Definition
- Excision and removal of the prostate gland via a surgical incision.
- Although 90 percent of prostectomies are performed via the transurethral approach, there are occasions when a surgical incision and removal is required.
- Four approaches can be used to excise the prostate gland:
- Transurethral prostectomy – removal of the prostatic tissue and/ or lesions transcystoscopically.
- Suprapubic prostectomy – performed after incising the bladder, which permits correction of associated conditions, such as calculi or diverticula.
- Retropubic prostectomy – avoids entry into the bladder and allows for good visualization of the field. Limited malignancies may be treated by this approach.
- Perineal prostectomy – affords excellent visualization and access to the prostate and seminal vesicle.
- A bilateral vasectomy may be performed in conjunction with a prostectomy to avoid retrograde infections.
Positioning
- Suprapubic and retropubic: Supine with slight trendelenberg
- Perineal: Exaggerated lithotomy with slight trendelenberg.
Packs/ Drapes
- Suprapubic: Laparotomy pack, extra drape sheets, transverse lap sheet.
- Retropubic: Laparotomy pack, impervious sheet, folded towel over scrotum and penis.
- Perineal: Cysto pack, towels around the perineal area, fenestrated sheet.
Instrumentation
- Majoy tray
- Long instruments
- Heaney needle holder
- Lahey clamps
- Prostatic urethral sounds
- Hemoclips
Supplies/ Equipment
- Basin set
- Blades
- Needle counter
- Dissector sponges
- Irrigation syringe
- Suction
- Solutions
- Lubricants
- Sutures
- Suprapubic catheter
- Drain
- Foley catheter
Procedure
- The surgeon makes the appropriate incision, and after access is gained into the space of Retzius, a self- retraining retractor is placed into the wound.
- Before the bladder is opened, the surgeon places two traction sutures on either side of the incision.
- The bladder may be grasped with a Allis clamp and pulled upward.
- A short incision is made into the bladder, and suction is applied to drain its contents.
- After draining the bladder, the surgeon places a bladder retractor in the bladder wound.
- The surgeon incises the prostatic mucosa by either knife or cautery, and the bladder retractors are removed.
- Using finger dissection, the surgeon enucleates the diseased prostate from its fossa, and the specimen is delivered and passed off to the scrub person.
- The cavity is inspected for bleeders. Many surgeons prefer to pack the cavity with a sponge for a few minutes to maintain hemostasis.
- Large bleeding vessels are ligated with suture or ligiclips.
- Oozing surfaces may be covered with a hemostatic agent.
- A foley catheter is placed into the bladder neck. Some surgeons prefer to drain the bladder through a suprapubic catheter, which is placed in the wound at this time through a small incision near the suprapubic incision.
- The bladder is then closed with two layers of 0 or 2-0 chromic interrupted sutures.
- A large penrose drain is placed into the space of Retzius; and the wound is closed in a routine manner.
