Simple Retropubic Prostatectomy Research Articles

LAPAROSCOPIC RETROPUBIC SIMPLE PROSTATECTOMY

Open retropubic simple prostatectomy is occasionally performed for symptomatic, large volume benign prostatic hyperplasia. We describe the technique of laparoscopic simple retropubic prostatectomy. Since August 2001 at our 2 institutions laparoscopic simple retropubic prostatectomy has been performed in 17 patients with symptomatic significant prostatomegaly on transrectal ultrasonography (60 gm or greater, mean 93). Essential aspects of our 5 port technique are transverse cystotomy just proximal to the prostatovesical junction, subcapsular plane development, prostatic adenomectomy, prostatic fossa trigonization and prostatic capsule suture repair. Demographic, perioperative and outcome data were recorded. Mean operative time was 156 minutes (range 85 to 380), blood loss was 516 ml (range 100 to 2,500), hospital stay was 48 hours (range 15 to 110), and Foley catheter duration was 6.3 days (range 3 to 7). Mean specimen weight on pathological examination was 72 gm (range 32 to 120). Five patients (29%) required blood transfusion. Complications occurred in 3 patients (19%), that is intraoperative hemorrhage, catheter clot obstruction and duodenal ulcer bleeding in 1 each. All patients reported complete continence during a followup period of 1 month to 2 years. Considerable improvement from baseline was noted in American Urological Association score (preoperative vs postoperative 24.5 vs 9.9) and the maximum urine flow rate (preoperative vs postoperative 7 vs 22.8 cc per minute). Laparoscopic simple retropubic prostatectomy for large benign prostate hyperplasia is feasible. Our initial experience is presented.

An improved technique for controlling bleeding during simple retropubic prostatectomy

An improved technique for controlling bleeding during simple retropubic prostatectomy

TESTICULAR ISCHEMIA FOLLOWING OPEN PROSTATECTOMY

Testicular ischemia is a known complication of inguinal herniorrhaphy and varicocelectomy. We report a case of acute testicular ischemia following simple retropubic prostatectomy. CASE REPORT A 49-year-old male underwent open retropubic prostatectomy for benign prostatic hyperplasia (BPH) and urinary retention, without complications. A 22Fr Foley catheter was placed intraoperatively. The patient had painless scrotal edema on postoperative day 1 and was treated with a scrotal support. On postoperative day 4 he complained of sudden onset left testicular pain. On physical examination the left hemiscrotum was erythematous with an enlarged and tender left testicle and thickening of the ipsilateral spermatic cord to the level of the external inguinal ring. Cremasteric reflexes were absent bilaterally. Laboratory evaluation showed leukocytosis and no evidence of bacteriuria. Color Doppler ultrasound demonstrated a heterogeneous left testicle devoid of flow to the left epididymis and testicle. Emergency scrotal exploration revealed an enlarged swollen left testicle and thickened spermatic cord. On opening the tunica vaginalis the testis appeared cyanotic and mottled with an indurated epididymis (see figure). The testicle and epididymis were in the normal axis without evidence of testicular torsion. Immediately after the tunica vaginalis was opened the testicle and epididymis became pink, suggesting reperfusion. Intraoperative Doppler showed a strong signal in the left distal spermatic cord. Brisk bleeding was identified following a small incision through the tunica albuginea, confirming good blood flow to the testis. The scrotum was closed in the standard fashion with a Penrose drain left indwelling. DISCUSSION Simple retropubic prostatectomy for BPH offers advantages over the less invasive modalities, including a lower re-treatment rate and more complete removal of the prostatic adenoma under direct visualization. Complications include bleeding requiring a blood transfusion, sepsis, urinary incontinence and retrograde ejaculation, with cardiovascular complications such as pulmonary emboli, myocardial infarctions, cerebrovascular accidents and deep vein thrombi occurring less than 1% of the time. 1 Iatrogenic testicular ischemia and infarction have been reported after inguinal herniorrhaphies and varicocelectomies. 2 Although scrotal edema and ecchymosis may be common after retropubic prostatectomy, acute scrotal pain secondary to ischemia is unusual. Doppler ultrasound is an effective noninvasive test with a sensitivity and specificity of 100% and 97%, respectively, in diagnosing testicular ischemia. 3 Testicular torsion and torsion-detorsion are the most likely culprits leading to an ischemic testis. However, this clinical scenario does not meet the usual presentation. The brisk restoration of pink color along with the presence of a strong Doppler signal after opening the tunica vaginalis in the absence of a twisted cord and in the setting of an already edematous scrotum makes a compelling argument for a scrotal compartmental syndrome. Scrotal compartmental syndrome causing testicular ischemia has yet to be reported in the literature as a complication of this procedure. Although compression and vasospasm of the testicular artery may occur intraoperatively from retraction, such findings would be an unusual presentation 4 days postoperatively. We report a unique phenomenon of resolution of testicular ischemia after opening the tunica vaginalis, suggestive of a scrotal compartmental syndrome presenting with negative flow to the unilateral testis and temporary ischemia following open prostatectomy for BPH.

