Outcomes of Intraoperative Preservation of Erectile Function and Urinary Continence in Robotic-Assisted Radical Prostatectomy: A Literature Review

Abstract

Prostate cancer is still one of the most common cancers in men globally. Although survival rates after treatment continue to rise, postoperative functional outcomes are now crucial when choosing a course of therapy. Because improved three-dimensional imaging and instrument accuracy enable more precise nerve-sparing and tissue-preserving dissection, robotic-assisted radical prostatectomy (RARP) is currently the recommended surgical technique for localized and chosen locally advanced disease. Despite these technological advancements, erectile dysfunction and urine incontinence are still frequent surgical complications that significantly impair quality of life, especially in younger and sexually active men. 105 peer-reviewed sources covering methodological advancements in nerve-sparing surgery, Retzius-sparing RARP, pelvic fascia and support-structure preservation, single-port and novel access modalities, anterior and posterior musculofascial reconstruction, surgeon experience and learning-curve effects, and their impact on positive surgical margin (PSM) and biochemical recurrence (BCR) rates are summarized in this review. Techniques that maintain the detrusor apron, puboprostatic ligaments, endopelvic fascia, and neurovascular bundles consistently speed up the recovery of potency and continence without increasing the duration of surgery. The quickest early continence recovery is provided by retzius-sparing and single-port transvesical techniques, although in anteriorly placed or locally advanced (T3a) illness, there is a trend toward greater positive-margin rates, highlighting the significance of cautious patient selection. Without sacrificing oncologic safety, musculofascial restoration and more surgeon expertise enhance early functional recovery. When the pentafecta objectives of continence, potency, freedom from biochemical recurrence, absence of comorbidities, and negative margins are balanced, the data supports a customized, anatomy-guided strategy to intraoperative preservation [20, 70].

Keywords: Prostate cancer; Robotic-assisted radical prostatectomy; Nerve-sparing; Retzius-sparing; Urinary continence; erectile function; Pentafecta

DOI: 10.7176/JHMN/121-05

Publication date: October 30th 2026