Radical perineal prostatectomy is a

surgical procedure Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

wherein the entire prostate gland is removed through an incision in the area between the

anus The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, d ...

and the

scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum cont ...

( perineum). It is used to remove early

prostate cancer Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that sur ...

, in select people who have a small well defined cancer in the prostate. It is less commonly used than the alternative methods of the retropubic route, or the robot assisted

laparoscopic Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medli ...

approach.Sullivan L.D. (2003) Radical Perineal Prostatectomy. In: Bruskewitz R.C. (eds) Atlas of the Prostate. Current Medicine Group, London. https://doi.org/10.1007/978-1-4615-6505-5_10Zippe C.D. (2006) Radical Perineal Prostatectomy. In: Novick A.C. et al. (eds
''Operative Urology at the Cleveland Clinic''
Humana Press. https://doi.org/10.1007/978-1-59745-016-4_37 When the

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

is small and confined to the prostate, radical perineal prostatectomy achieves the same rate of cure as the retropubic approach but less

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...

is lost and recovery is faster. One downside to the perineal approach is an increased risk of fecal incontinence. The procedure was first performed in 1904 by

Hugh H. Young Hugh Hampton Young (September 18, 1870 – August 23, 1945) was an American surgery, surgeon, urologist, and medical researcher. Biography Hugh H. Young was born in San Antonio, Texas, San Antonio, Texas on September 18, 1870. He was the son of ...

and assisted by

William S. Halstead William Storm Halstead (1903 in Mount Kisco, NY – September 1987 in Los Angeles, CA) was an American inventor. Halstead was a prodigious inventor who held more than 80 patents involving radio and television development. As a student at ...

, as a way of removing the prostate in cancer treatment.

Uses

Radical perineal prostatectomy is used to remove early

, in select people who have a small well defined cancer in the prostate. It is less commonly used than the alternative methods of the retropubic route, or the robot assisted

approach. It is more suited to younger men, age under 70 years, who have at least a ten-year life expectancy, few if any other medical problems, a Gleason score of less than 8 (4+4) and PSA of less than 10. It may be indicated where the man with prostate cancer is obese, has had several abdominal operations before, previous pelvic arterial bypass grafts or has a delayed recurrence of prostate cancer after salvage prostatectomy and

radiotherapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...

Technique

Diagram showing before and after a radical prostatectomy CRUK 473

Before surgery

Before the operation, an assessment of

life expectancy Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, current age, and other demographic factors like sex. The most commonly used measure is life expectancy at birth ...

is made. Physical examination including a digital rectal examination and routine blood tests are carried out. At least six

transrectal ultrasound Transrectal ultrasonography, or TRUS in short, is a method of creating an image of organs in the pelvis, most commonly used to perform an ultrasound-guided needle biopsy evaluation of the prostate gland in men with elevated prostate-specific an ...

guided

biopsies A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

taken from different zones of the prostate are usually obtained. Other considerations include bowel preparation the day before surgery and taking antibiotics.

Procedure

A radical perineal prostatectomy uses an incision in the area between the

and the

( perineum). There is more than one way of performing the procedure. In men with normal erections, a small cancer which can not be felt and Gleason scores of 6 or less, it may be possible to preserve the nerves for erection. The procedure usually takes around one hour.

After surgery

Over the course of the first day or two after the procedure, many men require a gradual transfer from oral fluids to soft foods. Additionally, men are encouraged to maintain mobility and painkillers may be necessary initially but tapered off over time. The hospital stay is usually short and the Foley catheter can be removed usually at three weeks after surgery. Longer term followup with PSA monitoring is required.

Complications and outcomes

Lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...

s can be sampled through the same incision, although this procedure is not common place in the U.S. at this time. When the

is small and confined to the prostate, radical perineal prostatectomy achieves the same rate of cure as the retropubic approach but less

is lost and recovery is faster. One downside to the perineal approach is an increased risk of fecal incontinence.

History

The procedure was first performed on a 70-year old married preacher on 7 April 1904 by American surgeon

and assisted by

, as a way of removing the prostate in cancer treatment, after prostatic massage and an early type of

transurethral resection of the prostate Transurethral resection of the prostate (commonly known as a TURP, plural TURPs, and rarely as a transurethral prostatic resection, TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, ...

had failed to relieve him of pain in his urethra. By 1937, Young reported a five-year survival rate of 50%. However, by the time the diagnosis of prostate cancer was made, it was usually too late to perform the procedure. Removing the prostate via the perineal route went out of favour in the 1970s. However, with the introduction the PSA test, better public awareness of options for treating localised disease, the ability to perform nerve-sparing surgery, and the advantage of there being potentially less post-operative complications using the perineal route, rekindled interest in the procedure.