An improved technique for controlling bleeding during simple retropubic prostatectomy.

BJU InternationalVolume 92, Issue 7 p. 813-817 An improved technique for controlling bleeding during simple retropubic prostatectomy M. Srougi, Corresponding Author M. Srougi Division of Urology, Federal University of São Paulo, São Paulo, BrazilM. Srougi, R. Peixoto Gomide 2055/81, 01409-003 – São Paulo, SP, Brazil. e-mail: srougi@attglobal.netSearch for more papers by this authorM.F. Dall’oglio, M.F. Dall’oglio Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this authorA.C. Bomfim, A.C. Bomfim Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this authorC. Andreoni, C. Andreoni Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this authorJ. Cury, J. Cury Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this authorV. Ortiz, V. Ortiz Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this author M. Srougi, Corresponding Author M. Srougi Division of Urology, Federal University of São Paulo, São Paulo, BrazilM. Srougi, R. Peixoto Gomide 2055/81, 01409-003 – São Paulo, SP, Brazil. e-mail: srougi@attglobal.netSearch for more papers by this authorM.F. Dall’oglio, M.F. Dall’oglio Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this authorA.C. Bomfim, A.C. Bomfim Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this authorC. Andreoni, C. Andreoni Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this authorJ. Cury, J. Cury Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this authorV. Ortiz, V. Ortiz Division of Urology, Federal University of São Paulo, São Paulo, BrazilSearch for more papers by this author First published: 27 October 2003 https://doi.org/10.1046/j.1464-410X.2003.04457.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume92, Issue7November 2003Pages 813-817 RelatedInformation

TREATMENT OF GRADE 4 RENAL STAB WOUNDS WITH ABSORBABLE FIBRIN ADHESIVE BANDAGE IN A PORCINE MODEL

In a porcine model we evaluated the efficacy of the absorbable fibrin adhesive bandage and other novel fibrin products for treating major renal stab wounds. In commercial swine we produced an almost lethal, grade 4 renal stab wound via a 3.5 cm. sagittal, centrally located, through-and-through laceration. Each pig then received treatment in random fashion, including conventional oversewing of capsular defects with absorbable gelatin sponge and horizontal mattress sutures in 6, external absorbable fibrin adhesive bandage that was pressure held for 60 seconds in 6, external and internal absorbable fibrin adhesive bandage that was applied externally, inserted into the renal defect and pressure held for 60 seconds in 6, liquid fibrin sealant that was placed in the laceration and held for 60 seconds in 8, fibrin foam that was applied in the same manner as liquid fibrin in 5 and closing of the peritoneum over the lacerated kidney without further treatment in 6. Blood loss and time to hemostasis were recorded. Animals were sacrificed at 6 weeks to evaluate the injured renal unit. Compared with conventional therapy the absorbable fibrin adhesive bandage applied externally alone or externally and internally resulted in significantly less bleeding and significantly less time to hemostasis (p <0.001). Liquid fibrin and fibrin foam did not reliably achieve hemostasis. Postoperatively computerized tomography and histological sectioning suggested that the absorbable fibrin adhesive bandage results in a stable, durable clot and healing is at least as successful as with conventional treatment. The absorbable fibrin adhesive bandage appears to be a safe, rapid means of renal salvage after injury.

