Perineal prostatectomy and anal incontinence Guilger NR et al. asymmetry index has been associated tinence.10,13 with anal incon- There was no significant statistical change in anal pressure parameters after perineal prostatectomy. The only change noted was an improvement in the sphincter asymmetry index, and this finding may be related to the integral theory of the pelvic floor. This theory states that the involvement of anterior, medium and posterior pelvic floor compartments and the interrelation of its structures and organs with the pelvic fascia and ligaments are important in anal continence.31-33 In a perineal prostatectomy, structures important to the maintenance of the posterior pelvic floor dynamic are divided, including the rectouretheral muscle, the perineal body, and the centrum tendineum. Therefore, some aspects in the configuration of both the rectum and the anal canal may change.32-36 One step in the perineal prostatectomy consists of perineal reconstruction and perineal body reattachment. Although visually imperceptible, this technical approach may have contributed to the change in reading patterns of sphincter asymmetry without a change in the absolute resting pressure values. The improvement in anal canal symmetry may support the integral theory of the pelvic floor and the role of fibrosis and reattachment of the perineal body in anal conti- nence.32,33 This finding may be of value in further studies in the identification of beneficial technical approaches during perineal surgery that may prevent anal incontinence. AUTHOR CONTRIBUTIONS Guilger NR gathered the material and developed the discussion. Jorge JMN developed the statistical and discussion. Costa RP recruited patients. Teixeira MG drafted the article. Nahas S revised the article. 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