Trial reportJournal of robotic surgery2026
MRI-informed urethral preservation strategy for early continence recovery after robot-assisted radical prostatectomy: a multicenter randomized controlled trial.
Trial report in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
Funding
Abstract
To evaluate whether an MRI-informed urethral preservation strategy based on preoperative membranous urethral length (MUL) and prostatic apical morphology improves early continence recovery after robot-assisted radical prostatectomy (RARP). This multicenter, prospective, randomized, assessor-blinded exploratory trial enrolled 100 patients with biopsy-confirmed prostate cancer scheduled for transperitoneal RARP. Patients were randomly assigned in a 1:1 ratio to an MRI-informed urethral preservation group or a conventional RARP group. In the intervention group, a prespecified algorithm combined three MUL strata (< 10, 10-<14, and ≥ 14 mm), apical morphology, and apical oncological risk to determine the planned urethral transection strategy; oncological safety findings overrode maximal preservation. The primary endpoint was social continence recovery at 1 month. The sample size was feasibility-based. A total of 100 patients were randomized, with 50 patients in each group. At 1 month, social continence recovery was observed in 32 patients (64.0%) in the MRI-informed group and 21 patients (42.0%) in the conventional group (unadjusted OR 2.46, 95% CI 1.10-5.49; P = 0.028). The median time to social continence recovery was 28 versus 46 days (HR 1.56, 95% CI 1.04-2.35; P = 0.032). Overall positive surgical margin rates (20.0% vs. 22.0%) and apical positive surgical margin rates (6.0% vs. 8.0%) were numerically similar. An MRI-informed urethral preservation strategy based on preoperative MUL and prostatic apical morphology may improve early continence recovery after RARP. Overall and apical positive surgical margin rates and anastomosis-related complication rates were numerically similar between groups. However, these secondary comparisons were underpowered and do not establish oncological or procedural safety. Larger, adequately powered randomized trials with longer follow-up are required.
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