgical technique has shown promising results in maintaining urinary continence rates post-surgery, with the majority of patients experiencing faster recovery of bladder control compared to traditional approaches. The robotic platform allows surgeons to perform precise dissection with improved dexterity and visualisation, particularly beneficial when working in the confined pelvic space.

Who is a Suitable Candidate?

Ideal Candidates

Ideal Candidates

  • Men with clinically localised prostate cancer
  • Men concerned about preserving urinary continence and sexual function
  • Patients with adequate performance status for general anaesthesia and surgery
  • Those with life expectancy greater than 10 years who would benefit from definitive treatment of prostate cancer
Contraindications

Contraindications

  • Metastatic prostate cancer
  • Significant adhesions from previous pelvic surgery
  • Severe cardiovascular or pulmonary disease precluding general anaesthesia
  • Uncorrected bleeding disorders or coagulopathy
  • Active urinary tract infection

The decision for Retzius-sparing robotic prostatectomy requires careful evaluation by an experienced urologist proficient in the technique. Individual anatomy, cancer characteristics, and patient preferences all play crucial roles in determining the most appropriate surgical approach for each patient.

Treatment Techniques & Approaches

  • Retzius-sparing Approach

    The Retzius-sparing technique involves accessing the prostate through the pouch of Douglas, the narrow space between the rectum and bladder. This posterior approach allows complete preservation of the anterior support structures of the bladder. Studies have shown that preservation of these support structures allow much faster recovery of urine control after surgery compared with the conventional robotic prostatectomy technique.

  • Nerve-sparing Modifications

    The neurovascular bundles, which contain the nerves and blood vessels supplying the penis and are responsible for erectile function, run along both sides of the prostate. During Retzius-sparing prostatectomy, preservation of the neurovascular bundles can be performed based on cancer characteristics. Using the high-magnification visualisation provided by the robotic system, urologists can perform precise dissection to preserve these structures when oncologically safe.

  • Technology & Equipment Used

    The procedure utilises modern robotic surgical systems featuring high-definition 3D visualisation, and instruments with enhanced dexterity. The robotic platform provides 10-times magnification, allowing identification of fine anatomical structures. Specialised instruments enable precise tissue handling and suturing. The system’s tremor filtration and motion scaling enhance surgical precision during critical dissection steps.

Wondering which approach is right for you?

Dr Tan Teck Wei will evaluate your specific needs and recommend the most suitable technique.

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The Treatment Process

Pre-Treatment Preparation

Before surgery, patients undergo comprehensive evaluation including imaging studies to stage the cancer, and cardiac and anaesthetic clearance if indicated. Bowel preparation is usually not required. Patients must fast for 6 hours prior to surgery, and discontinue blood-thinning medications as directed. Pre-operative antibiotics are administered to reduce infection risk. Some patients may benefit from pelvic floor exercises starting before surgery to optimise post-operative continence recovery.

During the Procedure

The surgery begins with the patient being put under general anaesthesia. The surgeon then makes 6 small incisions in order to insert the robotic instruments and other equipment for the surgery. A bedside assistant helps with the surgery whilst the main surgeon is seated at the robotic console to control the robot during the procedure. The procedure typically takes 2 to 4 hours depending on anatomical complexity.

Immediate Post-Treatment

Following surgery, patients recover in the post-anaesthesia care unit before transfer to their room. A urinary catheter inserted during the procedure whilst under general anaesthesia remains in place for bladder drainage, typically for 7 to 10 days. For men who do not want the usual urinary catheter, a suprapubic catheter may be inserted instead (a suprapubic catheter is a catheter that exits via a small opening in the lower abdomen, rather than through the urethra). Pain management usually only requires oral medications for the first few days due to the minimally-invasive surgical approach. Most patients can ambulate within hours of surgery, and begin taking fluids after waking up. Hospital discharge usually occurs within 1 to 2 days when patients are comfortable and mobile.

Recovery & Aftercare

  • First 24-48 Hours

    Initial recovery focuses on pain control, early mobilisation, and preventing complications. Patients should walk regularly to reduce blood clot risk and promote healing. Showering is usually permitted after 48 hours. Diet progresses from liquids to regular food as tolerated. Patients learn catheter care and receive supplies for home management. Warning signs including fever, severe pain, or heavy bleeding require immediate medical attention.

  • First Week

    During the first week, activity gradually increases with short walks multiple times daily. Heavy lifting and straining must be avoided. The urinary catheter requires daily cleaning and secure positioning. Follow-up appointments confirm proper healing and the catheter is removed after 7 to 10 days. Patients will usually visit the pelvic physiotherapist after the catheter is removed, to learn pelvic floor exercises which will optimise their post-operative continence recovery.

