THE ANATOMIC RADICAL PERINEAL PROSTATECTOMY - A CONTEMPORARY AND ANATOMIC APPROACH

Objectives. We applied the advances in anatomic techniques as develope d for the radical retropubic prostatectomy to the perineal approach to radical prostatectomy. The anatomic radical perineal prostatectomy ma ximizes cancer control and minimizes postoperative incontinence and im potence. This technique capitalizes on the many advantages associated with the perineal approach to the prostate. Methods. The anatomic radi cal perineal prostatectomy addresses the posterior surface and posteri or bladder neck regions prior to urethral division at the prostatic ap ex. Anatomic dissection of the striated urethral sphincter and preserv ation of the bladder neck, as well as a ''watertight'' anastomosis, ar e accomplished with excellent exposure. Cavernosal nerve preservation is possible in appropriately selected patients. Data are accumulated p rospectively and reported herein. Results. Prostate-specific antigen d etectability is seen in 2% and 4% of pT2 and pT2 to T3b cases, respect ively, 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 7 3%. Average length of hospital stay is less than 2 days, with most rec ent patients discharged on the day after surgery. Conclusions. The ana tomic 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. Copyright 1996 by El sevier Science Inc.