Objectives. To review a contemporary series of rectal injuries occurri
ng during radical perineal prostatectomy. Methods. Of 81 patients who
underwent radical perineal prostatectomy, 9 (11%) sustained a full-thi
ckness laceration of the anterior rectal wall, All 9 patients had a pr
eoperative bowel preparation, although only 1 received a complete oral
lavage regimen. All received prophylactic perioperative intravenous a
ntibiotics. None had undergone prior surgery to the rectum or perineum
or received prior pelvic radiation therapy. Results. In most cases in
jury occurred during division of the rectourethralis muscle, but in at
least hive instances the injury appeared to be the result of undue po
sterior retraction along the rectal wall. All injuries were recognized
at the time of surgery and repaired primarily. No patient had associa
ted postoperative complications. Conclusions. Rectal injury occurs wit
h significantly greater frequency with radical perineal prostatectomy
than with the retropubic approach. However, if the rectum is adequatel
y prepared, the injury promptly recognized and repaired, and postopera
tive care appropriate, the great majority of cases will not lead to at
tendant morbidity.