The Miami Cancer Institute technique: Puboprostatic complex preserving dorsal venous complex ligation with...

Urinary incontinence remains a major concern following robot-assisted radical prostatectomy (RARP) and can significantly affect postoperative quality of life. This study describes early continence and oncologic outcomes associated with a surgical approach incorporating puboprostatic ligament (PPL) preservation, selective dorsal venous complex (DVC) ligation, and routine cystourethropexy (the "Miami Cancer Institute technique"). We conducted a retrospective analysis of 373 patients who underwent RARP at a tertiary cancer center between January 2017 and December 2023 using this technique. Patients with prior pelvic surgery, preoperative urinary incontinence, or pelvic radiation were excluded. Early urinary continence was defined as complete dryness or use of ⩽1 safety pad per day at 3 months postoperatively. At 3 months, 83.1% of patients achieved continence. The mean operative time was 168.4 min, and mean estimated blood loss was 76.4 ml. Biochemical recurrence, defined as a postoperative PSA ⩾ 0.2 ng/ml confirmed on two measurements, occurred in 6.4% of patients within 1 year and in 15.0% over the entire follow-up period. In this single-surgeon retrospective cohort, the technique was associated with favorable early continence outcomes and acceptable descriptive oncologic surrogate measures. These findings are hypothesis-generating and warrant validation in comparative studies with longer follow-up.