Single Port Robotic Radical Prostatectomy: A Propensity-matched Comparison of Transvesical Versus Extraperitoneal Approaches from the Single Port Advanced Research Consortium.

BACKGROUND AND OBJECTIVES: 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.

MATERIALS AND METHODS: 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.

RESULTS AND LIMITATIONS: 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.

CONCLUSION: 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.