Search

Purpose To compare infectious complications after transrectal systematic prostate biopsy (SB) and magnetic resonance imaging (MRI)-targeted biopsy (TB) in a large retrospective cohort to assess whether one technique is superior to the other regarding infectious complications. Methods A total of 4497 patients underwent 5288 biopsies, 2875 (54%) SB and 2413 (46%) MRI-TB only. On average, 12 SB cores and 3.7 MRI-TB cores were taken per biopsy session during the study period. Infection-related complications within 30 days were compared. The primary endpoint was a positive urine culture. Secondary endpoints were positive blood cultures, urine tests with elevated leukocytes ≥ 100 E6/L and elevated C-reactive protein (CRP) ≥ 100 mg/L. Chi-square test was used to compare the cohorts. Results Positive urine cultures were found in 77 (2.7%) after SB and in 42 (1.7%) after MRI-TB (p = 0.022). In total, 46 (0.9%) blood culture positive infections were found, 23 (0.9%) occurred after SB and 23 (1.0%) after MRI-TB, (p = 0.848). Urine tests with elevated leukocytes ≥ 100 E6/L were found in 111 (3.9%) after SB and in 61 (2.5%) after MRI-TB (p = 0.006). Elevated CRP ≥ 100 mg/L was found in 122 (4.2%) after SB and in 72 (3.0%) after MRI-TB (p = 0.015). Blood cultures were drawn more often after SB than after MRI-TB, but the difference was not statistically significant. However, urine cultures and CRP were taken more often after SB than MRI-TB. Conclusion Blood culture positive infections were equally rare after SB and MRI-TB. However, all other infectious complications were more common after SB than MRI-TB.

Somatosensory feedback from peripheral receptors dynamically interacts with networks located in the spinal cord and brain to control mammalian locomotion. Although somatosensory feedback from the limbs plays a major role in regulating locomotor output, those from other regions, such as lumbar and perineal areas also shape locomotor activity. In mammals with a complete spinal cord injury, inputs from the lumbar region powerfully inhibit hindlimb locomotion, while those from the perineal region facilitate it. Our recent work in cats with a complete spinal cord injury shows that they also have opposite effects on cutaneous reflexes from the foot. Lumbar inputs increase the gain of reflexes while those from the perineal region decrease it. The purpose of this review is to discuss how somatosensory feedback from the lumbar and perineal regions modulate the spinal locomotor central pattern generator and reflex circuits after spinal cord injury and the possible mechanisms involved. We also discuss how spinal cord injury can lead to a loss of functional specificity through the abnormal activation of functions by somatosensory feedback, such as the concurrent activation of locomotion and micturition. Lastly, we discuss the potential functions of somatosensory feedback from the lumbar and perineal regions and their potential for promoting motor recovery after spinal cord injury.

Background Perianal/perineal rhabdomyosarcomas (PRMS) are easily misdiagnosed soft tissue tumours with a poor prognosis. This study was designed to analyze the clinical, diagnostic, pathological and prognostic features of PRMS, and to explore currently available therapeutic modalities. Methods Clinical data of PRMS patients admitted to the Sixth Affiliated Hospital and the Cancer Center of Sun Yat-sen University and from related Chinese literature published from 1987 to 2018 were collected and analyzed. The Chi-square test was used to evaluate the differences between each group. The Kaplan–Meier methods were applied to estimate and compare survival rates. Results A total of 35 patients were included in this study; 20 identified within related Chinese literatures and 15 from our center admitted during the period of 1997–2019. Out of these cases, 34 presented with perianal masses and the remaining one manifested as an inguinal mass. Moreover, 20 patients complained of pain and 16 of them were misdiagnosed as perianal abscesses, in which the presence of pain contributed to the misdiagnosis (p Conclusion PRMS are easily misdiagnosed lesions, which often leads to an unfavourable outcome in affected patients. Patients with painful perianal masses should be evaluated to exclude PRMS. MRI revealed that PRMS are closely related to the external anal sphincter. Multidisciplinary management is recommended in the treatment of PRMS.

