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CUP (Complete urethral preservation)

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User
Posted 18 Sep 2025 at 07:38

This appears to be another possible advance in prostate surgery.

Basically, at present, the uretha which runs through the prostate, is cut off at both ends when the prostate is removed, then rejoined.

CUP involves dissecting the uthera from the prostate leaving it intact before the gland is removed.

Apparently this will vastly improve incontinence side effects and prevent the loss to penis length associated with the shortening and rejoining of the uretha.

Seems a wonderful development to me. My only concern would be that the dissection might leave behind cancerous prostate cells but apparently this does not occur.

https://www.uclh.nhs.uk/news/new-surgical-technique-preserves-continence-men-after-prostate-removal

I suppose they'll now have to trial the new technique. Hopefully if the results are favourable, it will later be introduced.

It's great to see the surgical advances are keeping up with advances in radiotherapy.

Edited by member 18 Sep 2025 at 15:48  | Reason: Typo

User
Posted 18 Sep 2025 at 07:38

This appears to be another possible advance in prostate surgery.

Basically, at present, the uretha which runs through the prostate, is cut off at both ends when the prostate is removed, then rejoined.

CUP involves dissecting the uthera from the prostate leaving it intact before the gland is removed.

Apparently this will vastly improve incontinence side effects and prevent the loss to penis length associated with the shortening and rejoining of the uretha.

Seems a wonderful development to me. My only concern would be that the dissection might leave behind cancerous prostate cells but apparently this does not occur.

https://www.uclh.nhs.uk/news/new-surgical-technique-preserves-continence-men-after-prostate-removal

I suppose they'll now have to trial the new technique. Hopefully if the results are favourable, it will later be introduced.

It's great to see the surgical advances are keeping up with advances in radiotherapy.

Edited by member 18 Sep 2025 at 15:48  | Reason: Typo

User
Posted 24 Aug 2026 at 23:53

This was NHS in the West Midlands . There’s is not a lot of information about it , nothing in info given out at hospital . I’m going to ask Dr more when we see him in October, pleased whatever he did as it’s really aided my husbands recovery . If anyone would be interested I could report back after. Seems a really good thing 

User
Posted 25 Aug 2026 at 14:02

That being the case, the outcome looks similar to Retzius sparing. 

User
Posted 28 Aug 2026 at 15:09
Interestingly, I had my RP in September 2025 with CUP and Neurosafe and the good news for me was that I had absolutely no incontinence problems from the moment the catheter was removed.I should say that the surgery was performed privately so not sure if it's available via the NHS.
User
Posted 28 Oct 2026 at 23:00

I had this treatment, it’s superb!

I decided to self pay and find an elite high volume surgeon with extensive experience in Retzius Sparring techniques, CUP, Neurosafe & single port Da Vinci robot.  My outcome has been superb all nerves spared, zero pads from moment catheter removed & my PSA is now 0.01.

Its been a traumatic journey for my family & myself going through this. I love the NHS, but the one thing I can honestly say (hand on heart) is that finding a top high volume surgeon is invaluable. The money spent was the price of an average low end car and to spend it on your own health when faced with a life threatening disease was an easy decision for me to make.

I’m now getting on with my life and putting this behind me. 

Hope this helps anyone considering this treatment - I know how traumatic a prostate cancer diagnosis can be 👍

 

Edited by member 28 Oct 2026 at 23:19  | Reason: Not specified

User
Posted 29 Oct 2026 at 09:36

It's great to hear of such a good outcome! I went NHS with a highly regarded surgeon but no CUP and no Retzius sparing. I hadn't heard of CUP in 2021 and had been told (erroneously  I have since learned) that Retzius sparing was more likely to leave positive margins. I think the following months were the most miserable (and certainly the wettest) of my life. Hindsight is always 20:20 but I would have self funded had I been better informed. 

Peter

 

User
Posted 30 Oct 2026 at 09:57

The other day, one gent posted that he'd  had the 'hood technique'. What the hell is that, I thought.

Apparently.......Traditional prostatectomy or standard approaches can disrupt the delicate support systems around the bladder and urethra. The hood technique preserves a "hood" of tissue—including the detrusor apron, puboprostatic ligament complex, arcus tendineus, endopelvic fascia, and the pouch of Douglas.

Wow! I never knew I had a pouch of Douglas.

This new procedure is getting good reviews.

