Abstract

Objective:
This study aimed to compare perioperative, oncological, and functional outcomes of antegrade and retrograde nerve-sparing techniques in open radical prostatectomy.

Materials and Methods:
In this retrospective single-center study, 278 patients with localized prostate cancer and preserved preoperative erectile function (IIEF-5 ≥21) underwent open radical prostatectomy between 2016 and 2025, performed by a single surgeon. Antegrade dissection was used in 90 patients and retrograde in 188. Perioperative parameters (operative time, blood loss, hospital stay), oncological outcomes (surgical margins, biochemical recurrence [BCR]), and functional outcomes (continence, erectile function) were compared. Multivariate logistic regression was used to identify predictors of BCR, and a post-hoc power analysis was conducted.

Results:
The retrograde approach resulted in shorter operative time (151 vs. 167 minutes) and reduced hospital stay (6.5 vs. 7.4 days), whereas the antegrade approach was associated with lower blood loss (437 vs. 517 mL). Surgical margin positivity rates were similar (38.9% vs. 33.7%), but BCR was significantly higher in the antegrade group (33.3% vs. 18.8%). Functional outcomes were comparable between groups. Multivariate analysis identified preoperative PSA, ISUP grade, and surgical approach as independent predictors of BCR. The post-hoc power was calculated as 0.86, confirming adequate statistical power.

Conclusion:
Both nerve-sparing approaches are safe and effective in open radical prostatectomy. Retrograde dissection offers shorter operative time, reduced hospitalization, and lower BCR rates, while antegrade dissection provides superior hemostatic control. The choice of surgical technique should be individualized based on tumor characteristics and surgeon expertise.

Keywords: radical prostatectomy; antegrade approach; retrograde approach; nerve-sparing technique; functional outcomes

Key words: radical prostatectomy; antegrade approach; retrograde approach; nerve-sparing technique; functional outcomes