Senior Director & Unit Head, Urology, Kidney Transplant, Uro-Oncology, Robotic Surgery, Max Hospital, Gurugram
Part 10 of 11 in Prostate Cancer: Diagnosis and Management
The Retzius-Sparing Technique: Protecting Continence and Erectile Function After Surgery
September 6, 2026
Earlier robotic and laparoscopic radical prostatectomy techniques, approached through the retropubic space, carried a real risk of erectile dysfunction and delayed return of continence. Dr. Amit Goel described a newer approach, introduced by Bocciardi, that operates entirely from behind the bladder, never entering the retropubic space (the space of Retzius) at all.
Why the Approach Preserves Function Better
By staying behind the bladder for the full dissection, the Retzius-sparing technique protects the nerve bundles responsible for erectile function far more effectively than the conventional retropubic approach, and Dr. Goel described the resulting rate of erectile dysfunction as very low. Urinary continence recovers well too, which is why it has become his preferred approach for radical prostatectomy.
Cold Cutting Instead of Cautery
A specific technical detail Dr. Goel emphasised in his surgical videos: the posterior and lateral prostatic pedicles, where the nerves for erectile function run, are dissected with clips and cold cutting rather than heat or electrocautery, since heat in that zone risks damaging the nerves. The same care extends to the dorsal venous complex, which is cut without an initial suture, using increased intra-abdominal pressure to control bleeding, a step that also preserves a longer segment of urethra for the anastomosis afterward.
Extended Pelvic Lymph Node Dissection
Alongside the prostatectomy itself, Dr. Goel performs an extended pelvic lymphadenectomy rather than the more limited standard version, removing the obturator, external iliac and internal iliac nodal packets along with the nodes in the triangle of Marcille, lateral to the external iliac artery. He reserves this extended dissection for anything beyond very low-risk disease, where he judges the extra nodal clearance is not warranted.
This article is based on a Jivo Masterclass session conducted by Dr. Amit Goel, Director and Head of Unit, Renal Transplant, Uro-oncology, Urology and Robotic Surgery, Max Hospital, Gurugram, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Amit Goel taught doctors across Africa on April 20, 2025.
FROM THE LIVE Q&A
Dr. Navala Gabriel
What is the average cost of robotic surgery for prostate cancer?
Dr. Amit Goel
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
Frequently Asked Questions
What is the management of metastatic prostate cancer?▼
It depends on where the metastasis is. Bilateral orchidectomy is still a valid option for patients who don't want to spend money on ongoing hormone injections, and it works about as well as hormone therapy. For bone metastasis with pain or fracture risk, bone-strengthening injections and radiotherapy to the affected bone are added. Once the disease becomes castration-resistant, treatment moves to stronger anti-androgens such as abiraterone or enzalutamide, chemotherapy for visceral metastasis, and increasingly immunotherapy.
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?▼
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
What is the average cost of robotic surgery for prostate cancer?▼
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
What is Retzius-sparing prostatectomy?▼
It is a robotic surgical approach that operates entirely from behind the bladder, avoiding the retropubic space altogether, which better preserves the nerves responsible for erectile function and speeds recovery of continence.
Why is cold cutting used instead of cautery during prostate surgery?▼
Heat from electrocautery near the nerve bundles responsible for erectile function can damage them, so surgeons use clips and cold cutting in that zone instead.
In This Series: Prostate Cancer: Diagnosis and Management
- 1.Diagnosis and Management of Prostate Cancer
- 2.Prostate Cancer Risk Factors and Why Men of African Descent Face the Highest Risk
- 3.Recognizing Prostate Cancer: From Early Symptoms to Advanced and Metastatic Disease
- 4.How Prostate Cancer Is Diagnosed: PSA Testing and Digital Rectal Examination
- 5.Prostate Biopsy: TRUS-Guided and MRI Fusion Techniques
- 6.The Gleason Score: Grading Prostate Cancer and What It Means for Treatment
- 7.Staging Prostate Cancer: TNM Classification and PSMA PET Scans
- 8.Choosing a Treatment: Risk-Based Options From Active Surveillance to Surgery
- 9.Robotic, Laparoscopic and Open Radical Prostatectomy: Comparing the Evidence
- 10.The Retzius-Sparing Technique: Protecting Continence and Erectile Function After Surgery
- 11.Managing Metastatic and Castration-Resistant Prostate Cancer