Product Summary: AMA rates
Retropubic Prostatectomy (Eneucleation) of the adenoma of the prostate
Item Number: 37200, 105
For those large benign prostates where a TURP would be too time consuming, and too dangerous. Generally prostates over 200cc.
Not commonly performed in Australia. More recently a Robotic Assisted technique has been used for these large prostates
Still commonly used in the rest of the world especially third world countries.
Why is it done?
- This procedure is performed when the prostate gland is enlarged to such an extent that medication cannot relieve the urinary symptoms.
- Symptoms include: a weak stream, nightly urination, frequent urination, inability to urinate, (LUTS) kidney failure due to the weak urination (obstruction), bladder stones, recurrent bladder infections.
- Medication such as Flomaxtra, Xatral Minipress etc. should always be given as a first resort.
- Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar and can be used as a first line in these huge prostates.
- Prostate cancer first needs to be ruled out by doing a PSA, and when indicated, with a 3T MRI scan of the prostate with an abnormal PSA with a possible prostate biopsy of any suspicious lesions.
- A staged-TURP can also be performed to dis-obstruct a huge prostate. Either Bipolar resection or Laser can be utilised.
- Patient informed decision is vital.
- It provides a quicker solution with more marked side-effects and risks.
How is it done?
- Patients will receive a general anaesthesia, unless contra-indicated.
- Prophylactic anti-biotics is given.
- An indwelling catheter is placed.
- A lower midline incision is made ( or alternatively a horizontal Pfannensteil-incision).
- The retropubic space of Retzuis is entered.
- A Millen-procedure is done where the prostate capsule and lower part of the bladder is incised in the longitudinal aspect.
- The bladder neck mucosa is cut and freed from the prostate away from the ureters as to prevent injury.
- With blunt dissection the apex of the prostate is freed from with the urethra and each lobe is delivered separately.
- Copious bleeding is possible in this phase and this is where a cell-saver usage is critical to prevent blood transfusions with donor blood.
- Hemostatic sutures are placed over bilateral prostatic vascular pedicles to stop the bleeding.
- Sutures are placed to assist in reducing the cavity left after eneucleation.
- The bladder neck is pulled down into the cavity to assist with hemostasis.
- Prostate capsule and bladder is closed in 2 layers over a 3 way irrigation catheter.
- A drain is left for a couple of days.
- You may have continuous Antibiotics over the next few days.
- You will spend up to 5-7 nights in hospital.
- You will have a catheter for that time.
- A drain for 2-3 days.
- You will a trial without the catheter on the 5th day.
- You will be discharged as soon as you can completely empty your bladder.
- You may initially suffer from urge incontinence and dysuria (irritable voiding) and will improve within the next 6 weeks.
- Allow for 6 weeks for stabilization of symptoms.
- There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
- A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
- A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporisation.
- Don’t hesitate to ask Jo if you have any queries.
- DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!
- Blood loss requiring blood transfusion.
- Prolonged hospital stay.
- Retrograde ejaculation in more than 90% of patients. Therefore if you have not completed your family, this procedure is not for you unless absolutely necessary.
- Infertility as a result of the retrograde ejaculation.
- Stress incontinence especially in the elderly and the diabetic patients.
- Patients with Multiple Sclerosis, Strokes and Parkinsons have a higher risk of incontinence and risks should be discussed and accepted prior to surgery.
- Less chance of growth of prostate lobes usually within 3-5 years requiring a second procedure.
- NB! Each person is unique and for this reason symptoms vary!
You still have a peripheral zone of your prostate and regular PSA reviews are required up to the age of 75.
(This could be seen as controversial).
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