Background/Objectives: Early recovery of urinary continence and sexual function remains a key focus following radical prostatectomy. The transvesical single-port robot-assisted radical prostatectomy (SP-TV-RARP) approach is a novel technique with very limited evidence that has been suggested to preserve the Retzius space and allow extraperitoneal access through the bladder. We aimed to evaluate early functional and oncologic outcomes following SP-TV-RARP at a single academic institution. Methods: We retrospectively reviewed 21 patients who underwent SP-TV-RARP by a single surgeon between September 2024 and May 2025. Continence is defined as being pad-free, and return of erectile function is defined as having erections sufficient for penetration. Functional and oncologic outcomes were assessed using clinical follow-up documentation and analyzed with Kaplan–Meier analysis. Results: The median patient age was 65 years, and 52.4% had pT3 disease. Positive surgical margins were observed in 62% overall and 30% in men with organ-confined disease. No intraoperative or 30-day postoperative complications occurred. Approximately 43% of patients achieved continence within one day of urethral catheter removal, with 75% of patients being pad-free at 3 months. Median SHIM and AUA-SS scores did not significantly decline at 3 months compared to baseline. The median time to recovery of erectile function was 69 days, and 67% recovered at the last follow-up. Biochemical recurrence occurred in 2 patients (15.4%) within 6 months. Conclusions: SP-TV-RARP appears safe and may facilitate early return of urinary continence and erectile function. Although inferior oncologic outcome is a potential concern during early adoption, functional outcomes were favorable. Further prospective evaluation is warranted to confirm long-term oncologic efficacy.

Perirectal spacers theoretically reduce radiation dose to the rectum and adjacent structures during prostate radiation therapy and may reduce genitourinary toxicity. However, large-scale studies evaluating clinical outcomes associated with spacer placement outside of clinical trial settings remain limited. Using the Merative MarketScan™ Commercial and Medicare Databases, we identified individuals who underwent radiotherapy for prostate cancer from 2016 to 2022. Those who received a perirectal spacer prior to radiotherapy were compared with those who underwent radiotherapy without spacer placement. The primary outcomes were genitourinary and rectal toxicities within 12 months of treatment. Multivariable Cox proportional hazards models were constructed adjusting for age, comorbidity, insurance type, androgen deprivation therapy use, and radiotherapy modality. Twelve-month total healthcare costs were compared between groups. Among 32,319 eligible patients, 5,964 (18%) received a perirectal spacer. Perirectal spacer was associated with lower one-year incidence and hazard of all-cause urinary toxicity (18.6% vs 21.5%, HR 0.88, 95% CI: 0.83-0.93, p<0.01), urinary incontinence (13.8% vs 16.2%, HR 0.89, 95% CI: 0.83-0.95,p<0.01), and urinary tract infections (5.6% vs 6.3%, HR 0.86, 95% CI 0.78-0.96, p<0.01). Receipt of a perirectal spacer was not associated with significantly improved all-cause rectal toxicity (HR 0.94, 95% CI 0.87-1.01, p=0.09). Twelve-month total healthcare costs were lower in the spacer group ($35,417 vs $43,514; p<0.001). In this large observational claims-based study, perirectal spacer use during prostate radiotherapy was associated with reduced short-term urinary toxicities and healthcare costs, but not with a statistically significant difference in rectal toxicity, the primary FDA-approved indication.