Both approaches can yield good results if the surgeon is experienced and has expertise in performing the operation. In a radical perineal prostatectomy, the prostate gland is removed through an incision in the perineum, the area between the scrotum and the anus. In a radical retropubic prostatectomy, the surgeon makes an incision in the lower abdomen to remove the prostate, which is located retropubically, or behind the pubic bone. The principal advantage of the retropubic approach, in my opinion, is that the cavernosal nerves are more readily spared, because from the retropubic approach the prostate gland is lifted up off the nerves. In the perineal approach, the gland must be pulled down between the nerves. Another advantage of the retropubic approach is less chance for injuring the rectum during the surgery and less chance of postoperative rectal incontinence.