PROSTATECTOMY

 Methods of Prostatectomy
- TURP
- Open prostatectomy
- Laparoscopic
- Robotic
- Robotic assisted
 Open Prostatectomy approach

- Transvesical
- Retropubic ( Millin )
- Perineal
 INDICATIONS

- enlarged lateral lobes of prostate

- enlarged median lobe
 TRANSURETHRAL RESECTION

- Removal of prostatic tissue perurethrally

- No incision
- Less operative time
- Early mobilization
- Less post – op. complications
- Early recovery
 INSTRUMENTS & MATERIALS
- Cystoscope
- Resectoscope
- Cautery ( diathermy )
- Irrigating fluid
 ANAESTHESIA

- Spinal anaesthesia
- Epidural anaesthesia
- General anaesthesia
 POSITION OF THE PATIENT

- Lithotomy position
 PROCEDURE

- P & D done in Lithotomy position

- Cystoscope introduced per urethra

- confirm enlarged lobes of prostate

 contd..
- Resectoscope introduced through the
cystoscope & enlarged lobes resected
using a cautery device

- Irrigating fluid passed through the scope

flushes prostatic tissue bits in bladder
 Prostatic tissue bits collect in bladder

 removed after flushing the bladder

 Bleeding at the resected site controlled by

cautery
 Prostatic tissue bits send for
Histopathological exam.

 Haemostasis achieved

 No 20 / 22 Fr Triple lumen catheter

passed per urethrally
 Balloon inflated by 35 – 40 cc of NS.

 Traction given to the catheter so that balloon

retains in the Prostatic fossa
 Traction helps to achieve haemostasis

 Traction to be applied for at least 24 hrs

 Irrigation to be given by NS

 Irrigation to be continued till the

draining fluid is clear

 Indicates haemostasis at the prostatic fossa

 Traction to be discontinued after 24 hrs
to avoid Prostatic fossa necrosis

 Foley’s Catheter to be kept at least

for 5 days post operative
 COMPLICATIONS

- Haemorrhage
- Stricture
- rupture urethra
- Incontinence