Modified Denis technique: a simple solution for maximal hemostasis in suprapubic prostatectomy

Lezrek, M.; Ameur, A.; Renteria, Juan Miguel; Alj, H.A El; Beddouch, Amoqurane

doi:10.1016/s0090-4295(02)02513-x

Cited by 9 publications

(9 citation statements)

References 7 publications

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“…The volume of irrigation in group was similar to that reported in [5] before those authors introduced the modified bladder neck repair (12 L), but they did not use irrigation after they used their technique. The volume of irrigant in group 2 was more than reported by Lezrek et al [7] by 2.5 L, although they used the modified Denis technique, with its complications. As we report a new technique we were reluctant to use no irrigation, but the promising results could encourage the omission of irrigation after TVP.…”

Section: Discussionmentioning

confidence: 65%

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Open prostatectomy with a rectal balloon: A new technique to control postoperative blood loss

Mohyelden

Abdel-Kader

2015

Arab Journal of Urology

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ObjectivesTo evaluate a new technique, the rectal balloon (RB), to control blood loss after transvesical prostatectomy (TVP).Patients and methodsOver 2 years 100 patients were prospectively randomised into two equal groups. All patients underwent TVP for their benign prostatic hyperplasia but a RB (a balloon fixed to a three-way Foley catheter tip by a plaster strip, making it airtight) was used in group 2. The RB was placed in the rectum opposing the prostate and inflated (pressure controlled) for 15 min. Haemoglobin levels were assessed before and after TVP. Blood transfusion, the amount of saline used for irrigation, duration of catheterisation, hospital stay, and rectal complaints were recorded. Patients were followed up at 1 and 3 months after TVP.ResultsThe enucleated adenoma weight was 102 g in group 1 and 106 g in group 2. There was a significant difference between groups 1 and 2 in haemoglobin loss within the first 24 h after TVP, and in total loss, of 0.9 g and 0.2 g (P = 0.008), and 1.9 g and 1 g (P = 0.001), respectively. There was also a significant difference between the groups in the saline volume used for irrigation (11.4 vs. 2.5 L), catheter duration (5.7 vs. 4.3 days), and hospital stay (6.2 vs. 5.1 days), favouring group 2. Blood transfusions were needed in four patients in group 1 and one in group 2. There were no rectal complaints.ConclusionThe use of an inflated RB after TVP is a simple and safe procedure with no specific operative technique, that reduces postoperative blood loss, the incidence of blood transfusion, the volume of saline for irrigation, and shortens the catheterisation period and hospital stay, with no rectal complications.

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Section: Discussionmentioning

confidence: 65%

“…De La Pena used a removable purse-string suture, and Malment used removable partition sutures (cited in [4–6] ). Lezrek et al [7] used a removable partition purse-string suture at the bladder neck, and the prostatic fossa was drained.…”

Section: Introductionmentioning

confidence: 99%

Open prostatectomy with a rectal balloon: A new technique to control postoperative blood loss

Mohyelden

Abdel-Kader

2015

Arab Journal of Urology

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“…Suprapubic prostatectomy for benign prostatic hyperplasia (BPH) remains a viable option in the surgical treatment of BPH and is associated with a low re-treatment rate 1. It is the predominant method of surgical treatment of BPH in the developing world, and the results of many contemporary and earlier studies do show that suprapubic prostatectomy remains a very effective surgical procedure for BPH with good short-term and long-term outcomes 23456789. A historical and discouraging aspect of suprapubic prostatectomy has been the significant hemorrhage that can be encountered.…”

