Pfannenstiel Incision

Urologic Indications for a Pfannenstiel Incision

Extraperitoneal surgical approach to the prostate, bladder and distal ureters.
The Pfannenstiel incision offers cosmetic advantages, but it cannot be extended easily in case of unexpected intraoperative situations.

Patient positioning: supine position with slight hyperextension of the lumbar spine
General or spinal anesthesia
Perioperative antibiotic prophylaxis, if the urinary or gastrointestinal tract is entered or if risk factors for a wound infection are present.

Skin incision see fig. pfannenstiel incision.
Exposure of the ventral lamina of the rectus sheat and transverse division 2–3 cm cranial of the symphysis. The lateral border of the rectus sheat should be reached.
The ventral lamina of the rectus sheat is dissected of the rectus muscle to expose the midline between the rectus muscles. Caudally, the pyramidal muscles remain with the ventral lamina of the rectus sheat.
Division of the midline and fascia transversalis to separate both rectus muscles. Blunt dissection of the Retzius' space.
Using blunt dissection, the peritoneum is pushed superiorly and medially to expose the iliac vessels, spermatic cord and ureters.

Pfannenstiel incision: skin incision

Midline Incision

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

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Dr. med. Dirk Manski
man...@urologielehrbuch.de