Prostate Surgery Techniques Overview

Questions and Answers

What is a significant advantage of laser or electrovaporization of the prostate?

It always results in significant bleeding.

It is suitable for any prostate size.

It requires monopolar electrocautery.

It is associated with limited fluid absorption. (correct)

Which complication is less likely with a retropubic prostatectomy compared to other procedures?

Erectile dysfunction

Fluid absorption issues

Intraoperative and postoperative bleeding (correct)

Urinary incontinence

What is the primary purpose of the preoperative bowel preparation in open prostatectomy?

To reduce the size of the prostate

To prevent urinary tract infections

To improve fluid absorption

To enhance exposure during surgery (correct)

Which statement is true about suprapubic prostatectomy?

It minimizes effects on continence and erectile function. Signup and view all the answers

What is the typical weight of the prostate that is addressed during a suprapubic prostatectomy?

Between 50 g and 100 g Signup and view all the answers

During which surgical approach is the prostatic lobes enucleated using a finger inserted through the urethra?

Suprapubic prostatectomy Signup and view all the answers

Which of the following is NOT a standard part of care for open prostatectomy?

Use of laser technology Signup and view all the answers

What type of management is less effective when the prostate is very enlarged (>100 g)?

Endoscopic management Signup and view all the answers

What are common outcomes following prostatectomy?

Urinary incontinence and impotence Signup and view all the answers

What is the primary technique for diagnosing urethral stricture?

Retrograde urethrogram or cystoscopy Signup and view all the answers

Which method is preferred for the treatment of long or recalcitrant urethral strictures?

Open surgical excision Signup and view all the answers

Which procedure is considered the gold standard for urethral reconstruction?

Urethroplasty Signup and view all the answers

What complication may arise postoperatively in patients undergoing urinary procedures?

Urinary tract infection Signup and view all the answers

Which condition is most commonly associated with urethral strictures?

Scar tissue due to infectious urethritis Signup and view all the answers

What is typically required for urethroplasty?

Vascular flaps and free skin grafts Signup and view all the answers

What is the role of urodynamics in the management of urinary conditions?

To assess voiding pressures and obstructions Signup and view all the answers

What is the purpose of intravenous urography in preparing for urethroplasty?

To rule out upper tract lesions Signup and view all the answers

What is the recommended timing for definitive surgery following the use of diagnostic instruments?

10-12 hours after diagnostic use Signup and view all the answers

Which of the following describes a potential complication of urethroplasty fistula repairs?

Injury to the urethra from catheter insertion Signup and view all the answers

What position should the patient be placed in for the urethroplasty fistula repair?

Lithotomy position Signup and view all the answers

What is the significance of excising scar tissue during fistula repair?

To allow for the mobilization of tissue for closure Signup and view all the answers

What type of sutures are used to invert the bladder mucosa during the procedure?

Interrupted sutures Signup and view all the answers

Which surgical instrument set is essential for urethroplasty fistula repair?

Basic vaginal instrument set Signup and view all the answers

What is indicated as a common cause for the development of a urethroplasty fistula?

Obstetrical complications Signup and view all the answers

What is the purpose of the Foley catheter balloon after closure of the urethra?

To help control bleeding Signup and view all the answers

Which incision type is typically made during micro surgery for bladder procedures?

Transverse or midline lower abdominal incision Signup and view all the answers

What type of drains are mentioned for use in these surgical procedures?

Jackson Pratt drains Signup and view all the answers

During the surgical process, what should be done to control bleeding vessels?

They should be clamped, electrocoagulated, or ligated Signup and view all the answers

Which position is recommended for the patient during the procedure?

Slight Trendelenburg position with pelvis elevated Signup and view all the answers

What is the volume of the balloon typically inflated during catheter insertion?

30 mls Signup and view all the answers

What aids in the identification of the bladder during the surgical procedure?

Foley catheter infiltration Signup and view all the answers

What is the purpose of the suprapubic cystostomy tube after surgery?