Endoscopic reconstruction of vesicourethral obliteration after retropubic prostatectomy

Complete vesicourethral obliteration after retropubic prostatectomy presents a challenging reconstructive problem. We report on 4 men with complete vesicourethral obliteration after radical (n = 3) or simple (n = 1) retropubic prostatectomy in which an antegrade-retrograde endoscopic approach was used to obtain durable urethral patency, with preservation of urinary continence and potency.

SCROTAL HERNIATION OF THE BLADDER SECONDARY TO PROSTATE ENLARGEMENT

The roentgenographic findings of scrotal herniation of the bladder were first described by Levine in 1951.’ The term scrotal cystocele was used to describe the rare clinical condition of massive inguinoscrotal herniation of the bladder. Involvement of the bladder in inguinal hernias is not rare. However, herniation of a large portion of the bladder is uncommon. We report a case of massive inguinoscrotal herniation of the bladder secondary to large benign prostate hypertrophy. CASE REPORT A 78-year-old man presented with severe nocturia, a weak urinary stream, excessive straining and the need to squeeze the scrotum manually to void completely. Physical examination revealed a markedly enlarged prostate gland and a right inguinal hernia. Surgical history was significant for multiple repairs of the right inguinal hernia. Computerized tomography (CT) of the pelvis demonstrated a prostate gland measuring approximately 8 X 8 X 7 cm. (fig. 1, A). Subsequent images revealed the opacified bladder within the right inguinal canal, extending into the right hemiscrotum (fig. 1, B). Delayed supine images on excretory urography (Np) showed a large right inguinoscrotal herniation of the bladder with no evidence of ureteral displacement or dilatation (fig. 2). A simple retropubic prostatectomy revealed a 211 gm. benign prostate gland. The herniated portion of the bladder was reduced and elective hernioplasty was planned. DISCUSSION Herniation of the bladder may present as part of an obturator, ventral, ischiorectal, peritoneal or sciatic hernia. When the bladder is distended, it may also herniate into any pelvic or abdominal opening within its reach.2 Herniation of the bladder may be classified according to its relationship to the peritoneum. Paraperitoneal herniation is most common and is much more likely to be indirect. The bladder remains extraperitoneal being medial and alongside of the parietal

A case of giant prostatic hyperplasia

Giant prostatic hyperplasia (GPH) is an uncommon pathologic entity with only 10 reported cases of prostate glands exceeding 500 g. We report the uncomplicated removal of a 526-g prostatic adenoma by simple retropubic prostatectomy.

Surgical modifications for ligation of deep dorsal vein complex from retropubic space

The ligation and division of the dorsal vein complex is a critical surgical step in achieving hemostasis in mamy urologie operations, such as the radical retrogubic prostatectomy, anterior nerve-sparing approach in the radical cystoprostatectomy, ‘-’ ligation of the dorsal vein complex for venous leakage impotence,8-11 and simple retropubic prostatectomy. l2 Walsh et al. 1-3 have refined the radical retropubic prostatectomy and defined a clear anatomie approach for the ligation of the dorsal vein complex with nerve preservation for potency. The standard approach is to divide the two puboprostatic ligaments at their junction to the pubic bone prior to the isolation and ligation of the deep dorsal vein complex. Although the puboprostatic ligaments are avascular, the division of the two Iigments leads to a subsequent posterior depression of the prostate and bladder that can lead to hemorrhage from the ruptured superficial dorsal venous channels adjacent to the puboprostatic ligaments. Control of this hemorrhage can be difficult, and the bleeding can obliterate a proper surgical exposure for the next maneuver. We have made modifications from the standard technique by ligating the puboprostatic ligaments and the dorsal vein complex together as a single unit and then dividing the puboprostatic ligaments and the venous complex proximal or cephalad to the ligatures. This has been dorre in the last 24 consecutive radical prostatectomies, 10 radical cystoprostatectomies, 8 deep dorsal vein complex ligations for venous leakage impotente, and 2 cases for hemostasis in the simple retropubic prostatectomies for benign disease. The procedure is simple, effective, and avoids the unnecessary potential of superficial venous hemorrhage from the superficial dorsal venous channels.

