Abbreviations & Acronyms AFMS = anterior fibromuscular stroma BCR = biochemical recurrence BMI = body mass index CZ = central zone DPPM = dissection of puboperinealis and puborectalis muscle DVP = dorsal vein complex of the penis ECE = extracapsular extension EUS = external urethral sphincter ICIQ-SF = International Consultation on Incontinence Questionnaire Short-Form IQR = interquartile range IUS = internal urethral sphincter LRP = laparoscopic radical prostatectomy MRI = magnetic resonance imaging MsPP = puboperinealis muscle NVai = neurovegetative afferent innervation NVBP = neurovascular bundle preservation PA = apex of the prostate PDE5 = phosphodiesterase 5 inhibitors PSA = prostate-specific antigen PSM = positive surgical margins PUI = postoperative urinary incontinence PZ = peripheral zone RMD = rhabdomyo-dissection SB = spongiosum bulb of urethra TZ = transition zone VVSS = seminal vesiclesObjectives: To describe our surgical technique of "muscle-sparing" laparoscopic radical prostatectomy and to review relevant anatomical landmarks during the procedure. Methods: This was a prospective non-controlled case series of 120 consecutive patients who underwent laparoscopic radical prostatectomy, always carried out by the same surgeon (OL). The median follow-up period was 33 months. Dissection of the puboperinealis and puborectalis muscle consists of the precise dissection of the puborectalis and puboperinealis muscles from the periprostatic fascia. Rhabdomyodissection consists of an approach that spares the external urethral sphincter from the ventral surface of the prostate and membranous urethra. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications and outcomes of urinary continence were assessed. A descriptive statistical analysis was carried out. Results: Continence rates were 70.8%, 83.3% and 92.5%, at 0-2, 3-4 and 5-8 weeks after removal of the urethral catheter, respectively; 96.6% and 98.3% at 6 and 12 months after surgery. The positive surgical margin rate associated with rhabdomyo-dissection was 8.3%. Conclusions: Laparoscopic radical prostatectomy with dissection of the puboperinealis and puborectalis muscle, and rhabdomyo-dissection is an oncologically safe procedure, associated with very early recovery urinary continence in most patients. It is a technique that can be applied in most cases, as long as there is no invasion of the ventral side of the prostate.

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