Preservation of the superior fascia of the pelvic diaphragm is associated with greater continence recovery after non-nerve-sparing robot-assisted radical prostatectomy.

Early continence recovery after robot-assisted radical prostatectomy (RARP) remains challenging when nerve sparing (NS) is oncologically infeasible. We evaluated whether preservation of the superior fascia of the pelvic diaphragm (SFPD) was associated with continence recovery after non-NS RARP. We retrospectively analyzed 213 patients who underwent non-NS RARP (January 2021-May 2024). The SFPD was intraoperatively categorized into apical and proximal fascia (AF, PF); bilateral preservation of both (n = 138) was compared with all other patterns (n = 75) in the primary analysis. Secondary analyses examined AF and laterality. The primary outcome was pad-free recovery, analyzed by Kaplan-Meier curves with the log-rank test, restricted mean survival time (RMST) at 24 months, and multivariable logistic regression at 12 months. Bilateral SFPD preservation was associated with greater pad-free recovery (log-rank p = 0.0064; RMST difference - 2.82 months; p = 0.033), and the association persisted at 12 months after multivariable adjustment (adjusted odds ratio [OR] 2.16, 95% CI 1.07-4.38; p = 0.031). Secondary analyses indicated greater recovery with AF preservation (vs. none; log-rank p = 0.0001; RMST difference - 4.89 months; adjusted OR 3.15, 95% CI 1.22-8.46; p = 0.019), but not with PF alone. Bilateral AF preservation was associated with greater recovery than unilateral (log-rank p = 0.0039). Findings were consistent in proctor-restricted analyses. SFPD preservation (both-preserved vs. others) showed no adverse short-term oncological signal. Bilateral SFPD preservation was associated with greater continence recovery after non-NS RARP; exploratory analyses suggested a similar association with bilateral AF preservation.