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Radical Perineal Prostatectomy

Radical prostatectomy (removal of the prostate gland) is one of the most common treatments for localized prostate cancer. In addition to laparoscopic and robotic methods of performing a radical prostatectomy, our surgeons also perform radical perineal prostatectomy (RPP).

What is Radical Perineal Prostatectomy?

Radical perineal prostatectomy is the surgical removal of the prostate and seminal vesicles through a small incision in the perineum, the area between the anus and the scrotum. The perineum is the most direct route to the prostate gland. Radical perineal prostatectomy is for patients with localized prostate cancer (prostate cancer that has not spread beyond the gland).

Advantages of Radical Perineal Prostatectomy

RPP provides patients with several advantages including:

  • Shorter operating time than robotic prostatectomy
  • Short hospital stays (typically one day)
  • Low blood loss
  • Equally low rate of surgical complications compared to robotic prostatectomy
  • Short recovery period
  • Lower rates of urinary incontinence (equal to incontinence rates of other approaches)
  • Preservation of erectile function – About 65% of patients maintain erectile function following RPP; most remaining patients achieve normal erections through medication management or minimally invasive treatment options.

How Radical Perineal Prostatectomy is Performed

RPP is performed under general anesthesia and typically takes about 90 minutes. A single inverted U-shaped incision (about 2 inches) is made in the perineum through which the surgeon inserts special instruments used to remove the prostate gland and the seminal vesicles. A high-powered telescopic lens provides the surgeon with excellent visualization of the prostate during the procedure.

After the prostate is removed, the incision in the perineum is sutured. A urethral catheter is placed in the bladder prior to closing the incision to allow for urine drainage, which stays in place for one week. A separate catheter or drain will also be inserted in the surgical site to drain any fluids from this area during the hospital stay.

What to Expect Before and After Surgery

Before your procedure:

  • Prior to surgery, you will need to have pre-surgical tests performed
  • The night before surgery, you will be instructed to follow only a clear liquid diet in addition to using a bowel preparation kit to completely clear your bowels

After surgery:

  • Pain is typically minimal after surgery. You will be given pain medication as needed for post-operative pain.
  • A urinary catheter to drain urine from your bladder will stay in place for one week following surgery
  • A surgical drain at the incision will be placed to drain any fluids and is removed prior to leaving the hospital
  • One day after surgery, you will begin walking to encourage blood flow and help with the healing process
  • Most patients are discharged one day after surgery

Learn more about what to expect following radical prostatectomy here.

Candidates for Radical Perineal Prostatectomy

RPP is typically a good option for most men because the perineum is the most direct route to the prostate.

This procedure is also beneficial for men who:

  • Have had prior abdominal surgery resulting in post-operative scarring
  • Have had a kidney transplant or previous hernia surgery
  • Are obese

Side Effects of RPP

Minimally invasive surgery including RPP presents a number of benefits to patients and usually poses less risk of post-operative complications such as bleeding, infection, and pain. However, as in any surgical procedure, risks and complications can occur.

Rare side effects of RPP may include:

  • Bleeding
  • Urinary incontinence
  • Erectile dysfunction