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

This study aimed to evaluate the functional, oncological and learning-curve outcomes of the complete urethral preservation (CUP) technique during robot-assisted radical prostatectomy in a large single-centre cohort.

We retrospectively analysed patients undergoing robot-assisted radical prostatectomy (RARP) between June 2021 and August 2025 by a single high-volume surgeon. Outcomes were compared by CUP status. Continence was assessed at early (3-6 months) and late (12 months) follow-up, using a strict binary definition and with pad usage recorded separately. Oncological assessment included margin status (MS) and biochemical recurrence (BCR) over 3 years. Multivariable Cox regression assessed predictors of BCR. The learning curve was evaluated using LOESS-based probability smoothing.

A total of 459 patients were included, with successful CUP achieved in 316 (68.8%). Early continence was higher in the CUP cohort than in non-CUP patients (77% vs 67%, p = 0.02), while rates were similar at 12 months (83% vs. 80%, p = 0.74). CUP patients were significantly more likely to be pad-free/security pad only at both timepoints (p = 0.019 and 0.012, respectively). Positive MS rates and locations were comparable between groups. CUP was not associated with increased BCR risk on multivariable analysis (HR 1.06, 95% CI 0.56-1.98; p = 0.90). CUP likelihood improved with experience.

CUP is associated with improved early continence recovery and higher rates of pad-free status following RARP, without compromising margin status or biochemical recurrence. These findings support CUP as a safe and reproducible continence-preserving technique, with the likelihood of successful CUP increasing with surgical experience.