Anterior Reconstruction in Radical Prostatectomy

When treating localized prostate cancer, excellent oncological outcomes with low rate of complications are nowadays possible with radical prostatectomy (RP). However, functional outcomes in terms of continence and potency recovery are still less enthusiastic. Indeed, in patients who do not early recover continence quality of everyday life is markedly reduced, especially in younger and more active ones. The proportion of continent patients at 1 year after surgery ranges from 70% to 100% in the available. Such disparities in the literature are probably due to either non-homogeneous definition of continence or measurement methods (questionnaires, number of pads, pad test). Several factors have been identified as leading to, including patient characteristics (body mass index, age, prostate volume, and comorbidities), experience of the surgeon, and surgical precision. There are a number of steps and techniques for improving continence after RP: preservation of the bladder neck, nerve-sparing (NS) technique, preservation of the maximum urethral length, preservation of the puboprostatic ligaments and of the endopelvic fascia, reconstruction of the posterior rhabdosphincter, anterior reconstruction, and suture of the arcus tendineus to the bladder neck. The present chapter will try to cover the topic of anterior reconstruction, focusing on the anatomical rationale, the previously reported techniques and the outcomes of such a step.