Single Port (SP) robotic radical prostatectomy (RARP) has been increasingly used, with Extraperitoneal (EP) and Transvesical (TV) approaches being the most common. This study sought to describe the multi-institutional clinical experience of EP and TV SP-RARP.
A retrospective review was conducted using the prospectively maintained, Institutional Review Board-approved database of the SP Advanced Research Consortium (SPARC) to identify all consecutive patients who underwent EP or TV SP-RARP between 2019 and 2025. A 1:1 propensity score-matched comparison analysis was performed based on the age, prostate volume, PSA levels, and ISUP Grade Groups on the preoperative prostate biopsy.
A total of 2230 patients were reviewed, which included 1699 (76.2%) EP and 531 (23.8%) TV SP-RARP. Following propensity score-matched analysis, 884 patients were included, with 442 being analyzed from each group. History of previous abdominal surgery was more prevalent in the TV cohort (EP 33% vs TV 49.5%, SMD = 0.342). All procedures were completed successfully, with similar operative times (median, 184 vs 192 min, p = 0.733), risk of intraoperative complications (0.6% vs 1%, p = 0.307), and positive surgical margin status (pT2, 13.3% vs 14.7%, p = 0.070). Postoperatively, the SP-TV approach was associated with higher rates of same-day discharges (60.6% vs 78.2%, p < 0.001), a shorter Foley catheter duration (median, 7 vs 5 d, p < 0.001), with no differences in the incidence of major complications (3.2% vs 1.6%, p = 0.185). With 42.3% of patients achieving immediate urine continence following TV SP-RARP, the regionalized technique conferred improved early continence recovery at both 6 wk (44% vs 52.9%, p < 0.001), 3 mo (69.7% vs 79.1%, p = 0.040), and 6 mo (77.9% vs 87.2%, p < 0.001). At 12 mo, satisfactory erectile function was reported in 85.7% and 88.4% of the SP EP and TV groups, respectively (p = 0.174). At a median follow-up duration of 10 mo, biochemical recurrence rates were similar between the two groups (3.1% vs 3.6%, p = 0.678). Limitations of this study included the retrospective study design of the relatively novel surgical techniques, with limited long-term follow-up data.
TV SP-RARP offers notable advancements in patient comfort, featuring higher rates of same-day discharges, reduced opioid use, shorter Foley catheter duration, and early recovery of urine continence, whilst maintaining comparable perioperative safety and oncological adequacy to EP SP-RARP.
European urology oncology. 2026 May 07 [Epub ahead of print]
Nicolas A Soputro, Jacob Hershenhouse, Sam Cole, Jacob O'Hara, Jack Considine, Mehr Nasir-Moin, Narmina Khanmammadova, Yeonsoo Lee, Ruben Sauer-Calvo, Simon Kim, Alissa Elanjian, Anastasia Mavridis, Sean Horan, Abdulrahman Al-Bayati, Dattatraya Patil, Shamsunnahar Imtiaz, Rui M Bernardino, David G Gelikman, Karim Daher, Firas Abdollah, Adam Lorentz, David I Lee, Ram Pathak, Kshitij Hemal, Jullet Han, Jaschar Shakuri-Rad, Ryan J Nelson, Bertram Yuh, Jeffrey Bassett, Moses Kim, Jean Joseph, Jeffrey W Nix, Chad Ritch, Bruno Nahar, Mihir S Shah, Mutahar Ahmed, Michael D Stifelman, Simone Crivellaro, Riccardo Autorino, Jihad Kaouk
Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA., University of Southern California (USC), Los Angeles, CA, USA., Desai Sethi Institute of Urology, University of Miami, Miami, FL, USA., Hackensack University Medical Center, Hackensack, NJ, USA., Henry Ford Health System, Detroit, MI, USA., Thomas Jefferson University Hospital, Philadelphia, PA, USA., University of California Irvine, Irvine, CA, USA., Mayo Clinic Jacksonville, Jacksonville, FL, USA., University of Illinois at Chicago (UIC), Chicago, IL, USA., Emory University Hospital, Atlanta, GA, USA., Vandalia Health, Morgantown, WV, USA., Michigan Institute of Urology, Detroit, MI, USA., City of Hope, Duarte, CA, USA., Hoag Memorial Hospital, Newport Beach, CA, USA., Orange County Urology Associates, Newport Beach, CA, USA., University of Rochester Medical Center, Rochester, NY, USA., University of Alabama at Birmingham, Birmingham, AL, USA., Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA; RUSH University Medical Center, Chicago, IL, USA., Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: .