Robotic-assisted radical prostatectomy (RARP) provides improved functional outcomes with similar oncological outcomes as open surgery. The adaptation of pelvic fascia-sparing technique, aiming to preserve the supportive tissue around the urethra, improves urinary continence after RARP. Specifically, Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP), which involves removing the prostate from posterior and leaving the bladder in situ, has better early continence compared to the standard anterior approach. We explore whether bladder neck (BN) preservation can further improve immediate continence in patients undergoing RS-RARP.

Patients who received RS-RARP between 2018 to 2024 by a single surgeon were followed regularly. The decision to preserve BN was based on the location of the index tumor on the MRI. Only patients who were followed up for more than 6 months were included. Data including age, pre-operative PSA, pathological stage, cancer grading, margin status, status of bladder neck preservation, and pad usage were analyzed. Patients were divided into two groups: BN preserved and not preserved. The primary outcome is the immediate continence rate, defined as no pads within 1 week after Foley removal. The secondary outcome is pad numbers at each follow-up visit.

A total of 100 patients were included. There are 63 and 37 patients of patients with and without BN preservation, respectively. The mean age was younger in the BN preserved group (66.5 vs. 69.1, p=0.02). The baseline PSA, NCCN risk classification, and pathological staging were similar between the two groups (Table 1). Immediate continence was observed in 52.4% vs. 24.3% (p=0.0063) of patients with and without BN preservation, respectively. At 7 months, 95.4% vs. 61.2% of patients with and without BN preservation had 0 pad, respectively (Figure 1). Multivariate analysis showed BN preservation as an independent factor for immediate continence (OR=4.16, p=0.009).

In our cohort of patients who underwent RS-RSRP, BN preservation was an independent factor and had a 4-fold chance of immediate continence after catheter removal.

Bladder neck preservation further improves immediate continence in patients undergoing RS-RARP.