Male continence is maintained by a complex, interconnected network of structures. These include the internal and external urethral sphincters, as well as the pelvic floor musculature and endopelvic fascia. This chapter will delve into each of these components in detail including their anatomy and innervation. Notably, we will highlight recent insights into the multi-dimensional orientations of muscle fibers in the external urethral sphincter. We will then discuss the etiologies and pathophysiology of incontinence. Lastly, we will make the case that the long-held conception of the external urethral sphincter as an all-or-nothing lynchpin is outdated and oversimplified. Three illustrative examples of the internal sphincterotomy, the male sling, and the membranous urethroplasty will reinforce the idea that the external sphincter is a more complicated, robust, and resilient entity than previously considered.