Radical perineal prostatectomy: a simplified approach

Radical perineal prostatectomy (RPP) has been revisited by urologists in recent years, as preoperative staging has allowed identification of patients with low risk of nodal metastasis. Recent initiatives to contain hospital costs, as well as patient and physician concerns regarding use of the current blood supply, have led to development of less invasive and less morbid procedures. RPP has long been considered to be less morbid than radical retropubic prostatectomy (RRP). We present our technique of RPP. It has been used successfully in over 90 cases. This is a low risk and low morbidity procedure. There is markedly reduced blood loss, postoperative pain, and hospital stay, as compared to RRP. Positive margin rates are comparable using both techniques. Perineal prostatectomy should be considered an option for definitive treatment of localized prostatic carcinoma, when there is low probability of lymphatic involvement.