Independent and time-dependent predictors of urinary continence recovery after single-port robot-assisted radical prostatectomy: a retrospective cohort study

Abstract Background Postprostatectomy incontinence (PPI) following radical prostatectomy (RP) significantly affects patients’ quality of life. Although predictors of urinary continence recovery after conventional robot-assisted radical prostatectomy have been widely investigated, evidence regarding predictive factors for PPI recovery in the context of single-port robot-assisted radical prostatectomy (sp-RARP) remains limited. This study aimed to identify predictors associated with urinary continence recovery after sp-RARP and evaluate their predictive performance over time. Methods This retrospective study included 98 patients who underwent sp-RARP performed by the same surgeon (C.W.) at the First Affiliated Hospital of Harbin Medical University between July 2023 and December 2024. The primary endpoint was urinary continence recovery after sp-RARP. Potential predictors were evaluated using univariate and multivariate Cox proportional hazards regression analyses. The performance of the significant predictors was further assessed using time-dependent receiver operating characteristic (tdROC) curve analysis at 2, 4, 12, 24, and 48 weeks after surgery. Results Four independent predictors associated with urinary continence recovery were identified including age ( p = 0.024; HR = 0.964; 95% CI: 0.934–0.995), prostate volume ( p = 0.003; HR = 0.982; 95% CI: 0.970–0.994), modified “Hood” technique ( p = 0.005; HR = 3.091; 95% CI: 1.404–6.806), and bladder neck preservation (BNP) ( p = 0.029; HR = 1.972; 95% CI: 1.070–3.633). tdROC analysis demonstrated that the predictive performance of these factors varied throughout follow-up. Prostate volume showed the most sustained improvement in predictive ability, reaching an AUC of 0.909 at 48 weeks. Age and BNP level peaked at 12 and 24 weeks, with AUC values of 0.804 and 0.899, respectively, followed by slight decreases. The modified “Hood” technique demonstrated the highest predictive value at 4 weeks post-operatively (AUC = 0.858), with gradual attenuation over long-term follow-up. Conclusions Age, prostate volume, the modified “Hood” technique, and bladder neck preservation were independent predictors of urinary continence recovery after sp-RARP. Their predictive performance varied across the postoperative recovery period. The modified “Hood” technique showed the strongest predictive value during early recovery, whereas age and bladder neck preservation demonstrated relatively greater predictive value during the intermediate recovery period. Prostate volume progressively improved and sustained its predictive performance over long-term follow-up. These findings suggest that different clinical and surgical factors may contribute to urinary continence recovery at different stages after sp-RARP and may provide a basis for individualized prediction and postoperative management.