MRI-informed urethral preservation strategy for early continence recovery after robot-assisted radical prostatectomy: a multicenter randomized controlled trial
In brief
MRI-guided urethral preservation lifts 1-month continence to 64% versus 42%
In a multicenter randomized trial of 100 men undergoing robot-assisted prostatectomy, an MRI-based algorithm that tailors urethral transection to membranous urethral length and apical anatomy achieved social continence in 64% of patients at one month, compared with 42% using the conventional technique. Cancer-margin rates were similar, but the study was small, so larger trials are needed to confirm safety and durability.
- Journal
- Journal of robotic surgery (Q1)
- Published
- 26 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Lingxiang Lu, Fei Wang, Zhen Tian, Shuai Guo, Ke Wu, YuHua Huang, et al.
- PMID
- 42645643
- DOI
- 10.1007/s11701-026-03846-z
Why clinicians should know about it
- Picked for Urology (top studies of the week, 30 August 2026): MRI‑informed urethral preservation RCT after RARP
Abstract
To evaluate whether an MRI-informed urethral preservation strategy based on preoperative membranous urethral length (MUL) and prostatic apical morphology improves early continence recovery after robot-assisted radical prostatectomy (RARP). This multicenter, prospective, randomized, assessor-blinded exploratory trial enrolled 100 patients with biopsy-confirmed prostate cancer scheduled for transperitoneal RARP. Patients were randomly assigned in a 1:1 ratio to an MRI-informed urethral preservation group or a conventional RARP group. In the intervention group, a prespecified algorithm combined three MUL strata (< 10, 10-<14, and ≥ 14 mm), apical morphology, and apical oncological risk to determine the planned urethral transection strategy; oncological safety findings overrode maximal preservation. The primary endpoint was social continence recovery at 1 month. The sample size was feasibility-based. A total of 100 patients were randomized, with 50 patients in each group. At 1 month, social continence recovery was observed in 32 patients (64.0%) in the MRI-informed group and 21 patients (42.0%) in the conventional group (unadjusted OR 2.46, 95% CI 1.10-5.49; P = 0.028). The median time to social continence recovery was 28 versus 46 days (HR 1.56, 95% CI 1.04-2.35; P = 0.032). Overall positive surgical margin rates (20.0% vs. 22.0%) and apical positive surgical margin rates (6.0% vs. 8.0%) were numerically similar. An MRI-informed urethral preservation strategy based on preoperative MUL and prostatic apical morphology may improve early continence recovery after RARP. Overall and apical positive surgical margin rates and anastomosis-related complication rates were numerically similar between groups. However, these secondary comparisons were underpowered and do not establish oncological or procedural safety. Larger, adequately powered randomized trials with longer follow-up are required.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.