Early versus Long-Term Post-Prostatectomy Incontinence Recovery Among Three Robotic-Assisted Radical Prostatectomy Techniques: A Retrospective Cohort Study

Objective: To compare the early and long-term recovery outcomes of post-prostatectomy incontinence (PPI) among patients undergoing Retzius-sparing robotic-assisted laparoscopic prostatectomy ( RS -RARP), conventional 2-layer reconstruction, and conventional 3-layer total reconstruction. Methods: We conducted a retrospective cohort study of 79 patients who underwent RARP by at a single tertiary center. Patients were grouped as RS -RARP (n=19), 2-layer RARP (n=30), and 3-layer RARP (n=30). The primary outcome was PPI recovery, defined as “pad-free”, which was evaluated at immediate, 1, 3, and 6 months after RARP to distinguish between early (immediate/1 month) and long-term (3/6 months) outcomes. Secondary outcomes included cystographic parameters like bladder neck (BN) angle and BN downward distance. Statistical analysis utilized ANOVA and Chi-square tests, with p< 0.05 considered significant. Results: All three groups achieved excellent long-term continence rates (≥ 96.7% at 6 months, p=0.723). The RS -RARP group demonstrated a borderline statistical advantage of early PPI recovery at the immediate timepoint (89.5% vs. 60.0% in the other two groups, p=0.049). A similar favorable clinical trend was observed at the 1-month follow-up, though the difference did not reach statistical significance (p=0.251). Cystographic analysis revealed a significant difference in mean BN angle (p=0.001): 128.5∘for RS -RARP, 107.7∘for 2-layer RARP, and 120.1∘for 3-layer RARP. Conclusion: All three RARP techniques yield excellent long-term continence rates. RS -RARP demonstrated a favorable advantage in immediate PPI recovery, which supports the benefit of anterior structure preservation. However, the observed significant anatomical difference in BN angle did not translate into a statistically significant functional difference in long-term PPI recovery, highlighting the multifactorial etiology of continence restoration.