Anterior hood-sparing RARP with anterior reconstruction is a modification to the standard anterior RARP approach with a very short learning curve which provides patients with better early and late continence without compromise to oncological outcomes. Given the advantages of this approach, and the trend of operating on increasingly more aggressive disease, it will be of interest to surgeons wanting to improve their functional outcomes whilst minimising the impact on oncological outcomes.

https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1002/bco2.463

Let's hope that these new techniques become more readily available. 

User
Posted 30 Oct 2026 at 11:42

trying to preserve things to the limit, would increase the chances of leaving behind a few rogue cells?

..... and that could be a very unwelcome side effect. 

Luckily, my standard RARP resulted in no loss of length. Just as well as I don't have it to spare. But, given the description of how part of the urethra is lost due to cutting at either end of the gland, I do wonder why some lose length and others don't. Perhaps that is for another thread, it's a bit of a tangent here. 

 

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User
Posted 18 Sep 2025 at 18:57

Adrian, interesting article, I wonder what happens to the sphincter. 

Thanks Chris 

User
Posted 23 Aug 2026 at 22:38

I think my husbands had this but I can’t find much information about it . Does anyone have any info ? Is it currently used a lot ? I’d never heard of it til after his prostatectomy and surgeon said he had used a new technique and my husband has had no post surgery incontinence at all . Any info gratefully received 

User
Posted 24 Aug 2026 at 07:28

It seems the process is also known as TULP (Total Length Urethral Preservation)

https://www.sciencedirect.com/science/article/pii/S2590089726000368

It seems it's still being trialed. I'd have thought, a bit like Neurosafe (checks of margins during surgery) and Retzius sparing RARP,  that CUP/TULP, due to additional costs, will be more easly available privately than on the NHS?

Edited by member 24 Aug 2026 at 07:35  | Reason: Add link

User
Posted 24 Aug 2026 at 23:53

This was NHS in the West Midlands . There’s is not a lot of information about it , nothing in info given out at hospital . I’m going to ask Dr more when we see him in October, pleased whatever he did as it’s really aided my husbands recovery . If anyone would be interested I could report back after. Seems a really good thing 

User
Posted 25 Aug 2026 at 09:50
Would have saved me from the peritonitis, sepsis and 3 weeks in hospital that resulted from my leaking urethra.
User
Posted 25 Aug 2026 at 10:16

A bit of recent research into CUP.

https://pubmed.ncbi.nlm.nih.gov/42255328/

Results: A total of 459 patients were included, with successful CUP achieved in 316 (68.8%). Early continence was higher in the CUP cohort than in non-CUP patients (77% vs 67%, p = 0.02), while rates were similar at 12 months (83% vs. 80%, p = 0.74). CUP patients were significantly more likely to be pad-free/security pad only at both timepoints (p = 0.019 and 0.012, respectively). Positive MS rates and locations were comparable between groups. CUP was not associated with increased BCR risk on multivariable analysis (HR 1.06, 95% CI 0.56-1.98; p = 0.90). CUP likelihood improved with experience.

It appears to improve early incontinence but after a year the incontinence levels are much the same as normal RARP? 

Edited by member 25 Aug 2026 at 10:29  | Reason: Add link

User
Posted 25 Aug 2026 at 14:02

That being the case, the outcome looks similar to Retzius sparing. 

User
Posted 28 Aug 2026 at 15:09
Interestingly, I had my RP in September 2025 with CUP and Neurosafe and the good news for me was that I had absolutely no incontinence problems from the moment the catheter was removed.I should say that the surgery was performed privately so not sure if it's available via the NHS.
User
Posted 30 Aug 2026 at 12:18

Interesting.

I was lead to believe by a urologist some time back that there isn't actually any tissue of the urethra through the prostate, just a hole in the prostate tissue. I guess that can't be true.

User
Posted 28 Oct 2026 at 23:00

I had this treatment, it’s superb!

I decided to self pay and find an elite high volume surgeon with extensive experience in Retzius Sparring techniques, CUP, Neurosafe & single port Da Vinci robot.  My outcome has been superb all nerves spared, zero pads from moment catheter removed & my PSA is now 0.01.

Its been a traumatic journey for my family & myself going through this. I love the NHS, but the one thing I can honestly say (hand on heart) is that finding a top high volume surgeon is invaluable. The money spent was the price of an average low end car and to spend it on your own health when faced with a life threatening disease was an easy decision for me to make.

I’m now getting on with my life and putting this behind me. 

