Radical perineal prostatectomy

An alernate surgical approach

Radical perineal prostatectomy was the first type of surgical approach used to remove the prostate gland (starting in 1905). 

Now it is usually reserved for men who cannot undergo retropubic surgery due to other medical problems, including obesity. 

It might also be a viable option if the surgeon believes there is little chance that the cancer has spread to the lymph nodes.

Differs from radical retropubic prostatectomy

During this surgery for prostate cancer, an incision is made under the man’s scrotum, in front of his rectum.

This pros of this procedure for prostate removal are:

  • Shorter surgery (one and a half hours to four hours)
  • May also be less painful 
  • Shorter hospital stay
  • Quicker return to work and strenuous activities
  • The incision is small and hidden
  • It avoids major muscle groups
  • Less blood loss
  • Less risk of adverse cardiovascular effects
  • Men can avoid scar tissue from previous gut surgeries 
  • Cancer control is similar to retropubic and robotic approaches (81% of men were cancer-free at 4 years, according to one study by Saranchuk et al)  

The cons are that:

  • Lymph nodes cannot be viewed or removed with the same incision
  • The surgeon cannot easily view and save the nerve bundles

Impotence may be a greater concern.  That's why this approach is not used as often as:

Higher risk of impotence is something that you definitely need to consider and discuss with the doctor.  If sexual side effects are not a concern for you, then it might be an viable option. 

Urinary incontinence rates are similar to retropubic and robotic approaches. 

Recovery for radical perineal prostatectomy

Like radical retropubic prostatectomy, a man’s hospital stay is generally:

  • 2 to 3 days following surgery
  • 3 to 5 weeks of recovery time at home

He will also need to have a catheter for up to 2 weeks.

Risks of surgery

The risks are the same as for other types of surgery for prostate cancer, including:

  • Heart attack
  • Stroke
  • Blood clots
  • Anesthesia reactions
  • Infection

Return to treatments
Radical retropubic prostatectomy
Laparoscopic radical prostatectomy
Robotic-assisted laparoscopic radical prostatectomy

References:

Korman H.  Radical Perineal Prostatectomy for Prostate Cancer. http://emedicine.medscape.com/article/447239-overview.  Accessed March 28, 2015. 

The American Cancer Society. Prostate Cancer. http://www.cancer.org. Accessed March 17, 2015.

Walsh PC. Guide to Surviving Prostate Cancer. New York, NY: Time Warner Book Group; 2001.

Always consult a medical professional.

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