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Retzius-Sparing Robot-Assisted Radical Prostatectomy

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Patterns and Predictors of Urinary Continence Recovery After Extraperitoneal Single-Port Robot-Assisted Radical

Lorenzo Santodirocco^1,2, Luca A Morgantini¹, Marwan Alkassis¹

¹Department of Urology, University of Illinois at Chicago, Chicago, IL 60607, USA.

Journal of Clinical Medicine

|April 14, 2026

Summary

Nerve-sparing surgery and an uncomplicated recovery are key for urinary continence after robot-assisted radical prostatectomy (RARP). Younger age and larger prostate volume also contribute to better outcomes in this study.

Keywords:

nerve-sparing surgery robot-assisted radical prostatectomy urinary continence

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Area of Science:

Urology
Surgical Oncology
Reconstructive Surgery

Background:

Urinary continence recovery post-robot-assisted radical prostatectomy (RARP) is complex, often oversimplified to binary outcomes.
Modeling continence as an ordered process can better capture functional trajectories and identify predictors.

Purpose of the Study:

To model urinary continence recovery as an ordered process after extraperitoneal RARP.
To identify independent predictors of continence recovery at 6 months post-surgery.

Main Methods:

Retrospective analysis of 180 patients undergoing extraperitoneal single-port RARP.
Classification of continence into three ordered categories: early, late, and persistent incontinence.
Multivariable ordinal logistic regression analysis including nerve-sparing (NS) status, complications, age, and prostate volume.

Main Results:

Nerve-sparing (NS) surgery was the strongest predictor of favorable continence recovery (p < 0.001).
Absence of postoperative complications (p = 0.003), younger age, and larger prostate volume were also associated with improved continence.
Sensitivity analyses confirmed the robustness of NS surgery's effect, irrespective of prostate volume replacements (BMI, case number, PSA).

Conclusions:

Continence recovery after extraperitoneal RARP is primarily linked to NS surgery and an uncomplicated postoperative course.
Age and prostate volume provide further refinement in predicting functional outcomes.
An ordinal outcome model offers a clinically meaningful framework for evaluating post-prostatectomy functional recovery.