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Background: Little is known regarding functional outcomes after robot-assisted radical cystectomy (RARC) and intracorporeal neobladder (ICNB) reconstruction., Objective: To report on urinary continence (UC) and erectile function (EF) at 12 mo after RARC and ICNB reconstruction and investigate predictors of these outcomes., Design, Setting, and Participants: We used data from a multi-institutional database of patients who underwent RARC and ICNB reconstruction for bladder cancer., Surgical Procedure: The cystoprostatectomy sensu stricto followed the conventional steps. ICNB reconstruction was performed at the physician's discretion according to the Studer/Wiklund, S pouch, Gaston, vescica ileale Padovana, or Hautmann technique. The techniques are detailed in the video accompanying the article., Measurements: The outcomes measured were UC and EF at 12 mo., Results and Limitations: A total of 732 male patients were identified with a median age at diagnosis of 64 yr (interquartile range 58-70). The ICNB reconstruction technique was Studer/Wiklund in 74%, S pouch in 1.5%, Gaston in 19%, vescica ileale Padovana in 1.5%, and Hautmann in 4% of cases. The 12-mo UC rate was 86% for daytime and 66% for nighttime continence, including patients who reported the use of a safety pad (20% and 32%, respectively). The 12-mo EF rate was 55%, including men who reported potency with the aid of phosphodiesterase type 5 inhibitors (24%). After adjusting for potential confounders, neobladder type was not associated with UC. Unilateral nerve-sparing (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.88-7.85; p < 0.001) and bilateral nerve-sparing (OR 6.25, 95% CI 3.55-11.0; p < 0.001), were positively associated with EF, whereas age (OR 0.93, 95% CI 0.91-0.95; p < 0.001) and an American Society of Anesthesiologists score of 3 (OR 0.46, 95% CI 0.25-0.89; p < 0.02) were inversely associated with EF., Conclusions: RARC and ICNB reconstruction are generally associated with good functional outcomes in terms of UC. EF is highly affected by the degree of nerve preservation, age, and comorbidities., Patient Summary: We investigated functional outcomes after robot-assisted removal of the bladder in terms of urinary continence and erectile function. We found that, in general, patients have relatively good functional outcomes at 12 months after surgery., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: The aim of this study was to assess whether age ≥75 years impairs surgical, functional, and oncological outcomes after robot-assisted radical prostatectomy (RARP)., Materials and Methods: Patients with prostate cancer (PCa) were stratified in ≥75( n  = 669) vs. <70 years( n  = 8,268). Multivariable cox regression analyses (MVA) tested for effect of senior age on erectile function-, urinary continence-recovery, biochemical recurrence (BCR), and metastatic progression (MP)., Results: RARP duration, blood loss, and 30d complication rates were similar between groups. For patients ≥75 vs. <70 years, rates of erectile function after 36 and urinary continence after 12 months were 27 vs. 56% ( p  < 0.001) and 85 vs. 86% ( p  = 0.99), respectively. Mean quality of life (QoL) score after 12 months improved in both groups ( p  = 0.9). At 48 months, BCR- and MP-free rates were 77 vs. 85% ( p  < 0.001) and 97 vs. 98% ( p  = 0.3), respectively. MVA confirmed the negative effect of senior age on erectile function but no significant effect on urinary continence, BCR or MP, before and after propensity score matching., Conclusion: Apart from erectile function, senior age has no significant effect on urinary continence recovery, BCR- or MP-free rates after RARP. Post-RARP QoL improved even in senior patients. Modern therapy of senior PCa patients should be based on individual counseling than just age.

