Early continence and postoperative urodynamic findings after single-port transvesical robot-assisted radical prostatectomy: a preliminary prospective physiologic case series

Introduction

Prostate cancer is a leading malignancy among men worldwide, and the incidence continues to rise with the widespread adoption of prostate-specific antigen (PSA)-based screening and advanced imaging modalities (1). Robot-assisted radical prostatectomy (RARP) has become the primary surgical treatment for localized prostate cancer, offering improved visualization and anatomical precision compared with open techniques (2). Despite these advantages, early postoperative urinary incontinence remains a major concern and one of the most impactful determinants of postoperative quality of life (QoL) (3). Achieving a rapid return to continence continues to be a significant clinical challenge.

In recent years, considerable effort has been devoted to refining surgical approaches to preserve continence mechanisms during prostatectomy (4). Techniques that avoid disrupting the Retzius space or restore posterior support of the urethra have demonstrated faster functional recovery than conventional transperitoneal approaches (5,6). Building upon these concepts, single-port transvesical robot-assisted radical prostatectomy (SP-TVRP) has emerged as an alternative extraperitoneal access method that enables prostate removal without violating the Retzius space. Early reports have shown promising continence outcomes, suggesting that this anatomical preservation may facilitate rapid functional recovery following surgery. However, these findings have been based primarily on subjective metrics, such as pad usage and questionnaire scores (7-10).

To date, evidence describing early continence after SP-TVRP has relied mainly on pad use and questionnaires, and postoperative urodynamic study (UDS) data remain limited. Because our study did not include baseline UDS or a control group, the present analysis was designed as a descriptive physiologic case series rather than a definitive test of preservation or superiority. We aimed to characterize postoperative bladder storage, voiding, and urethral sphincteric findings 3 months after SP-TVRP and to examine whether these findings were compatible with early continence recovery. We present this article in accordance with the STROBE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0368/rc).

Methods

Study design and patient selection

This was a single-center, single-surgeon, prospective case series conducted between September 2024 and April 2025. Patients diagnosed with localized to locally advanced prostate cancer who underwent SP-TVRP using the SP robotic system (da Vinci SP; Intuitive Surgical Inc., Sunnyvale, CA, USA) were prospectively enrolled.

The inclusion criteria were revised to include clinically localized or locally advanced prostate cancer (cT2–T3b) suitable for radical prostatectomy without radiologic nodal or distant metastasis. The remaining inclusion criteria were: (I) male patients aged ≥40 years; (II) American Society of Anesthesiologists physical status ≤3; and (III) ability and willingness to provide written informed consent. The exclusion criteria were: (I) prostate volume >80 cc; (II) history of prior prostate surgery or intervention, such as transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP); (III) neurogenic bladder or voiding dysfunction due to neurological disease; (IV) radiologic evidence of lymph node or distant metastasis; and (V) urethral stricture.

Low-risk patients were counseled regarding active surveillance, radical prostatectomy, and radiotherapy, and treatment selection reflected shared decision making and patient preference. For intermediate- to high-risk disease, prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) was performed preoperatively; patients with radiologic nodal or distant metastasis or patients considered to require pelvic lymph node dissection (PLND) were not enrolled. PLND was not performed in this cohort; therefore, all patients were pathologically pNx. Patients with high-risk or locally advanced disease were counseled preoperatively that multimodal treatment could be required depending on final pathology and postoperative PSA kinetics.

Operative technique

The operating surgeon had performed more than 500 multiport radical prostatectomies before adopting the single-port (SP) transvesical approach. Under general anesthesia, the patients were placed in the lithotomy position. A urethral Foley catheter was inserted, and the bladder was filled with 500 mL normal saline to achieve distension. A 2.5 cm lower midline incision was made, and the SP access port was inserted. The pneumovesicum was established and maintained at a pressure of 10 mmHg using the AirSeal insufflation system (CONMED, Utica, NY, USA). The robotic system was docked, and the bladder trigone was identified.

A posterior mucosal incision was made at the trigone, followed by dissection between the prostate and the bladder neck. The seminal vesicles and vas deferens were isolated and dissected. The Denonvilliers fascia was dissected to mobilize the posterior aspect of the prostate toward the apex. After completing the posterior dissection, anterior bladder mucosal incision and dissection were performed on the anterior bladder. The apical dissection and urethral transection were performed according to the same principle used in conventional multiport transperitoneal RARP. Although the intravesical SP view is more restricted than that of multiport surgery, the prostate was placed on gentle traction after circumferential apical dissection, and periurethral prostatic tissue was swept away from the apex to maximize the preserved functional urethral segment before transection.