Comparison of alpha1 Adrenoceptors in the Prostate Capsule of Men with Symptomatic and Asymptomatic Benign Prostatic Hyperplasia

The objective of this study was to compare the binding and functional properties of alpha 1 adrenoceptors in prostate capsules obtained from men with symptomatic and asymptomatic benign prostatic hyperplasia (BPH) undergoing simple retropubic prostatectomy and cystoprostatectomy respectively. Saturation experiments using 125I-Heat demonstrated that the density and binding affinity of alpha 1 adrenoceptors in the prostate capsules obtained from men with symptomatic and asymptomatic BPH were similar. Non-cumulative dose response experiments using phenylephrine demonstrated that the magnitude of the contractile response to phenylephrine was 4-fold greater in the prostate capsules from men with symptomatic BPH than from those with asymptomatic BPH. The EC50 of phenylephrine in the prostate capsules of men with symptomatic and asymptomatic BPH was similar. A correlation between alpha 1 adrenoceptor density and phenylephrine Emax was not observed, implying that either alpha 1 adrenoceptors are not localised exclusively to the prostate smooth muscle or that spare alpha 1 adrenoceptors exist. This study suggests that the neuropharmacological properties of the prostate capsule may play a significant role in the development of infravesical obstruction in the ageing male population.

Improved Hemostasis During Simple Retropubic Prostatectomy

During simple retropubic prostatectomy, ligation of the dorsal vein complex and lateral pedicles before enucleation of the adenoma reduces blood loss.

Infection stones of prostate gland: Laboratory diagnosis and clinical management

Similar to “infected” renal calculi, stone culture techniques have demonstrated “infected” prostatic calculi in men whose relapsing bacterial infections were preoperatively localized to the prostate gland. Three cases are presented to illustrate this condition. In 1 patient infection was cured by simple perineal prostatectomy and total prostatolithotomy; persistence of infection occurred in 1 patient following simple retropubic prostatectomy and prostatolithotomy because of a few small residual calculi; in 1 patient infection persisted following transurethral resection with removal of all visible calculi. The latter patient also had clinical evidence of chronic left seminal vesiculitis.

Prostatectomy, A Comparison of the Results of the Retropubic and Suprapubic Approach

No AccessJournal of Urology1 Aug 1950Prostatectomy, A Comparison of the Results of the Retropubic and Suprapubic Approach Jarratt P. Robertson and Samuel K. Cohn Jarratt P. RobertsonJarratt P. Robertson More articles by this author and Samuel K. CohnSamuel K. Cohn More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)68641-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1950 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited by Горовий В, Шапринський В, Барало І, Капшук О, Кобзін О, Потєха Ю, Лонський Л, Дмитришин С, Дубовий А and Мудрицький В (2020) Hystory of Introduction of Retropubic Simple Prostatectomy in Patients with Benign Prostatic HyperplasiaHealth of Man, 10.30841/2307-5090.2.2020.212896, VOL. 0, NO. 2, (42-56) Volume 64Issue 2August 1950Page: 359-366 Advertisement Copyright & Permissions© 1950 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Jarratt P. Robertson More articles by this author Samuel K. Cohn More articles by this author Expand All Advertisement PDF downloadLoading ...