Prostate Fossa Packing: A Simple, Quick and Effective Method of Achieving Hemostasis in Suprapubic Prostatectomy

Abstract

Introduction: Suprapubic prostatectomy remains a very common surgical treatment for bladder outlet obstruction from an enlarged prostate in the developing world. It is a technically simple procedure which can be learned by nonurologists who perform the bulk of these procedures in the developing world. Intraoperative and postoperative bleeding, however, can be a problem. We describe our experience with prostatic fossa packing at the time of the procedure, as a very simple, quick and effective technique for maximal hemostasis. Material and Methods: We have used this technique for several years at our institution and the results have been excellent. However, the major advantages of this technique became highlighted when the primary author visited Eritrea on a medical mission trip and used it in 42 consecutive cases. We looked at the hemorrhagic complications, both intraoperatively and postoperatively, infections and other complications related to the technique. Results: The 42 patients were typical of the patients that are seen in the developing world for suprapubic prostatectomy. The age range was 49–102 years. 75% had indwelling urethral catheters secondary to urinary retention. The duration of the catheters was from 2 weeks to 10 months. All the patients who had the indwelling catheters had bacteriuria. 56% had associated bladder calculi and 25% had associated inguinal hernias. The average surgical time was 45 min. The average intraoperative blood loss was estimated at 160 ml. There were no blood transfusions. There were no infections and there were no complications related to the packing. Conclusion: Packing of the prostatic fossa at the time of enucleation of the adenoma is a very simple, quick and effective way to achieve hemostasis in suprapubic prostatectomy. It is also very easy to learn. With this technique we have achieved zero rate of transfusion and no infections. The surgical time is also reduced. We have had no morbidities associated with this technique and highly recommend it.

Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

“…The use of temporary packing to obtain haemostasis is a practiced adjunct to surgical procedures in the pelvis 16 including urological procedures such as open radical and Millin's prostatectomies and cystectomies, and has become an acceptable approach to control haemorrhage from hepatic injuries. 17 This technique of packing the prostate has been demonstrated to be an effective method of controlling bleeding even in adverse circumstances with the absence of any direct long-term complications.…”

Immediate Transurethral Plasma Kinetic Enucleation of the Prostate Gland for Treatment of Benign Prostatic Hyperplasia-Associated Massive Hemorrhage: A Single-Center Experience

“…In addition to systemic support, the basic principles of BMH treatment are: (i) removing blood clots from the bladder; (ii) controlling bleeding; (iii) keeping the bladder drainage unobstructed (of which controlling bleeding is the core procedure). The means of hemostasis are compression of the bladder neck by a catheter balloon ( 19 ), transurethral surgery ( 5 ), and open surgery ( 20 ). Furthermore, if the patient suffers excessive loss of blood and cannot tolerate anesthesia or surgery, selective prostatic artery embolization (PAE) may be considered ( 21 , 22 ).…”

Evolution of bloodless surgery: A case for bloodless suprapubic prostatectomy

“…In many hands, the transfusion rate has remained high with little or no difference from series reported many decades ago,1112 whereas in others, the transfusion rate has significantly decreased38 and even reaching the 0% mark [Table 1]. 4571415 The few authors that have reported successful bloodless suprapubic prostatectomy seem to have achieved such results mainly through improved surgical hemostasis 4571415. Lezrek et al 7.…”

“…The authors reported a mean intraoperative blood loss of 264 ml, with none of the patients receiving blood transfusion [Table 1]. Mireku-Boateng and Jackson14 in a series of 42 patients used the approach of prostate fossa packing. The authors reported an average intraoperative blood loss of 160 ml, with no patient receiving blood transfusion [Table 1].…”

“…Furthermore, there are unpublished accounts of some surgeons that routinely transfuse all their patients undergoing open prostatectomy. However, of great encouragement is that some authors have significantly improved the surgical technique of doing open prostatectomy that they have been able to achieve 0.0% blood transfusion rate in their reported series 4571415…”