Objectives: To evaluate the rates of third- and fourth-degree tears and related predisposing factors for the tears in singleton vaginal deliveries. Methods : This was a retrospective study of third- and fourth-degree perineal tears in all women who underwent vaginal delivery in a tertiary hospital in Assir region between January 2014 and December 2019. There are approximately 5000 deliveries per year at the Abha Maternity and Children Hospital. The total number of deliveries during the study period was 31,788, of which 19,374 were delivered vaginally. Results: A total of 85 women (0.43% of all vaginal deliveries) had third-degree (n=81) or fourth-degree (n=4) perineal tears. The mean age of the women was 31 years (range: 16-46 years). Fifty-two of the 85 women (61%) were primiparous. Of the various obstetric parameters, episiotomy, occipitoposterior presentation, primigravida, multipara, and a previous episiotomy were found to be significant predisposing factors to third- and fourth-degree tears in our patients. Conclusion: The low incidence of obstetric anal sphincter injuries in this study is likely the result of proactive manual protection of the perineum, valid indications for episiotomy, and attendance of senior staff members at all difficult deliveries. Saudi Med J 2020; Vol. 41 (11): 1241-1244 doi: 10.15537/smj.2020.11.25498 How to cite this article: Al Ghamdi DS. A retrospective study of the incidence and predisposing factors of third- and fourth-degree perineal tears. Saudi Med J. 2020 Nov;41(11):1241-1244. doi: 10.15537/smj.2020.11.25498.

Highlights • Perineal inclusion cysts may harbor clinically occult malignant degeneration. • Histological analysis of large inclusion cysts required to rule out occult malignancy. • Perineal cysts with malignant degeneration are diagnostic, reconstructive challenge. • Risk of malignancy in perineal inclusion cysts helps treatment decisions. • Large perineal cyst requires multidisciplinary surgical team for excision and closure. • Colostomy as adjunct of perineal reconstruction after excision of inclusion cyst. • Perineal inclusion cysts may present as atypical, cavitating lesions., Introduction Cutaneous squamous cell cancer (cSCC) is a common condition, with straight forward and well-known heuristics regarding diagnosis, treatment, and surveillance. cSCC arising in an epidermal inclusion cyst is rare, but not unheard of. In contrast, the authors’ are unaware of any prior reports of cSCC arising in an epidermal inclusion cyst within an atypical cavernous and cavitating lesion in the perineum. Presentation of case A 48-year-old male presented with a cavitating and rapidly growing cutaneous perineal lesion. Preliminary diagnostic procedures (biopsy) showed benign pathology and imaging showed no involvement of perineal organs such as prostate or rectum. Discordance between initial diagnostics and clinical features prompted multi-specialty consultation, including dermatological pathology. Repeat biopsy yielded in situ, possibly invasive squamous cell cancer, arising in the background of an epidermal inclusion cyst. Wide excision with advancement flap reconstruction was employed, with temporary diverting colostomy to avoid perineal sepsis. Discussion Location and appearance of this lesion provided a diagnostic and treatment challenge requiring multi-specialty involvement for diagnosis and successful treatment. Specialists from urology, general surgery, dermatology, general and dermatological pathology, plastic and reconstructive surgery, colorectal surgery and medical and radiation oncology were involved in diagnosis, treatment plan and execution. None of the specialists involved had seen this singular presentation before, and this created an ownership and management challenge. Conclusion The cavitating, atypical appearance of lesion complicated diagnosis. Location required pre-treatment coordination and deliberation between dermatology, urology, general surgery, and plastic surgery. Malignant degeneration of inclusion cysts, although rare, has to be kept in mind, especially when presenting with rapid growth, and persistence in ruling out malignant diagnosis is fundamental.

This video shows an open recurrent perineal hernia repair with mesh through a perineal approach. The patient is a 57-year-old female known to have a retro-rectal neuroendocrine tumour resected in 2015 using a perineal approach with coccygectomy. In 2017 she was treated for a local recurrence, by a conventional abdominoperineal excision (cAPE) and primary closure.

