Modified technique in Freyer's prostatectomy to achieve hemostasis

Abstract

Background:The ratio of open surgery to endoscopic resection has large variations among different countries like India. Although TURP is considered as the gold standard, it is still out of reach for a vast majority of rural population due to the unavailability of expertise or equipment. One of the major complications of open prostatectomy is persistent bleeding from prostate bed. This study is an attempt to develop a technique by which complete hemostasis can be achieved by giving traction to the Foley's catheter thereby compressing the venous plexus and the avulsed prostate arteries at the bladder neck by the inflated balloon thereby reducing blood loss in open prostatectomy. Methods: A total of 130 cases of BPH were operated by Freyer's suprapubic trans-vesicle prostatectomy. Bladder mucosa is reposited below the balloon and the balloon inflated to 60ml of normal saline and traction is applied to the catheter and maintained by strapping the catheter to the thigh of the patient for 24-48 hours. Results: The average blood loss was 20.9 ml which proves that the Foley's balloon pressure traction method at the bladder neck is effective in achieving hemostasis in patients undergoing open prostatectomy. Conclusions: The balloon pressure technique is an effective method of achieving hemostasis and avoids blood transfusion in almost all of the patients treated.