Continence-preserving anatomic radical retropubic prostatectomy

Abstract

Introduction. Urinary continence, especially in regard to the time required to regain urinary control after radical prostatectomy, remains a significant complication of the procedure. Technical Considerations. The “no touch” or “avoidance” surgical principles that are the basis for continence-preserving radical prostatectomy primarily focus on the preservation of the following components of the external striated urethral sphincteric complex: the entire circumferential musculature of the rhabdosphincter, the fascial investments (the pubourethral ligaments anterolaterally and median fibrous raphe posteriorly), and the innervation of both the rhabdosphincter by way of the intrapelvic branch of the pudendal nerve (somatic) and the mucosal and smooth muscle components by way of the urethral branch of the inferior hypogastric plexus (autonomic). Conclusions. The clinical impact of preserving the external striated urethral sphincter, its innervation, and its fascial attachments by performing a continence-preserving anatomic retropubic prostatectomy is a shorter time to achieve urinary continence.