Sexual dysfunction and impaired quality of life due to fecal incontinence are common after classic operations for anorectal malformations. We hypothesized that modern repairs may result in improved outcomes.Following ethical approval for this single institution cross-sectional study, all patients 16 years or older treated for rectourethral, vestibular or perineal fistula from 1983 onward were sent detailed postal questionnaires on sexual function and quality of life. Each respondent was age and gender matched to 3 controls randomly selected from the general population. Penoscrotal/gynecologic abnormalities were obtained from the records.A total of 41 patients (62%) with a median age of 22 years participated in the study. Of the patients 20 were males with rectourethral fistula (prostatic in 60%), 10 were females with vestibular/perineal fistula and 11 were males with low malformations. Although experience of sexual relationships and orgasmic function were reported in comparable proportions to controls, age at coital debut was significantly delayed in all groups of patients (p ≤0.046). Erectile function was preserved after sagittal repair but absent ejaculations or azoospermia affected 3 males with rectourethral fistula (15%). Penoscrotal/gynecologic abnormalities affected 12% of patients. Overall quality of life scores were comparable to controls but a trend was found for lower scores on emotional items in males with rectourethral fistula (p = 0.06) and for a negative effect on sexual life in females (p = 0.03).While erectile and orgasmic function appear preserved after sagittal repair, further evaluation of fertility issues in males with rectourethral fistula is indicated. Larger multicenter studies are needed to confirm our findings.

A 17-year old girl who had been admitted to another hospital with perianal swelling and pain was diagnosed with perianal abscess. She had been given anti-biotheraphy and anti-inflamatory medication. Because her swelling and pain got worse, she was referred to our pediatric clinic. After her physical examination, she was prediagnosed with perianal abscess/tumor, and reffered to our department for magnetic resonance imaging examination, after which she was diagnosed with perianal tumor, and biopsy was performed. Alveolar-embryonal (mixed) type rhabdomyosarcoma (RMS) was diagnosed in the histopathology. Even though RMS is diagnosed frequently in childhood and adolescence, perianal and perineal location for this tumor is relatively rare. We wanted to highlight the rare localization and possible differential diagnosis for this type of tumor.

Introduction: Pelvic exenteration (PE) is the only curative treatment for certain locally advanced intrapelvic malignancies. PE has high morbidity, and optimal reconstruction of the pelvic floor remains undetermined. Materials and methods: A retrospective chart review was performed at a tertiary university center to assess the surgical and oncological outcomes of 39 PE procedures over a 12-year period. The majority of patients (n = 25) underwent transverse musculocutaneous gracilis (TMG) flap reconstruction for pelvic floor reconstruction. Results: The 1- and 5-year overall survival (OS) was 72% (95%CI 58%-86%) and 48% (95%CI 31%-65%), respectively. In multivariate analysis, lymph node metastasis (HR 3.070, p = 0.024) and positive surgical margins (HR 3.928, p = 0.009) were risk factors for OS. In this population, 71.8% of the patients had at least one complication. The complication rate was 65.4% and 84.6% for patients with versus without flap reconstruction, respectively (p = 0.191). The length of stay was longer for patients with a major complication 16,0 +/- 5,9 days vs. 29,4 +/- 14,8 days, p = 0.001, but complications did not affect OS. Conclusion: For selected patients, PE is a curative option for locally advanced, residual, or recurrent intrapelvic tumors. Pelvic floor and vulvovaginal defects can reliably be reconstructed using TMG flaps. TMG flaps are favored in our institution over abdominal-based flaps because the donor site morbidity is reasonable and TMG does not interfere with enterostomy. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Background and aim We describe a series of three successive patients with perianal rhabdomyosarcoma (PRMS) from 2014 to 2017 managed with combined chemotherapy, radical surgery, and radiotherapy. Methods Ethical consent was obtained. Data including tumor presentation, treatment, and survival was collected from hospital reports. Results Two girls aged 15 and 16 years (patient #1 and #2) and one boy aged five years (patient #3) were referred because of a suspected perianal abscess. MRI showed large perianal tumors from 7 to 12 cm in diameter that surrounded or infiltrated the anal sphincters and were inconsistent with abscess. Tumor biopsies showed RMS of alveolar (#1 and #2) and embryonal (#3) types. Patient #1 had lymph node and bone metastases, patient #2 lymph node metastases, and patient #3 no metastases. Pretreatment staging, IRS Clinical Group, and Risk Groups were: Stage 4, II, high; Stage 3, GII, intermediate; and Stage 3, I, low, respectively. All underwent colostomy before neoadjuvant chemotherapy (CWS-RMS 2009 program). Neoadjuvant chemotherapy failed to clear the tumors from anal sphincters preventing anus-saving surgery, and all patients underwent abdominoperineal excision. All removed specimens had free margins with negative lymph nodes. After adjuvant chemotherapy and local radiation, the patients were tumor free after 48, 13, and 18 months. Conclusion In PRMS local surgical control required abdominoperineal excision. Confusion between PRMS and abscess may cause unnecessary delay in management. Level of Evidence IV (Treatment Study, Case Series with no Comparison Group).

