MUSC Health Urologist Offers Radical Perineal Prostatectomy

Medicine is continuously evolving, and for many years, the favored approach for a radical prostatectomy (surgical procedure for the removal of the prostate) has been retropubic, either open, or more commonly today, robotic. With the retropubic approach, a surgeon makes an incision in the lower abdominal wall to gain access to the prostate, which is located behind the pelvic bone. However, on occasion this approach is not possible for a variety of reasons.

There are still a small number of surgeons who can do a radical perineal prostatectomy. In contrast to the retropubic approach during a perineal prostatectomy, the prostate is removed through an incision in the region between the scrotum and the anus. Thomas Keane, M.D., chair of urology at MUSC Health, is one of the few surgeons who does this approach and the only physician to perform this technique in South Carolina. As a result, he receives referrals from all over the country and, on occasion, from outside the United States.

Dr. Keane, a native of Ireland, knows how rare it is to find someone who can perform this procedure. He says, "There are very few people today who are familiar with this technique and I've even been invited back to Ireland to do it a couple of times." This approach was first described in the 1800s and has been considerably modified since that time. With the development of the retropubic approach it fell out of favor in many centers, but it has a major advantage in some situations.

It is ideal for patients who have scar tissue from injury or multiple surgeries or other obstructions that make a retropubic approach out of the question. Some other benefits to this technique include minimal blood loss and operating time is usually 1.5 to 2 hours, which is considerably shorter than the robotic approach. Recent data has shown that continence returns more quickly than with other approaches. The rates of incontinence and impotence are comparable to other methods and there are no differences in cancer control rates on a stage-by-stage comparison.

Dr. Keane is also very aware of nerve-sparing when performing this surgery. Protecting the nerves at the site of the surgery as well as any nerves surrounding the tissue that is removed is a priority. "We can dissect and preserve the nerves with this approach as we do with others and achieve excellent nerve-sparing."

Keane speaks from experience. "What matters most is not the approach, but the skill of the surgeon." he says. "Either open or robotic retropubic prostatectomy is an excellent approach, however, so is the perineal. The key to a good outcome is to find a good surgeon who knows what he or she is doing and does it frequently."

Keane is immensely proud of his team. He says, "When you come here, to an academic medical center like MUSC you are primarily going to be taken care of by fellowship-trained experts, who are well published and teaching the next generation of surgeons. I would match this department with any urology group anywhere."

Find out more about the MUSC Health Prostate and Genitourinary Cancers Program and the treatment options offered.