Dr. med. Dirk Manski

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Retropubic Simple Prostatectomy: Steps of the Millin Technique

fig. principle of retropubic simple prostatectomy, popularized by Millin:
A) sagittal section through the prostate adenoma
B) transverse capsulotomy and mobilization of the prostatic adenoma
C) situs after simple prostatectomy with hemostatic sutures at the bladder neck and closure of prostatic capsule. An irrigation catheter is blocked in the prostatic fossa.
figure: surgical principle of retropubic simple prostatectomy for BPH

Indications for Millin's Simple Prostatectomy

The most common indication for surgical therapy of BPH is moderate to severe symptoms of BPH, which cannot be controlled with medication and lower the quality of life of the patients. Furthermore, surgical therapy is indicated:

Retropubic adenomectomy of the prostate is indicated for the surgical treatment of benign prostatic hyperplasia with large adenoma (> 75 ml). The retropubic approach offers the advantage of better hemostasis and improved vision for the apical adenomectomy. The retropubic approach is not ideal for large middle lobes and significant obesity. Consider transvesical simple prostatectomy for large bladder stones or bladder diverticula.

Contraindications to Retropubic Prostatectomy

Prostate cancer, low life expectancy, coagulation disorders, untreated urinary tract infection.

Surgical Technique of Millin's Simple Prostatectomy

Preoperative Patient Preparation

Surgical Approach:

Dissection of the Prostatic Adenoma:

Hemostasis after Retropubic Prostatectomy:

Wound Closure:

Postoperative Care after Retropubic Prostatectomy

General measures: pain management, consider patient-controlled analgesia. Early mobilization and exercises to prevent thrombosis and pneumonia. Thrombosis prophylaxis. Laboratory tests (hemoglobin, creatinine), regular physical examination of the abdomen and incision wound.

Complications of Retropubic 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


J. A. Smith, S. S. Howards, G. M. Preminger, and R. R. Dmochowski, Hinman’s Atlas of Urologic Surgery Revised Reprint. Elsevier, 2019.

  Deutsche Version: transvesikale Adenomektomie