Surgical techniques for enhancing postoperative urinary continence in robot-assisted radical prostatectomy: a comprehensive review

Abstract

Prostate cancer (PCa) is one of the most common malignancies affecting the male reproductive system. Robot-assisted radical prostatectomy (RARP) has been a standard treatment for PCa for over 20 years. However, postoperative urinary incontinence remains a frequent complication for patients who undergo RARP. Numerous surgical techniques have been developed to improve postoperative continence recovery, broadly categorized into preservation and reconstruction methods. Preservation techniques include safeguarding the bladder neck, distal urethra, detrusor apron, retropubic space, neurovascular bundles, and controlling the dorsal venous complex. Reconstruction techniques aim to mitigate the impairment of urethral sphincter function caused by surgery. While these approaches substantially enhance post-RARP urinary continence recovery, challenges remain in tailoring surgical plans to individual patient needs. This review explores the application of these representative techniques, discusses their current limitations, and highlights potential directions for future advancement.