LESSON 3: Procedures in Genitourinary Surgery

Section Iv: operations on the bladder and prostate

3-29

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3-29. RETROPUBIC PROSTATECTOMY.

a. General. This operation involves enucleation of the prostatic hypertrophied lobes directly through a capsular incision in the upper surface of the prostate rather than through the bladder.

b. Operative Procedure. See Figure 3-9.

(1) Through a vertical or transverse suprapubic incision, the abdominal wall is opened to expose the space of Retzius. The bladder is not directly opened. The precystic fat is extracted using long, smooth tissue forceps. Large vessels are ligated, using 18-inch transfixion sutures of chromic gut number 0 threaded on small Mayo needles.

 

(2) The prostatic capsule is incised transversely, using number 7 scalpel with a number 10 blade. The prostate is freed and enucleated, employing scissors and Allis forceps. Deep bleeding vessels are clamped with long hemostats and ligated with long plain gut number 2-0 or number 3-0 sutures with medium curved taper point Atraumatic needles.

 

(3) A wedge excision of the posterior bladder neck is made, using long Allis forceps, a long scalpel, and scissors. A wedge of tissue may be sutured over the defect in the bladder neck after removal of the prostate. In radical prostatectomy, a V-shaped portion of the bladder mucosa may be sutured over the defect in the bladder neck.

 

(4) A multieyed Robinson or Foley retention catheter is placed via the urethra. A Malecot cystostomy tube may be placed in the bladder if the surgeon desires.

 

(5) The incision in the prostatic capsule is closed with a continuous suture of chromic gut number 0. Penrose drains are placed in the retropubic space, the abdominal incision is closed in layers, and the wound is dressed.

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