Comparison of Ultrapreservation and Retzius-Sparing Techniques in Robotic Radical Prostatectomy: Single-Center Experience

<i>Background and Objectives</i>: This study aimed to compare perioperative, functional, and oncological outcomes of ultrapreservation and Retzius-sparing techniques in robotic radical prostatectomy for patients with localized prostate cancer. <i>Materials and Methods</i>: We retrospectively evaluated data from 189 patients who underwent robotic radical prostatectomy using either the ultrapreservation (<i>n</i> = 97) or the Retzius-sparing (<i>n</i> = 92) technique by a single surgeon at a single center between January 2022 and November 2024. Patients were divided into two groups based on the surgical technique. Demographics, perioperative outcomes, functional outcomes (continence and potency), oncological outcomes, and complications were compared. <i>Results</i>: There were no statistically significant differences in baseline demographics between the groups (<i>p</i> > 0.05). The ultrapreservation group demonstrated superior perioperative outcomes: operative time (174.8 vs. 188.7 min, <i>p</i> < 0.001), console time (112.4 vs. 132.0 min, <i>p</i> < 0.001), blood loss (119.0 vs. 133.3 mL, <i>p</i> = 0.002), and hospital stay (2.3 vs. 2.5 days, <i>p</i> = 0.004) were all significantly shorter. Complication rates were comparable between groups (8.2% vs. 10.9%). In terms of continence, the Retzius-sparing group achieved earlier recovery after catheter removal (56.5% vs. 27.8%, <i>p</i> < 0.001), while long-term continence outcomes were similar (12-month: 93.8% vs. 91.3%, <i>p</i> = 0.703). Potency recovery favored the ultrapreservation group at 3 and 6 months postoperatively (3 months: 76.9% vs. 41.2%, <i>p</i> < 0.001; 6 months: 79.5% vs. 60.0%, <i>p</i> = 0.013). Oncological outcomes were comparable between groups. <i>Conclusions</i>: Both ultrapreservation and Retzius-sparing techniques provide safe oncological outcomes with distinct functional advantages. The ultrapreservation technique offers perioperative advantages and superior potency recovery, while the Retzius-sparing approach facilitates faster early continence recovery. Clinical decision-making should be individualized: ultrapreservation may be preferred in younger patients with good preoperative potency prioritizing erectile function preservation, while Retzius-sparing may benefit patients prioritizing immediate continence recovery, particularly those with baseline erectile dysfunction or advanced age.