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Page 2 of 10 Olivero et al. Mini-invasive Surg 2022;6:6 https://dx.doi.org/10.20517/2574-1225.2021.117

spontaneous erections and 264 (21.3%) used a PDE-5 inhibitor. Overall, the trifecta outcome was reached by
42.1% of the study’s population. The trifecta outcome was easily reached by younger patients and patients who
underwent a full nerve-sparing (NS) prostatectomy. In the multivariable model, age [odds ratio (OR) = 0.89; 95%
confidence interval (CI): 0.84-0.90; P < 0.01] and type of NS surgery [partial NS (OR = 3.34; 95%CI: 1.01-11; P =
0.04) full NS (OR = 4.57; 95%CI: 1.86-12; P < 0.01)] resulted as independent predictors.

Conclusion: rs-RARP is associated with optimal trifecta outcome rate. Age and NS technique are independent
predictors of trifecta outcomes.

Keywords: Prostate cancer, robot-assisted radical prostatectomy, Retzius sparing, functional outcomes, trifecta
outcome

INTRODUCTION
[1]
Robot-assisted radical prostatectomy (RARP) was introduced in the early 2000s . Since its introduction,
RARP has gained popularity among surgeons due to the well-known advantages, such as three-dimensional
binocular magnification, motion scaling, tremor filtration, and good surgeon ergonomics . Furthermore,
[2]
[3]
since radical treatment of prostate cancer (PCa) is associated with optimal oncologic outcomes , the focus
of the urologist is to improve the quality of life (QoL) after treatment, and urinary continence and sexual
[4]
potency preservation are the two most frequent QoL alterations that bother patients after RARP .

The three main long-term goals of RARP are complete removal of cancer, recovery of continence, and
[5]
recovery of potency, which are commonly gathered with the name of “trifecta outcome” . Various studies
have reported the rate of trifecta outcome in RARP , ranging from 23% to 86%. This considerable
[6,7]
variability is mainly due to the different definitions of trifecta adopted in the literature .
[8]
[9]
Retzius-sparing robot-assisted radical prostatectomy (rs-RARP) was first proposed by our group in 2010
and is recognized by the European Association of Urology (EAU) guidelines as an effective surgical option
[10]
for PCa treatment . The technique’s success is due to a shorter continence recovery time than the
traditional robotic approach [11-13] . Recently, it has been demonstrated that the technique is also safe during
the learning curve phase [13-15] .

Although urinary continence recovery and other specific outcomes after rs-RARP have been described [16,17] ,
no series analyzing the trifecta rates extensively after rs-RARP have been previously published, and further
research is needed to evaluate both sexual function outcomes and oncologic outcomes .
[18]

This study aimed to evaluate trifecta outcome rates at 24 months after rs-RARP and identify possible
outcomes predictors.

METHODS
Study population
Data from 1488 PCa patients treated with rs-RARP at a single high-volume European center (ASST Grande
Ospedale Metropolitano Niguarda, Milan, Italy) between January 2011 and March 2019 were analyzed. Data
were extrapolated from an ongoing prospective database, and all patients had at least 24 months of follow-
up.