The Pubovesical Complex–Sparing Laparoscopic Radical Prostatectomy Improves Early Urinary Continence Without Compromising Oncologic Safety: A Prospective, Randomized, and Double‐Blinded Clinical Trial

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BACKGROUND: Post-prostatectomy urinary incontinence significantly impacts quality of life. Techniques that preserve periprostatic structures have shown promise in promoting earlier continence recovery, particularly with robotic-assisted surgery. The study aimed to evaluate the effect of pubovesical complex (PVC) preservation on urinary continence recovery in patients undergoing laparoscopic radical prostatectomy (LRP). METHODS: In this randomized, blinded, prospective clinical trial, 72 patients with localized prostate cancer were assigned to standard LRP or LRP with PVC preservation. The primary endpoint was urinary continence recovery, defined as complete absence of leakage or pad use, assessed at 24 h, 15 days, 1, 3, and 6 months post-catheter removal. Secondary endpoints included operative time, blood loss, complications, and oncologic outcomes. RESULTS: At 6 months, continence was significantly higher in the PVC group (82.4% vs. 57.6%; p = 0.027). Earlier timepoints showed improved, though not statistically significant, continence rates in the PVC group. Operative time (109 vs. 75 min; p < 0.001) and blood loss (365 vs. 247 ml; p = 0.010) were greater with PVC preservation. Complication and margin positivity rates were similar between groups. CONCLUSION: PVC preservation during LRP significantly improves urinary continence recovery without compromising oncologic safety. This accessible technique can be adopted in centers lacking robotic platforms, offering equitable benefits for patients in resource-limited settings. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC), RBR-7f25wsz.

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