Background: The aim of this study was to assess insignificant prostate cancer (iPCa) rates after robot-assisted radical prostatectomy (RARP) in contemporary patients who were preoperatively eligible for active surveillance (AS). iPCa indicates no risk of PCa progression., Methods: We retrospectively analyzed 2837 RARP patients (2010-2019) who fulfilled at least one AS entry criteria set: Prostate Cancer Research International - Active Surveillance (PRIAS), University of California San Francisco (UCSF) (San Francisco, CA, USA), National Comprehensive Cancer Network (NCCN) or University of Toronto, ON, Canada. We utilized four different iPCa definitions: 1) based on pT2 and Gleason Score ≤6 and also cumulative tumor-volume; 2) ≤2.5mL; 3) ≤0.7mL; or 4) ≤0.5mL. For each AS set we tested the rates of iPCa and compared between age <70 vs. ≥70 years. This was complemented by multivariable logistic regression (LRM) predicting iPCa, adjusted for age and clinical AS variables. Finally, within the subgroup who had iPCa, we tested the rate of those who were deemed preoperatively AS ineligible., Results: Between most (PRIAS) and least stringent (TORONTO) AS sets, iPCa was correctly predicted in 70-57%. Similarly, for iPCa definitions 2-4, rates were 59-42%, 34-19% and 27-14%. Senior patients harbored decreased proportions of iPCa. LRM confirmed that advanced age is associated with a lower chance of iPCa. More stringent AS sets lead to higher rates of AS ineligibility, e.g. 53% for PRIAS, despite iPCa., Conclusions: AS sets show limited accuracy for stricter iPCa definitions, which further declined with advanced age. Greater AS stringency resulted in more AS ineligible patients despite harboring iPCa. In consequence, patients are at risk for overtreatment. Clinicians must consider age and different AS sets that result in highly variable detection rates of iPCa.

Purpose: The purpose of this study was to investigate the effect of a surgically constructed bilateral peritoneal flap (PIF) as an adjunct to robot-assisted radical prostatectomy (RARP) and pelvic lymph node dissection (PLND) on the incidence of lymphoceles., Materials and Methods: A total of 530 men with localized prostate cancer underwent a RARP with bilateral extended standardized PLND in a prospective randomized controlled trial. In group A, a PIF was created by suturing the margins of the bladder peritoneum to the ipsilateral endopelvic fascia at 2 points on each side. In group B, no PIF was created. The patients were followed 30 and 90 days after the surgery to assess the incidence, extent and treatment of lymphoceles., Results: Lymphoceles occurred in 22% of group A patients and 33% of group B patients (p=0.008). Symptomatic lymphoceles were observed in 3.3% of group A patients and 8.1% of group B patients (p=0.027). Lymphoceles requiring intervention occurred significantly less frequently in group A patients (1.3%) than in group B patients (6.8%, p=0.002). The median lymphocele size was 4.3 cm in group A and 5.0 cm in group B (p=0.055). No statistically significant differences were observed in minor or major complications unrelated to lymphocele, blood loss, or surgical time between groups A and B., Conclusions: Bilateral PIFs in conjunction with RARP and PLND significantly reduce the total incidence of lymphoceles, the frequency of symptomatic lymphoceles and the rate of associated secondary interventions.

Objective: To assess suitability of Comprehensive Complication Index (CCI ® ) vs. Clavien-Dindo classification (CDC) to capture 30-day morbidity after robot-assisted radical cystectomy (RARC)., Materials and Methods: A total of 128 patients with bladder cancer (BCa) undergoing intracorporeal RARC with pelvic lymph node dissection between 2015 and 2021 were included in a retrospective bi-institutional study, which adhered to standardized reporting criteria. Thirty-day complications were captured according to a procedure-specific catalog. Each complication was graded by the CDC and the CCI ® . Multivariable linear regression (MVA) was used to identify predictors of higher morbidity., Results: 381 complications were identified in 118 patients (92%). 55 (43%), 43 (34%), and 20 (16%) suffered from CDC grade I-II, IIIa, and ≥ IIIb complications, respectively. 16 (13%), 27 (21%), and 2 patients (1.6%) were reoperated, readmitted, and died within 30 days, respectively. 31 patients (24%) were upgraded to most severe complication (CCI ®  ≥ 33.7) when calculating morbidity burden compared to corresponding CDC grade accounting only for the highest complication. In MVA, only age was a positive estimate (0.44; 95% CI = 0.03-0.86; p = 0.04) for increased cumulative morbidity., Conclusion: The CCI ® estimates of 30-day morbidity after RARC were substantially higher compared to CDC alone. These measurements are a prerequisite to tailor patient counseling regarding surgical approach, urinary diversion, and comparability of results between institutions., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: Erklärung zu finanziellen InteressenForschungsförderung erhalten: Ja; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: Ja; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: Ja; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: Nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: Nein.Erklärung zu nichtfinanziellen InteressenAffiliated Board Member – ERUS Vorstandmitglied Deutsche Gesellschaft für Roboter-assistierte Urologie

