Prostatectomy

Prostatectomy
Surgical Technology
for the
Surgical Technologist
Chapter 17

Types of Prostatectomies
• Transurethral Resection of the Prostate
– TURP
• Suprapubic Prostatectomy
• Retropubic Prostatectomy
• Perineal Prostatectomy
• Transurethral Needle Ablation
– TUNA
– Not in book

TURP
• Pts are usually 60+ years old
• Typically performed in the OR or the Cysto room
• General or regional anesthetic
• Lithotomy position
• Glycine irrigation
Postoperative cathether-26fr, 30cc, 3 way
Cysto Room
Draping
Cystoscopy Instrumentation
Camera
Suprapubic Prostatectomy
• For prostates that are too large to remove endoscopically or for cancer
• Supine position
• Pfannenstiel incision

Bladder exposed
Bladder entered
Blunt dissection of the prostate
Prostate foss sutured to bladder mucosa
Bladder closed
Suprapubic Prostate Specimen
Retropubic Prostatectomy
• Performed much in the same way as the suprapubic approach
• Bladder not entered
• Provides better visualization of the prostatic fossa and better hemostatic control

Perineal prostatectomy
• Rarely used
• Provides good exposure of the prostatic fossa
• Performed in high lithotomy position with extreme trendelenburg
• Risks
– Position may cause injury to the elderly pt
– High risk of injury to the rectum
Perineal prostatectomy

TUNA-Transurethral needle ablation
• Can be performed under sedation with local
• Outpatient procedure
• Cost effective
• Uses low level radio frequency to generate frictional heat