Perineal Prostatectomy Walking in the Land of Dinosaurs Sam D Graham, Jr Blue Ridge Urology
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Perineal Prostatectomy
Walking in the Land of Dinosaurs Sam D Graham, Jr
Blue Ridge Urology
There was a time when ships were wood and men were steel Al Weyman Chief Resident, Surgery University of Rochester 1974
Perineal Lithotomy Perineal Prostatectomy Johns Hopkins Modern Modifications
History of Perineal Surgery
A strong and intelligent person being seated on a high stool, lays hold of the patient in a supine posture, with his back towards him, and his hips being placed on his knees, with his legs drawn backwards he orders the patient to seize his own hams with his hands, and to draw them towards his body with all his power, and at the same time he secures them in that position. Then the physician, having carefully pared his nails, introduces his index and middle fingers of the left hand, first the one gently, afterwards the other into the anus, and places the fingers of his right hand lightly on the lower part of the abdomen. First of all the stone must be sought for about the neck of the bladder and when it has been brought into that position a lunated incision must be made through the integuments immediately over and extending to the neck of the bladder near the anus, with the horns a little inclined towards the ischia; then a second incision is to be made in the transverse form in the convex part of the wound so as to open the neck of the bladder."
15th Century Op Note, Celsian Lithotomy
Ambrose Pare’
Frere Jaques
1866-H Kuchler Partial Prostatectomy for Cancer 1867-Theodur Bilroth Perineal Prostatectomy
1903 Hugh Young
The Teachers
The Instruments
The Position
The New Teachers
The New Instruments
The Same Instruments
The New Position
The Incision
Central Tendon
Recto-Urethralis
Denonvilliers Fascia
Nerve Sparing
Urethra
Reconstruction
Postoperative Care
109 minutes average operating time
1 day stay in hospital
Average blood loss < 100 cc
Rare use of narcotics (< 5% use prescriptions)
Sitz baths at least twice a day
Catheter out in 10 days
Advantages of Perineal Prostatectomy
Minimal Capital Outlay
High Risk Patients not suitable for other approaches Obese patients
Prior abdominal surgery
Prior mesh hernia repair
Perineal Prostatectomy in the Obese Patient
Group I BMI 30-34.9
(n=27)
Group II BMI 35-39.9
(n=22)
Group III BMI > 40 (n=9)
Blood Loss (cc)
500 529 544
OR Time (min)
104 105 107
Perineal Prostatectomy in the Obese Patient
Group I BMI 30-34.9
(n=27)
Group II BMI 35-39.9
(n=22)
Group III BMI > 40 (n=9)
Continent 24 18 7
Stress 1 0 1 Urge
Incontinence-2ppd
Mild Stress (<1 ppd)
1 3 1
Perineal Prostatectomy in the Obese Patient
Group I BMI 30-34.9
(n=27)
Group II BMI 35-39.9
(n=22)
Group III BMI > 40 (n=9)
Spontaneous 3 2 3
Partial/Assisted 16 9 4
None
4 4 2
Not Discussed 4 7
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