Limits...
Transient occlusion of bilateral internal iliac arteries facilitates bloodless operative field in subcapsular prostatectomy.

Takeuchi T, Zaitsu M, Mikami K, Yui S, Takeshima Y, Okamoto N, Imao S - Case Rep Med (2012)

Bottom Line: Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH).It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL.In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki 211-8510, Japan.

ABSTRACT
Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH). Nevertheless, open subcapsular prostatectomy is still performed for large BPH. While enucleation of prostatic adenoma is being performed, unneglectable bleeding can occur and surgeons need to rush to remove adenomas, often using fingers and in a blinded fashion. The blood supply to the prostatic capsule and adenoma can be reduced to a marked extent in subcapsular prostatectomy if the bilateral internal iliac arteries are transiently occluded. Thus, a bloodless operative field is reasonably acquired during enucleation of adenoma, which would, otherwise, be a cause for concern to surgeons due to bleeding. It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL. In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

No MeSH data available.


Related in: MedlinePlus

Transabdominal ultrasonography of large BPH in Case 1.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3295615&req=5

fig1: Transabdominal ultrasonography of large BPH in Case 1.

Mentions: In Case 1, BPH of 160 g estimated by transabdominal ultrasonography (Figure 1) was determined to be removed by open subcapsular prostatectomy. Bilateral internal iliac arteries were isolated and taped following a lower midline skin incision. Then, two lines of sutures with absorbable strings were applied to the prostatic capsule. After the bilateral internal iliac arteries were occluded with Bulldog clamps (Figure 2), the prostatic capsule was incised between the lines of sutures. Despite the quite large size of the prostatic adenoma to be enucleated, there was little bleeding until the prostatic adenoma was removed. The prostatic adenoma was enucleated and the urethra was cut with scissors, while prostatic vessels at 5 o'clock and 7 o'clock were ligated and cut under clear vision (Figure 3). Finally, a prostatic adenoma of 159 g was removed (Figure 4). The Bulldog clamps were removed before closing incision of the prostatic capsule, then hemostasis was secured. The occlusion time of internal iliac arteries was 90 minutes. The bladder neck at 5 o'clock and 7 o'clock was tied with a prostatic bed and the incised prostatic capsule was approximated with absorbable sutures. A three-way urethral catheter was placed and the balloon was inflated to 50 mL. The bladder was continuously irrigated with saline and the urethral catheter was tracted with 500 g for several hours. Blood transfusion was completely unnecessary although the exact amount of bleeding could not be evaluated, because the suction fluid was a mix of urine and blood. The postoperative course was uneventful. Pre- and postoperative hematocrit values were 40.7 and 31.9%, respectively.


Transient occlusion of bilateral internal iliac arteries facilitates bloodless operative field in subcapsular prostatectomy.

Takeuchi T, Zaitsu M, Mikami K, Yui S, Takeshima Y, Okamoto N, Imao S - Case Rep Med (2012)

Transabdominal ultrasonography of large BPH in Case 1.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3295615&req=5

fig1: Transabdominal ultrasonography of large BPH in Case 1.
Mentions: In Case 1, BPH of 160 g estimated by transabdominal ultrasonography (Figure 1) was determined to be removed by open subcapsular prostatectomy. Bilateral internal iliac arteries were isolated and taped following a lower midline skin incision. Then, two lines of sutures with absorbable strings were applied to the prostatic capsule. After the bilateral internal iliac arteries were occluded with Bulldog clamps (Figure 2), the prostatic capsule was incised between the lines of sutures. Despite the quite large size of the prostatic adenoma to be enucleated, there was little bleeding until the prostatic adenoma was removed. The prostatic adenoma was enucleated and the urethra was cut with scissors, while prostatic vessels at 5 o'clock and 7 o'clock were ligated and cut under clear vision (Figure 3). Finally, a prostatic adenoma of 159 g was removed (Figure 4). The Bulldog clamps were removed before closing incision of the prostatic capsule, then hemostasis was secured. The occlusion time of internal iliac arteries was 90 minutes. The bladder neck at 5 o'clock and 7 o'clock was tied with a prostatic bed and the incised prostatic capsule was approximated with absorbable sutures. A three-way urethral catheter was placed and the balloon was inflated to 50 mL. The bladder was continuously irrigated with saline and the urethral catheter was tracted with 500 g for several hours. Blood transfusion was completely unnecessary although the exact amount of bleeding could not be evaluated, because the suction fluid was a mix of urine and blood. The postoperative course was uneventful. Pre- and postoperative hematocrit values were 40.7 and 31.9%, respectively.

Bottom Line: Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH).It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL.In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki 211-8510, Japan.

ABSTRACT
Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH). Nevertheless, open subcapsular prostatectomy is still performed for large BPH. While enucleation of prostatic adenoma is being performed, unneglectable bleeding can occur and surgeons need to rush to remove adenomas, often using fingers and in a blinded fashion. The blood supply to the prostatic capsule and adenoma can be reduced to a marked extent in subcapsular prostatectomy if the bilateral internal iliac arteries are transiently occluded. Thus, a bloodless operative field is reasonably acquired during enucleation of adenoma, which would, otherwise, be a cause for concern to surgeons due to bleeding. It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL. In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

No MeSH data available.


Related in: MedlinePlus