(UroToday.com) Dr. Nicolas A. Soputro delivered a podium presentation comparing outcomes between transvesical (TV) and extraperitoneal (EP) approaches for single-port robotic-assisted radical prostatectomy (SP-RARP). As utilization of the da Vinci SP platform continues to expand, surgeons remain interested in identifying operative approaches that may improve postoperative recovery while preserving cancer control. The study focused on evaluating whether the transvesical technique could offer perioperative and functional advantages compared with the more commonly utilized extraperitoneal approach.
To investigate this question, Dr. Soputro and collaborators analyzed data from the SP Advanced Research Consortium (SPARC), a prospectively maintained multi-institutional database. Patients undergoing either TV or EP SP-RARP were identified and assessed for perioperative variables, postoperative complications, oncologic outcomes, and urinary continence recovery.
The study cohort consisted of 2,230 patients, including 531 who underwent the transvesical approach and 1,699 treated through the extraperitoneal route. Baseline characteristics were generally similar between groups, although the TV cohort more frequently included patients with prior abdominal operations and smaller prostate glands.
Operative outcomes demonstrated several advantages associated with the TV approach. Surgeons performing TV SP-RARP reported shorter console times and lower estimated blood loss, while maintaining low rates of intraoperative complications comparable to the EP cohort. In the postoperative setting, patients undergoing TV procedures experienced shorter hospital stays, decreased catheterization times, and were more commonly discharged without opioid medications. Major postoperative complications also occurred less frequently following the transvesical approach.
One of the most notable findings involved early urinary recovery. Patients treated with TV SP-RARP regained continence more rapidly throughout the first postoperative months compared with those undergoing EP surgery. At 6 weeks, continence rates favored the TV cohort, and this advantage persisted at 3- and 6-month follow-up intervals. By one year, continence outcomes between the two techniques became more comparable, with both groups achieving high overall recovery rates.
Importantly, the improved recovery profile associated with the transvesical approach did not appear to compromise oncologic efficacy. Rates of biochemical recurrence remained low and were not significantly different between the two surgical techniques at median follow-up.
The investigators emphasized that the TV SP approach may provide meaningful quality-of-life benefits, particularly in facilitating earlier return of urinary control and supporting enhanced recovery pathways after prostatectomy. Reduced opioid exposure and shorter hospital stays may also have implications for outpatient robotic prostatectomy programs moving forward.
Dr. Soputro concluded that transvesical SP-RARP represents a safe and effective alternative to the extraperitoneal approach, offering favorable perioperative recovery and earlier functional improvement while maintaining acceptable short-term oncologic outcomes. Further investigation with longer follow-up will help clarify the durability of these findings and define optimal patient selection for the transvesical technique.
During the discussion period, Dr. Marco Paciotti asked whether the observed benefits of the transvesical approach were limited to patients who specifically met selection criteria for TV SP-RARP, despite the use of propensity score matching. In response, Dr. Soputro emphasized that the transvesical technique is not intended to be a “one-size-fits-all” approach and acknowledged that careful patient selection remains an important factor when considering candidacy for the procedure.
Presented by: Nicolas A. Soputro, MD, Department of Urology, Cleveland Clinic
Written by: Ian Ong, Junior Specialist, Department of Urology, University of California, Irvine during the American Urological Association (AUA) 2026 Annual Meeting, Washington, DC, Fri, May 15 – Mon, May 18, 2026.