The Robosling Technique in Robotic Radical Prostatectomy Promotes Early and Sustained Return of Continence in Elderly Patients

Aim: The Robosling technique is a novel autologous fascial sling which supports the urethrovesical anastomosis in robotic radical prostatectomy (RARP) and has shown promise in improving early continence. Although curative surgery for prostate cancer is uncommonly offered to elderly patients aged ≥ 75, increase in active surveillance and overall life expectancy challenges this paradigm, though continence remains a challenge in this cohort. We sought to investigate the role of the Robosling technique in elderly patients to promote early return of continence. Methods: Our prospective RARP database (2016– 2023) was analysed, recording demographic, surgical, pathological and functional outcomes. The primary endpoint was defined as pad-free continence, 1-year post-operatively. Patients aged ≥ 75 undergoing RARP with or without Robosling were compared using Chi-square/Fisher-exact and t -tests with p < 0.05 considered significant. Multinomial logistic regression was performed to account for confounders. Results: 62 patients were included in the analysis (Robosling n=24). No significant differences were detected in surgical or pathological outcomes. Robosling was associated with improved pad-free continence rates from 6-months post-operatively (62.5% vs 30.0%, p =0.018) and sustained at 1-year (79.2% vs 30.0%, p < 0.01). Mean pad-use was lower in the Robosling cohort at all time points (0.21 vs 1.0 pads at 1-year, p < 0.05). On multivariate analysis, Robosling remained independently associated with improved pad-free continence (OR 0.11, 95% CI 0.03– 0.37, p< 0.001). Conclusion: The Robosling technique is associated with significantly improved early and sustained pad-free continence rates in the elderly population in this single-surgeon study. While patient selection remains paramount, this intraoperative technique may mitigate a key quality-of-life concern in this cohort. Keywords: prostate cancer, prostatectomy, elderly, procedure, robotic surgical, treatment outcome, urinary incontinence