The degree and side of neurovascular bundle sparing (NVBS) were determined preoperatively using magnetic resonance imaging (MRI) findings, biopsy International Society of Urological Pathology (ISUP) grade, tumor laterality, transrectal ultrasound (TRUS) findings, and intraoperative assessment. Because the narrow intravesical working space limited posterior-to-lateral traction and did not permit a conventional posterior-to-lateral hood-type dissection, nerve-sparing dissection was generally developed from the anterior-to-lateral direction along the venous structures surrounding the prostate. When the dissection was carried close to the prostate, medial to the periprostatic venous structures, the plane was regarded as an interfascial plane. When NVBS was indicated, dissection was performed beneath the dorsal vein complex (DVC) to preserve the NVBS. In cases where NVBS was not required or when the tumor was located anteriorly, dissection was performed above the DVC, followed by DVC ligation. The anterolateral aspect was developed up to the level of the prostatic pedicles.

Energy use around the neurovascular bundles was minimized. Metal clips were not used through the SP transvesical access; arterial bleeding was controlled selectively with bipolar cautery, whereas venous oozing was controlled with 4-0 Vicryl sutures when needed.

The prostate was then completely excised from the body. Meticulous hemostasis was achieved, followed by posterior reconstruction. Urethrovesical anastomosis was performed with a continuous double-arm 3-0 barbed suture, and a new Foley catheter was inserted with balloon inflation confirmed. The specimen was placed in a laparoscopic retrieval bag, the robotic system was de-docked, and the specimen was removed through the port. The bladder wall was subsequently repaired, and a 150 mL saline filling test confirmed the watertight anastomosis.

Postoperative care and follow-up

All patients began oral intake on the first postoperative day, and no dietary restrictions were applied thereafter. Cystography was routinely performed on postoperative day 7 to assess anastomotic integrity. If no leakage was observed, the Foley catheter was removed and most patients were discharged.

Follow-up evaluations were performed at 1 month and 3 months postoperatively. At each visit, serum PSA, International Prostate Symptom Score (IPSS), QoL, Overactive Bladder Symptom Score (OABSS), and International Index of Erectile Function-5 (IIEF-5) questionnaires were completed. Continence status was assessed using self-reported pad usage and the use of safety pads.

UDS

At 3 months postoperatively, all patients underwent comprehensive urodynamic evaluation according to International Continence Society (ICS) standards (11). Filling cystometry was performed with the patient in the sitting position using room-temperature saline infused at a rate of 30–50 mL/min. The following parameters were recorded during the filling and voiding phases: maximum cystometric capacity (MCC), presence of detrusor overactivity (DO), detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (MaxPdet), maximum flow rate (Qmax), postvoid residual urine volume (PVR), bladder sensation parameters, bladder compliance, bladder outlet obstruction index (BOOI = PdetQmax − 2 × Qmax), bladder contractility index (BCI = PdetQmax + 5 × Qmax), maximum urethral closure pressure (MUCP), functional urethral length (FUL), and abdominal leak point pressure (ALPP). All pressures were set to zero at atmospheric pressure and measured relative to the symphysis pubis.

Urethral pressure (Pura) profilometry was performed using a Laborie urodynamic system (Laborie Medical Technologies, Portsmouth, NH, USA) with a dual-sensor transurethral catheter withdrawn through the urethra at a constant rate of 2 mm/s with a mechanical puller. Pura was recorded continuously along the urethral length, and urethral closure pressure (Pclo) was derived as Pura minus the simultaneously recorded intravesical pressure (Pves). MUCP was defined as the maximum Pclo, and FUL was defined as the length of the urethral segment over which Pclo remained positive, in accordance with ICS recommendations for Pura measurement. FUL was therefore interpreted as functional pressure-profile length during Pura profilometry and not as an anatomic membranous urethral length.

