(2) The prostatic capsule is incised transversely, using number 7 scalpel
with a number 10 blade. The prostate is freed and enucleated, employing scissors and
Allis forceps. Deep bleeding vessels are clamped with long hemostats and ligated with
long plain gut number 2-0 or number 3-0 sutures with medium curved taper point
(3) A wedge excision of the posterior bladder neck is made, using long Allis
forceps, a long scalpel, and scissors. A wedge of tissue may be sutured over the defect
in the bladder neck after removal of the prostate. In radical prostatectomy, a V-shaped
portion of the bladder mucosa may be sutured over the defect in the bladder neck.
(4) A multieyed Robinson or Foley retention catheter is placed via the
urethra. A Malecot cystostomy tube may be placed in the bladder if the surgeon
(5) The incision in the prostatic capsule is closed with a continuous suture of
chromic gut number 0. Penrose drains are placed in the retropubic space, the
abdominal incision is closed in layers, and the wound is dressed.
3-30. PERINEAL PROSTATECTOMY
a. General. Either enucleation of adenomas or radical prostatectomy may be
carried out through a perineal exposure.
b. Patient Preparation. The patient is placed on the operating table in an
extreme lithotomy position. The buttocks are elevated on pads sufficient to tilt the pelvis
and flatten the perineum on the vertical plane. The thighs are fully flexed with the knees
to the chest and the feet are supported in stirrups. The arms are extended on
armboards and shoulder braces applied with the usual precautions. Measures must be
taken to reduce strain on the muscles and nerves of the back and legs and also prevent
respiratory embarrassment from compression of the abdomen and chest. Draping is
with an O'Connor drape and perineal sheet.
c. Operative Procedure.
(1) Through a curved incision made just above the anal margin, the skin, fat,
and subcutaneous fascia are divided. Straight hemostats are used for bleeding vessels
in the superficial tissues and curved hemostats for deeper tissues. The tissue on either
side of the central tendon is dissected, using Metzenbaun scissors and forceps.
McBurney retractors followed by Young bifurcated prostatectomy retractors are placed
as dissection progresses. The levator ani muscles are exposed and retracted.
(2) The gland is exposed and enucleated. The surgeon manipulates the
gland with a finger in the rectum via the O'Connor drape finger cot or with the hand
protected by a second glove.