SIMPLE RETROPUBIC PROSTATECTOMY (for BPH,urinary retention)

After the induction of adequate General anesthesia, the patient was laid supine on the table, the genitalia and lower abdomen were prepped and draped in the usual fashion. 18 French Foley catheter was used to drain the bladder to empty and then removed. Low midline incision was made from the pubic symphysis to just below the umbilicus. Incision was carried down to the rectus fascia using electrocautery. Rectus fascia was sharply opened using electrocautery and midline placement was confirmed and the incision wasn’t opened up for the entirety of the rectus fascia. Blunt dissection was used to separate the peritoneum from the retroperitoneum and expose the pre-pubic space of Retzius. The Balfour retractor was then positioned into place with 2 narrow blades retracting the bladder and peritoneal contents cranially.

Stadium figure-of-8 sutures of 2-0 Vicryl were then placed in two rows over the anterior surface of the prostatic capsule. The 2 midline sutures were tagged with a snap. Approximately 15-20 sutures were used to complete the 2 rows of Stadium sutures. The lateral borders of the 2 rows of sutures were also tagged with figure-of-eight 2-0 Vicryl suture oriented vertically to prevent tearing of the prostatic capsule. Electrocautery was then used to open the prostatic capsule between the 2 rows of suture. The incision was carried down to the adenoma layer which was noted to be smooth and shiny versus the fibrous muscular capsule layer. Once the adenoma was reached then finger dissection was used to shell out the adenoma on either side away from the capsular layer. There was noted to be significantly sized median lobe which was also shelled out intact in continuity with the rest of the adenoma. At the apex of the adenoma the urethra was pinched transected. The adenoma was then passed off the table as specimen. There was minimal bleeding at this point. The posterior lip of bladder neck was then sutured down to the posterior prostatic fossa thereby creating a waterfall configuration for the bladder neck to open into the urethra. Ureteral orifices were well away from the bladder neck here. 22 French 3 Foley catheter was then passed into the bladder but not inflated at this point. The capsular incision was then closed with 2 separate 0 Vicryl sutures starting at the lateral aspect of the capsulotomy towards the midline. 2 sutures were then tied to each other at the midline over the incision. Catheter was reviewed and those found to be no leak. 40 mL of sterile water were placed into the balloon. A flat Jackson-Pratt drain was in place and the pre-vesicle space and brought out through separate stab incision left lower quadrant. This was connected to bulb suction. Rectus fascia was closed with a #1-0 PDS suture. Subcutaneous tissues were then infiltrated with 10 mL of half percent Marcaine plain. Skin was then closed with clips. Incision was clean and dried and dressed with a dry sterile dressing. Patient was awakened from anesthesia extubated uneventfully and transferred to PACU in stable condition having tolerated procedure well. No complications.