Role of puboprostatic and pubovesical ligaments in urinary incontinence: a systematic review

The puboprostatic ligament (PPL) and the pubovesical ligament (PVL) are critical anatomical structures that play a significant role in maintaining urinary continence by supporting the urethra and bladder neck. Despite their well-documented functions, the impact on continence outcomes of preserving or reconstructing these ligaments during surgical procedures, particularly radical prostatectomy, remains underexplored. This systematic review synthesises current evidence on the anatomy, function, and clinical implications of the PPL and PVL.

A comprehensive literature search was conducted in the PubMed database following the PRISMA guidelines, selecting studies related to the anatomical characteristics, functional roles, and clinical management of these ligaments.

Anatomical studies consistently highlight the structural complexity and supportive roles of the PPL and PVL in maintaining urethral and bladder neck positioning, which are essential for continence. Functional studies, on the other hand, further explain their involvement in the urethral closure process, while clinical evidence demonstrates that sparing or reconstructing these ligaments during radical prostatectomy significantly improves both early and long-term continence outcomes, suggesting that their preservation is crucial for enhancing postoperative continence recovery.

These findings emphasise the importance of these ligaments in continence mechanisms and require them to be considered in future surgical innovations. Further research is needed to refine surgical techniques and to better understand the biomechanical properties of these ligaments so as to optimise patient outcomes.