THE INFLUENCE OF THE CHOICE OF FASCIAL RARP TECHNIQUE ON THE RESTORATION OF CONTINENCE AND ERECTILE FUNCTION
B.V. Khanaliev
,
I.R. Chudiev,
T-A.A. Aliev,
U.A. Aliev
ABSTRACT
Background. Prostate cancer (PCa) is a malignant neoplasm arising from the glandular epithelium of the prostate. It currently ranks among the most frequently diagnosed oncological diseases in men. Robot-assisted radical prostatectomy (RARP) is considered the primary radical treatment for localized forms of PCa. Purpose. To assess the effectiveness of robot-assisted radical prostatectomy using various types of fascial dissection.
Materials and methods. From 2018 to 2024, a total of 200 robot-assisted radical prostatectomies (RARP) with bilateral preservation of the neurovascular bundles were performed at the Urology Department of the N.I. Pirogov National Medical and Surgical Center in patients with localized prostate cancer. All patients were randomized into four groups of 50 individuals: Group 1 — intrafascial RARP; Group 2 — interfascial RARP; Group 3 — extrafascial RARP. All procedures were performed by a single robotic surgeon using a standardized technique.
Conclusion. Intrafascial dissection provides the best chances for rapid recovery of function: continence and erectile function are achieved more frequently and earlier compared with the interfascial technique; when patients are properly selected and surgery is performed by an experienced surgeon, oncological safety is not compromised. The interfascial technique yields intermediate outcomes: functionally inferior to the intrafascial method but potentially more reliable in terms of resection margins in patients with a higher risk of extracapsular extension. Extrafascial dissection maximizes oncological radicality at the expense of functional outcomes, making it appropriate for patients with elevated risk of positive margins or suspected extracapsular tumor growth.
ABOUT AUTHORS
Head of the urology department Institute for Advanced Medical Studies, National Medical and Surgical Center named after N.I. Pirogov; Moscow, Russia
https://orcid.org/0000-0003-1188-2144 | SPIN-код: 5639-1843 | AuthorID: 1077100
Urologist in the urology department Institute for Advanced Medical Studies, National Medical and Surgical Center named after N.I. Pirogov; Moscow, Russia
https://orcid.org/0009-0006-3795-1071 | AuthorID: 758490
Urologist in the urology department Institute for Advanced Medical Studies, National Medical and Surgical Center named after N.I. Pirogov; Moscow, Russia
https://orcid.org/0009-0007-2318-9693 | AuthorID: 389138
Urologist in the urology department Institute for Advanced Medical Studies, National Medical and Surgical Center named after N.I. Pirogov; Moscow, Russia
https://orcid.org/0009-0009-3457-5148 | AuthorID: 410329
LITERATURE
- Шевченко Ю. Л., Карпов О. Э., Ветшев П. С., Степанюк И. В. Робототехника в хирургии: истоки, реалии, перспективы // Вестник Национального медико-хирургического центра имени Н. И. Пирогова. — 2008. — Т. 3, № 2. — С. 72–76.
- Gezginci E., Özkaptaş O., Yalçın Ş., Akın Y., Rassweiler J., Gözenc A. S. Postoperative Pain and Neuromuscular Complications Associated With Patient Positioning After Robotic Assisted Laparoscopic Radical Prostatectomy: A Retrospective Non-Placebo and Nonrandomized Study // International Urology and Nephrology. — October 2015. — Vol. 47, No. 10. — P. 1635–1641. DOI: 10.1007/s11255-015-1088-8.
- Лоран О. Б., Котов С. В., Велиев Е. И., Няхин В. А. Анализ качества жизни пациентов в течение первого года после радикальной позадилонной простатэктомии // Онкоурология. — 2005. — № 2. — С. 50–53.
- Shin H. J., Yoon H. K., Lee J. H. at al. Robotic Single-Port Surgery Using the Da Vinci SP Surgical System for Benign Gynecologic Disease: A Preliminary Report // Journal of Minimally Invasive Gynecology. — March 2020.
- Пушкарь Д. Ю., Колонтарев К. Б. Робот-ассистированная радикальная простатэктомия. Функциональный результат. Часть I // Хирургия. Журнал имени Н. И. Пирогова. — 2019. — № 3 (1). — С. 111–120. DOI: 10.17116/hirurgia2019031111.
- Пушкарь Д. Ю., Колонтарев К. Б. Робот-ассистированная радикальная простатэктомия. Функциональный результат. Часть II // Хирургия. Журнал имени Н. И. Пирогова. — 2019. — № 4. — С. 80–86. DOI: 10.17116/hirurgia201904180.
KEYWORDS: prostate cancer; robotic prostatectomy; ability to retain urine; erectile function; prostate-specific antigen.
CORRESPONDENCE: Turpal-Ali A. Aliev, e-mail: turpal.urolog@mail.ru
FOR CITATIONS: Khanaliev B.V., Chudiev I.R., Aliev T-A.A., Aliev U.A. The iInfluence of the Choice of Fascial RARP Technique on the Restoration of Continence and Erectile Function // Bulletin of the Medical Institute of Continuing Education. — 2025. — Т. 5, № 4. — С. 87–90. — DOI 10.36107/2782-1714_2025-5-4-87-90.
FUNDING SOURCE: The authors declare no funding for the study.
DECLARATION OF COMPETING INTEREST: The authors declare no apparent or potential conflicts of interest related to the publication of this article.
DATA AVAILABILITY STATEMENT: Data from the current study are available from the corresponding author upon reasonable request.
AUTHOR CONTRIBUTIONS
B.V. Khanaliev — study design, overall study management, text editing
U.A. Aliev, I.R. Chudiev — developing the research methodology, conducting statistical analysis, writing the text.
T-A.A. Aliev — analysis of literature data, data collection and systematization, generalization of results, writing the text.
INFORMED CONSENT FOR PUBLICATION: authors received written consent from patients for publication of medical data and photographs.
COMPLIANCE WITH ETHICAL PRINCIPLES: The study conducted complies with the standards of the Declaration of Helsinki (Declaration Helsinki) as amended in 2024. The study protocol's compliance with ethical principles was confirmed by the Local Ethics Committee Medical Institute of Continuing Education, Russian Biotechnology University (ROSBIOTECH) on (Volokolamskoe highway, 11, Moscow, Russia), protocol №12/7-4 from 28 october 2025.