Retzius-Sparing Robotic Prostatectomy Melbourne
Retzius-sparing robotic radical prostatectomy is an advanced posterior approach to prostate cancer surgery. Rather than dissecting through the anterior space of Retzius, Dr Dias accesses the prostate from behind the bladder via the pouch of Douglas. This preserves the puboprostatic ligaments, endopelvic fascia, dorsal venous complex and the anterior support structures of the bladder — anatomy that is critical for early return of urinary continence.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- Significantly faster return of urinary continence — many men pad-free within days to weeks
- Preservation of the puboprostatic ligaments and endopelvic fascia
- Maintains the natural suspensory support of the bladder neck and urethra
- Less disruption of the dorsal venous complex, reducing bleeding
- Equivalent oncological outcomes when performed by an experienced robotic surgeon
- Same minimally invasive benefits — small incisions, short hospital stay
- May benefit erectile function recovery through preservation of accessory neurovascular pathways
The Procedure
The procedure is performed under general anaesthesia using the da Vinci robotic platform through the same small abdominal incisions as a standard robotic prostatectomy. Rather than dropping the bladder and entering the anterior pelvis, Dr Dias incises the peritoneum at the pouch of Douglas and approaches the prostate from behind. The seminal vesicles, prostate and bladder neck are dissected from this posterior window, with careful nerve-sparing along the neurovascular bundles. The vesicourethral anastomosis is then completed without ever disturbing the anterior pelvic floor support. Surgery typically takes 2–3 hours.
Who Is a Candidate?
Retzius-sparing prostatectomy is suitable for most men with localised prostate cancer, and is particularly attractive for men who prioritise the earliest possible return of urinary continence — for example, those returning quickly to work or active lifestyles. Very large prostates, large median lobes, prior prostate surgery (such as TURP or HoLEP) and anterior or apical tumours may favour a standard anterior approach. Dr Dias will review your MRI, PSA and biopsy histology to recommend the technique best suited to your cancer and anatomy.
Recovery
Hospital stay is typically 1–2 nights with a urinary catheter for 7–10 days. The defining feature of recovery is continence: published Retzius-sparing series consistently show the majority of men are pad-free within 1–4 weeks of catheter removal, compared to 3–12 months for the standard anterior approach. Light activities can be resumed within 1–2 weeks and full recovery within 4–6 weeks. Erectile function recovery follows the same trajectory as standard nerve-sparing prostatectomy, with continued improvement for up to 24 months.
Risks & Considerations
Risks are similar to standard robotic prostatectomy and include bleeding, infection, anaesthetic risk, temporary urinary incontinence, erectile dysfunction, changes in orgasm, bladder neck contracture and lymphocele. The posterior approach has a learning curve and requires significant robotic experience to maintain equivalent margin status — an important reason to be treated by a high-volume robotic surgeon. Dr Dias will discuss all risks and his personal outcomes during your consultation.