TL;DR
Overall, incontinence prevention and treatment after RARP is becoming increasingly individualized with many options available for clinicians to offer to patients and continued innovation and discovery in functional recovery after RP are imperative.
PURPOSE OF REVIEW Despite several advancements in the surgical technique of robotic prostatectomy, urinary incontinence and sexual dysfunction remain as significant side effects. The purpose of this review is to compare and evaluate the various modifications during the robotic prostatectomy that can help improve both urinary and sexual function outcomes. RECENT FINDINGS Surgical innovations such as Retzius-sparing, anatomical reconstruction, and various tissue preservation techniques demonstrate high recovery rates of urinary continence up to 90% within 12 months. However, postoperative sexual potency outcomes vary widely across techniques and remain largely influenced by preoperative patient factors. Approaches such as endopelvic fascia preservation and ultrapreservation show promising erectile recovery rates up to 80% at one year. It is reassuring that these technical modifications continue to maintain acceptable oncological safety while helping to improve functional outcomes. SUMMARY We evaluated recent surgical innovations in robotic prostatectomy that can help improve both sexual function outcomes while maintaining oncological safety. Future studies should focus on head-to-head comparisons of these anatomical techniques through well designed prospective studies to establish superiority in functional recovery after prostatectomy.
A bibliometric and visualization analysis of global RARP incontinence research, aiming to provide a reference for clinicians and researchers working to improve continence outcomes, found the United States led in both publication volume and total citations, followed by Japan and Italy.
Introduction. Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for benign prostatic hyperplasia (BPH), while various endoscopic enucleation techniques are gaining increasing popularity. Despite the advantages of the minimally invasive transurethral approach, urinary incontinence (UI) remains one of the most significant and undesirable postoperative complications, potentially developing in the postoperative period and substantially impairing daily activities. Objective. To evaluate treatment options for UI following transurethral surgery for BPH. Materials & methods. A systematic review of the PubMed and Elibrary.ru databases was conducted for the period from 1999 to 2026 to identify all relevant studies. The search was limited to publications in Russian and English. Results. Following transurethral surgery for BPH, various UI types may develop, including urge, stress, and mixed incontinence. Reported rates of UI after transurethral procedures for BPH vary considerably across the literature, ranging from 0.5% to 60%. This wide variability reflects the lack of a unified definition and diagnostic approach to this complication. Management of urge urinary incontinence after transurethral surgery for BPH involves a multimodal approach, including anti-inflammatory and antibacterial agents, antimuscarinics, and beta-3 adrenergic receptor agonists; in more severe cases, intradetrusor botulinum toxin injections are employed. For stress urinary incontinence (SUI) associated with the transurethral approach in BPH, first-line therapy consists of pelvic floor muscle training (including biofeedback-guided exercises, magnetic or electrical stimulation). In more severe cases, surgical interventions are considered, such as sling placement or artificial urinary sphincter implantation. Conclusion. Pelvic floor muscle training represents one of the most promising treatment modalities for UI following transurethral surgery for BPH. However, further research is needed to clarify optimal rehabilitation strategies, as current evidence remains insufficient to fully assess the efficacy, safety, and potential interactions of different treatment approaches for post-transurethral incontinence in men.
Introduction Prostate cancer represents one of the most prevalent malignancies affecting the male population worldwide. With increasing survival rates, greater attention has been directed toward postoperative complications, particularly erectile dysfunction and urinary incontinence. Patient concerns A 70-year-old male patient with histologically confirmed prostate carcinoma reported lower urinary tract symptoms including dysuria and nocturia. Diagnosis The pathological diagnosis was organ-confined acinar adenocarcinoma of the prostate, pT2, ISUP Grade Group 1, with negative surgical margins (R0). Interventions and outcomes After pelvic ultrasound, consultation with an anesthesiologist and a cardiologist, the patient underwent retrograde robot-assisted radical prostatectomy. Conclusion This case illustrates the practical application of the retrograde approach, emphasizing its anatomical rationale and technical considerations rather than demonstrating superiority over conventional antegrade nerve sparing. Careful patient selection, sound anatomical knowledge, and adherence to oncological principles remain essential for balancing cancer control with functional preservation. Further prospective comparative studies are required to clarify the role of retrograde nerve-sparing dissection in contemporary robot-assisted radical prostatectomy.
Background/Objectives: To evaluate the surgical and functional outcomes of robot-assisted simple prostatectomy (RASP) for men with bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), aiding informed clinical decision-making. Methods: We conducted a prospective study of 69 patients undergoing RASP for BPH-related LUTS or acute urinary retention (AUR). Three high-volume robotic urologists from a single center, utilising a modified Millins technique, performed the RASP procedures. Pre-operative data included demographics (age, prostate-specific antigen (PSA), prostate volume), LUTS measures (International Prostate Symptom Score (IPSS), quality-of-life (QOL), flow rates, pad use), and intraoperative parameters (operative time, blood loss, histology, hospital stay). Postoperative outcomes were collected at 6–8 weeks and included symptom scores, flow rates, pad use, and patient satisfaction. Data were analysed using descriptive statistics and multivariate linear logistic regression; significance was set at 95% confidence. Results: Median patient age was 74 years (interquartile range (IQR) 72–77) with a median prostate volume of 143 cc (IQR 123–195) and preoperative IPSS of 19 (IQR 15.0–23.0). Median console time was 60 min (IQR 50.0–65.0), estimated blood loss was 350.0 mL (IQR 200–500), and specimen weight was 105.5 g (IQR 67.25–132.5). Median hospital stay was 1.0 day; all patients passed their trial of void (TOV) postoperatively, with an IPSS improvement of 78.9% (12 points), QOL improvement of 75% (3 points), maximum flow rate (Qmax) increase of 16.3 mL/s and an overall patient satisfaction of 10 out of 10 (extremely satisfied), independent of specimen size, operative duration, or pad usage. Conclusions: RASP appears to be a safe and effective surgical option for men with high-volume BPH and bothersome LUTS, offering substantial symptom improvement and excellent patient satisfaction. Its advantages may extend to patients with very large prostates or concurrent bladder pathology. However, findings are limited by our modest sample size and short follow-up. Larger prospective and comparative trials are warranted to better define the role of RASP in the treatment algorithm for BPH.
INTRODUCTION Urinary incontinence (UI) remains a distressing complication following surgical treatment of benign prostatic hyperplasia (BPH). Although postoperative UI is well described, few prospective studies have distinguished predictors of stress urinary incontinence (SUI) from those of urge urinary incontinence (UUI). METHODS In this prospective cohort study (July 2022-July 2024), 133 men undergoing bipolar transurethral resection of the prostate (B-TURP) or bipolar enucleation of the prostate (BipolEP) were followed-up for ≥ 1 year. Preoperative and intraoperative variables were evaluated using univariate testing and multivariable logistic regression to identify independent predictors of persistent SUI and UUI. RESULTS SUI occurred in 20.3% of patients and was independently associated with older age and use of the enucleation technique with additional univariate associations observed for larger prostate volume, lower baseline Qmax, and greater resected tissue weight. UUI occurred in 15.8% and was independently predicted by higher IPSS scores and preoperative detrusor overactivity with univariate association also noted for older age; no intraoperative factor predicted UUI. CONCLUSIONS SUI is primarily driven by anatomical and surgical factors, whereas UUI reflects underlying bladder dysfunction. Differentiating these predictive profiles supports individualized patient counseling, procedural planning, and preoperative risk stratification for men undergoing transurethral prostatectomy.