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Peer-reviewedCC BYCancers

Total en Bloc Urethra Preservation at Robot-Assisted Prostatectomy (ToP-RAP): A Prospective IDEAL Stage 1-2a Study.

  • Mahmoud Farzat1,2
  • Mykyta Kachanov3
  • Malte W Vetterlein3,4
  • Georg Salomon4
  • Ibrahim Al Taie1,2
  • Su Jung Oh-Hohenhorst3
  • Florian M Wagenlehner2
  • Hubert John5
  • Jorn H Witt6,7
  • Sami-Ramzi Leyh-Bannurah3,4,8
8 affiliations
  1. 1Department of Urology and Robotic Urology, Diakonie Klinikum Siegen, 53127 Siegen, Germany.
  2. 2Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35390 Giessen, Germany.
  3. 3Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
  4. 4Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
  5. 5Department of Urology, Winterthur Kantonsspital, 8401 Winterthur, Switzerland.
  6. 6Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
  7. 7Department of Urology, Urosurgery and Robotic Surgery, Clinic Bel Etage, 40217 Dusseldorf, Germany.
  8. 8Prostate Center Gronau, Department of Urology, Uro-Oncology and Robot-Assisted Urology, St. Antonius-Hospital, 48599 Gronau, Germany.
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Abstract

Background/objective: Urinary continence recovery after robot-assisted radical prostatectomy remains variable despite technical refinements intended to preserve function. We describe Total en bloc Urethra Preservation at Robot-assisted Prostatectomy (ToP-RAP), a technique that preserves the entire intraprostatic urethra and avoids urethral transection, and report short-term functional and oncological outcomes. Methods: Patients with PSA ≤ 15 ng/mL, prostate volume ≤ 80 mL, biopsy ISUP grade ≤ 3, and predefined selection criteria underwent surgery in this single-arm, two-center, IDEAL stage 1-2a development study (ClinicalTrials.gov NCT07678489). Surgical, perioperative safety, continence, and oncological outcomes based on PSA, imaging, and secondary treatment were assessed descriptively. Results: The first 16 consecutive patients were treated between 02/2024 and 05/2025. Median age was 66 years (IQR 62-71), PSA was 6.7 ng/mL (IQR 4.7-9.6), and prostate volume was 33 mL (IQR 29-46). Biopsy ISUP grades 1, 2, 3 were in 19%, 44%, and 38% of patients, respectively. On MRI, 38% of patients had multifocal bilateral lesions. Urethral repair of ≤1 cm was required in 13% of patients. All patients underwent at least interfascial nerve sparing. One posterolateral positive surgical margin and one perioperative complication (fascial dehiscence) occurred, no further complications were observed within 90 days. Median follow-up was 7.2 months (IQR 6.1-10.7). No patient had PSA persistence, biochemical recurrence, or secondary treatment. Overall, 15 of 16 patients (94%) recovered urinary continence, and 94% did so within 5 days. Limitations include the small cohort and short follow-up. Conclusions: Early findings support the feasibility and short-term safety of ToP-RAP. The observed early continence recovery warrants evaluation in larger cohorts with longer follow-up.

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Cite

BibTeXRIS
BibTeX
@article{farzat2026total,
  title = {{Total en Bloc Urethra Preservation at Robot-Assisted Prostatectomy (ToP-RAP): A Prospective IDEAL Stage 1-2a Study.}},
  author = {Mahmoud Farzat and Mykyta Kachanov and Malte W Vetterlein and Georg Salomon and Ibrahim Al Taie and Su Jung Oh-Hohenhorst and Florian M Wagenlehner and Hubert John and Jorn H Witt and Sami-Ramzi Leyh-Bannurah},
  journal = {Cancers},
  year = {2026},
  month = sep,
  doi = {10.3390/cancers18193134},
  url = {https://europepmc.org/article/MED/42882829},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Total en Bloc Urethra Preservation at Robot-Assisted Prostatectomy (ToP-RAP): A Prospective IDEAL Stage 1-2a Study.
AU  - Mahmoud Farzat
AU  - Mykyta Kachanov
AU  - Malte W Vetterlein
AU  - Georg Salomon
AU  - Ibrahim Al Taie
AU  - Su Jung Oh-Hohenhorst
AU  - Florian M Wagenlehner
AU  - Hubert John
AU  - Jorn H Witt
AU  - Sami-Ramzi Leyh-Bannurah
PY  - 2026
DA  - 2026/09/28
JO  - Cancers
DO  - 10.3390/cancers18193134
UR  - https://europepmc.org/article/MED/42882829
AB  - Background/objective: Urinary continence recovery after robot-assisted radical prostatectomy remains variable despite technical refinements intended to preserve function. We describe Total en bloc Urethra Preservation at Robot-assisted Prostatectomy (ToP-RAP), a technique that preserves the entire intraprostatic urethra and avoids urethral transection, and report short-term functional and oncological outcomes. Methods: Patients with PSA ≤ 15 ng/mL, prostate volume ≤ 80 mL, biopsy ISUP grade ≤ 3, and predefined selection criteria underwent surgery in this single-arm, two-center, IDEAL stage 1-2a development study (ClinicalTrials.gov NCT07678489). Surgical, perioperative safety, continence, and oncological outcomes based on PSA, imaging, and secondary treatment were assessed descriptively. Results: The first 16 consecutive patients were treated between 02/2024 and 05/2025. Median age was 66 years (IQR 62-71), PSA was 6.7 ng/mL (IQR 4.7-9.6), and prostate volume was 33 mL (IQR 29-46). Biopsy ISUP grades 1, 2, 3 were in 19%, 44%, and 38% of patients, respectively. On MRI, 38% of patients had multifocal bilateral lesions. Urethral repair of ≤1 cm was required in 13% of patients. All patients underwent at least interfascial nerve sparing. One posterolateral positive surgical margin and one perioperative complication (fascial dehiscence) occurred, no further complications were observed within 90 days. Median follow-up was 7.2 months (IQR 6.1-10.7). No patient had PSA persistence, biochemical recurrence, or secondary treatment. Overall, 15 of 16 patients (94%) recovered urinary continence, and 94% did so within 5 days. Limitations include the small cohort and short follow-up. Conclusions: Early findings support the feasibility and short-term safety of ToP-RAP. The observed early continence recovery warrants evaluation in larger cohorts with longer follow-up.
SN  - 2072-6694
ER  -