Autologous Vas Deferens Sling for Early Urinary Continence During Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Randomized Controlled Clinical Trial.

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.