  • Long-term Recovery

    After catheter removal, most men experience some degree of urinary leakage requiring protective pads or diapers initially. Continence typically improves progressively over weeks to months, with most patients achieving excellent control within 3 to 6 months with the Retzius-sparing robotic prostatectomy technique. Sexual function recovery varies but may continue improving over the first 12 months. Regular PSA monitoring begins at 2 to 3 months after surgery to confirm cancer control. Return to full activities including exercise usually occurs by 4 to 8 weeks.

Dr Tan Teck Wei provides comprehensive post-procedure support to ensure optimal recovery.

Schedule your consultation to learn more about what to expect.

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Benefits of Retzius-sparing Robotic Prostatectomy

This surgical approach offers several evidence-based advantages for appropriate candidates. The preservation of anterior support structures of the bladder often leads to improved early urinary continence rates, with many patients experiencing faster recovery of bladder control. The minimally invasive robotic technique results in less blood loss, reduced post-operative pain, and shorter hospital stays compared to open surgery.

The enhanced visualisation and precision afforded by robotic technology may improve the ability to preserve the neurovascular bundles when oncologically appropriate, potentially benefiting sexual function recovery. The Retzius-sparing approach maintains the natural anatomical relationships that support pelvic organ function. Studies have demonstrated comparable cancer control rates to traditional approaches while potentially offering functional advantages.

Risks & Potential Complications

Common Side Effects

Temporary urinary incontinence affects most patients initially, though severity varies. Men typically require pads or diapers for several weeks to months while continence recovers. Erectile dysfunction may occur, particularly if nerve-sparing is not possible due to cancer location. Recovery of sexual function depends on multiple factors including age and pre-operative function.

Other common side-effects include temporary bladder spasms, especially while the catheter remains in place. Mild pelvic discomfort and fatigue are expected during initial recovery. Some men experience temporary changes in orgasmic sensation or climacturia (urine leakage during orgasm).

Rare Complications

Serious complications occur infrequently but may include significant bleeding requiring transfusion, injury to surrounding organs, or anastomotic leak between bladder and urethra. Infection risk remains low with appropriate antibiotic prophylaxis. Deep vein thrombosis or pulmonary embolism are rare with early mobilisation.

Long-term complications may include bladder neck contracture requiring dilation or incision. Rarely, persistent severe incontinence may require additional procedures. Lymphocele formation can occur if lymph node dissection is performed. Dr Tan employs meticulous technique and proven protocols to minimise all surgical risks while ensuring comprehensive cancer treatment.

Cost Considerations

The cost of Retzius-sparing robotic prostatectomy varies based on several factors including the complexity of your case, length of hospital stay, and specific surgical requirements. The total cost typically encompasses surgeon fees, anaesthesia services, robotic system usage, operating theatre time, and hospital accommodation. Additional pathology testing and post-operative care are also included in comprehensive treatment packages.

While robotic surgery may have higher upfront costs than traditional open surgery, the reduced hospital stay and faster recovery often offset these differences. The potential for improved functional outcomes may also reduce long-term healthcare needs. Our clinic provides transparent, detailed cost estimates during consultation, helping you understand all financial aspects before proceeding with treatment.

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Dr Tan Teck Wei

MBBS (S’pore)

DFD (CAW)

MRCS (Edin)

MMed (Surgery)

FAMS (Urology)

Dr Tan Teck Wei is a Senior Consultant Urologist in Singapore who specialises in the management of complex urological cancers, including those affecting the kidneys, prostate, and bladder.

He is fellowship-trained in open, laparoscopic and robotic surgery. He also specialises in the management of other urological conditions including:

  • Prostate Enlargement
  • Recurrent Urinary Tract Infections
  • Stones

To date, Dr Tan Teck Wei has been involved in more than 500 robot-assisted surgeries, building up his volume of cases from his fellowship training days and cementing his expertise in robotic surgery.

Dr Tan Teck Wei believes in the holistic management of his patients, and seeks to journey with them from diagnosis to cure.  Dr Tan is effectively bilingual in English and Mandarin, making him a popular choice with the young and old, as well as international patients.

Dr Tan Teck Wei possesses a wealth of specialist experience in the field of Urology. He has previously held positions as a Consultant Urologist and Director of Genitourinary Oncology at Tan Tock Seng Hospital.

