eMedicine Specialties > Urology > Cancer, Prostate

Prostate Cancer - Radical Perineal Prostatectomy: Multimedia

Author: Howard J Korman, MD, FACS, Consulting Staff, Department of Urology, William Beaumont Hospital
Coauthor(s): Michael J Harris, MD, Consulting Staff, Northern Institute of Urology, PC; Consulting Staff, Department of Surgery, Section of Urology, Munson Medical Center; Damon James Dyche, MD, Resident Physician, Department of Urology, William Beaumont Hospital
Contributor Information and Disclosures

Updated: Apr 27, 2009

Multimedia

In the high lithotomy position, the legs are supp...
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Media file 1: In the high lithotomy position, the legs are supported with Allen or Yellowfin stirrups, and gel-type padding (eg, jelly roll) is placed under the sacrum. Pneumatic stirrups facilitate leg repositioning during surgery and are a helpful adjunct.
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In the high lithotomy position, the legs are supp...

In the high lithotomy position, the legs are supported with Allen or Yellowfin stirrups, and gel-type padding (eg, jelly roll) is placed under the sacrum. Pneumatic stirrups facilitate leg repositioning during surgery and are a helpful adjunct.

The inverted-U incision is placed in the mid peri...
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Media file 2: The inverted-U incision is placed in the mid perineum, medial to the ischial tuberosities and anterior to the mid anus.
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The inverted-U incision is placed in the mid peri...

The inverted-U incision is placed in the mid perineum, medial to the ischial tuberosities and anterior to the mid anus.

A lateral view illustrates the difference in appr...
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Media file 3: A lateral view illustrates the difference in approaches and the proximity of the rectum to the apex of the prostate. The authors use the Young suprasphincteric approach.
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A lateral view illustrates the difference in appr...

A lateral view illustrates the difference in approaches and the proximity of the rectum to the apex of the prostate. The authors use the Young suprasphincteric approach.

The Thompson perineal retractor provides excellen...
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Media file 4: The Thompson perineal retractor provides excellent surgical exposure.
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The Thompson perineal retractor provides excellen...

The Thompson perineal retractor provides excellent surgical exposure.

The Denonvilliers aponeurosis (fascia) is careful...
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Media file 5: The Denonvilliers aponeurosis (fascia) is carefully incised, and the cavernosal nerve bundles are delicately separated from the prostate.
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The Denonvilliers aponeurosis (fascia) is careful...

The Denonvilliers aponeurosis (fascia) is carefully incised, and the cavernosal nerve bundles are delicately separated from the prostate.

The urethra is dissected out of the apex. Caverno...
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Media file 6: The urethra is dissected out of the apex. Cavernosal nerves are preserved bilaterally as the urethra is dissected out of the apex of the prostate up to the verumontanum.
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The urethra is dissected out of the apex. Caverno...

The urethra is dissected out of the apex. Cavernosal nerves are preserved bilaterally as the urethra is dissected out of the apex of the prostate up to the verumontanum.

A length of urethra is dissected out of the prost...
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Media file 7: A length of urethra is dissected out of the prostate base, and the bladder neck is left intact.
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A length of urethra is dissected out of the prost...

A length of urethra is dissected out of the prostate base, and the bladder neck is left intact.

The urethro-urethrostomy anastomosis is completed...
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Media file 8: The urethro-urethrostomy anastomosis is completed with 2 running sutures to ensure an optimally watertight anastomosis. The 2 sutures are nearly ready to be tied together to complete the anastomosis. Note the cavernosal nerve bundles on each side of the urethral anastomosis.
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The urethro-urethrostomy anastomosis is completed...

The urethro-urethrostomy anastomosis is completed with 2 running sutures to ensure an optimally watertight anastomosis. The 2 sutures are nearly ready to be tied together to complete the anastomosis. Note the cavernosal nerve bundles on each side of the urethral anastomosis.

The Penrose drain in the completed incision is re...
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Media file 9: The Penrose drain in the completed incision is removed on the first postoperative day.
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The Penrose drain in the completed incision is re...

The Penrose drain in the completed incision is removed on the first postoperative day.

Time until continence in weeks after catheter rem...
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Media file 10: Time until continence in weeks after catheter removal. Socially dry is defined as the use of 0-1 pad daily, and totally dry is defined as the use of no pads. The use of more than 1 pad daily is considered incontinence.
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Time until continence in weeks after catheter rem...

Time until continence in weeks after catheter removal. Socially dry is defined as the use of 0-1 pad daily, and totally dry is defined as the use of no pads. The use of more than 1 pad daily is considered incontinence.

The percentage of men reporting erectile function...
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Media file 11: The percentage of men reporting erectile function adequate for vaginal penetration with or without the use of sildenafil (Viagra) in months following unilateral and bilateral cavernosal nerve-sparing radical perineal prostatectomy.
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The percentage of men reporting erectile function...

The percentage of men reporting erectile function adequate for vaginal penetration with or without the use of sildenafil (Viagra) in months following unilateral and bilateral cavernosal nerve-sparing radical perineal prostatectomy.

Nerve-sparing radical perineal prostatectomy.
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Media file 12: Nerve-sparing radical perineal prostatectomy.
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Nerve-sparing radical perineal prostatectomy.

Nerve-sparing radical perineal prostatectomy.

More on Prostate Cancer - Radical Perineal Prostatectomy

Overview: Prostate Cancer - Radical Perineal Prostatectomy
Treatment: Prostate Cancer - Radical Perineal Prostatectomy
Follow-up: Prostate Cancer - Radical Perineal Prostatectomy
Multimedia: Prostate Cancer - Radical Perineal Prostatectomy
References
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References

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Further Reading

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Keywords

prostate cancer, radical perineal prostatectomy, prostate-specific antigen, PSA, RPP, radical retropubic prostatectomy, RRP, digital rectal exam, digital rectal examination, DRE, radical prostatectomy, prostatectomy, urinary incontinence, fecal incontinence, postprostatectomy incontinence, scrotal hyperesthesia, impotence, erectile function, anastomotic stricture, urethral stricture, transient fecal urgency, Lowsley tractor, Denonvilliers fascia, pelvic lymph node dissection, PLND, da Vinci robotic system, robotic prostatectomy, robotic surgery

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Contributor Information and Disclosures

Author

Howard J Korman, MD, FACS, Consulting Staff, Department of Urology, William Beaumont Hospital
Howard J Korman, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Michigan State Medical Society, Oakland County Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Harris, MD, Consulting Staff, Northern Institute of Urology, PC; Consulting Staff, Department of Surgery, Section of Urology, Munson Medical Center
Michael J Harris, MD is a member of the following medical societies: American Association of Clinical Urologists, American Urological Association, Association of American Physicians and Surgeons, Société Internationale d'Urologie (International Society of Urology), and Southwest Oncology Group
Disclosure: Lilly  Honoraria Speaking and teaching

Damon James Dyche, MD, Resident Physician, Department of Urology, William Beaumont Hospital
Damon James Dyche, MD is a member of the following medical societies: Alpha Omega Alpha and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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