Introduction: Robot-assisted simple prostatectomy (RASP) is a relatively new minimally invasive procedure for surgical treatment to manage symptomatic, therapy-refractory benign prostate hyperplasia (BPH) in prostate volumes >80 cm 3 . Thus, postoperative morbidity based on Clavien-Dindo and hematological parameters in RASP and open simple prostatectomy (OSP) procedures are examined., Patients and Methods: We retrospectively reviewed a total of 78 patients: 39 patients underwent RAPS and 39 OSP. The following parameters were statistically evaluated and compared: age, PSA value, prostate volume, ASA score, duration of hospital stay, operative time, Hb decrease on postoperative (po) day 1 and in the 5 five po days, CRP peak in the first 5 po days and transfusion rate., Results: The comparison between RASP and standard OSP showed no significant differences regarding the mean patient age (73 vs. 74 years; p =0.54), PSA values (7.7 vs. 10.7 ng/ml; p =0.17), ASA score (2.2 vs. 2.3; p =0.26) and prostate volume (130 vs. 113 cm 3 ; p =0.07). Patients in the RAPAE group had statistically significant longer surgery (178 vs. 110 min; p =<0.01) with a significantly smaller decrease in Hb on po day 1 (1.9 vs. 3.3 g/dl; p ≤0.01) and in the first 5 po days (2.4 vs. 4.2 g/dl; p ≤0.01), lower need for preserved blood (3% vs. 26%; p =0.01) and number of blood bags (0.1 vs. 1.3; p =0.01), a lower po Clavien-Dindo score (0.44 vs. 1.23; p =0.003) and lower CRP values (52 vs. 104 mg/l; p ≤0.01) in the first 5 po days., Conclusion: RASP is a safe procedure that offers the advantage of reduced blood loss and blood bag consumption and rare complications due to the minimally invasive surgical method. The OSP group showed an increased occurrence of complications due to bleeding, leading to prolonged hospitalization and significantly increased need for blood transfusion. The lesser increase of CRP in RASP group is a result of the lower invasiveness of the robot-assisted procedure.

Objective: The objective of this study was to assess the surgical, oncological and short-term functional outcomes in patients undergoing salvage robot-assisted radical prostatectomy (SRARP) for the treatment of radiation-resistant prostate cancer., Patients and Methods: The records of 3,500 men who underwent RARP from February 2006 to July 2011 were retrospectively reviewed. All peri- and postoperative data were recorded prospectively in our database. A total of 13 patients (0.37%) who had undergone SRARP for the treatment of radiation-resistant prostate cancer were identified., Results: The primary treatment was external beam radiotherapy in 7 patients (53.8%) and brachytherapy in 6 patients (46.2%). The interval from radiotherapy to biochemical recurrence (BCR) varied from 12 to 108 months (median 48.9). Neurovascular bundle preservation was performed in 3 patients (23.1%). No intraoperative or major complications were encountered. Minor complications were encountered in 4 patients (30.7%). At 12 months, 7 patients were continent (53.8%), 3 exhibited mild incontinence (23.1%) and 3 (23.1%) were incontinent. Regarding potency, none of the patients were potent at 6 months, but 3 patients (23.1%) were potent at 1 year. Regarding BCR, 3 of the patients (23.1%) never reached a prostate-specific antigen nadir of zero, and during the follow-up period only 3 patients (23.1%) exhibited BCR. No disease-specific mortality was evident during follow-up., Conclusions: Although early in its development, it appears that SRARP is technically feasible and offers satisfactory surgical, oncological and short-term functional outcomes., (Copyright © 2013 S. Karger AG, Basel.)

