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Retzius-Sparing Robot-Assisted Radical Prostatectomy

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Early Continence and Erectile Function Recovery Following Transvesical Single-Port Robot-Assisted Radical

Brandon L Ward^1,2, Anthony Y Zhang^1,3, Michael S Leapman^1,4

¹Yale School of Medicine, Yale University, New Haven, CT 06492, USA.

|September 13, 2025

Summary

Transvesical single-port robot-assisted radical prostatectomy (SP-TV-RARP) shows promise for early urinary continence and sexual function recovery in prostate cancer patients. While oncologic outcomes require further study, functional results are encouraging.

Keywords:

erectile dysfunction minimally invasive surgical procedures prostate cancer robot-assisted prostatectomy single-port robotic surgery urinary incontinence

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Area of Science:

Urology
Surgical Oncology
Robotic Surgery

Background:

Early recovery of urinary continence and sexual function is crucial after radical prostatectomy.
The transvesical single-port robot-assisted radical prostatectomy (SP-TV-RARP) is a novel technique with limited evidence.
This approach may preserve the Retzius space and allow extraperitoneal access through the bladder.

Purpose of the Study:

To evaluate the early functional and oncologic outcomes of SP-TV-RARP.
To assess the safety and efficacy of this novel surgical approach.

Main Methods:

Retrospective review of 21 patients who underwent SP-TV-RARP by a single surgeon.
Assessment of continence (pad-free) and erectile function (sufficient for penetration).
Analysis of functional and oncologic outcomes using clinical follow-up and Kaplan-Meier analysis.

Main Results:

43% of patients achieved continence within one day of catheter removal; 75% were pad-free at 3 months.
Median time to recovery of erectile function was 69 days, with 67% recovery at last follow-up.
Positive surgical margins were 62% overall; 15.4% experienced biochemical recurrence within 6 months.

Conclusions:

SP-TV-RARP appears safe and may facilitate early return of urinary continence and erectile function.
Functional outcomes were favorable, but oncologic outcomes require further investigation.
Prospective studies are needed to confirm long-term oncologic efficacy.