On detailed review of the raw tracings, the proximal sensor recording Pves was found to migrate out of the bladder during catheter withdrawal in several studies, producing progressive subatmospheric drift of the Pves channel after the sensor passed the bladder neck. Because Pclo is computed as Pura minus Pves, this drift spuriously elevated Pclo and substantially overestimated the apparent profile length, and, when it overlapped the Pura peak, MUCP as well. To mitigate this artifact, Pclo was re-derived using a fixed Pves value taken from the stable pre-withdrawal segment immediately before the sensor exited the bladder, and FUL and MUCP were re-measured from the baseline-corrected profile. In studies in which the Pves channel remained stable throughout the Pura peak, MUCP was not materially changed by this correction. Because these baseline-corrected values remained estimates derived from clinical tracings, MUCP and FUL were interpreted descriptively rather than as definitive anatomic or mechanistic measurements.

During filling, DO was defined as involuntary detrusor contraction exceeding 15 cmH₂O. Bladder compliance was calculated as the ratio of the volume change to the pressure change (DeltaV/DeltaPdet) between the start of filling and MCC. During the voiding phase, flow and pressure curves were used to determine BOOI and BCI, which were interpreted according to ICS nomograms. For ALPP testing, cough and Valsalva maneuvers were performed at standardized bladder volumes in the sitting position; if no leakage occurred at the highest provoked abdominal pressure, the result was recorded as no leak at tested pressure.

Endpoints

The primary endpoint was the urodynamic profile at 3 months after SP-TVRP, focusing on storage (MCC, compliance, and DO), voiding (Qmax, PVR, BOOI, and BCI), and urethral sphincter parameters (MUCP, FUL, and ALPP). Secondary endpoints included early continence recovery rate, changes in functional scores (IPSS, QoL, OABSS, and IIEF-5), postoperative PSA trends, and perioperative outcomes. Zero-pad continence was defined as no pad use, whereas social continence was defined as no pad use or use of one safety pad per day.

Statistical analysis

All statistical analyses were performed using SPSS Statistics software (version 21.0; IBM Corp., Armonk, NY, USA). Continuous variables are expressed as means ± standard deviations or medians with interquartile ranges (IQRs), depending on the data distribution. Categorical variables are presented as numbers and percentages. The normality of the data distribution was assessed using the Shapiro-Wilk test. For variables that did not follow a normal distribution, comparisons between preoperative and postoperative values were performed using the Wilcoxon signed-rank test. Statistical significance was set at P<0.05.

Ethical considerations

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Review Board of Hallym University Sacred Heart Hospital (IRB No. 2024-05-011-002). All patients were informed of the study details and provided written consent prior to participation.

Results

Patient characteristics

A total of 11 patients were prospectively enrolled, and none were lost to follow-up. All surgeries were successfully completed without the need for additional ports or conversion to an open approach. The median age was 67 years (range, 54–79 years), and the mean preoperative PSA level was 11.4±6.2 ng/mL. The mean prostate volume was 32.9±9.1 cc. Two patients (18.2%) received neoadjuvant androgen deprivation therapy. The preoperative ISUP grade was 4 or 5 in 81.8% of cases. The clinical stages were cT2 in 72.7%, cT3a in 18.2%, and cT3b in 9.1% (Table 1). No patient underwent PLND; all patients were therefore classified as pNx.

Primary endpoint: urodynamic findings at 3 months

All patients successfully underwent standardized UDS at 3 months postoperatively. DO was detected in only one patient (9.1%). The median MCC was 450 mL (IQR, 410–500 mL), and median bladder compliance was 64 mL/cmH₂O. The median Qmax was 10 mL/s, and the median PVR was 0 mL (IQR, 0–100 mL). The median BOOI was 16 (IQR, 6–34), and the median BCI was 93 (IQR, 68–104), with most patients falling within the non-obstructed or equivocal range (Figure 1).

Figure 1 Individual postoperative urodynamic parameters at 3 months after SP-TVRP. Each point represents an individual patient value, and horizontal bars represent medians. BCI, bladder contractility index; BOOI, bladder outlet obstruction index; MCC, maximum cystometric capacity; Qmax, maximum flow rate; PVR, postvoid residual urine volume; SP-TVRP, single-port transvesical robot-assisted radical prostatectomy.

