Endoscopic radical perineal prostatectomy: Preliminary results

Vasileios Α. Pangalos, Antonios Katsimantas, Konstantinos Sfetsas, Konstantinos Ioannidis, Athanasios Archontakis


Radical Perineal Prostatectomy (RPP) is the oldest surgical technique for prostate cancer. Prostate’s anatomy allows for RPP to be considered as a minimally invasive technique. However, only a few surgeons perform it, probably due to technical difficulties arising from the constricted surgical field, as well as surgeons’ insufficient training. We introduce Endoscopic Radical Perineal Prostatectomy as an evolution of  RPP and present our results in a series of patients. ERPP combines the advantages of both RPP and laparoscopic techniques in terms of surgical results while, at the same time, offers surgeons an invaluable training tool.


Η ριζική περινεϊκή προστατεκτομή είναι η παλαιότερη χειρουργική θεραπεία για τον καρκίνο του προστάτη. Παρόλο που, λόγω ανατομίας του προστάτη, η ριζική περινεϊκή προστατεκτομή αποτελεί ελάχιστα επεμβατική τεχνική, εκτελείται σήμερα από ένα μικρό αριθμό ουρολόγων. Αυτό μπορεί να οφείλεται, αφενός, στο ιδιαίτερο χειρουργικό πεδίο και, αφετέρου, στη δυσκολία που παρουσιάζει η εκπαίδευση των νέων χειρουργών σ’ αυτήν. Με την παρούσα εργασία εισάγουμε την ενδοσκοπική ριζική περινεϊκή προστατεκτομή  και παρουσιάζουμε τα αποτελέσματά της σε μία σειρά ασθενών. Η τεχνική αυτή συνδυάζει τα πλεονεκτήματα ριζικής περινεϊκής προστατεκτομής και της λαπαροσκοπίας, αποτελεί ένα βήμα προς στην τελειοποίηση της επέμβασης, ενώ συγχρόνως την καθιστά εκπαιδευτικότερη.


prostate cancer; surgical treatment; endoscopic radical perineal prostatectomy; προστατικός καρκίνος, χειρουργική θεραπεία, ενδοσκοπική ριζική περινεϊκή προστατεκτομή

Full Text:



Young, H. H. VIII. Conservative Perineal Prostatectomy: The Results of Two Years’ Experience and Report of Seventy - Five Cases. Ann. Surg. 41, 549 - 557 (1905).

Millin, T. Retropubic Urinary Surgery. In: Carcinoma of the Prostate: Radical Retropubic Prostatectomy. Baltim. Md Williams Wilkins 15 - 17, (1947).

Walsh, P. C., Lepor, H. & Eggleston, J. C. Radical prostatectomy with preservation of sexual function: Anatomical and pathological considerations. The Prostate 4, 473 - 485 (1983).

Walsh, P. C. & Donker, P. J. Impotence following radical prostatectomy: Insight into etiology and prevention. 1982. J. Urol. 167, 1005 - 1010 (2002).

Weldon, V. E. & Tavel, F. R. Potency - sparing radical perineal prostatectomy: anatomy, surgical technique and initial results. J. Urol. 140, 559 - 562 (1988).

Archontakis, A. Radical Perineal Prostatectomy. Chapter 3, p. 16 - 19, (Army General Staff, 2007).

Abbou, C. C. et al. [Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case]. Prog. En Urol. J. Assoc. Fr. Urol. Société Fr. Urol. 10, 520 - 523 (2000).

Binder, J. & Kramer, W. Robotically - assisted laparoscopic radical prostatectomy. BJU Int. 87, 408 - 410 (2001).

Lowrance, W. T. et al. Contemporary open and robotic radical prostatectomy practice patterns among urologists in the United States. J. Urol. 187, 2087 - 2092 (2012).

Laydner, H. et al. Perineal robot - assisted laparoscopic radical prostatectomy: Feasibility study in the cadaver model. J. Endourol. Endourol. Soc. 28, 1479 - 1486 (2014).

Mirza, M., Art, K., Wineland, L., Tawfik, O. & Thrasher, J. B. A comparison of radical perineal, radical retropubic, and robot - assisted laparoscopic prostatectomies in a single surgeon series. Prostate Cancer 2011, 878323 (2011).

Lance, R. S. et al. A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group. BJU Int. 87, 61 - 65 (2001).

May, M. et al. Radical retropubic vs. radical perineal prostatectomy: A comparison of relative benefits in four urban hospitals. Urol. Nurs. 27, 519 - 526 (2007).

Salomon, L. et al. Radical prostatectomy by the retropubic, perineal and laparoscopic approach: 12 years of experience in one center. Eur. Urol. 42, 104 - 110; discussion 110 - 111 (2002).

Sullivan, L. D., Weir, M. J., Kinahan, J. F. & Taylor, D. L. A comparison of the relative merits of radical perineal and radical retropubic prostatectomy. BJU Int. 85, 95 - 100 (2000).

Matsubara, A. et al. Inguinal hernia after radical perineal prostatectomy: Comparison with the retropubic approach. Urology 70, 1152 - 1156 (2007).

Gillitzer, R. et al. Single center comparison of anastomotic strictures after radical perineal and radical retropubic prostatectomy. Urology 76, 417 - 422 (2010).

Stamey, T. A., Villers, A. A., McNeal, J. E., Link, P. C. & Freiha, F. S. Positive surgical margins at radical prostatectomy: Importance of the apical dissection. J. Urol. 143, 1166 - 1172; discussion 1172 - 1173 (1990).

Weldon, V. E., Tavel, F. R., Neuwirth, H. & Cohen, R. Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy. J. Urol. 153, 1565 - 1569 (1995).

Archontakis, A. Radical Perineal Prostatectomy. Chapter 16, p. 174 - 175, (Army General Staff, 2007).

Wallner, C., Dabhoiwala, N. F., DeRuiter, M. C. & Lamers, W. H. The anatomical components of urinary continence. Eur. Urol. 55, 932 - 943 (2009).

Walz, J. et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur. Urol. 57, 179 - 192 (2010).

Silverstein, A. D. et al. Cost comparison of radical retropubic and radical perineal prostatectomy: Single institution experience. Urology 63, 746 - 750 (2004).

Wroński, S. Radical perineal prostatectomy - the contemporary resurgence of a genuinely minimally invasive procedure: Procedure outline. Comparison of the advantages, disadvantages, and outcomes of different surgical techniques of treating organ - confined prostate cancer (PCa). A literature review with special focus on perineal prostatectomy. Cent. Eur. J. Urol. 65, 188 - 194 (2012).

Saito, S. & Murakami, G. Anatomical study of perineal pelvic lymphadenectomy. Int. J. Urol. Off. J. Jpn. Urol. Assoc. 14, 978 - 980 (2007).

Saito, S. & Murakami, G. Radical perineal prostatectomy: A novel approach for lymphadenectomy from perineal incision. J. Urol. 170, 1298 - 1300 (2003).

Keller, H., Lehmann, J. & Beier, J. Radical perineal prostatectomy and simultaneous extended pelvic lymph node dissection via the same incision. Eur. Urol. 52, 384 - 388 (2007).

Fu, Q., Moul, J. W. & Sun, L. Contemporary radical prostatectomy. Prostate Cancer 2011, 645030 (2011).

Archontakis, A. & Bolomytis, s. Oncological and functional results of radical perineal prostatectomy in the treatment of clinically locally advanced prostate cancer. The experience of the urology clinic of the 401 GMHA. Hellenic urology 2014/1.

DOI: http://dx.doi.org/10.19264/hj.v27i4.103