The puboprostatic ligaments are paired condensations of the endopelvic fascia connecting the anterior surface of the prostate and the bladder neck to the posterior surface of the pubic symphysis. They are the male equivalent of the pubovesical ligaments in females. They lie on either side of the dorsal venous complex (Santorini plexus) between the pubic bone and the prostate, and are intimate with the anterior urethra and the external urethral sphincter.
Anchor the prostate and bladder neck to the pubic bone, provide anterior pelvic floor support to the prostate and bladder neck, and play a role in urinary continence by maintaining the bladder neck in its retropubic position.
The puboprostatic ligaments must be divided during radical retropubic prostatectomy to gain access to the dorsal venous complex and the anterior urethra. The ligaments contain fibres of the external urethral sphincter and levator ani, making their careful preservation or reconstruction a focus of continence-preserving prostatectomy techniques. Some surgeons perform puboprostatic ligament-sparing prostatectomy or reconstruction to improve early post-operative continence recovery. The ligaments are also divided in laparoscopic and robot-assisted prostatectomy.
Division of the puboprostatic ligaments during radical prostatectomy disrupts the anterior urethral support mechanism contributing to the incontinence commonly experienced post-operatively; ligament reconstruction and careful urethral anastomosis technique reduce the severity and duration of incontinence.