Introduction: The objective of this study is to evaluate the surgical, oncological and short-term functional outcomes in patients with a pathologic prostate specimen weight ≥100 g versus patients with a pathologic prostate specimen weight ≤50 g undergoing robot-assisted radical prostatectomy (RARP)., Patients and Methods: The records of 4,000 men who underwent RARP from February 2006 to April 2012 were reviewed retrospectively. A total of 185 men had a pathologic prostate specimen weight ≥100 g (group A). A matched pairs analysis was performed using our database to identify men with a pathologic prostate specimen weight ≤50 g but with equivalent clinicopathologic characteristics to serve as the control group (group B)., Results: Our results indicated that although the intraoperative results were more than satisfying in patients with large glands, there is a significant increase in blood loss, operative time needed, increased need for bladder neck reconstruction as well as an increase in intraoperative complications. Nevertheless, patients with large glands exhibit less aggressive tumors, less positive surgical margins and a lower incidence of biochemical recurrence. Regarding functional outcomes, patients with larger glands had no difference regarding continence rates when compared to patients with smaller glands but exhibited significantly lower potency rates., Conclusions: Although RARP in patients with a pathologic prostate specimen weight ≥100 g is technically challenging, in experienced hands it can be considered a safe procedure with excellent surgical, oncological and functional outcomes. Nevertheless, this conclusion is limited, in that it is from a single institution with a large case volume and may not be reflective of outcomes at centers with smaller volumes and less experience., (Copyright © 2012 S. Karger AG, Basel.)

Background: The aim of this study was to evaluate the perioperative oncological and functional outcomes after robot-assisted radical prostatectomy (RALP) in older men., Patients and Methods: The records of n = 2,000 men who underwent RALP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients ≥ 75 years were indentified. Subsequently this subgroup was compared to the overall patient cohort with regard to perioperative results, pathological tumor stage, functional outcomes after 12 months and the prostate cancer-specific mortality and biochemical recurrence free survival., Results: The following results reflect the comparison of the cohort of patients who were ≥75 years of age versus the overall cohort of patients. A statistical difference of the parameters analyzed was observed only for minor complications 15.5 % versus 11.4 % (p<0.05), neurovascular bundle (NVB) preservation 51.1 % versus 65.7 % (p<0.05) and potency after 12 months 39.6 % versus 66.2 % (p<0.001). Major complications were noted in 2.2 % versus 1.3 % of cases. A Gleason score <7 was noted in 37.4 % versus 42.8 %, a Gleason score 7 in 51.1 % versus 47.7 % and a Gleason score >7 in 11.6 % versus 9.5 %. Tumor stages pT2 and pT3 were noted in 68.8 % versus 73.5 % and in 31.2 % versus 25.2 %, respectively. The positive surgical margin status was encountered in 11.1 % versus 8.9 % of cases, respectively. At 12 months 86.9 % versus 92.8 % of patients were continent and 39.6 % versus 66.2 % were potent, respectively. After a median follow-up of 17.2 months the prostate cancer-specific mortality in the subgroup of elderly patients was 0 % and the biochemical recurrence-free survival was 95.5%., Conclusions: The RALP approach in patients ≥75 years of age is a safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes as well as acceptable erectile function. Nevertheless, RALP should be limited to a selected cohort of patients with a good health status and an individual life expectancy of more than 10 years. For the assessment of the final oncological benefits of RALP in this patient population a longer follow-up is necessary.