Hope this helps anyone considering this treatment - I know how traumatic a prostate cancer diagnosis can be 👍

 

Edited by member 28 Oct 2026 at 23:19  | Reason: Not specified

User
Posted 29 Oct 2026 at 09:36

It's great to hear of such a good outcome! I went NHS with a highly regarded surgeon but no CUP and no Retzius sparing. I hadn't heard of CUP in 2021 and had been told (erroneously  I have since learned) that Retzius sparing was more likely to leave positive margins. I think the following months were the most miserable (and certainly the wettest) of my life. Hindsight is always 20:20 but I would have self funded had I been better informed. 

Peter

 

User
Posted 29 Oct 2026 at 09:51

Hi Senna,

 

That's brilliant news! CUP does sound like a game changer and like you say a high volume experienced surgeon is invaluable.

All the best with your recovery and future

John

User
Posted 30 Oct 2026 at 09:57

The other day, one gent posted that he'd  had the 'hood technique'. What the hell is that, I thought.

Apparently.......Traditional prostatectomy or standard approaches can disrupt the delicate support systems around the bladder and urethra. The hood technique preserves a "hood" of tissue—including the detrusor apron, puboprostatic ligament complex, arcus tendineus, endopelvic fascia, and the pouch of Douglas.

Wow! I never knew I had a pouch of Douglas.

This new procedure is getting good reviews.

Anterior hood-sparing RARP with anterior reconstruction is a modification to the standard anterior RARP approach with a very short learning curve which provides patients with better early and late continence without compromise to oncological outcomes. Given the advantages of this approach, and the trend of operating on increasingly more aggressive disease, it will be of interest to surgeons wanting to improve their functional outcomes whilst minimising the impact on oncological outcomes.

https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1002/bco2.463

Let's hope that these new techniques become more readily available. 

User
Posted 30 Oct 2026 at 10:19

So, not just early continence improvement. 

Do we take 'late' to mean ongoing continence? I. e. Does this method improve continence full stop?

Peter 

User
Posted 30 Oct 2026 at 10:47

Originally Posted by: Online Community Member
So, not just early continence improvement. 

Hi, mate.

According to this it seems like Retzius is better than the hood technique for long term incontinence?

In multivariable regression, both retzius sparing and hood had a better return of 3-month continence versus standard RARP (retzius sparing: OR 3.82, CI 2.28-6.38, p < 0.0001; hood: OR 2.39, CI 1.46-3.91, p = 0.0006). At 12-months, only retzius sparing had better continence than standard RARP (retzius sparing: OR 3.88, CI 2.08-7.24, p < 0.0001; hood: OR 1.65, CI 0.91-3.01, p = 0.10). Moreover, at 20 months, only retzius sparing had better continence than standard RARP (retzius sparing: OR 3.27, CI 1.72-6.21, p = 0.0003; hood: OR 1.63, CI 0.87-3.08, p = 0.13)

https://www.urotoday.com/conference-highlights/aua-2025/aua-2025-prostate-cancer/159977-aua-2025-recovery-of-urinary-continence-after-robotic-assisted-radical-prostatectomy-a-multicenter-comparison-of-retzius-sparing-hood-and-standard-techniques.html

I do love a bit of research. 😁

User
Posted 30 Oct 2026 at 10:55

Hmm. Give a little, take a little? What do you think? 

 However, retzius sparing RARP had the most positive margins (standard 29.5%; retzius sparing 37.4%; hood 30.0%; p = 0.039): 

User
Posted 30 Oct 2026 at 11:08

Originally Posted by: Online Community Member
Hmm. Give a little, take a little? What do you think? 

They took about two inches from me which I could ill afford to lose. 😁

Joking apart, it's great to see that advances are being made to reduce side effects. I suppose rather than 'chopping everything out', trying to preserve things to the limit, would increase the chances of leaving behind a few rogue cells? 

Edited by member 30 Oct 2026 at 11:24  | Reason: Additional text

User
Posted 30 Oct 2026 at 11:42

trying to preserve things to the limit, would increase the chances of leaving behind a few rogue cells?

..... and that could be a very unwelcome side effect. 

Luckily, my standard RARP resulted in no loss of length. Just as well as I don't have it to spare. But, given the description of how part of the urethra is lost due to cutting at either end of the gland, I do wonder why some lose length and others don't. Perhaps that is for another thread, it's a bit of a tangent here. 

 

 
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