OBJECTIVE: To evaluate the role of bladder neck (BN) mucosal eversion during retropubic radical prostatectomy (RRP) on the rate of BN sclerosis and urinary incontinence, with the hypothesis that BN mucosal eversion is not essential to improve the clinical outcome after RRP. PATIENTS AND METHODS: One hundred patients with stage T1c-T2c prostate cancer had RRP by the same surgeon and were randomly divided in two equal groups; one had a vesico-urethral anastomosis with and one with no BN mucosal eversion. The patients were assessed by retrograde cysto-urethrography 4 days after surgery to evaluate the presence of urinary leakage. The occurrence of BN sclerosis and the rate of urinary incontinence (more than one pad/day) was assessed by double-blind interviews at 2 days, 2 months and 6 months after catheter removal, and the incidence of BN sclerosis was also assessed after 12 months. RESULTS: In the groups with or with no BN mucosal eversion, 48 and 47 patients, respectively, fulfilled the selection criteria. Urinary leakage after vesico-urethral anastomosis was more common after mucosal eversion (33% vs 21%), but not significantly (P = 0.251). BN sclerosis occurred in only one patient, with no mucosal eversion. The rate of urinary continence was similar in both groups at 2 days (69% vs 68%, respectively), 2 months (90% vs 87%) and 6 months (92% vs 92%) after surgery. Urinary extravasation at 4 days after surgery was followed by same rate of BN sclerosis and urinary continence as in patients with no urinary extravasation. CONCLUSION: BN mucosal eversion before vesico-urethral anastomosis during RRP is not essential to reduce the frequency of BN sclerosis or urinary incontinence. Early radiological urinary extravasation at the vesico-urethral anastomosis did not increase the risk of BN sclerosis or urinary incontinence.