Section: Introductionmentioning

confidence: 99%

Evolution of bloodless surgery: A case for bloodless suprapubic prostatectomy

Okorie

Pisters

2019

Niger Med J

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Allogeneic blood transfusion is commonly prescribed to patients undergoing suprapubic prostatectomy for benign prostatic hyperplasia as a treatment option to replace blood loss. Historically, suprapubic prostatectomy has been perceived as an extremely high hemorrhagic surgery, and this has led to the association of suprapubic prostatectomy with a high rate of allogeneic blood transfusion. However, the outcome of suprapubic prostatectomy has significantly improved over the years and has become less hemorrhagic in many hands – creating the opportunity to consistently avoid allogeneic blood transfusion. On the other hand, the efficacy of blood transfusion has come under more stringent scrutiny as many clinical studies have reported inconsistent effects of blood transfusion on patient outcome. In contemporary practice, a more conservative/bloodless approach in the perioperative management of anemia in surgical patients is strongly being advocated with convincing evidence that many surgical patients can be routinely and safely managed without allogeneic blood transfusion. There is no large-scale discussion on bloodless surgery in urology in the contemporary literature, especially in the area of suprapubic prostatectomy that has been historically associated with a high rate of blood transfusion. This review article will discuss the evolution of bloodless surgery including the ongoing controversies surrounding blood transfusion in general, and then the relatively small but ongoing penetration of bloodless surgical approach in the field of suprapubic prostatectomy. Furthermore, the authors' approach to bloodless suprapubic prostatectomy will be highlighted, and in doing so, it can be emphasized that suprapubic prostatectomy is no more as hemorrhagic as was historically perceived, but rather a routine bloodless suprapubic prostatectomy is now possible in many hands.

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“…Surgeons have tried to modify these surgeries in different routes. [ 7 8 9 10 11 ] The rational to leave a cystostomy is the possibility of clot retention, or a possible postoperative urinary retention after Foley removal.…”

Section: Introductionmentioning

confidence: 99%

Cystostomy–free open suprapubic transvesical prostatectomy: Is it a safe method?

et al. 2016

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Aim:To compare open suprapubic transvesical prostatectomy (OSP) without insertion of suprapubic cystostomy, OSP with insertion of cystostomy, and transurethral resection of the prostate (TURP).Patients and Methods:A total of 104 patients with an indication for prostatectomy were retrospectively assigned to TURP (group 1), OSP with cystostomy (group 2), and OSP without cystostomy (group 3). They were evaluated for length of the operation, length of hospital stay, post-operative complications, hemoglobin drop, changes of blood pressure, and intraoperative blood loss.Results:Mean age was 67.2 ± 8.7 in group 1, 73.3 ± 8.4 in group 2, and 74.0 ± 5.7 in group 3. Prostatic volume was 35.9 ± 13.8, 74.1 ± 33.8, and 74.3 ± 31.8 in groups 1, 2, and 3, respectively. There was no significant difference in prostatic volume between groups 2 and 3 (P = 0.99), but in group 1 it was lesser than groups 2 and 3 (P = 0.00). Length of the operation was 1.2 ± 0.2 in group 3 and 1.1 ± 0.2 in group 2, without a significant difference (P = 0.45). Length of hospital stay in group 3 (2.3 ± 0.4 days) was lesser than that in group 2 (2.6 ± 0.7) (P = 0.01). The amount of hemoglobin drop was 1.1 ± 0.9 in group 1, 1.1 ± 0.7 in group 2, and 1.4 ± 0.91 in group 3 without a significant difference between all groups. The amount of bleeding during operation was 173 ± 103 in group 2 and 161 ± 78 in group 3 (P = 0.98).Conclusion:OSP without insertion of cystostomy tube is a relatively safe method; however, larger studies are needed. It is also comparable to TURP in terms of postoperative efficacy and complications.

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Modified Denis technique: a simple solution for maximal hemostasis in suprapubic prostatectomy

Cited by 9 publications

References 7 publications

Open prostatectomy with a rectal balloon: A new technique to control postoperative blood loss

Open prostatectomy with a rectal balloon: A new technique to control postoperative blood loss

Evolution of bloodless surgery: A case for bloodless suprapubic prostatectomy

Cystostomy–free open suprapubic transvesical prostatectomy: Is it a safe method?

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