Radical perineal prostatectomy is a

surgical procedure Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

wherein the entire

prostate The prostate is an male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemica ...

gland is removed through an incision in the area between the

anus In mammals, invertebrates and most fish, the anus (: anuses or ani; from Latin, 'ring' or 'circle') is the external body orifice at the ''exit'' end of the digestive tract (bowel), i.e. the opposite end from the mouth. Its function is to facil ...

and the

scrotum In most terrestrial mammals, the scrotum (: scrotums or scrota; possibly from Latin ''scortum'', meaning "hide" or "skin") or scrotal sac is a part of the external male genitalia located at the base of the penis. It consists of a sac of skin ...

(

perineum The perineum (: perineums or perinea) in placentalia, placental mammals is the space between the anus and the genitals. The human perineum is between the anus and scrotum in the male or between the anus and vulva in the female. The perineum is ...

). It is used to remove early

prostate cancer Prostate cancer is the neoplasm, uncontrolled growth of cells in the prostate, a gland in the male reproductive system below the bladder. Abnormal growth of the prostate tissue is usually detected through Screening (medicine), screening tests, ...

, 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 human pelvis, pelvis using small Surgical incision, incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few ...

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 Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

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 is com ...

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

fecal incontinence Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents—including flatus (gas), liquid stool elements and mucus, or solid feces. FI is a sign or a symptom ...

. The procedure was first performed in 1904 by Hugh H. Young and assisted by William S. Halstead, 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 Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when ...

, 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 (RT, RTx, or XRT) is a treatment using ionizing radiation, generally provided as part of cancer therapy to either kill or control the growth of malignant cells. It is normally delivered by a linear particle ...

Technique

Diagram showing before and after a radical prostatectomy CRUK 473

Before surgery

Before the operation, an assessment of

life expectancy Human life expectancy is a statistical measure of the estimate of the average remaining years of life at a given age. The most commonly used measure is ''life expectancy at birth'' (LEB, or in demographic notation ''e''0, where '' ...

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 ant ...

guided

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

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

(

). 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 In urology, a Foley catheter is one of many types of urinary catheters (UC). The Foley UC was named after Frederic Foley, who produced the original design in 1929. Foleys are indwelling UC, often referred to as an IDCs (sometimes IDUCs). This dif ...

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 includ ...

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

History

The procedure was first performed on a 70-year old married preacher on 7 April 1904 by American surgeon Hugh H. Young and assisted by William S. Halstead, 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.