Baseline-corrected Pura profilometry demonstrated heterogeneous MUCP estimates and short FUL estimates ranging from ≤1 cm to approximately 2.4 cm. Corrected median FUL of 15 mm (IQR, 10–20 mm) for the intravesical-pressure drift artifact described in the Methods. The uncorrected automated profile lengths were markedly and artifactually longer (median 98 mm, with individual values exceeding 170 mm), reflecting subatmospheric drift of the Pves channel during catheter withdrawal rather than a true increase in urethral length. No ALPP-induced stress leakage was observed in eight patients (72.7%) (Table 2).

Secondary endpoints

Perioperative and pathological outcomes

All procedures were completed without conversion or additional ports. The mean total operative time was 180.6±27.2 min and the console time was 133.0±30.3 min. Bilateral NVBS was performed in 63.6% of patients and unilateral NVBS in 18.2%. The mean estimated blood loss was 254.6±248.5 mL. Two patients (18.2%) experienced transient hypotension after the DVC was opened, which was successfully managed by lowering the pneumovesical pressure. Step-specific operative-time metrics were moved to Table S1 to keep the main manuscript focused on clinically relevant perioperative and functional outcomes.

Routine cystography was performed on postoperative day 7 to evaluate the vesicourethral anastomosis. No leakage was detected in 10 patients (90.9%), whereas one patient (9.1%) had a small, localized leak requiring catheter maintenance for one additional week until healing was confirmed. None of the patients required readmission or experienced a Clavien-Dindo grade III or higher complication during the 3-month follow-up (Table 3).

The final pathological stage was pT2 in 54.6%, pT3a in 9.1%, and pT3b in 36.4% of patients. The ISUP grades were distributed as follows: grade 1 (18.2%), grade 2 (9.1%), grade 3 (45.5%), grade 4 (9.1%), and grade 5 (18.2%). Positive surgical margins (PSMs) were identified in five patients (45.5%), most commonly in pT3 disease. PSA persistence (≥0.1 ng/mL at 1 month) occurred in two patients (18.2%) (Table 4). Available case-level oncologic details for patients with PSM and/or PSA persistence are provided in Table S2. Patients with PSA persistence were managed with serial PSA surveillance and were considered for adjuvant or early salvage treatment according to pathologic risk and PSA kinetics.

Early continence and functional outcomes

Four patients (36.4%) achieved zero-pad continence immediately after Foley catheter removal, whereas two additional patients used only one safety pad. At 1 month, 6 patients (54.5%) were zero-pad continent and one additional patient used one safety pad. At 3 months, 10 patients (90.9%) were zero-pad continent and the remaining patient used one safety pad, resulting in a 0–1 safety-pad rate of 100%.

Mean pad usage declined from 2.64±2.98 pads at postoperative week 1 to 2.27±3.07 at 1 month and 0.18±0.60 at 3 months. The IPSS increased temporarily at 1 month but returned to baseline or improved by 3 months. A comparable pattern was observed for OABSS, which initially worsened and subsequently normalized by 3 months. In contrast, erectile function declined, with mean IIEF-5 scores decreasing by 3 months (Figure 2). No patient was taking a phosphodiesterase type 5 inhibitor preoperatively, and penile rehabilitation, erectile hardness, intercourse success, and sexual bother were not systematically assessed.

Figure 2 Functional outcomes after SP-TVRP. Data are presented as mean ± standard deviation. IIEF-5, International Index of Erectile Function-5; IPSS, International Prostate Symptom Score; m, month; OABSS, Overactive Bladder Symptom Score; SP-TVRP, single-port transvesical robot-assisted radical prostatectomy.

Discussion

This study should be interpreted as a preliminary prospective physiologic case series rather than as evidence that SP-TVRP definitively preserves continence mechanisms. Within that framework, the 3-month postoperative UDS findings showed favorable storage parameters, mostly non-obstructed or equivocal voiding physiology, and ALPP results compatible with early continence recovery. Because no baseline UDS or control group was available, these results demonstrate postoperative findings at 3 months and do not prove preservation, improvement, or superiority relative to other RARP approaches.

Our continence outcomes are concordant with contemporary series of transvesical SP prostatectomy, which have consistently reported rapid functional recovery. Propensity-matched and single-center studies have shown high immediate and 3-month continence rates after SP-TVRP and related transvesical approaches, often outperforming conventional multiport transperitoneal RARP (12,13). In our cohort, more than one-third of patients were zero-pad continent immediately after catheter removal and nearly all were zero-pad continent by 3 months.

