Aira Hospital

Transvesical suprapubic prostatectomy – that is enucleating the prostatic adenoma (prostatectomy) through an incision above the pubis (suprapubic) and through the bladder (transvesical). This was the standard technique in the western world until the introduction of the transurethral technique (operation with an endoscope through the urethra).

The bleeding from the prostatic bed after the enucleation is controlled with suturing if needed and/or pressure from the catheter balloon placed in the cavity. Continuous irrigation with sterile saline and uninterrupted supervision from an active staff member is crucial for this technique to work. Today these prerequisites are present in Aira Hospital.  

Spinal anesthesia is preferred. With the patient in supine position the bladder is filled with saline to facilitate identification and opening of the bladder.

 

The bladder is dissected free in the preperitoneal space through a Phannestiel incision (low transverse incision) and opened with a pair of long forceps.

	VIDEO opening the bladder  ← click here

 

The prostate adenoma is enucleated with the index finger. An index finger of the other hand in the rectum will facilitate the enucleation when difficulties are faced. Don’t forget to change glove in that case.

VIDEO enucleation of adenoma        ↑ click here

 

A Fooley catheter No 22-24 with a 30 cc balloon is placed in the bladder with the balloon in the prostate cavity. The balloon is filled with enough saline to fill up and compress the prostate cavity. That will reduce the bleeding.

 

If bleeding is heavy and difficult to control with balloon pressure the prostatic cavity can be sutured with interrupted heavy Chromic Catgut sutures

 

A large bore tube  -an old and discarded tracheal tube is excellent for this - is placed into the bladder through the abdominal and bladder wall. It is fixed to the skin with a heavy suture.

 

The bladder wall is closed with a double layer of inverting continuous absorbable suture.

 

Irrigation with saline through the catheter is started immediately after the bladder wall has been closed.

 

A small bore tube drain - a piece of i.v. line with holes cut in will do fine for that -  is placed in the prevesical space and fixed to the skin with a suture.

 

The incision is closed as usual.

 

Postoperative uninterrupted irrigation and continuous surveillance is crucial

 

Be sure that the patient has a high oral fluid intake. Furosemide 20 mg i.v. QID will secure a high urinary output.

After 24 hours the prevesical drain is removed, the suprapubic tube is closed and the urine drained from the catheter. The large tube is preserved for another 24 hours as a security measure in case the catheter gets blocked and irrigation will be needed. After 48 hours the suprapubic tube is removed. The catheter and skin sutures are removed one week after surgery.