Total periurethral anatomical preservation during single-port extraperitoneal robot-assisted radical prostatectomy...

Recovery of urinary continence remains one of the principal determinants of functional success after robot-assisted radical prostatectomy (RARP). The modified hood technique, which preserves the periurethral anatomical structures during apical dissection, is a promising strategy for accelerating continence recovery. This study evaluated the feasibility, perioperative safety, and early functional outcomes of single-port extraperitoneal RARP (SPE-RARP) incorporating a modified hood technique. A retrospective single-center study was conducted in 60 consecutive patients who underwent SPE-RARP, with follow-up at 1 week and 1, 3, and 6 months after catheter removal. Patients for whom lymphadenectomy was planned or who had received neoadjuvant hormone therapy were excluded. SPE-RARP was performed using the da Vinci SP robotic system, incorporating the modified hood technique. Following specimen extraction, posterior musculofascial reconstruction preceded circumferential vesicourethral anastomosis. The primary endpoint was complete pad independence after catheter removal. Secondary outcomes included perioperative parameters, positive surgical margin (PSM) rate, and biochemical recurrence (BCR). The continence rates were 78.3%, 93.3%, 98.3%, and 100% at 1 week and 1, 3, and 6 months after catheter removal, respectively. Clavien-Dindo grades I-II complications occurred in 10 patients. The PSM rate was 20.0% in the predominantly high-risk cohort. BCR was observed at 6 months postoperatively in 2 of 33 patients (6.1%) who did not receive postoperative ADT. Limitations include the retrospective single-center design, absence of a control group, and incomplete 12-month oncological follow-up. SPE-RARP using the modified hood technique was technically feasible and was associated with promising early urinary continence recovery in this selected cohort.