Introduction: Bladder neck preservation plays a pivotal role in early continence recovery following radical prostatectomy. However, achieving optimal preservation becomes technically challenging in patients with large prostate glands due to distorted anatomy and increased bladder outlet resistance. Despite the availability of various surgical modifications, there is no universally accepted approach for maximizing anatomical preservation at the prostatic origin. Objective: To describe a step-by-step surgical technique for maximum anatomical bladder neck preservation tailored for large prostate glands, aiming to enhance postoperative continence outcomes without compromising oncological safety. Methods: We present a detailed intraoperative protocol focusing on anatomical planes, judicious dissection, and selective mucosal trimming to preserve the native bladder neck structure. The technique emphasizes precise identification of the true vesicoprostatic junction, preservation of detrusor apron fibers, and reconstruction strategies to maintain functional continuity. Conclusion: This technique offers a reproducible and anatomically oriented approach to bladder neck preservation in patients with large prostate glands undergoing radical prostatectomy. It has the potential to improve early urinary continence while maintaining surgical margins. The authors declare no conflicts of interest or commercial associations during the last 2 years that might influence the content of this video. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure. No funding was received for this article. Runtime of video: 5 mins 57 secs.
Sakthivel et al. (2025) studied this question.