Objectives: Fournier’s gangrene is a rare but serious necrotizing infection of the skin and subcutaneous tissues affecting mainly the genital, perineal and perianal regions with poor outcome. Multidisciplinary approach ensures the best management with the mainstay of treatment is the repeated adequate surgical debridement. Broad spectrum antibiotics and hemodynamic support, if needed, are also crucial. Plastic surgery is concerned with reconstruction of the residual defect after control of the infection and stabilization of the patient’s condition. Methods: we present 14 patients with Fournier’s gangrene in the period between July 2009 and August 2015. Those patients were evaluated and managed based on onset, severity of the problem, presence of predisposing factors, site and size of residual defects. Results: Mean age of patients was 47.8 years, male to female ratio was 2.5:1, diabetes mellitus was the commonest predisposing factor, and the scrotum was most frequently involved site. No mortality has been recorded. Conclusion: Fournier’s gangrene is no longer a life threatening condition. It is best treated by early and repeated debridement under broad-spectrum antibiotic cover. Reconstruction markedly reduces financial and psychological stress of patients as well as hospital stay and accelerates early return to normal life.

Background: Patients with rectal prolapse often have significant comorbidities that lead surgeons to select a perineal resection for treatment despite a reported higher recurrence rate over abdominal approaches. There is a lack of data to support this practice in the laparoscopic era. The objective of this study was to evaluate if risk-adjusted morbidity of perineal surgery for rectal prolapse is actually lower than laparoscopic surgery. Design: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database as performed for patients undergoing surgical treatment of rectal prolapse between 2005 and 2011. Outcomes were analyzed according to procedure-type: laparoscopic rectopexy (LR), laparoscopic resection/rectopexy (LRR), open rectopexy (OR), open resection/rectopexy (ORR), and perineal resection (PR). A multivariate logistic regression was used to compare risk-adjusted morbidity and mortality between each procedure. Main outcome measures were 30-day morbidity and mortality. Results: Among 3,254 cases sampled, a laparoscopic approach was used in 22%, an open abdominal approach in 30%, and PR in 48%. Patients undergoing PR were older (76) and had a higher ASA (3) compared to laparoscopic (58, 2) and open abdominal procedures (58, 2). Risk-adjusted mortality could not be assessed due to a low overall incidence of mortality (0.01%). Overall morbidity was 9.3%. ORR was associated with a higher risk-adjusted morbidity compared to PR (OR: 1.89 CI (1.19–2.99), p=0.03). There were no significant differences in risk-adjusted morbidity found between LR and LRR compared to PR (OR 0.44 CI (0.19–1.03), p=0.18; OR 1.55 CI (0.86–2.77), p=0.18). Laparoscopic cases averaged 27min longer than open cases (p&nbsp

