Abstract

Objectives: The objective of this study was to evaluate the efficacy and safety of an autologous vas deferens (AVD) sling for improving early urinary continence after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods: In this single-center, prospective, randomized trial, 200 patients at high risk for postoperative urinary incontinence were randomized to undergo RS-RARP with or without AVD sling suspension. The primary endpoint was immediate urinary continence, defined as the use of 0–1 safety pads/day within 7 days after catheter removal. Secondary outcomes included continence recovery up to 3 months, EPIC-26 and IPSSs, and subgroup analysis according to the preoperative membranous urethral length (MUL). Multivariable logistic regression was performed to identify predictors of continence recovery. Results: The AVD sling group showed higher immediate (69.0% vs. 55.0%; p = 0.041) and 1-month continence rates (81.0% vs. 67.0%; p = 0.024) than the RS-RARP group. EPIC-26 scores and IPSSs also favored the AVD sling group during the early postoperative period (both p < 0.01). In exploratory subgroup analyses, patients with preoperative MUL < 12 mm appeared to derive greater early continence benefit from the sling procedure. The AVD sling remained independently associated with continence recovery at the immediate (adjusted OR 2.23, p = 0.014) and 1-month (adjusted OR 2.60, p = 0.008) assessments. Differences between groups decreased after postoperative month 2. The operative time was longer in the AVD sling group, whereas complication rates and short-term oncological outcomes were similar between groups. Conclusions: The AVD sling may improve early urinary continence recovery during the first postoperative month after RS-RARP, particularly in high-risk patients with shorter preoperative MUL.

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