{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:03:01Z","timestamp":1790672581990,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 \u2264 15 ng\/mL, prostate volume \u2264 80 mL, biopsy ISUP grade \u2264 3, and predefined selection criteria underwent surgery in this single-arm, two-center, IDEAL stage 1\u20132a 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\u201371), PSA was 6.7 ng\/mL (IQR 4.7\u20139.6), and prostate volume was 33 mL (IQR 29\u201346). 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 \u22641 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\u201310.7). 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.<\/jats:p>","DOI":"10.3390\/cancers18193134","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:00:34Z","timestamp":1790589634000},"page":"3134","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Total en Bloc Urethra Preservation at Robot-Assisted Prostatectomy (ToP-RAP): A Prospective IDEAL Stage 1\u20132a Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Mahmoud","family":"Farzat","sequence":"first","affiliation":[{"name":"Department of Urology and Robotic Urology, Diakonie Klinikum Siegen, 53127 Siegen, Germany"},{"name":"Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35390 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6543-0309","authenticated-orcid":false,"given":"Mykyta","family":"Kachanov","sequence":"additional","affiliation":[{"name":"Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5987-3883","authenticated-orcid":false,"given":"Malte W.","family":"Vetterlein","sequence":"additional","affiliation":[{"name":"Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"},{"name":"Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Georg","family":"Salomon","sequence":"additional","affiliation":[{"name":"Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"given":"Ibrahim","family":"Al Taie","sequence":"additional","affiliation":[{"name":"Department of Urology and Robotic Urology, Diakonie Klinikum Siegen, 53127 Siegen, Germany"},{"name":"Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35390 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4483-3499","authenticated-orcid":false,"given":"Su Jung","family":"Oh-Hohenhorst","sequence":"additional","affiliation":[{"name":"Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2909-0797","authenticated-orcid":false,"given":"Florian M.","family":"Wagenlehner","sequence":"additional","affiliation":[{"name":"Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35390 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Hubert","family":"John","sequence":"additional","affiliation":[{"name":"Department of Urology, Winterthur Kantonsspital, 8401 Winterthur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Jorn H.","family":"Witt","sequence":"additional","affiliation":[{"name":"Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany"},{"name":"Department of Urology, Urosurgery and Robotic Surgery, Clinic Bel Etage, 40217 Dusseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6156-2117","authenticated-orcid":false,"given":"Sami-Ramzi","family":"Leyh-Bannurah","sequence":"additional","affiliation":[{"name":"Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"},{"name":"Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"},{"name":"Prostate Center Gronau, Department of Urology, Uro-Oncology and Robot-Assisted Urology, St. Antonius-Hospital, 48599 Gronau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1016\/j.euo.2025.05.004","article-title":"Robotic Versus Open Radical Prostatectomy, Differences in Prostate Cancer-specific Survival-12 Years of Follow-up in the LAParoscopic Prostatectomy Robot Open 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