Posterior Reconstruction of the Rhabdosphincter

Urinary incontinence following prostatectomy is a potential adverse effect of surgically treating prostate cancer. There is a huge variability in defining continence, which can lead to differing reported rates of incontinence (ranging from 2% to 47%). Stress incontinence, resulting from sphincter and pelvic floor dysfunction, is often responsible for persistent incontinence. The present chapter describes the anatomical disruption that occurs during a radical prostatectomy, particularly involving the rhabdosphincter and the posterior suspension system. The goal is to restore the posterior support system, lengthen the urethral sphincteric complex, and maximize continence recovery. Studies have shown that posterior reconstruction can lead to improved early continence recovery rates, but long-term effects may vary. Surgeon expertise and anatomical knowledge play a significant role in the success of these procedures. In conclusion, posterior reconstruction is recognized as a valuable technique to enhance early continence recovery following prostatectomy. However, its long-term impact and broader applicability, such as in orthotopic neobladder reconstructions, require further investigation.