(2) Heavy chromic sutures are placed on each side of the urethra and sewn
to the periosteum and cartilage on the posterior side of the pubis.
(3) The outside of the bladder wall is then sutured with chromic gut suture to
the rectus muscle to further suspend the urethra and bladder.
The area is drained, and the wound is closed in layers.
3-28. SUPRAPUBIC PROSTATECTOMY WITH CYSTOSTOMY
a. General. This procedure involves enucleation of the prostatic adenomas or
hypertrophied masses via a suprapubic approach. It is required because as the male
ages, the prostate gland enlarges and gradually obstructs the urethra, giving rise to
symptoms of urinary obstruction. The enlargement may be benign or malignant. In
benign hypertrophy, only the periurethral portion of the gland is removed. When
malignancy is involved, however, total or radical prostatectomy is done. This may
involve excision of the entire gland and its capsule, together with associated structures,
a portion of the trigone of the bladder, and the seminal vesicles.
b. Patient Preparation. The patient is placed in the supine or modified
Trendelenburg position, with the legs apart and the weight of the torso supported by
shoulder braces. An O'Connor drape may be fanfolded at the pubis, with the penis
exposed through the fenestration and the finger cot in the rectum. A towel folded
lengthwise is placed over the fanfolded drape at the pubic level, and a fenestrated
disposable drape is used at the site of the suprapubic incision.
c. Operative Procedure.
(1) The bladder is distended via catheter irrigation, as for cystotomy.
Vasectomy is frequently done as a preliminary procedure to prevent postoperative
(2) The bladder is approached through the routine cystotomy incision, and
the top of the bladder is dissected free, using long thumb forceps and Metzenbaum
(3) The wall of the bladder is grasped on each side of the midline with Allis
forceps. Two traction sutures of chromic gut number 0 on Ferguson number 12 needles
may be placed through the wall of the bladder at this point and retained on straight
(4) The muscle layers of the bladder are spread by blunt dissection with a
hemostat until the mucosa is exposed. Allis forceps are placed on either side, and the
bladder is incised, using a scalpel with a number 10 blade. The opening is extended
with scissors. Bladder retractors--either long-bladed loops or self-retaining type--are
placed, and the bladder is explored.