Objective: Posterior urethral strictures are difficult cases to treat for urologists. Anastomotic open urethroplasty is the major surgical treatment option, and various modifications/manipulations to the procedure have been recommended in the literature. We aimed to assess the advantages of performing antegrade endoscopy through the suprapubic cystostomy tract during perineal urethroplasty. Material and methods: Thirty-six perineal urethroplasties combined with suprapubic cystoscopy were performed in 33 adult male patients between 2005 and 2011. Pre-and peri-operative records of the patients were evaluated, with a particular focus on suprapubic cystoscopy findings during urethroplasty. Results: The mean patient age was 41 years, and the mean lesion length was 2.6 cm (range 1-10 cm). Lesions were secondary to pelvic trauma in 21 patients, to a history of prostatic surgery in 8 patients, and to other miscellaneous causes in the 4 remaining patients. In 23 cases with normal bladder necks, the anastomosis was created under the guidance of antegrade cystoscopy with fluoroscopy. In 10 cases, stiff guide wires or paddles were used in addition to endoscopic light to identify the correct anastomosis site. In two procedures, fistula openings were identified during endoscopy, and fistula repair was performed along with anastomosis. In one case involving the longest lesion with involvement of the bladder neck, a combined perineal-transpubic urethroplasty was performed. The mean follow up duration was 19 (3-38) months. The overall success rate was 91%, and the re-operation rate was 9%. Conclusion: Suprapubic cystoscopy is an easy-to-perform adjunctive modality in perineal urethroplasty. This method provides the benefits of supplementary endoscopic findings and feasibility of certain maneuvers that facilitate debridement and anastomosis formation concurrent with perineal urethroplasty. Amaç: Posterior üretra darlıkları ürologlar için tedavisi zor olgular arasında yer almaktadır. Cerrahi tedavide temel seçenek olan anastomotik açık uretroplasti için literatürde çeşitli manuplasyonlar ve modifikasyonlar tanımlanmıştır. Bu çalışmada perineal uretroplasti sırasında suprapubik sistostomi traktından uygulanan antegrad endoskopinin avantajlarını değerlendirmeyi amaçladık. Gereç ve yöntemler: 2005-2011 yılları arasında toplam 36 seans suprapubik sistoskopi yardımlı perineal uretroplasti operasyonu uygulanan 33 yetişkin erkek hastanın, özellikle uretroplasti sırasındaki sistoskopik bulgular başta olmak üzere, operatif verileri incelendi. Bulgular: Hastaların ortalama yaşı 41 yıl ve lezyon uzunluğu 2,6 (1-10) cm idi. Etyolojik faktör olarak 21 hastada travma, 8 hastada prostat cerrahisi, ve 4 hastada diğer nedenler saptandı. Yirmi üç olguda mesane boynu normaldi ve antegrad sistoskopun ışığı kılavuzluğunda anastomoz gerçekleştirildi. On olguda doğru anastomoz hattını saptamak için, ilaveten, sert kılavuz tellerden ve iğnelerden yararlanıldı. İki olguda endoskopi sırasında fistül saptandı ve anastomoza ilave olarak fistül onarımı uygulandı. Mesane boynunu da kapsayacak şekilde, en uzun darlığa sahip olan 1 olguda combine perineal-transpubik onarım uygulandı. Hastaların ortalama takip süresi 19 (3-38) ay idi. Genel başarı oranı %91 ve re-operasyon oranı %9 idi. Sonuç: Suprapubik sistoskopi perineal uretroplasti sırasında yararlanılabilecek kolaylıkla uygulanabilen bir yardımcı yöntemdir. Bu yöntem perineal uretroplasti sırasında debridman ve anastomoz safhalarını kolaylaştıracak destekleyici endoskopik bulgular sağlaması ve çeşitli manevralara imkan tanıması açısından avantaj sağlar.

Metastatic cutaneous Crohn's disease is a rare entity first described by McCallum et al. in 1976. It is diagnosed when histologically characteristic granulomata are seen at a site not contiguous with inflammatory disease in the gastrointestinal tract. We herein report presentation, diagnosis and management of a 28 year old lady with disabling, symptomatic cutaneous Crohn's of the buttocks and natal cleft refractory to Infliximab therapy. To the best of our knowledge only four other adult cases have been reported in the literature of metastatic cutaneous Crohn's disease of the buttock area distant from a flexure or area of skin apposition. The differential diagnosis in this case was Hidradenitis Suppurativa. A good cosmetic result and excellent symptom control were achieved with extensive debridement, wide local excision, vacuum assisted closure and delayed skin grafting.

Introduction: UTI is a well known entity amongst young girls, and the majority of girls have recurrent infections within one year. Anything that disturbs the usual vaginal environment would result in conditions favouring the production of unwanted microorganisms leading to infections of this very sensitive area. Studies have shown that, there is an evident relation of UTI's among students and practices of personal hygiene. Aim: To determine association between the behavioural risk factors and UTI among nursing girls. Materials and Methods: The present study was undertaken amongst unmarried nursing students of a Medical College Hospital. A predesigned pretested questionnaire was used to know the personal hygiene of students and to find out its association with UTI in the last three months. Chi-square test was used to analyse the data. Results: A significant association was observed between perineal hygiene and UTI. The major risk factors of UTI identified were incorrect perineal washing technique, use of synthetic/silk innerwears, not sundrying the innerwears, improper menstrual hygiene. Conclusion: There are still major gaps in the knowledge regarding causation of UTI among the nursing students. This calls for an urgent need for educational talks periodically addressing these gaps.