The anatomical rationale for these favorable early outcomes is aligned with prior work on continence-preserving techniques in radical prostatectomy. Conventional anterior transperitoneal RARP typically requires dissection within the Retzius space, risking disruption of the puboprostatic ligament, endopelvic fascia, DVC, and anterior bladder attachments, all of which contribute to urethral support and continence (2,3). In contrast, Retzius-sparing, extraperitoneal, and transvesical approaches were developed to preserve these structures (5,14-18). Randomized trials and meta-analyses have demonstrated that Retzius-sparing RARP yields higher rates of immediate and early continence compared with standard anterior approaches, albeit with a modestly higher PSM rate in some series (19-21). SP-TVRP can be regarded as an evolution of this anatomical preservation philosophy, performed entirely through the bladder without violating the peritoneum (22).

The unusually long uncorrected FUL values initially generated by automated Pura profilometry were not interpreted as anatomic membranous urethral length. After review of the raw tracings, we found that migration of the Pves sensor out of the bladder during catheter withdrawal produced subatmospheric Pves drift, which artifactually increased calculated Pclo and prolonged the apparent pressure profile. After baseline correction, FUL estimates were short and compatible with a residual sphincteric pressure-profile segment after prostatectomy, but the corrected MUCP and FUL values should still be interpreted cautiously because an independent fixed Pves channel was not used.

At the same time, our urodynamic data highlight that voiding physiology after SP-TVRP is not homogeneous. Several patients had BCI values <100 and one fulfilled urodynamic criteria for obstruction, despite good overall continence. Recognizing detrusor underactivity or equivocal obstruction may be useful for tailoring postoperative counseling, monitoring patients with slow or incomplete voiding, and selecting adjunctive therapies when needed.

Patient #7 had a Qmax of 1 mL/s and PVR of 200 mL despite favorable patient-reported continence. This finding could reflect true impaired detrusor contractility with possible outlet obstruction, situational inhibition during pressure-flow testing, or a technical artifact of the study. Because this patient did not demonstrate clinically significant urinary retention during routine follow-up, repeat uroflowmetry or repeat UDS would be required before assigning definitive pathophysiologic meaning to this outlier result.

The apparent discrepancy between negative ALPP testing in 72.7% of patients and zero-pad continence in 90.9% at 3 months may reflect differences between provoked laboratory stress testing and patient-reported daily pad use. Pad use is influenced by leakage volume, activity level, individual bother, safety behavior, and cultural differences in pad use, and a positive provoked leak during UDS does not necessarily translate into daily pad use.

The evolution of symptom scores in our cohort is consistent with early postoperative healing. IPSS and OABSS temporarily worsened at 1 month, likely reflecting irritative and obstructive symptoms related to anastomotic healing and perioperative inflammation, but returned to baseline or improved by 3 months. In contrast, erectile function declined over the same period, in line with the longer trajectory of postprostatectomy erectile recovery, which typically extends over 12–24 months even with nerve sparing (23).

The sexual-function data should be interpreted as exploratory because IIEF-5 was the only sexual outcome instrument used. We did not systematically record baseline sexual activity status, penile rehabilitation, erectile hardness, intercourse success, or patient-reported sexual bother, and these omissions limit conclusions regarding broader functional QoL. Nerve-sparing decisions were made side by side using MRI, biopsy grade and laterality, TRUS findings, and intraoperative assessment, but the high-risk profile of the cohort means that oncologic justification for nerve sparing must remain central.

Oncologic safety remains the most important unresolved issue in this series. The PSM rate of 45.5% and PSA persistence rate of 18.2% are major concerns and should not be treated as minor findings. Although the operating surgeon had performed more than 500 multiport radical prostatectomies and had a recent pathologic T2 PSM rate of less than 5% in multiport practice, SP-TVRP requires adaptation to different visual landmarks, restricted traction, and a confined intravesical working space. In the surgeon’s subsequent 40-case SP-TVRP experience, the PSM rate decreased from 50% in cases 1–10 to 30% in cases 11–20, 20% in cases 21–30, and 10% in cases 31–40. This trend suggests a learning-curve effect, but the present 11-patient dataset cannot establish that the high PSM rate is unrelated to the approach itself. Technical modifications intended to maximize continence, particularly around the apex and neurovascular bundles, may also have contributed to margin risk in early cases and require further refinement.

