The anatomic radical perineal prostatectomy: a contemporary and anatomic approach.

OBJECTIVES: We applied the advances in anatomic techniques as developed for the radical retropubic prostatectomy to the perineal approach to radical prostatectomy. The anatomic radical perineal prostatectomy maximizes cancer control and minimizes postoperative incontinence and impotence. This technique capitalizes on the many advantages associated with the perineal approach to the prostate.

METHODS: The anatomic radical perineal prostatectomy addresses the posterior surface and posterior bladder neck regions prior to urethral division at the prostatic apex. Anatomic dissection of the striated urethral sphincter and preservation of the bladder neck, as well as a "watertight" anastomosis, are accomplished with excellent exposure. Cavernosal nerve preservation is possible in appropriately selected patients. Data are accumulated prospectively and reported herein.

RESULTS: Prostate-specific antigen detectability is seen in 2% and 4% of pT2 and pT2 to T3b cases, respectively at an average follow-up of 1 year. Immediate full continence is seen in 30% of cases; ultimately, 97.5% achieve full urinary control. Nerve-sparing techniques result in spontaneous erectile activity in 73%. Average length of hospital stay is less than 2 days, with most recent patients discharged on the day after surgery.

CONCLUSIONS: The anatomic radical perineal prostatectomy is a safe and effective method of treating men with clinically localized prostate cancer and should be part of every urologist's surgical armamentarium.