Potency-sparing radical perineal prostatectomy: anatomy, surgical technique and initial results.

By integrating a re-examination of perineal anatomy with the recently described anatomy of the pelvic nerve plexus and the cavernous nerves, a modification of radical perineal prostatectomy that can preserve potency has been developed. In 16 patients who underwent this procedure immediately after bilateral pelvic lymphadenectomy the traditional low morbidity of radical perineal prostatectomy was retained, and potency was preserved in 5 of 9 patients (56 per cent), including all whose tumor was confined within the specimen margins. Review of the anatomy of the pelvic fascia also demonstrates that additional fascia around the lateral and dorsal surfaces of the prostate can be removed during radical perineal prostatectomy when one is willing to sacrifice the cavernous nerves to achieve a more radical excision of the prostate.