Objective To evaluate the mid- to long-term effects of the pelvic-peritoneal structure-sparing (PPSS) technique, which aims to preserve the stability of pelvic floor structures, on urinary continence recovery after robot-assisted radical prostatectomy (RARP).

Methods This single-center retrospective cohort study included 82 patients who underwent RARP between October 2017 and May 2018, all operated on by the same surgeon. Patients were divided into a PPSS group (n = 53) and a non-PPSS group (n = 29). Standard RARP was performed in the non-PPSS group, whereas the PPSS group involved preservation of pelvic floor structures and cold-knife apical dissection for urethral function protection. Baseline characteristics were comparable between the two groups. Follow-up lasted up to 7 years. Urinary continence was defined as the use of 0-1 pad per day and was assessed at 3, 6, 12, 24 months postoperatively and at the last follow-up (July 2025). Kaplan-Meier analysis and Cox regression were used to compare continence recovery rates and identify influencing factors.

Results The median follow-up duration was 1178 days (range: 1-2743 days). The PPSS group had significantly higher continence recovery rates at 3 and 6 months (71.6% and 75.4%) compared with the non-PPSS group (44.8% and 48.2%; P = 0.030 and P = 0.025, respectively), while no significant difference was observed at 12 months and thereafter. Multivariate Cox regression analysis showed that the PPSS technique (hazard ratio HR = 2.59, 95% CI: 1.39-4.81, P = 0.002) and age (HR = 0.94, 95% CI: 0.91-0.97, P = 0.001) were independent predictors of continence recovery.

Conclusion The PPSS technique improves early postoperative urinary continence without increasing the rate of positive surgical margins. Although it does not significantly enhance long-term continence, it may still contribute positively to patients' postoperative quality of life.