Technical details to achieve perfect early continence after radical prostatectomy

Urinary incontinence after radical prostatectomy (RP) is still an issue and may compromise patient quality of life and psychosocial behavior, regardless of oncologic outcomes. As this condition usually resolves by the end of the first postoperative year, many surgeons focused their attention on "early" return of urinary continence (UC). The aim of this non-systematic review is to present an overview of the current knowledge on the anatomy and the surgical techniques addressed to early functional recovery of continence after RP. The available literature data suggest that the preservation of bladder neck, pubo-prostatic ligaments, endopelvic fascia and vesico-urethral complex may play a role in recovery of early UC. Similarly, bladder neck reconstruction, anterior and/or posterior myo-fascio-ligamentous support to the anastomosis and tension-free watertight vesico-urethral anastomosis can improve early UC recovery post RP. More recently surgical approaches (i.e. Retzius-sparing technique) seem to add a piece in the jigsaw in the scenario of the early recovery of UC. Notwithstanding the efforts of the surgeons, more evidence from randomized studies is required to prove benefits of the different approaches and the "ideal" RP is far to be standardized.