@carl123
I disagree most urologists don’t downgrade, misrepresent or ignore studies. Certainly radiation is substantially improving as well as studies reflecting how long ADT can necessarily be needed . It is hard for anyone to stay on top of things, and that is why patients do need Centers of Excellence. Just as studies show the improvement in surgery.
Studies consistently show that Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is superior to standard anterior robot-assisted radical prostatectomy (S-RARP) regarding faster recovery of early urinary continence and improved, sometimes faster, return to erectile function. RS-RARP preserves key anterior anatomical structures, which improves functional outcomes while achieving comparable cancer control (oncological outcomes).

PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Key Findings on RS-RARP Superiority
Faster Continence Recovery: RS-RARP patients demonstrate significantly higher early continence rates (at 1 week, 1 month, and 3 months) compared to standard RARP, with some studies finding it reduces time to continence by over 80 days.
Improved Sexual Function: Multiple studies and meta-analyses suggest improved preservation of erectile function compared to the standard approach.
Quality of Life (QoL): Due to faster continence and potency recovery, patients report improved QoL scores.
Comparable Oncological Safety: Despite higher visibility challenges, studies indicate no significant differences in biochemical recurrence (BCR) rates between RS-RARP and standard RARP.
Lower Complications: Evidence suggests RS-RARP may lead to a lower incidence of postoperative hernia and similar or lower overall complication rates.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Limitations and Considerations
Learning Curve: RS-RARP involves a smaller, more challenging workspace, which may result in a steeper learning curve for surgeons.
Positive Surgical Margins (PSM): Some studies have suggested that RS-RARP could be associated with higher PSMs (specifically in patients with anterior lesions) compared to the standard approach, though not necessarily leading to worse functional outcomes or higher recurrence.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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These results suggest that, particularly in the hands of experienced robotic surgeons, RS-RARP can offer superior functional results for patients undergoing radical prostatectomy.
PubMed Central (PMC) (.gov)

PubMed Central (PMC) (.gov)
Single-port (SP) RALP is generally considered better for patient recovery, offering less pain, shorter hospital stays, and superior cosmetic results compared to multiport (MP) RALP. Studies show SP-RALP provides similar cancer control and functional outcomes (continence/erectile function) while using a smaller 1-inch incision.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Key Study Findings (SP-RALP vs. MP-RALP)
Patient Recovery: SP-RALP patients often report lower postoperative pain, reduced opioid use, and faster discharge (frequently < 24 hours).
Oncologic & Functional Outcomes: Early results show similar prostate cancer control and similar or better recovery of urinary and sexual function compared to multi-port.
Technical Aspects: SP-RALP offers improved precision in limited spaces, especially through extraperitoneal approaches.
Limitations: SP-RALP has a steeper learning curve for surgeons and generally higher procedure costs.
Perioperative: Some studies suggest SP-RALP may have shorter operative times but, in some cases, higher rates of positive surgical margins, though most studies show comparable results to multiport.
UroToday
UroToday
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Conclusion
While multi-port is more common and supported by two decades of data, single-port is rapidly proving superior in terms of postoperative pain and hospital stay duration, making it a highly attractive, less-invasive option for patients.
European Urology
European Urology
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Single-Port versus Multiple-Port Robot-Assisted Radical Prostatectomy
Dec 7, 2021 — Single-port robotic radical prostatectomy was associated with shorter hospital stays. Only 60.6% of single-port patients (109/180) required analgesia compared t...
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PubMed Central (PMC) (.gov)