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Modification of retropubic adenomectomy: improved hemostasis and outcome
Ioannis Filiadis1, Vasileios Adamopoulos, Erotokritos Konstandinidis
1Department of Urology, General Hospital of Kavala, Amer. Eri. Stavrou 62, Kavala 652 01, Greece.
Introduction:
Our modification is based on the employment of the ligation of both the deep dorsal penile vein (DDPV) and the lateral vesicoprostatic pedicles before enucleation of adenoma in retropubic adenomectomy, for treatment of bladder outflow obstruction due to large benign prostate hyperplasia (BPH).
Patients And Methods:
From January 2004 till May 2005, 18 patients suffering from large BPH obstruction (mean value of adenoma 145.4 cm(3)) were operated with this modification.
Results:
The mean hematocrit values preoperatively and 12 h postoperatively were 40 and 36.6%, respectively. Accordingly no patient required transfusion. Postoperative bladder complaints (pain, discomfort) were not mentioned. In 3/18 (16.7%) of the patients transient stress incontinence was observed after catheter removal and totally subsided in all of them at the 1-month follow up.
Discussion:
This modification eliminates any possible source of bleeding and therefore converts an operation which is traditionally associated with blood loss to a totally bloodless procedure. Furthermore, the ligation of DDPV in association to retropubic adenomectomy may be proved helpful in a proportion of patients with impotence.
Conclusion:
In experienced hands, the employment of both DDPV ligation and transfixion of lateral vesicoprostatic pedicles may significantly optimise the postoperative results of retropubic adenomectomy.