Background: The objective of this study was to assess the surgical and oncological outcomes in patients with a preoperative prostate specific antigen (PSA) value <4 ng/ml undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer., Patients and Methods: The records of 2000 men who underwent RARP from February 2006 to April 2010, were retrospectively reviewed. A total of 169 (8.4%) patients with a preoperative PSA value <4 ng/ml were identified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margin status as well as presence of biochemical progression and of disease-specific mortality during the follow-up period., Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who had a preoperative PSA value <4 ng/ml. A statistical difference of the analyzed parameters was observed in the median PSA value; 10.3 ng/ml (0.3-220 ng/ml) vs. 2.8 ng/ml (0.3-3.9 ng/ml) (p<0.001), in bilateral NVB; 65.7% vs. 85.2% (p<0.001), in Gleason score <7; 42.8% vs. 59.1% (p<0.05), in Gleason score 7; 47.7% vs. 36.6% (p<0.05) and in Gleason score >7 in 9.5% vs. 3.5% (p<0.001). Organ-confined disease was noted in 73.5% vs. 86.3% (p<0.05), extraprostatic extension in 25.2% vs. 13.7% (p<0.05). The percentage of cancer found in the prostate specimen was 16.1% (1-99%) vs. 7.3% (1-96%) (p<0.05) and a positive surgical margin status was encountered in 8.9% vs. 4.7% (p<0.05) of patients. Pelvic lymph node dissection was performed in 1623 patients (81.2%) of the overall cohort out of whom 64 cases (3.2%) were positive for metastasis. In the patient cohort of PSA value <4 ng/ml, pelvic lymph node dissection was performed in 114 patients (67.4%), out of which one case (0.5%) was positive for metastasis (p<0.05). After a median follow-up of 24.2 months (range 3-56 months), 162 patients (95.8%) were free of biochemical progression and no disease-specific mortality was evident., Conclusion: RARP in patients with a preoperative PSA value <4 ng/ml is a safe surgical procedure with limited complications and excellent oncological outcome.

Background: The objective of this study was to assess the surgical and the oncological outcomes in patients with a preoperative prostate specific antigen (PSA) value >20 ng/ml, undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer., Patients and Methods: The records of 2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 147 (7.3%) patients with a preoperative PSA value >20 ng/ml were identified. A comparison was performed between the overall patient cohort and the patients with PSA >20 ng/ml. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margins and lymph node status, as well as biochemical progression and disease-specific mortality during the follow-up period., Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who had a preoperative PSA >20 ng/ml. A statistical difference of the analyzed parameters was observed for median PSA value 10.3 ng/ml vs. 34.8 ng/ml (p<0.05), for bilateral neurovascular bundle preservation 65.7% vs. 19.7% (p<0.001), for a Gleason score <7, 42.8% vs. 12.9% (p<0.05) and for a Gleason score >7 in 9.5% vs. 19.7% (p<0.05). Organ-confined disease was noted in 73.5% vs. 31.9% (p<0.05) and extraprostatic extension in 25.2% vs. 86.1% (p<0.05). The percentage of cancer found in the prostate specimen was 16.1% vs. 38.1% (p<0.05) and a positive surgical margin (PSM) status was encountered in 8.9% vs. 33.3% (p<0.05) of patients. Positive lymph nodes were encountered in 3.2% vs. 17.1% of patients (p<0.05). After a median follow-up of 19.6 months (range 3-56 months), 118 patients (80.2%) were free of biochemical progression and no disease-specific mortality was evident., Conclusion: Although RARP in patients with preoperative PSA >20 ng/ml is a safe surgical procedure with limited complications, the risk of positive lymph nodes, as well as the PSM status are found to be significantly higher. Patients should be informed of these probable outcomes, as well as for a possible need for adjuvant treatment before undergoing the procedure.

