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Objectives <p>To prospectively explore the feasibility and histopathological concordance of virtual reality (VR)-based 3D prostate models in robot-assisted radical prostatectomy (RARP) and to evaluate the association between VR-derived membranous urethral length (MUL) and early urinary continence recovery.</p> Methods <p>VR-based 3D prostate models were generated for 35 patients with localized prostatic adenocarcinoma who underwent RARP. Tumor localization, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) on the 3D models were compared with the final histopathology using Cohen’s kappa coefficient and standard diagnostic accuracy measures. Urinary continence was assessed using the Expanded Prostate Cancer Index Composite (EPIC) survey, with social continence defined as the use of no pads or one safety pad per day and complete continence defined as zero pad use. Continence recovery was evaluated at 1, 3, and 6 months.</p> Results <p>The mean patient age in the cohort was 63.2 years, the mean prostate-specific antigen (PSA) concentration was 13.36 ng/mL, and the mean prostate volume was 52.7&#xa0;cc. Nerve-sparing surgery was performed in 74.3% of the patients, and extended pelvic lymph node dissection was performed in 20%. Pathologic stage ≥T3a occurred in 45.7% of patients, with a Gleason score ≤ 7 in 71.4%, an SVI in 14.3%, and positive margins in 2.9%. Perioperative complications were minimal (5.7%), with no transfusions. Continence recovery occurred in 85.7% of the patients at 3 months and 91.4% at 6 months. MUL correlated negatively with pad use at 3 months (Spearman’s ρ = − 0.52), and a 14-mm MUL cutoff was associated with early continence recovery (AUC = 0.86). VR 3D models showed almost perfect agreement with the final histopathology for extraprostatic extension (EPE) (κ = 0.88; accuracy 94.3%) and perfect agreement for SVI (κ = 1.00).</p> Conclusions <p>VR-based 3D prostate models may represent a useful adjunct for surgical planning in RARP and could help inform nerve-sparing strategies. MUL, as measured by these models, may be a valuable factor associated with early urinary continence recovery. These exploratory findings should be interpreted with caution and require confirmation in larger, multicenter prospective studies with longer follow-up periods.</p>

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Virtual reality-based 3D prostate models for robot-assisted radical prostatectomy: a prospective exploratory study of membranous urethral length and early urinary continence recovery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月3日

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  • Raed A. Azhar,
  • Ahmad M. Albarakaty,
  • Shady Saikali,
  • Mohamed Elkoushy

摘要

Objectives

To prospectively explore the feasibility and histopathological concordance of virtual reality (VR)-based 3D prostate models in robot-assisted radical prostatectomy (RARP) and to evaluate the association between VR-derived membranous urethral length (MUL) and early urinary continence recovery.

Methods

VR-based 3D prostate models were generated for 35 patients with localized prostatic adenocarcinoma who underwent RARP. Tumor localization, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) on the 3D models were compared with the final histopathology using Cohen’s kappa coefficient and standard diagnostic accuracy measures. Urinary continence was assessed using the Expanded Prostate Cancer Index Composite (EPIC) survey, with social continence defined as the use of no pads or one safety pad per day and complete continence defined as zero pad use. Continence recovery was evaluated at 1, 3, and 6 months.

Results

The mean patient age in the cohort was 63.2 years, the mean prostate-specific antigen (PSA) concentration was 13.36 ng/mL, and the mean prostate volume was 52.7 cc. Nerve-sparing surgery was performed in 74.3% of the patients, and extended pelvic lymph node dissection was performed in 20%. Pathologic stage ≥T3a occurred in 45.7% of patients, with a Gleason score ≤ 7 in 71.4%, an SVI in 14.3%, and positive margins in 2.9%. Perioperative complications were minimal (5.7%), with no transfusions. Continence recovery occurred in 85.7% of the patients at 3 months and 91.4% at 6 months. MUL correlated negatively with pad use at 3 months (Spearman’s ρ = − 0.52), and a 14-mm MUL cutoff was associated with early continence recovery (AUC = 0.86). VR 3D models showed almost perfect agreement with the final histopathology for extraprostatic extension (EPE) (κ = 0.88; accuracy 94.3%) and perfect agreement for SVI (κ = 1.00).

Conclusions

VR-based 3D prostate models may represent a useful adjunct for surgical planning in RARP and could help inform nerve-sparing strategies. MUL, as measured by these models, may be a valuable factor associated with early urinary continence recovery. These exploratory findings should be interpreted with caution and require confirmation in larger, multicenter prospective studies with longer follow-up periods.