Open ProstatectomyOpen Prostatectomy Advantages Compare with
TURPlower retreatment rate more complete removal of the prostatic
adenoma under direct visionavoids the risk of dilutional
hyponatremia (the TURP syndrome)Open Prostatectomy Disadvantages
Compare with TURPthe need for a lower midline incision longer
hospitalization and convalescence period.perioperative
hemorrhageTHE INDICATIONS FOR PROSTATECTOMYacute urinary retention;
recurrent or persistent urinary tract infections; significant
symptoms from bladder outlet obstruction not responsive to medical
therapy;recurrent gross hematuria of prostatic
origin;pathophysiologic changes of the kidneys, ureters, or bladder
secondary to prostatic obstruction; and bladder calculi secondary
to obstruction.Open prostatectomy should be considered when the
obstructive tissue is estimated to weigh more than 75 g.
Jenis Open ProstatectomyRetropubic approach (Millin)Suprapubic
approach (Freyer)Retropubic approach (Millin)Open Prostatectomy -
Retropubic approach (Millin)This approach to open prostatectomy was
popularized by Terrence Millin, who reported the results of the
procedure in 20 patients in Lancet in 1945 ( Millin, 1945 )In
retropubic prostatectomy, the enucleation of the hyperplastic
prostatic adenoma is achieved through a direct incision of the
anterior prostatic capsule.Advantagesexcellent anatomic exposure of
the prostate, direct visualization of the prostatic adenoma during
enucleation to ensure complete removal,precise transection of the
urethra distally to preserve urinary continence, clear and
immediate visualization of the prostatic fossa after enucleation to
control bleeding, and minimal to no surgical trauma to the urinary
bladder.DisadvantagesThe disadvantage of the retropubic approach,
compared with the suprapubic prostatectomy, is that direct access
to the bladder is not achieved.
Suprapubic approach (Freyer)Suprapubic approach or Transvesical
Prostatectomy (Freyer)Enucleation of the hyperplastic prostatic
adenoma through an extraperitoneal incision of the lower anterior
bladder wall.This approach to open prostatectomy was first carried
out by Eugene Fuller in New York in 1894AdvantagesThe major
advantage of this suprapubic procedure over the retropubic approach
is that it allows direct visualization of the bladder neck and
bladder mucosa. This operation suited for patient with:a large
median lobe protruding into the bladdera clinically significant
bladder diverticulumLarge bladder calculiIt may also be preferable
for obese men, in whom it is difficult to gain direct access to the
prostatic capsule and dorsal vein complex DisadvantagesThe
disadvantage, compared with the retropubic approach, is that direct
visualization of the apical prostatic adenoma is reduced. As a
result, the apical enucleation is less precise, and this factor may
affect postoperative urinary continence.
