Side-specific lower detrusor apron-sparing robot-assisted radical prostatectomy: functional and oncological outcomes

To describe a lower detrusor apron-sparing (LDAS) modification of robot-assisted radical prostatectomy (RARP) adapting anterior-compartment preservation to side-specific oncological risk, and report perioperative, functional and oncological outcomes.

We retrospectively analysed a prospectively maintained, single-surgeon cohort of 167 men with localised prostate cancer undergoing RARP with unilateral or bilateral LDAS nerve-sparing (2019-2025). On the LDAS side the lower detrusor apron and anterior periurethral support were preserved without opening the endopelvic fascia, with conventional dissection contralaterally when risk was higher. Patient-reported outcomes were collected electronically. Continence was defined as 0-1 safety pad/24 h (strict, 0 pad), erectile recovery as penetrative intercourse with or without phosphodiesterase-5 inhibitors, and biochemical recurrence (BCR) as two consecutive PSA values ≥ 0.2 ng/mL.

Clavien-Dindo ≥ III complications occurred in 1.2%; mean stay 0.6 days (46% same-day discharge). Continence (0-1 pad) was 85%, 97%, 99% and 100% at 6 weeks, 6, 12 and 24 months; strict (0-pad) continence was 51%, 84%, 92% and 97%. Intercourse capability reached 71% at 12 months. Outcomes did not differ by LDAS laterality. Positive surgical margins (PSM) occurred in 16% overall and 8.2% of LDAS-preserved sides. Over a median follow-up of 37 months (IQR 19-55), BCR-free survival rates were 99%, 96%, 94% and 89% at 1, 2, 3 and 5 years; BCR did not differ by LDAS-side PSM status (p = 0.7).

Side-specific LDAS RARP was associated with rapid continence recovery, low morbidity and favourable mid-term oncological outcomes. Lacking a contemporaneous comparator, these single-surgeon findings are hypothesis-generating and require prospective, multicentre, comparative validation.