For intermediate- or high-risk and locally advanced prostate cancer, radical prostatectomy should be presented as an oncologic intervention within a potential multimodal pathway rather than primarily as a continence-preserving technology (24). In this study, intermediate- to high-risk patients underwent preoperative PSMA PET/CT and had no radiologic nodal or distant metastasis, but PLND was not performed and all cases were pNx. Therefore, occult nodal disease cannot be excluded, and PSA persistence in this cohort may reflect nodal disease, local residual disease, or residual benign tissue rather than surgical-margin status alone (25).

The early functional benefit of SP-TVRP may also be modified or lost if adjuvant or salvage radiotherapy and/or ADT are required (26). Randomized evidence and the ARTISTIC meta-analysis support early salvage radiotherapy rather than routine adjuvant radiotherapy for many men after prostatectomy, but postoperative radiotherapy can worsen urinary, bowel, and sexual outcomes (27). Therefore, 3-month continence should not be interpreted as the final functional outcome in patients with PSM, PSA persistence, or a high likelihood of secondary treatment.

The absence of preoperative UDS is a major limitation; therefore, the study cannot determine whether bladder storage, voiding, or sphincteric function was preserved, improved, or worsened from baseline. The lack of PLND, pNx status in all patients, two cases of neoadjuvant ADT, incomplete sexual-function assessment, and use of pad counts without ICIQ-UI SF or EPIC-26 urinary incontinence domains further limit interpretation. Pura profilometry was also limited by the absence of an independent fixed Pves channel; future studies should incorporate a separate intravesical line to avoid Pves drift during withdrawal.

This study has additional limitations. It is a single-center, single-surgeon series with a small sample size and no direct control group undergoing conventional or Retzius-sparing transperitoneal RARP. The short follow-up of 3 months precludes assessment of long-term functional trajectories, biochemical recurrence-free survival, and the effect of adjuvant or salvage therapy. Larger, multicenter comparative studies with longer follow-up, serial UDS, validated patient-reported outcome measures, and complete oncologic and secondary-treatment data are needed.

The main strength of the study is that it prospectively applies standardized postoperative UDS to a novel surgical approach for which functional outcomes have otherwise been described mainly by pad use and questionnaires.

Conclusions

At 3 months after SP-TVRP, postoperative UDS demonstrated favorable bladder storage findings and urethral findings compatible with early continence recovery in this small prospective cohort. The study does not prove physiological preservation, superiority over other approaches, or oncologic safety because it lacks baseline UDS, a control group, long-term follow-up, nodal staging, and complete secondary-treatment outcomes. The high PSM rate and PSA persistence underscore the need for careful selection, technical maturation, and longer follow-up before broad adoption of SP-TVRP. At present, SP-TVRP should be regarded as hypothesis-generating and potentially most appropriate for carefully selected node-negative patients in whom the anticipated functional benefit does not compromise oncologic principles or the need for nodal staging.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0368/rc

Data Sharing Statement: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0368/dss

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0368/prf

Funding: This work was supported by Hallym University Research Fund (No. HURF-2024-01).

