Rigi10™ Malleable Penile Prosthesis
Also Known As
Radical perineal prostatectomy (RPP), Young's procedure, perineal approach prostatectomy, minimally invasive perineal prostatectomy
Definition
Perineal prostatectomy is a surgical procedure in which the prostate gland is removed through an incision made in the perineum (the area between the scrotum and rectum).1 This approach can be performed as a radical procedure, where the entire prostate and some of the surrounding tissue, including the seminal vesicles (glands that help produce semen), are removed.2 During the procedure, the surgeon accesses the prostate through a small incision, separates it from surrounding structures, and removes it while preserving critical nerves and blood vessels when possible.3 The bladder is then reattached to the urethra, and a catheter is placed to drain urine during healing.4 This technique is primarily used to treat localized prostate cancer and offers specific advantages including reduced blood loss, shorter operative time, and excellent access to the prostatic apex and neurovascular bundles.5
Clinical Context
Perineal prostatectomy is primarily indicated for the treatment of localized prostate cancer that has not spread beyond the prostate gland.1 Patient selection criteria typically include those with organ-confined disease, a life expectancy of at least 10 years, and good overall health status.2 The procedure is particularly advantageous for obese patients, as the perineal approach provides direct access to the prostate regardless of abdominal size, and for patients with previous abdominal surgeries where other approaches might be challenging.3
The surgical procedure involves placing the patient in an exaggerated lithotomy position with elevated pelvis and outwardly rotated hips.1 A curved Lowsley retractor is used to bring the prostate to the perineal plane, facilitating access.1 For nerve-sparing purposes, Denonvillier’s fascia is carefully incised and separated along with the neurovascular bundles to preserve erectile function when oncologically appropriate.1
Expected outcomes include cancer control comparable to other surgical approaches, with continence rates of 93-95% and potency rates ranging from 41-77% depending on preoperative status and nerve-sparing technique.3 The procedure typically results in shorter hospital stays (often discharge by postoperative day 2), reduced blood loss, and minimal pain management requirements compared to other approaches.4 Potential complications include urinary incontinence, erectile dysfunction, positive surgical margins (particularly at the anterior surface and bladder neck), and standard surgical risks.5