Special Surgical Procedures II LESSON 3: Procedures in Genitourinary Surgery Section Iv: operations on the bladder and prostate
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3-28. SUPRAPUBIC PROSTATECTOMY WITH CYSTOSTOMY
a. General. This procedure involves enucleation of the prostatic adenomas or hypertrophied masses via a suprapubic approach. It is required because as the male ages, the prostate gland enlarges and gradually obstructs the urethra, giving rise to symptoms of urinary obstruction. The enlargement may be benign or malignant. In benign hypertrophy, only the periurethral portion of the gland is removed. When malignancy is involved, however, total or radical prostatectomy is done. This may involve excision of the entire gland and its capsule, together with associated structures, a portion of the trigone of the bladder, and the seminal vesicles.
b. Patient Preparation. The patient is placed in the supine or modified Trendelenburg position, with the legs apart and the weight of the torso supported by shoulder braces. An O'Connor drape may be fanfolded at the pubis, with the penis exposed through the fenestration and the finger cot in the rectum. A towel folded lengthwise is placed over the fanfolded drape at the pubic level, and a fenestrated disposable drape is used at the site of the suprapubic incision.
c. Operative Procedure.
Figure 3-9. Enucleation of prostate by suprapubic approach.
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