OBJECTIVE This study compares the effectiveness of a bladder neck preservation procedure with that of bladder neck resection in maintaining postprostatectomy urinary continence. METHODS Bladder neck preservation was attempted in 107 men and completed in 91; bladder neck resection was performed in 99 patients. Successful follow-up was performed in 90 and 98 patients, respectively, during a mean interval of 42 months. The two groups were compared for return of urinary continence at monthly intervals to 1 year, the incidence of positive surgical margins, and recurrence, using an unpaired t test and regression curves. RESULTS Continence at 1 month was 11.2% for patients undergoing a bladder neck resection and 23.3% for those with preservation of the bladder neck. At 3 months, the continence rates were 44.3% and 62.4%, respectively; at 6 months, they were 70.1% and 82.4%, respectively; and at 1 year, they were 86.3% and 89.4%, respectively. There was no significant difference in time to continence at 1 year between the two groups; however, there was a significantly decreased time to continence seen in patients with preservation of the bladder neck. The incidence of positive margins and organ-confined disease was not significantly different between the two groups. Detectable serum prostate-specific antigen levels were seen in 17.3% of patients undergoing bladder neck resection and in 16.7% of those with bladder neck preservation. CONCLUSIONS Preservation of the bladder neck is technically feasible; in selected patients, it is effective in eradicting disease without an increased recurrence rate. The procedure does not produce an improved rate of postprostatectomy incontinence, although it can be expected to shorten the interval of incontinence.