<unk>  was developed in 1945 by Terence Millin at the All Saints Hospital in London. The procedure was brought to the United States by one of Millin's students, Samuel Kenneth Bacon, M.D., adjunct professor of surgery, University of Southern California, and was refined in 1982 by Patrick C. Walsh at the James Buchanan Brady Urological Institute, Johns Hopkins Medical School. It can be performed in several different ways with several possible associated procedures. The most common approach is to make an incision in the skin between the umbilicus and the top of the pubic bone. Since initial description by Walsh, technical advancements have been made, and incisional length has decreased to 8–10 cm (well below the belt-line). The pelvis is then explored and the important structures such as the urinary bladder, prostate, urethra, blood vessels, and nerves are identified. The prostate is removed from the urethra below and the bladder above, and the bladder and urethra are reconnected. The blood vessels leading to and from the prostate are divided and tied off. Recovery typically is rapid; individuals are usually able to walk and eat within 24 hours after surgery. A catheter running through the penis into the bladder is typically required for at least a week after surgery. A surgical drain is often left in the pelvis for several days to allow drainage of blood and other fluid. Additional components of the operation may include: * Lymphadenectomy—Prostate cancer often spreads to nearby lymph nodes in the early stages, especially the sentinel lymph node. Removal of select lymph nodes in the pelvis allows microscopic evaluation for evidence of cancer within these nodes. A complication called lymphocele may occur from drainage of the lymphatic fluid, especially if more pelvic lymph nodes are removed. If cancer is found in the lymph nodes, different therapies may be offered. * Nerve-sparing surgery—Select individuals will be eligible for nerve-sparing surgery. Nerve-sparing surgery attempts to protect the cavernous nerves of penis, which control erection. These nerves are very thin and fragile and run next to the prostate and may be destroyed during surgery, leading to impotence. If the cancer is clinically unlikely to have spread beyond the prostate, nerve-sparing surgery should be offered to minimize impotency and to speed up urinary control. An intraoperative electrical stimulation penile plethysmograph may be applied to assist the surgeon in identifying the difficult to see nerves.
Radical retropubic prostatectomy
Radical perineal prostatectomy
Transurethral resection of the prostate
Laparoscopic radical prostatectomy
Transurethral incision of the prostate
Lower anterior resection
Pinealectomy
Transurethral needle ablation of the prostate