Dr. med. Dirk Manski



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Suprapubic Simple Prostatectomy


fig. principle of suprapubic simple prostatectomy, transvesical technique initially described by Harris and Hryntschak:
A) sagittal section through the prostate adenoma
B) After opening of the bladder, the bladder neck is incised and a mobilization of the adenoma is done
C) Situs after simple prostatectomy, hemostatic sutures at the bladder neck and closure of the bladder is done. An irrigation catheter is blocked in the prostatic fossa.
figure: surgical principle of suprapubic transvesical prostatectomy for BPH

Indications for Suprapubic Simple Prostatectomy

The most frequent indications for surgical treatment of benign prostatic hyperplasia are moderate to severe BPH symptoms, which cannot be alleviated with BPH medication (see section medical treatment of BPH). Other indications for surgical treatment include recurrent urinary retention, bladder stones, recurrent urinary tract infection, recurrent hematuria and postrenal kidney failure due to insufficient bladder emptying.

The surgical technique of retropubic simple prostatectomy [fig. principle of suprapubic prostatectomy] is ideal for very large adenoma (>75 ml) without a significant middle lobe, bladder diverticula which require surgical correction, large bladder stones, inguinal hernia (to be corrected together with prostatectomy), complex urethral diseases (e.g. after hypospadia operations) and contraindications for lithotomy position.

Contraindications to Suprapubic Prostatectomy

Prostate cancer, small prostate (prefer TURP), low life expectancy, coagulation disorders, untreated urinary tract infection.

Surgical Technique of Suprapubic Simple Prostatectomy

Preoperative Patient Preparation

Surgical Approach:

Dissection of the Prostatic Adenoma:

Hemostasis after Suprapubic Prostatectomy:

Wound Closure:

Postoperative Management after Suprapubic Prostatectomy

Complications of Suprapubic Prostatectomy







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



References



  Deutsche Version: transvesikale Adenomektomie