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    Suprapubic Prostatectomy

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    Saumitra Joshi
    Suprapubic prostatectomy is used to treat benign prostatic hyperplasia and other conditions like recurrent urinary retention. It involves making an incision above the pubic bone to access the prostate. The prostate adenoma is then dissected out and the bladder neck is closed. Post-operatively, a catheter is placed in the bladder for irrigation and drainage. Potential complications include bleeding, urinary incontinence, and infection.

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    Suprapubic Prostatectomy

    Uploaded by

    Saumitra Joshi
    62 views12 pages
    Suprapubic prostatectomy is used to treat benign prostatic hyperplasia and other conditions like recurrent urinary retention. It involves making an incision above the pubic bone to access the prostate. The prostate adenoma is then dissected out and the bladder neck is closed. Post-operatively, a catheter is placed in the bladder for irrigation and drainage. Potential complications include bleeding, urinary incontinence, and infection.

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    Suprapubic prostatectomy is used to treat benign prostatic hyperplasia and other conditions like recurrent urinary retention. It involves making an incision above the pubic bone to access the prostate. The prostate adenoma is then dissected out and the bladder neck is closed. Post-operatively, a catheter is placed in the bladder for irrigation and drainage. Potential complications include bleeding, urinary incontinence, and infection.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    62 views12 pages

    Suprapubic Prostatectomy

    Uploaded by

    Saumitra Joshi
    Suprapubic prostatectomy is used to treat benign prostatic hyperplasia and other conditions like recurrent urinary retention. It involves making an incision above the pubic bone to access the prostate. The prostate adenoma is then dissected out and the bladder neck is closed. Post-operatively, a catheter is placed in the bladder for irrigation and drainage. Potential complications include bleeding, urinary incontinence, and infection.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 12

    Suprapubic

    Prostatectomy
    Saumitra Abhijit Joshi
    4th year BAMS
    Indications
    • The most frequent indication is for 
    surgical treatment of benign prostatic hyperplasia with 
    moderate to severe BPH symptoms, which cannot be
    alleviated with BPH medication.
    • Other indications for surgical treatment include :
    1. recurrent urinary retention
    2. bladder stones,
    3.recurrent urinary tract infection,
    4.recurrent haematuria and 

    5.postrenal kidney failure due to insufficient bladder emptying.


    Contraindications
    • Prostate cancer,
    • low life expectancy
    • coagulation disorders
    • untreated urinary tract infection.
    Preoperative procedure :
    • Exclusion or treatment of a urinary tract infection
    • Pre- operative antibiotics prophylaxis
    • Complete Urine analysis
    • Complete blood count
    • Chest X-ray and ECG – in geriatric patients
    • Correction of coagulopathies, if any.
    • Obtain consent of the patient, after explaining all the possible complications that
    may occur during the surgery.
    Operative procedure :
    • General anaesthesia or spinal anaesthesia should be given.
    • Place the patient in a supine position on the operative table, with the umbilicus
    over the break of the table.
    • After that, hyperextend the table slightly, placing the patient in a mild
    Trendelenburg position.
    • Disinfection and draping
    • introduce a urethral catheter into the bladder, through which the bladder is filled
    to approximately 250 mL with sterile water or saline before the catheter is
    removed.
    Surgical Approach :
    • Lower midline incision or Pfannenstiel incision
    • Cut the Linea alba.
    • After blunt dissection of the retropubic space, insert a wound
    retractor
    • Vertical cystostomy, which is secured with sutures to prevent
    further tearing
    • Remove bladder stones or resect bladder diverticula, if present
    Dissection of the Prostatic Adenoma:

    • Circular incision of the bladder neck with the electric scalpel


    after identification of the ureteral orifices
    • The plane between prostatic adenoma and peripheral prostatic
    tissue ("prostatic capsule") is developed with scissor dissection
    • Blunt finger dissection completes the mobilization of the
    prostatic adenoma. The apical dissection should avoid excessive
    traction of the urethra (and the urinary sphincter).
    Haemostasis after Suprapubic
    Prostatectomy:
    • The bladder mucosa is readvanced into the prostatic fossa by two
    figure-of-eight sutures at the 4 o'clock and 8 o'clock position (do not
    incorporate the the ureteric orifices).
    • A running suture of the bladder neck is done between the figure-of-
    eight sutures.
    • Major bleeding should be stopped now, other discrete bleeding sites are
    controlled with electrocautery or suture ligatures.
    • An irrigation catheter (20–22 CH) is placed into the prostatic fossa and
    blocked with 50–100 ml, depending on the size of the prostatic
    adenoma.
    • If sufficient hemostasis after blocking of the catheter is not achieved,
    the bladder neck can be narrowed to tamponade the prostatic fossa
    with fast absorbable sutures (purse-string suture). The bladder neck
    can be opened after 8 days using the catheter ballon or the
    spontaneous resolution of the sutures have to be awaited.
    Wound Closure:

    • Optional: insert a suprapubic tube


    • Two-layer closure of the cystotomy
    • Irrigation of the wound cavity
    • Insert a wound drainage (e.g. closed gravity system)
    • Separate closure of fascia, subcutis and cutis
    Postoperative Management after
    Suprapubic Prostatectomy

    • After surgery: continuous irrigation of the bladder, pain management


    via patient-controlled analgesia, exercises to prevent thrombosis and
    pneumonia. Excessive bleeding may be controlled by increasing the
    catheter block or by gentle catheter traction. If not successful,
    proceed with transurethral coagulation to control bleeding.
    • First day: reduce or stop the continuous irrigation, patient
    ambulation.
    • Second day: reduction of the catheter balloon to 30 ml. Removal of
    wound drainage (if <75 ml/24 h drainage).
    • Third to fifth day: removal of the irrigation catheter, cystography
    may be performed to ensure a watertight closure of the bladder.
    Complications of Suprapubic
    Prostatectomy
    • Bleeding: re-exploration (transurethral coagulation) and/or blood transfusion are seldom
    necessary
    • Rarely urinary incontinence
    • Rarely erectile dysfunction
    • Often retrograde ejaculation (80–90%)
    • Urinary tract infections
    • Bladder neck sclerosis, urethral stricture
    • Wound infection
    • Urinoma
    • Thrombosis, pulmonary embolism
    Thank You ….

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