suprapubic cystoprostatectomy

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: The midline incision of the lower abdomen is about 10 to 12 cm long. Open the rectus abdominis in the middle. Use the indicator of wet gauze to push the peritoneum back up and reveal the bladder. 3. Cut the bladder and expose the prostate: Cut the bladder on the pubis. The irrigation solution in the bladder is aspirated with a suction device, and the incision is extended downward until the bladder neck and prostate are exposed. 4. Excision of the prostate: Open the bladder incision with a deep abdomen, that is, see the enlarged prostate. At this point, you should first explore the presence of other comorbidities (such as stones or diverticulum) in the bladder. If stones are found, use stone pliers to remove stones. Then, in the most obvious place where the prostate protrudes into the bladder (usually the middle lobe of the prostate), a transverse incision is made with a long-handled knife or a long-bend cut, the bladder mucosa and the prostate capsule are cut, and the long curved scissors are used for a little separation. Extend the finger and separate the posterior side of the prostate in the capsule, then separate the left and right sides. Finally, the urethra is pinched off at the front end of the gland and completely removed. It is also possible not to make a transverse incision, but use the right hand to directly break the bladder mucosa directly in the middle or lateral lobe of the prostate, enter the prostate capsule, and smoothly separate the leaves from the inner surface of the prostate and the capsule. When separating to the front of the bladder neck, special care should be taken not to tear the capsule to avoid damage to the prostatic venous plexus, causing massive bleeding. When separating the anterior urethra of the prostate, the urethra should be partially broken or pinched off, and the urethra mucosa should not be removed from the membrane to avoid postoperative urethral stricture. When the gland is isolated, the operator can extend the left hand finger into the anus if necessary, and push up the prostate forward and upward for surgery. Gloves and surgical gowns should be replaced when removing the finger. If there is adhesion tissue in the deep part of the prostate, it can be lifted by the tissue clamp and lifted, and cut with a long bend. Immediately after the glands are completely removed, the glandular fossa is blocked with a hot saline gauze strip to control bleeding. The gauze strip must be properly blocked in the glandular fossa. The removed glands need to be checked for completeness. 5. Suture hemostasis: 10 minutes later, remove the gauze stopper and check the glandular fossa. If the edge of the glandular fossa is more oozing, the chromic gut can be used to suture the bladder mucosa and the posterior margin of the prostate capsule at 5 to 7 points to stop bleeding. When suturing, the needle should not be too deep to avoid breaking the rectum or damaging the ureteral orifice. Under normal circumstances, more can stop bleeding. 6. Place the balloon catheter to stop bleeding: use a 30ml volume balloon catheter (foley) or a self-made large balloon catheter into the prostate gland from the urethra, inflate the balloon with 30ml saline, gently guide the catheter Tightening outward, pressing the gland to stop bleeding. If the hemostasis is imperfect, the saline capacity can be appropriately increased. 7. Bladder drainage: a thick urethral catheter was placed in the bladder. The bladder incision was sutured continuously with a 2-0 chrome gut, and the suture was sutured. The catheter was taken from the uppermost end of the incision (high drainage). 8. Incision suture: the posterior pubic space is placed with a cigarette drainage, which is led out from under the incision. The abdominal wall was sutured intermittently with silk. The balloon catheter is fixed to the front inner side of the left thigh with a tape under a certain tensile force.