Prostate cancer is the most prevalent non-skin solid malignancy among male renal transplant recipients. Curative treatment options for localised prostate cancer include robot-assisted radical prostatectomy (RARP) and radiotherapy. The largest multicentre study of transperitoneal RARP post-renal transplant included 41 men treated across four European centres between 2009 and 2019 [1]. While the standard anterior approach is feasible, it poses risks of damaging the transplant kidney and the vesico-ureteric anastomosis during anterior dissection and development of the space of Retzius.

Since Galfano et al. [2] published the first series of Retzius-sparing RARP (RS-RARP) involving 200 patients in 2013, the technique whereby the key anterior structures of the bladder such as the endopelvic fascia, dorsal vascular complex (DVC), arcus tendineus, levator ani muscle, pubo-prostatic and pubo-vesical ligaments are preserved has gained popularity [3, 4]. The Milan team reported early continence rates of 92% and low 1-year biochemical recurrence rates. Over the next decade, RS-RARP, despite its technical complexity, was increasingly adopted worldwide. A 2022 meta-analysis comparing RS-RARP with standard RARP, incorporating four randomised controlled trials and six prospective observational studies, found that RS-RARP was associated with significantly better continence at 3 and 6 months [5].

The use of RS-RARP can be viewed as a safer option for renal transplant recipients [6], as it avoids any dissection close to the transplant kidney, which is usually located in either the left or right iliac fossa. Here, we provide a step-by-step guide on how to perform an RS-RARP in renal transplant recipients.

前列腺癌是男性肾移植受者中最普遍的非皮肤实体恶性肿瘤。局限性前列腺癌的治愈性治疗选择包括机器人辅助根治性前列腺切除术 （RARP） 和放疗。最大的经腹膜 RARP 肾移植后多中心研究包括 2009 年至 2019 年期间在 4 个欧洲中心接受治疗的 41 例男性 [1]。虽然标准的前路是可行的，但在前清扫和 Retzius 间隙发育过程中，它存在损伤移植肾和膀胱输尿管吻合术的风险。

自 Galfano 等[2]于 2013 年发表了涉及 200 名患者的首个保留 Retzius 的 RARP（RS-RARP）系列以来，保留膀胱关键前部结构（如盆腔内筋膜、背侧血管复合体（DVC）、肌腱弓、肛提肌、耻骨前列腺韧带和耻骨膀胱韧带的技术越来越受欢迎[3,4].Milan 团队报告了 92% 的早期失禁率和较低的 1 年生化复发率。在接下来的十年中，尽管 RS-RARP 技术复杂，但在全球范围内得到了越来越多的采用。2022 年的一项荟萃分析将 RS-RARP 与标准 RARP 进行了比较，纳入了 4 项随机对照试验和 6 项前瞻性观察性研究，发现 RS-RARP 与 3 个月和 6 个月时的尿失禁显著改善相关 [5]。

对于肾移植受者来说，使用 RS-RARP 可以被视为一种更安全的选择 [6]，因为它避免了靠近移植肾的任何解剖，移植肾通常位于左髂窝或右髂窝。在这里，我们提供了有关如何在肾移植受者中执行 RS-RARP 的分步指南。