Abstract
Radical prostatectomy continues to play a central role in the management of localized prostate cancer. The majority of patients diagnosed with prostate cancer will undergo radical prostatectomy. A decrease in the morbidity of this surgical procedure has been accomplished through an improved understanding of pelvic anatomy and a greater understanding of the natural history of prostate cancer. Recently, minimally invasive techniques have been applied to radical prostatectomy (laparoscopic prostatectomy) in order to further decrease the morbidity of this operation. What remains to be determined is whether this approach confers the same long term surgical outcomes as the open approach. One method which offers known long term outcomes coupled with decreased morbidity is the radical perineal prostatectomy. The purpose of this paper is to review the criteria for patient selection as well as outcomes of the radical perineal prostatectomy.
Highlights
Perineal prostatectomy is the oldest means of prostate resection and has its origins from the perineal lithotomy which was first described in 400 BC [1]
Throughout the 18th and 19th centuries, several surgeons reported the removal of portions of the prostate similar to Covillard; the first planned prostate enucleation through a median perineal incision was performed by Guthrie in 1834 [2]
Radical perineal prostatectomy is an example of a surgical technique which has stood the test of time
Summary
Perineal prostatectomy is the oldest means of prostate resection and has its origins from the perineal lithotomy which was first described in 400 BC [1]. Covillard is credited with performing the first removal of a portion of the prostate during removal of a bladder stone through the perineum in 1639, he and other surgeons, at the time, used a median incision in the perineum rather than the curved incision described by Celsus [2]. Throughout the 18th and 19th centuries, several surgeons reported the removal of portions of the prostate similar to Covillard; the first planned prostate enucleation through a median perineal incision was performed by Guthrie in 1834 [2]. This subsequently led to the use of the median perineal incision for the removal of prostatic carcinoma. In 1866, Kuchler was the first to suggest that the entire prostate could be removed using this approach, but it was Billroth, in 1867, who first described the perineal prostatectomy for the treatment of prostate cancer in a professional journal [3]
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