Small Hole Prostatectomy
- Spinal anesthesia is better choice.
- Well distend the urinary bladder.
- Make a small suprapubic incision 2 to 3 cm and cut the rectus sheath under neath than separate the recti.
- Open the urinary bladder under direct vision and empty it with suction.
- Palpate the inside of the urinary bladder, especially the prostatic area.
- Enter into prostatic urethra and enucleated the prostate by pushing the finger forwards towards the pubes to separate the lateral lobes, and then working the finger between the adenoma and the false capsule.
- This enucleation is facilitated by using the right or left index finger as required, or bimanually by putting the left finger in rectum and right in urinary bladder or vise versa in opposite side, or request the operation theater staff that he put his two fingers in rectum and elevate the prostate and little stable it.
- Take out the prostate from prostatic cavity to urinary bladder and from their out side.
- Put the three ways folly’s catheter of number 22 per urethraly and close the urinary bladder.
- Put a retropubic drain and close the wounds in layers.
- Bleeding is not a problem if blood pressure is normal and enucleation is in its natural plane.
- Post operative catheter traction can be applied.
- If bleeding anticipating pack the prostatic cavity with bandage and one end of it take out separately to surface (an ultimate solution to bleeding).
- Packing can be removed after 06 hours or on wards before the retropubic drain which is usually removed with in 24 hours.
- Irrigate the bladder with sterile saline by means of a three-way Foley catheter for 24 hours or so and remove the catheter on 5th post operative day or onwards.