Dr Tan’s expertise in conducting MRI-targeted Prostate Biopsies led to his advisory role with the Ministry of Health’s Agency for Care Effectiveness. Furthermore, he has served as an Adjunct Assistant Professor and Clinical Teacher at the National University of Singapore (NUS) Yong Loo Lin School of Medicine and the Nanyang Technological University-Imperial College London’s Lee Kong Chian School of Medicine respectively.

He has actively participated in humanitarian initiatives as a member of the Singapore Navy surgical team, collaborating with the Indonesian Navy to provide healthcare services to the communities in Padang and Ambon. It is his passion to improve the standards of healthcare to patients both in Singapore and overseas.

  • Former Consultant Urologist and Director of Genitourinary Oncology, Tan Tock Seng Hospital
  • Adjunct Assistant Professor, National University of Singapore (NUS) Yong Loo Lin School of Medicine
  • Clinical Teacher, Nanyang Technological University-Imperial College London’s Lee Kong Chian School of Medicine
  • Advisor, Ministry of Health’s Agency for Care Effectiveness
  • Surgical Team, Singapore Navy
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Ready to Take the Next Step?

If you’re considering Retzius-sparing robotic prostatectomy, Dr Tan Teck Wei can help you understand if it’s the right choice for your needs. With considerable experience in robotic prostate surgery, he provides personalised care throughout your journey.

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    Frequently Asked Questions

    How long does Retzius-sparing robotic prostatectomy take to perform?

    The surgical procedure typically takes between 2 to 4 hours, though this varies based on individual anatomy and complexity. Factors affecting duration include prostate size, presence of adhesions from prior surgery, and whether nerve-sparing is performed. Your surgeon will provide a more specific estimate based on your particular case. Total time in the operating theatre including preparation and recovery is approximately 3 to 5 hours.

    When can I return to work after surgery?

    Most patients with desk-based jobs can return to work within 2 to 3 weeks following surgery. Those with physically demanding occupations may require 6 to 8 weeks before resuming full duties. The timing depends on your recovery progress, continence status, and comfort level. Many patients work from home initially while managing early continence recovery. Your surgeon will provide specific guidance based on your occupation and recovery progress.

    How effective is this surgery for cancer control?

    Retzius-sparing robotic prostatectomy demonstrates cancer control rates comparable to traditional surgical approaches when performed for appropriate candidates. Long-term studies show positive outcomes for localised prostate cancer. Success depends on accurate pre-operative staging and complete cancer removal. Your surgeon will discuss expected outcomes based on your specific cancer characteristics including PSA level, Gleason score, and clinical stage.

    Will I need additional cancer treatment after surgery?

    Many patients with localised prostate cancer require no additional treatment following successful surgery. Final pathology results guide further management decisions. If adverse features like positive margins or lymph node involvement are found, adjuvant radiation or hormone therapy may be recommended. Regular PSA monitoring helps detect any recurrence early. Your urologist will develop an individualised follow-up plan based on your pathology results.

    What’s the difference between Retzius-sparing and standard robotic prostatectomy?

    The key difference lies in the surgical approach and preservation of anatomical structures. Retzius-sparing technique approaches the prostate from behind, preserving the anterior support structures of the bladder and the space of Retzius. Standard robotic prostatectomy goes through this space, potentially disrupting supportive ligaments and fascia. Studies suggest Retzius-sparing may offer faster continence recovery while maintaining equivalent cancer control, though individual results vary based on multiple factors.

    How long will I need to use a urinary catheter?

    The urinary catheter typically remains in place for 7 to 10 days following surgery to allow proper healing of the connection between the bladder and urethra. For men who do not want the usual urinary catheter, a suprapubic catheter may be inserted instead (a suprapubic catheter is a catheter that exits via a small opening in the lower abdomen, rather than through the urethra). The exact duration of the urinary catheter depends on surgical factors and individual healing. After removal, temporary incontinence is expected while your body adjusts.

    Conclusion

    Retzius-sparing robotic prostatectomy represents an important advancement in surgical treatment for localised prostate cancer. By preserving crucial anatomical structures while ensuring comprehensive cancer removal, this technique offers the potential for improved functional outcomes without compromising oncological results. The combination of robotic precision and anatomical preservation may help maintain your quality of life during cancer treatment.

    If you’re considering surgical options for prostate cancer, understanding the nuances of different approaches helps inform your decision. Dr Tan Teck Wei can evaluate your specific situation and determine whether Retzius-sparing robotic prostatectomy aligns with your treatment goals and cancer characteristics.