Retropubic extravesical prostatectomy

1. Prostatic hyperplasia causes mechanical obstruction of the bladder neck, which is ineffective by non-surgical treatment. 2. The residual urine volume exceeds 60ml. 3. Due to obstruction induced diverticulum or stones, kidney and ureteral water. 4. Chronic or recurrent urinary tract infections due to obstruction. Treatment of diseases: urinary infection, prostatic hyperplasia Indication 1. Prostatic hyperplasia causes mechanical obstruction of the bladder neck, which is ineffective by non-surgical treatment. 2. The residual urine volume exceeds 60ml. 3. Due to obstruction induced diverticulum or stones, kidney and ureteral water. 4. Chronic or recurrent urinary tract infections due to obstruction. Preoperative preparation 1. Most of the patients are elderly, the general condition is poor, and often accompanied by other diseases (such as hypertension, heart disease and diabetes), so the patient's general condition must be thoroughly and carefully examined and estimated before surgery. In addition to general physical examination, special attention should be paid to the determination of renal function (such as blood non-protein nitrogen, co 2 binding force and phenol red test). In addition, blood pressure needs to be measured multiple times to check the fundus, ECG, chest fluoroscopy and liver function. If there is renal insufficiency, the bladder should be drained and the operation should be performed after the renal function is improved. 2. Preoperative patients often have urinary tract infections, catheterization can improve the above situation, but long-term indwelling can cause infection. In order to reduce postoperative wound infection, antibiotics can be taken several days before surgery, and the bladder can be washed with an antibacterial solution half an hour before surgery. A commonly used antibacterial solution is 1:2000 nitrofurazone, 1:5000 potassium permanganate. After the bladder is washed, it is filled with the rinsing solution. 3. Cystoscopy can directly observe the bladder condition, the type of prostatic hypertrophy and other complications of the bladder (such as stones, diverticulum, etc.), but do not need to be routinely performed before surgery. 4. Before prostatectomy, in order to prevent orchitis, bilateral vasectomy is usually performed first. Surgical procedure 1. Position: supine position, slightly lower head, slightly separated legs. 2. Incision: Starting from 2 cm below the umbilicus, a longitudinal incision of 8 to 10 cm was made to the upper edge of the pubis. Pull the rectus abdominis and cone muscles to the sides. 3. Expose the prostate with the wet gauze fingers to push the peritoneum back up, or use gauze clamp gauze ball to push the pubic bone and prostate fat away from the pubic prostate ligament to reveal the front of the prostate and the anterior prostatic plexus. When pushing open, avoid damage to the pubic symphysis and pre-prostatic venous plexus. 4. Cut the prostate capsule: Insert a gauze on each side of the prostate to fix and cushion the prostate. Using a small rounded needle and a black filament thread, the prostate vein is ligated along the bladder neck and the lower 1.5 points in two rows, the veins of the prostate venous plexus are ligated, and the blood vessels are cut between the two rows of ligatures. Between the two rows of ligatures, 1 cm from the junction of the bladder prostate, make a 3 ~ 5 cm transverse incision, cut the prostate capsule, and go straight to the gland. The bleeding point on the envelope was sutured with a thin thread. 5. Excision of the prostate: After hemostasis, use the curved scissors to separate the upper and lower ends of the incision, and then use the right hand to extend between the gland and the capsule, and separate the tip of the gland, the leaves on both sides and the neck of the bladder. The urethra at the tip of the gland is cut or pinched with scissors, and the gland is taken out from the incision. Subsequently, the corneal gland was filled with hot saline gauze to stop bleeding, and the excised gland was examined for completeness. 6. Excision of residual glands and exploration of the bladder: 10 minutes later, the gauze was taken out, the bleeding point was examined, and the hemostasis was clamped with a long hemorrhoid, and the gut was ligated. Review the gland fossa, if there are residual glands, use scissors to cut off. Then, the finger is inserted into the bladder through the bladder neck. If there is a stone, it is taken out by a stone pliers. 7. Wedge resection of the posterior margin of the bladder neck, enlarge the neck of the bladder: If the neck of the bladder is too narrow, it can not be passed, in order to prevent postoperative urinary dysfunction, wedge resection can be done at the posterior edge of the bladder prostate junction, the edge of the incision Suture continuously with the gut to enlarge the neck of the bladder. 8. Place the catheter balloon into the glandular fossa: insert a 20- to 30-volume balloon catheter from the urethra (the size of the balloon should be based on the size of the prostate). The balloon must be placed in the glandular fossa, the tip of the catheter Extend into the bladder. 9. Suture capsule: 6~7 needles of the prostate capsule incision with 1-0 chrome gut suture [Fig. 1 (10)]; if the rupture is larger, it can be sutured continuously, then on the suture, a few needles Strengthen the stitching. Then, the extracapsular tissue of the prostate is sutured intermittently with a silk thread. 10. Fill the saline tube and tighten the balloon catheter. Inject 30 ml of normal saline into the balloon and tighten the catheter to compress the gland to stop bleeding. Then, rinse the bladder with a hot and humid saline through a catheter, and rinse the small clots until the reflux is clear or slightly reddish. 11. Suture the incision: take out the gauze on both sides of the prostate, rinse the wound with warm saline, drain the cigarette after the pubic space, and suture it layer by layer.