ArticleWorld journal of urology2026
Side-specific lower detrusor apron-sparing robot-assisted radical prostatectomy: functional and oncological outcomes.
Article in World journal of urology, 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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Abstract
purposeTo describe a lower detrusor apron-sparing (LDAS) modification of robot-assisted radical prostatectomy (RARP) adapting anterior-compartment preservation to side-specific oncological risk, and report perioperative, functional and oncological outcomes.
methodsWe retrospectively analysed a prospectively maintained, single-surgeon cohort of 167 men with localised prostate cancer undergoing RARP with unilateral or bilateral LDAS nerve-sparing (2019-2025). On the LDAS side the lower detrusor apron and anterior periurethral support were preserved without opening the endopelvic fascia, with conventional dissection contralaterally when risk was higher. Patient-reported outcomes were collected electronically. Continence was defined as 0-1 safety pad/24 h (strict, 0 pad), erectile recovery as penetrative intercourse with or without phosphodiesterase-5 inhibitors, and biochemical recurrence (BCR) as two consecutive PSA values ≥ 0.2 ng/mL.
resultsClavien-Dindo ≥ III complications occurred in 1.2%; mean stay 0.6 days (46% same-day discharge). Continence (0-1 pad) was 85%, 97%, 99% and 100% at 6 weeks, 6, 12 and 24 months; strict (0-pad) continence was 51%, 84%, 92% and 97%. Intercourse capability reached 71% at 12 months. Outcomes did not differ by LDAS laterality. Positive surgical margins (PSM) occurred in 16% overall and 8.2% of LDAS-preserved sides. Over a median follow-up of 37 months (IQR 19-55), BCR-free survival rates were 99%, 96%, 94% and 89% at 1, 2, 3 and 5 years; BCR did not differ by LDAS-side PSM status (p = 0.7).
conclusionSide-specific LDAS RARP was associated with rapid continence recovery, low morbidity and favourable mid-term oncological outcomes. Lacking a contemporaneous comparator, these single-surgeon findings are hypothesis-generating and require prospective, multicentre, comparative validation.
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