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0368/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Review Board of Hallym University Sacred Heart Hospital (IRB No. 2024-05-011-002). All patients were informed of the study details and provided written consent prior to participation.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med 2018;378:1767-77. [Crossref] [PubMed]
2. Moretti TBC, Magna LA, Reis LO. Open, Laparoscopic, and Robot-Assisted Radical Prostatectomy Oncological Results: A Reverse Systematic Review. J Endourol 2023;37:521-30. [Crossref] [PubMed]
3. Chen Y, Hao H, Chen S, et al. Insights into urinary incontinence after robot-assisted radical prostatectomy: urgent urinary incontinence or stress urinary incontinence. World J Urol 2023;41:3635-42. [Crossref] [PubMed]
4. Katsimperis S, Juliebø-Jones P, Ta A, et al. Surgical techniques to preserve continence after robot-assisted radical prostatectomy. Front Surg 2023;10:1289765. [Crossref] [PubMed]
5. Zhou X, Fu B, Zhang C, et al. Transvesical robot-assisted radical prostatectomy: initial experience and surgical outcomes. BJU Int 2020;126:300-8. [Crossref] [PubMed]
6. Desai MM, Aron M, Berger A, et al. Transvesical robotic radical prostatectomy. BJU Int 2008;102:1666-9. [Crossref] [PubMed]
7. Ramos-Carpinteyro R, Ferguson EL, Chavali JS, et al. First 100 cases of transvesical single-port robotic radical prostatectomy. Asian J Urol 2023;10:416-22. [Crossref] [PubMed]
8. Kaouk J, Beksac AT, Abou Zeinab M, et al. Single Port Transvesical Robotic Radical Prostatectomy: Initial Clinical Experience and Description of Technique. Urology 2021;155:130-7. [Crossref] [PubMed]
9. Ferguson EL, Ramos-Carpinteyro R, Soputro N, et al. Single-Port Robotic Radical Prostatectomy Using Transvesical and Transperineal Access in Patients with a Hostile Abdomen. J Endourol 2024;38:150-8. [Crossref] [PubMed]
10. Abou Zeinab M, Beksac AT, Ferguson E, et al. Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis. World J Urol 2022;40:2001-8. [Crossref] [PubMed]
11. Rosier PFWM, Schaefer W, Lose G, et al. International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn 2017;36:1243-60. [Crossref] [PubMed]
12. Ramos-Carpinteyro R, Ferguson E, Soputro N, et al. Predictors of Early Continence After Single-port Transvesical Robot-assisted Radical Prostatectomy. Urology 2024;184:176-81. [Crossref] [PubMed]
13. Soputro NA, Mikesell CD, Younis SK, et al. Propensity-matched Comparison of Single-port Transvesical Versus Standard Multiport Robotic Radical Prostatectomy. Eur Urol Oncol 2026;9:45-54. [Crossref] [PubMed]
14. Freire MP, Weinberg AC, Lei Y, et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol 2009;56:972-80. [Crossref] [PubMed]
15. Galfano A, Ascione A, Grimaldi S, et al. A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 2010;58:457-61. [Crossref] [PubMed]
16. Nguyen LN, Head L, Witiuk K, et al. The Risks and Benefits of Cavernous Neurovascular Bundle Sparing during Radical Prostatectomy: A Systematic Review and Meta-Analysis. J Urol 2017;198:760-9. [Crossref] [PubMed]
17. Patel VR, Coelho RF, Palmer KJ, et al. Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 2009;56:472-8. [Crossref] [PubMed]
18. Rocco F, Carmignani L, Acquati P, et al. Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol 2006;175:2201-6. [Crossref] [PubMed]
19. Asimakopoulos AD, Topazio L, De Angelis M, et al. Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates. Surg Endosc 2019;33:2187-96. [Crossref] [PubMed]
20. Lv T, Yang J, Cheng B. Oncological and functional outcomes of Retzius-sparing vs. standard robot-assisted radical prostatectomy: evidence on randomized-controlled trials studies. J Robot Surg 2025;19:165.
21. Qiu X, Li Y, Chen M, et al. Retzius-sparing robot-assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single-blind trial with a 1-year follow-up. BJU Int 2020;126:633-40. [Crossref] [PubMed]
22. Chung JH, Kim H, Bang WJ, et al. Early Experience of the Single-Port Robotic Transvesical Radical Prostatectomy: Case Series. J Urol Oncol 2024;22:188-95.
23. Al Hussein Al Awamlh B, Wallis CJD, Penson DF, et al. Functional Outcomes After Localized Prostate Cancer Treatment. JAMA 2024;331:302-17. [Crossref] [PubMed]
24. Tilki D, Chen MH, Wu J, et al. Persistent Prostate-Specific Antigen Following Radical Prostatectomy for Prostate Cancer and Mortality Risk. JAMA Oncol 2025;11:502-10. [Crossref] [PubMed]
25. Parker CC, Clarke NW, Cook AD, et al. Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial. Lancet 2020;396:1413-21. [Crossref] [PubMed]
26. Kneebone A, Fraser-Browne C, Duchesne GM, et al. Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): a randomised, controlled, phase 3, non-inferiority trial. Lancet Oncol 2020;21:1331-40. [Crossref] [PubMed]
27. Vale CL, Fisher D, Kneebone A, et al. Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data. Lancet 2020;396:1422-31. [Crossref] [PubMed]