Background: The aim of this study is to evaluate the surgical, the oncological and the functional outcomes in men ≥75 years of age undergoing robot-assisted radical prostatectomy (RARP)., Patients and Methods: The records of N=2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients who were ≥75 years of age were indentified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive-margin status, continence and potency in 12 months, disease-specific mortality and presence of biochemical progression at the follow-up period., Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who were ≥75 years of age. A statistical difference of the analyzed parameters was observed only minor complications 11.4% vs. 15.5% (p<0.05), neurovascular bundle (NVB) preservation 65.7% vs. 51.1% (p<0.05) and potency after 12 months 66.2% vs. 39.6% (p<0.001). Major complications were noted in 1.3% vs. 2.2% of cases. A Gleason score <7 was noted in 42.8% vs. 37.3%, a Gleason score 7 in 47.7% vs. 51.1% and a Gleason score >7 in 9.5% vs. 11.6%. Organ-confined disease was noted in 73.5% vs. 68.8%, extraprostatic extension in 25.2% vs. 31.2% and positive surgical margin status was encountered in 8.9% vs. 11.1% of cases. At 12 months, 92.8% vs. 86.9% of patients were continent and 66.2% vs. 39.6% were potent. After a median follow-up of 17.2 months no disease-specific mortality was evident and 95.5% were free of biochemical progression in the cohort of patients who were ≥75 years of age., Conclusion: Our findings suggest that RARP in patients ≥75 years of age is a safe surgical procedure with limited complications, excellent oncologic and continence outcomes as well as acceptable potency outcomes. Nevertheless, RARP should be limited to a selected cohort of patients with a good overal health status and an individual life expectancy of more than 10 years in order for the oncological advantages of surgery to be achieved.

Purpose: The objective of this study was to assess the surgical, oncologic, and short-term functional outcomes of patients with a history of transurethral resection of the prostate (TURP) who underwent robot-assisted laparoscopic prostatectomy (RALP)., Patients and Methods: The records of 2000 men who underwent RALP from February 2006 to April 2010 were retrospectively reviewed. A total of 80 men had undergone TURP before RALP. A match-paired analysis was performed using our database to identify 80 additional men without a history of TURP with equivalent clinicopathologic characteristics to serve as a control group (non-TURP group). The parameters compared included patient preoperative clinicopathologic characteristics, intraopeoperative characteristics, postoperative oncologic characteristics, minor and major postoperative complications, continence, and potency., Results: The mean time between TURP and RALP was 3.6 months (3-6 months). Regarding preoperative characteristics, a statistical difference was only observed regarding preoperative patient potency in the TURP vs non-TURP group. Regarding intraopeoperative characteristics, a statistical difference was observed regarding the need for bladder neck reconstruction and skin-to-skin operative time. Regarding postoperative pathologic characteristics, the positive surgical margin rate was not significant when the two groups were compared. The continence and potency rates in 12 months were similar (87.5%/91.25%) and (70.3%/86.5%) for both patient cohorts., Conclusion: Although the procedure is technically more demanding, exhibits a prolonged operative time and time interval before continence and potency returns, it can be safely performed without compromising functional results as well as the radical nature of cancer surgery.

Background: The aim of this study was to evaluate the surgical, oncological and functional outcomes in men ≤50 years of age treated with robot-assisted laparoscopic radical prostatectomy (RARP)., Patients and Methods: The records of 2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 68 patients who were ≤50 years of age were indentified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margin status, continence and potency 12 months after treatment and presence of biochemical progression and disease-specific mortality during the follow-up period., Results: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who were ≤50 years of age. A statistical difference of the analyzed parameters was observed in prostate weight 56.1 g vs. 31.4 g (p<0.05), in bilateral neurovascular bundle (NVB) preservation 65.7% vs. 92.6% (p<0.05), and in oncological and functional outcomes. Organ-confined disease was noted in 73.5% vs. 78.5% (p<0.05), extraprostatic extension in 25.2% vs. 21.5% (p<0.05) and positive surgical margins were encountered in 8.9% vs. 5.8% (p<0.05). A Gleason score <7 was noted in 42.8% vs. 54.4% (p<0.05), a Gleason score 7 in 47.7% vs. 41.2% (p<0.05) and a Gleason score >7 in 9.5% vs. 4.4% (p<0.05). At 12 months, 92.8% vs. 95.5% were continent and 66.2% vs. 93.7% (p<0.001) were potent. After a median follow-up of 17.8 months, 97.1% patients of the ≤50 years patient cohort were free of biochemical progression and no disease-specific mortality was evident., Conclusion: Our findings suggest that RARP in patients ≤50 years of age is a safe surgical procedure with limited complications and excellent oncologial and functional outcomes. Although the preservation of the NVB in such patients is preferable, this can be performed without compromising the radical nature of cancer surgery.