Radical perineal prostatectomy

Historically, perineal prostatectomy was the primary type of surgery for prostate cancer, performed for the first time by Billroth in 1867 mostly without visual control. However, Hugh Hampton Young received credit for the first perineal prostatectomy after reporting in 1905 his experience with a mostly visually controlled operation and new special instruments [1]. Different perineal routes of access to the prostate have been described, but the most commonly used route is Young’s suprasphincteric approach ventral to the external and internal sphincter ani. It was the mainstay of surgical treatment until by the mid of last century pelvic lymph node dissection became part of the procedure. Radical retropubic prostatectomy began to take over since it allowed simultaneous pelvic lymph node dissection through the same incision. By the early 1980s, introduction of anatomic radical retropubic prostatectomy [2] left only a limited number of centers worldwide practicing and teaching perineal prostatectomy. Renewed interest in perineal prostatectomy ensued with introduction of laparoscopic pelvic lymph node dissection. In addition, with the widespread use of prostate specific antigen (PSA) in the 1980s, a shift toward lower clinical stages and localized disease took place, and implementation of various nomograms allowed preoperatively to predict the probability of lymph node involvement. The trend toward less invasive surgery and technical refinements in perineal prostatectomy has finally thrust perineal prostatectomy again to the forefront as a less invasive surgical treatment option for some types of prostate cancer.