Cystopexy following anterior-approach robot-assisted radical prostatectomy enhances early continence recovery

To evaluate the effect of cystopexy on continence recovery after anterior-approach transperitoneal robot-assisted radical prostatectomy (RaRP). We retrospectively analyzed continence recovery of patients with prostate cancer receiving RaRP in a transperitoneal anterior-approach manner with or without cystopexy. Continence recovery is defined as complete intact continence without safety pad utility. Demographic data, preoperative cancer staging, intraoperative surgical techniques such as neurovascular bundle (NVB) preservation, bladder neck sparing (BNS), cystopexy and postoperative cancer stage, surgical margin status were analyzed via multivariable and univariable regression analysis to evaluate contributing factors associated with continence recovery. We included one hundred and sixty-one consecutive RaRP performed by a single surgeon from 2011 to 2019 without cystopexy and another forty-one consecutive RaRP performed by another single surgeon with cystopexy from 2019 to 2023. Compared to patients without cystopexy, patients receiving cystopexy after anterior-approach RaRP have significant early continence recovery rate at 1-week (p < 0.0001) and 4-weeks (p = 0.0391). In addition, multivariable regression analysis revealed that BNS contributed to better continence recovery at 4 weeks (p = 0.0094). Patients receiving RaRP without NVB preservation had worse continence recovery at 12 weeks (p = 0.0015) and 24 weeks (p = 0.0098). Cystopexy after anterior -approach RaRP may enhance early recovery of continence at 1 week and 4 weeks. The simple technique may be adapted for a better functional outcome of continence.