Indications
Presence of complications
Symptoms interfering with day to day activities
Open techniques
Transvesical
Retropubic
Transvesical prostatectomy (Freyer’s)
A Pfannenstiel incision
The bladder is opened
A finger into the prostatic urethra
The prostate is enucleated
Advantages
Simple (easy approach).
Less time, less bleeding
. No indication for sophisticated instruments.
Any bladder calculi can be removed.
Disadvantages
If there is an unexpected bladder carcinoma it will contaminate the skin incision (enhances dissemination).
The bladder wall is incised. It takes 10 days to heal. The catheter cannot be removed for 10 days.
Probability of a urinary fistula..
Wound related complications (see below).
Retropubic prostatectomy (Millin’s)
A Pfannenstiel incision.
The capsule of the prostate is incised in the retropubic space.
Then the prostate is enucleated without incising the bladder.
Advantages
The bladder is not incised
Disadvantages
The dissection is deep in the pelvis.
Time consuming.
More bleeding.
Transurethral resection of the prostate (TURP)
Has become the “gold standard
Using the rigid cystoscope and the resectoscope i.e. piecemeal removal of the prostate
Time consuming- approximately 1g per 1 minute Need sophisticated instruments and expertise
Advantages
No wound related complications
The bladder stones can be removed
TURP Syndrome
During the procedure sodium glycine (or tap water) is used to irigate the prostatic tissue. The fluid will get absorbed into the Circulation. There is hypervolaemia and hyponatraemia.
This results in cerebral oedema. If the surgery is done under spinal
anaesthesia the patient will develop headache, drowsiness,
continue read… Part 6
