Urinary incontinence remains a major functional complication after radical prostatectomy. Although laparoscopic radical prostatectomy (LRP) provides perioperative advantages over open radical prostatectomy (ORP), its impact on continence recovery remains uncertain. This study aimed to compare urinary continence recovery at 3, 6, and 12 months after ORP and LRP and to explore clinical predictors of postoperative continence. This retrospective two-centre cohort included 75 consecutive patients undergoing ORP (n = 50) or LRP (n = 25) between January 2022 and December 2024, performed by the same surgical team. Continence was defined as 0–1 pad/day and assessed at predefined intervals. Between-group differences were expressed as absolute risk differences with 95% confidence intervals (CIs). Prespecified multivariable logistic regression models were constructed, with Firth penalized regression applied at 12 months due to sparse events. Baseline oncologic characteristics were comparable, with higher body mass index (BMI) in the ORP group (P < 0.001). LRP was associated with shorter operative time, lower blood loss, and reduced hospitalization (all P < 0.001). Continence rates did not differ significantly at 3 months (62% vs. 64%), 6 months (72% vs. 76%), or 12 months (86% vs. 88%). Surgical approach was not independently associated with continence at any time point, whereas higher BMI was consistently associated with persistent incontinence. Continence recovery was broadly similar between ORP and LRP. Despite perioperative advantages of LRP, functional outcomes were more strongly associated with patient-related factors than with surgical access. Larger prospective studies are warranted.
