RETROPUBIC abdominal prostatectomy has become a preferred technique to remove an adenoma of the prostate or the entire gland for carcinoma. Millin popularised the retropubic approach in 1945. Stearns (1961) described modifications in technique with equally good results. The retropubic approach has been accepted because it represents the shortest and most direct attack upon a surgical prostatic lesion. The purpose of this paper is to review thirteen years' experience with the retropubic technique and the results obtained. In addition, we wish to emphasise the feasibility of simultaneous intrapelvic hernial repair following the prostatectomy. Many minor details are not embodied in this review.One hundred and sixty-three retropubic prostatectomies were performed between 1950 and 1963. During this period 269 transurethral resections and ten suprapubic operations were done. Radical operations for carcinoma have not been included. The average age of the patients was 65 years and the ages ranged from 45 to 87. Approximately one-half of the patients had hypertension or arteriosclerotic vascular disease; ten had previous myocardial infarcts; and eight had diabetes mellitus. Co-existing inguinal hernias were noted in twenty-four patients (15 per cent.). Choice of Operation.-Our indications for open prostatectoiny are somewhat more liberal than those usually recommended. The symptoms of prostatic obstruction are the guide lines for surgical intervention. Our feeling is that adenomas over 25 g. are amenable to open surgery and transurethral resections are more useful for small adenomas, median bars, and bladder neck contractures. The presence of an associated inguinal or femoral hernia, urethral stricture or coexisting bladder pathology weighs in favour of the retropubic approach. Mortality is no greater with open surgery than with the transurethral approach. Associated cardiovascular or other medical diseases are not necessarily a contraindication to open surgery where relief of obstruction is 'necessary. Spinal anzsthesia aids in reducing post-operative morbidity and pulmonary complications.Preparation of the Patient.-Evaluation includes careful physical examination, excretory urograms, chest X-ray, urinalysis, electrocardiogram, blood urea nitrogen, fasting blood sugar, acid phosphatase, alkaline phosphatase, prothrombin time, urine culture and the bacterial sensitivities. Cystoscopy is not performed unless urologic disease other than prostatic adenoma is suspected. Antero-posterior and oblique cystograms are invaluable to evaluate intravesical prostatic encroachment, residual urine, bladder tumours, and diverticula. An appropriate antibiotic, as determined by sensitivity studies, is used pre-operatively if urinary tract infection is present. All patients were given post-operative antibiotic therapy. After a careful work-up, each patient is evaluated as to surgical risk and procedure of choice.
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