Urinary continence after robot‐assisted radical prostatectomy with complete urethral preservation

Objectives This study aimed to evaluate the functional, oncological and learning‐curve outcomes of the complete urethral preservation (CUP) technique during robot‐assisted radical prostatectomy in a large single‐centre cohort. Patients and Methods We retrospectively analysed patients undergoing robot‐assisted radical prostatectomy (RARP) between June 2021 and August 2025 by a single high‐volume surgeon. Outcomes were compared by CUP status. Continence was assessed at early (3–6 months) and late (12 months) follow‐up, using a strict binary definition and with pad usage recorded separately. Oncological assessment included margin status (MS) and biochemical recurrence (BCR) over 3 years. Multivariable Cox regression assessed predictors of BCR. The learning curve was evaluated using LOESS‐based probability smoothing. Results A total of 459 patients were included, with successful CUP achieved in 316 (68.8%). Early continence was higher in the CUP cohort than in non‐CUP patients (77% vs 67%, p = 0.02), while rates were similar at 12 months (83% vs. 80%, p = 0.74). CUP patients were significantly more likely to be pad‐free/security pad only at both timepoints ( p = 0.019 and 0.012, respectively). Positive MS rates and locations were comparable between groups. CUP was not associated with increased BCR risk on multivariable analysis (HR 1.06, 95% CI 0.56–1.98; p = 0.90). CUP likelihood improved with experience. Conclusions CUP is associated with improved early continence recovery and higher rates of pad‐free status following RARP, without compromising margin status or biochemical recurrence. These findings support CUP as a safe and reproducible continence‐preserving technique, with the likelihood of successful CUP increasing with surgical experience.