To help drain urine during the healing process Signup and view all the answers

What is the primary goal of the dissection during prostate resection?

To preserve the neurovascular bundle Signup and view all the answers

Which device is used to help locate nerves during an open prostatectomy?

CaverMap Signup and view all the answers

What percentage of patients may experience erectile dysfunction after radical prostatectomy?

40% to 70% Signup and view all the answers

What is the most direct surgical approach to the prostate according to the information provided?

Perineal approach Signup and view all the answers

What surgical procedure may include removal of the prostate gland and bladder?

Radical cystoprostatectomy Signup and view all the answers

What is a consequence of using the CaverMap during surgery?

It only assists in locating nerves Signup and view all the answers

How long may some patients take to achieve erection postoperatively after prostate surgery?

Up to 18 months Signup and view all the answers

What is the purpose of nerve-sparing procedures during prostatectomy?

To preserve sexual potency Signup and view all the answers

Study Notes

Laser and Electrovaporization of the Prostate

Increasing popularity due to rare but potentially dangerous side effects.
Limited fluid absorption; saline can be used without monopolar electrocautery.
Reduced bleeding compared to traditional methods.
Urinary outcomes comparable to transurethral resection.
Less effective for prostates >100 g; open surgical procedures may be necessary.

Prostatectomy Techniques

Simple Retropubic Prostatectomy:
- Enucleation of hypertrophic tissue via anterior prostatic capsule incision.
- Offers excellent exposure and controllable bleeding.
- Standard preoperative care includes bowel preparation and antibiotics.
Suprapubic Prostatectomy:
- Enucleates most of the prostate while preserving the capsule.
- Limited to large benign glands (50 g - 100 g).
- Utilizes a midline incision; prostatic lobes enucleated via transvesicocapsular approach.
- Hemostatic agents and Foley catheter pressure used for bleeding control.

Surgical Procedures and Instruments

Positioning:
- Slight Trendelenburg positioning with pelvic elevation and adducted legs.
Instruments Required:
- Basic laparotomy set, bladder and prostatic instruments, Jackson Pratt drains, lubricants, syringes, urinary drainage systems, self-retaining retractors, and appropriate anesthesia.

Micro Surgery Approach

Foley Catheter Insertion:
- Facilitates identification of the bladder.
Incision and Dissection:
- Midline lower abdominal incision, clamping, electrocoagulation, and ligation of bleeding vessels.
- Bladder explored for calculi or tumors.
- Prostate resection starts at the urethra, preserving neurovascular bundles.

Nerve-Sparing Surgery

CaverMap Device:
- Helps locate nerves during surgery; does not guarantee erectile function post-surgery.
Studies indicate 40%-70% of radical prostatectomy patients experience varying degrees of erectile dysfunction postoperatively.

Perineal Prostatectomy

Direct approach through an avascular field; less risk of bleeding.
Suitable for radical cystoprostatectomy; urinary incontinence and impotence are common outcomes.

Robotic-Assisted Prostatectomy

Laparoscopic approach facilitates enucleation; traction on the Foley catheter aids the procedure.

Urethral Stricture

Voiding symptoms resemble BPH; often benign causes due to scarring.
Diagnosed with retrograde urethrogram or cystoscopy; treated with dilation or transurethral incision.

Urethroplasty

Gold standard for urethral reconstruction; effective for strictures, trauma, and congenital anomalies.
Requires urethral grafts, includes managing symptomatic urinary tract infections prior to surgery.
Procedures may include Horston Divine Urethroplasty and Johnson Urethroplasty.

Urethroplasty Fistula Repair

Address abnormal passages between the urethra and vagina, leading to incontinence.
Requires proper positioning in lithotomy, basic vaginal instrument set, and meticulous surgical technique to excise scar tissue and repair the bladder mucosa.

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Description

This quiz explores various techniques for prostate surgery, focusing on laser and electrovaporization methods. Learn about their benefits, side effects, and comparisons with traditional approaches. Understand the implications for patient outcomes based on prostate size and surgical options.