OBJECTIVETo compare pain in the first 24 h, the perioperative variables and the histopathological results among patients who had perineal (PRP) and retropubic radical prostatectomy (RRP), in a randomized trial.PATIENTS and METHODSPatients with localized prostate cancer were accrued after selection using inclusion and exclusion criteria; they were prospectively randomized into four different groups: P1 (PRP with general anaesthesia), P2 (RPP with general plus epidural anaesthesia), R1 (RRP with general anaesthesia), and R2 (RRP with general plus epidural anaesthesia) and data collected for age, body mass index, prostate weight, serum prostate-specific antigen level, Gleason score and clinical stage. Pain after RP was evaluated using numerical and oral scales, and by morphine intake delivered by a patient-controlled analgesia pump. Perioperative features assessed prospectively were operating time, intraoperative bleeding, time to diet, time to ambulation, hospital stay and complications. Immediate oncological results were assessed based on histopathological evaluation, e.g. Gleason score, tumour volume, prostate volume, surgical margins and final pathological stage.RESULTSBetween October 2004 and October 2007 80 patients were accrued (mean age 63 years, range 42-80). the groups were similar for preoperative data, but group R1 had larger prostates (P = 0.001). for postoperative pain, group R1 had a significantly greater intensity of pain, based on the visual analogue scales, and greater morphine intake during the first 24 h than the other three groups. Groups P1 and P2 had significantly less bleeding (511 and 612 mL) than groups R1 and R2 (926 and 1165 mL; P < 0.001), regardless of both prostate size and anaesthesia. Complications occurred in 27.5% and 25% (not significant) of patients after PRP and RRP, respectively. There were no differences in positive surgical margin rate and histopathological evaluation among the groups.CONCLUSIONSPatients who had RRP with general anaesthesia had a greater intensity of pain and higher morphine intake than the other groups. Men who had PRP had significantly less bleeding and shorter hospital stay than those having RRP. Universidade Federal de São Paulo, Div Urol, BR-04532080 São Paulo, Brazil Universidade Federal de São Paulo, Div Anaesthesiol, BR-04532080 São Paulo, Brazil Universidade Federal de São Paulo, Div Urol, BR-04532080 São Paulo, Brazil Universidade Federal de São Paulo, Div Anaesthesiol, BR-04532080 São Paulo, Brazil Web of Science

PURPOSE: Operative repair for complicated pouch and rectal fistulas is often difficult. We present our experience with ten consecutive patients operated on for complicated pouch and rectal fistulas by transposition of the rectus abdominis muscle. METHODS: Ten patients with high and complex pouch and rectal fistulas were treated with the interposition of a vascularized rectus abdominis muscle flap. Air patients received standard bowel preparation and antibiotics. All were diverted by a temporary ileostomy. RESULTS: Causes of fistulas included Crohn's disease (n = 3), previous rectal surgery (n = 5), anal atresia (n = 1), and sphincter repair (n = I). Three patients had a third recurrence. The procedure was performed in combination with a plastic surgeon. AU fistulas healed. No special postoperative care was required. There were no cosmetic or functional complaints caused by transposition of the rectus abdominis muscle. CONCLUSIONS: Transposition of the rectus abdominis muscle is a suitable technique in treatment of fistulas between the rectum or ileal pouch and the vagina or urinary system, with no obvious side effects and excellent clinical outcome.

Introduction: Radical perineal prostatectomy was the first surgery described for prostatic carcinoma (Young, 1904) but it lost its eminent status after Walsh's description in 1982 of anatomic radical retropubic prostatectomy followed by the enthusiasm in laparoscopy and now robotics. It made resurgence after it was realized in early 1990s that the pelvic lymph node dissection is needed only in selected cases. Last decade witnessed over 80 publications addressing the results and advances in the perineal approach. Strangely, centres from the subcontinent have chosen to ignore this resurgence. We describe our early experience with the technique in 35 patients and present the case for its more widespread usage. Patients and Methods: Thirty five patients of clinically localized carcinoma prostate were operated by perineal route in our institution from December 2006 onwards. All patients had serum prostate specific antigen levels less than 10 ng/ml. Results: Operating time was 2 to 3.5 hours (mean 2.5 hours). Rectal injury occurred in three patients but was closed primarily in all and none required a colostomy. Mean duration of hospital stay was four days. The disease was organ confined in 25(71%). Positive margins were seen in 5(14%) patients. Biochemical recurrence occurred in 17% patients at one year. Seventy six percent patients had achieved continence at one year. Conclusions: As the world is taking note of radical perineal prostatectomy again, with a very small learning curve, minimal invasion and good oncological control urologists from Indian subcontinent should also embrace this procedure in view of the relative limited resources available.