Urinary continence after robot-assisted radical prostatectomy with complete urethral preservation

Area of Science:

• Urology
• Robotic Surgery
• Oncology

Background:

• Robot-assisted radical prostatectomy (RARP) is a standard treatment for prostate cancer.
• Optimizing functional outcomes, particularly urinary continence, remains a key focus in RARP.
• The complete urethral preservation (CUP) technique is an approach to RARP aiming to enhance continence recovery.

Purpose of the Study:

• To evaluate functional, oncological, and learning-curve outcomes of the CUP technique in RARP.
• To compare outcomes between patients who underwent CUP and those who did not.
• To assess the safety and reproducibility of the CUP technique in a large single-center cohort.

Main Methods:

• Retrospective analysis of 459 patients undergoing RARP by a single high-volume surgeon.
• Outcomes assessed included continence (early and late follow-up), pad usage, margin status (MS), and biochemical recurrence (BCR) over 3 years.
• Multivariable Cox regression and LOESS-based probability smoothing were used for analysis.

Main Results:

• Successful CUP was achieved in 68.8% of patients.
• The CUP cohort showed higher early continence rates (77% vs. 67%) and pad-free status.
• Oncological outcomes (MS and BCR) were comparable between CUP and non-CUP groups, with no increased BCR risk associated with CUP.

Conclusions:

• CUP is associated with improved early continence and higher pad-free rates after RARP.
• The CUP technique does not compromise oncological safety (margin status or BCR).
• CUP is a safe, reproducible, continence-preserving technique, with successful implementation improving with surgical experience.