Intracapsular Subtotal Prostatectomy in Normal Dogs: Use of an Ultrasonic Surgical Aspirator

Abstract

In an attempt to reduce postoperative incontinence associated with excisional prostatectomy and the recurrence of prostatic disease after less radical surgeries, a new technique for subtotal prostatectomy was developed using an ultrasonic surgical aspirator. During laparotomy, a longitudinal incision was made in the ventral surface of each lobe of the prostate gland. Biopsies for histology and culture were taken. Through the ventral incisions, the ultrasonic surgical aspirator was used to resect approximately 85% of the glandular tissue from inside the capsule. The ultrasonic surgical aspirator allowed resection of the glandular tissue without damaging the vessels, nerves, and connective tissue stroma. The ventral portion of the capsule was excised. The dorsal portions of the capsule were apposed on the ventral midline by suturing their ventral margins to form a periurethral cuff. As preclinical research, seven intact male dogs were evaluated by physical examination, complete blood cell count, serum urea nitrogen, urinalyses, and urethral pressure profile (UPP) with urethral electromyograms (EMGs). The dogs underwent subtotal prostatectomy and castration. All dogs were continent after surgery. UPPs and EMGs at 1 and 2 months after surgery were no different than before surgery. This contrasts to our previous studies in which excisional prostatectomy reduced maximal urethral closure pressure (MUCP) in dogs without prostatic disease. The use of the ultrasonic surgical aspirator for intracapsular subtotal prostatectomy facilitated removal of glandular tissue with decreased hemorrhage and provided preservation of the prostatic urethra, nerves, and vessels involved in maintaining urinary continence.