Surgical steps of transvesical prostatectomy

When people reach middle age or old age, the functions of various organs in the body are not as good as before, and they will also be accompanied by various diseases during this period. Transvesical prostatectomy seems complicated, but in fact it is not as complicated as imagined. As long as the patient actively cooperates with the treatment, the later effect can be very good. So what are the specific steps of transvesical prostatectomy? Let us learn about it together.

Surgical steps:

1. Lie on your back with your head slightly lowered and your legs slightly apart.

2. Make a midline incision in the lower abdomen. The incision should be about 10 to 12 cm long. Pull open the rectus abdominis muscle in the middle. Use the index finger wrapped in wet gauze to push the peritoneum upward to expose the bladder.

3. Open the bladder and expose the prostate. Open the bladder on the pubic bone, suck out the flushing solution in the bladder with an aspirator, and extend the incision downward until the bladder neck and prostate are exposed.

4. Resection of the prostate. Use a deep abdominal hook to pull open the bladder incision, and you will see the enlarged prostate. At this time, you should first explore whether there are other complications in the bladder (such as stones or diverticula, etc.). If stones are found, use lithotripsy to remove the stones. Then, use a long-handled knife or long curved scissors to make a horizontal incision at the most obvious point where the prostate protrudes into the bladder (usually the middle lobe of the prostate), cut the bladder mucosa and the prostate capsule, and separate them slightly with long curved scissors. Insert your fingers and separate the posterior side of the prostate first, then the left and right sides in the capsule. Finally, pinch the urethra at the front end of the gland and remove it completely ~⑷. You can also use the index finger of your right hand to directly break the bladder mucosa next to the middle lobe or lateral lobe of the prostate, enter the prostate capsule, and separate the lobes completely along the gap between the prostate body and the inner surface of the capsule. When separating the front part of the bladder neck, special attention should be paid to not tearing the capsule in this part, so as not to damage the anterior prostatic venous plexus and cause heavy bleeding. When separating the urethra at the front end of the prostate, the urethra should be cut or pinched at the tip of the prostate, and the urethral mucosa of the membranous part should not be torn off in large pieces, so as not to cause postoperative urethral stenosis.

When separating the gland, the surgeon can insert the index finger of the left hand into the anus and push the prostate forward and upward to facilitate the operation. When removing the finger, the gloves and surgical gown should be changed.

If there is adhesion tissue deep in the prostate, it can be clamped with a tissue clamp and lifted up, and then cut off with long curved scissors. After the gland is completely removed, the glandular fossa is immediately blocked with a hot salt water gauze strip to control bleeding. The gauze strip must be blocked exactly in the glandular fossa. The removed gland needs to be checked for integrity.

5. Suture to stop bleeding. After 10 minutes, remove the gauze plug and check the glandular crypt. If there is a lot of bleeding at the edge of the glandular crypt, use chromium intestinal thread to suture the bladder mucosa and the posterior edge of the prostate capsule at 5 to 7 o'clock to stop bleeding. When suturing, the needle should not be inserted too deep to avoid piercing the rectum or damaging the ureteral orifice. Generally, the bleeding can be stopped.

6. Place balloon catheter to compress and stop bleeding. Use a 30ml balloon catheter (Foley) or a homemade larger balloon catheter to insert into the prostate fossa from the urethra, inflate the balloon with 30ml saline, and have an assistant gently pull the catheter outward to compress the glandular fossa to stop bleeding. If hemostasis is not perfect, the volume of saline can be appropriately increased.

7. Bladder drainage. A thick mushroom-shaped catheter is placed in the bladder, and the bladder incision is sutured continuously with 2-0 chromium intestinal sutures and intermittent silk sutures. The catheter is led out from the top of the incision (high drainage).

8. Suture the incision. Place cigarettes in the retropubic space for drainage and draw them out from below the incision. Suture the abdominal wall layer by layer with silk sutures. Fix the balloon catheter to the anterior inner side of the left thigh with tape under a certain tension.

We encounter various difficulties and diseases in our lives. Some diseases require surgery, whether major or minor. Transvesical prostatectomy is not a particularly complicated surgery. The key lies in whether the patient can face it with a positive attitude and strictly demand himself in daily life, eating habits, and work and rest time. Only in this way can the disease be cured quickly and the person can recover as soon as possible.