Figure 2

Dynamic mid-sagittal magnetic resonance imaging (MRI) of conventional robot-assisted radical prostatectomy (RARP): preoperatively at rest (A), preoperatively with abdominal pressure (B), postoperatively at rest (C), and postoperatively with abdominal pressure (D). Dynamic mid-sagittal MRI of Retzius-sparing RARP: preoperatively at rest (E), preoperatively with abdominal pressure (F), postoperatively at rest (G), and postoperatively with abdominal pressure (H). Yellow dashed line: attachment between the anterior bladder wall and the abdominal wall. Blue dashed line: the anterior wall of the rectum. (B, F) When applying abdominal pressure (orange arrow), the bladder is compressed caudally. At the same time, the pelvic organs are rotated forward (red arrow) with the anterior wall of the bladder (yellow dashed line) attached to the abdominal wall as a fulcrum, and the membranous urethra is compressed forward (blue dashed line). (C) The attachment of the anterior wall of the bladder moving caudally. (D) When applying abdominal pressure (orange arrow), the bladder is compressed caudally, the bladder neck is enlarged (red circle), and urinary incontinence is observed. (H) When applying abdominal pressure (orange arrow), the bladder is compressed caudally. At the same time, the pelvic organs are rotated forward (red arrow) with the anterior wall of the bladder (yellow dashed line) attached to the abdominal wall as a fulcrum, and the membranous urethra is compressed forward (blue dashed line).