DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Bladder outlet obstruction.
2. Benign prostatic hypertrophy.
3. Urinary retention.
POSTOPERATIVE DIAGNOSES:
1. Bladder outlet obstruction.
2. Benign prostatic hypertrophy.
3. Urinary retention.
OPERATION PERFORMED: Simple retropubic prostatectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General with endotracheal intubation.
DESCRIPTION OF OPERATION: After the patient was brought to the operating room and adequate anesthesia was achieved, the previously placed Foley catheter appeared not to be draining well. His bladder was palpably distended. He was then shaved. The urethral catheter was removed. He was prepped and draped in the usual sterile fashion. A 22 French urethral catheter was placed to decompress the bladder. Approximately 1 liter of urine was returned. The catheter was subsequently removed. A low midline incision was made from the umbilicus to the pubic symphysis. The linea alba was then opened, and the rectus muscle was then retracted laterally. A Balfour retractor was placed. It should be noted, upon entering the prevesical and retropubic space, there appeared to be some edema involving the tissue and some fluid, probably urine, suggestive of maybe an extravesical bladder perforation secondary to chronic bladder outlet obstruction.
At this point, the peritoneum and the extraperitoneal fat were then swept superiorly. There were some large veins in the loose areolar tissue and fat over the anterior capsule of the prostate. These were suture ligated and divided. The prostate was palpated. The vesical neck was then visualized and palpated. Two traction sutures were then placed in the prostatic capsule above and below the planned site of the capsular incision, which was made about 1 cm distal to the bladder neck.
A capsulotomy was then made, and the LigaSure was then used to further extend the capsulotomy and at the same time maintain hemostasis. The cleavage plane between the prostatic adenoma and the surgical capsule was then developed using the Metzenbaum scissors. Digital enucleation was then performed. The adenoma was completely removed. The apex of the prostatic urethra was sharply excised. The specimen was completely removed. There was some troublesome bleeding noted in the prostatic fossa.
Hemostatic sutures using 2-0 chromic in a figure-of-eight position were placed at the 5 and 7 o’clock position. The prostatic fossa was then copiously irrigated with normal saline. The posterior lip of the bladder neck was then tacked down into the prostatic fossa using 2-0 chromic. A 22-French, 30 mL 3-way Foley catheter was then placed and inserted through the urethra into the bladder. A transverse incision of the prostatic capsule was then closed using 2-0 chromic in a continuous locking fashion. The catheter was then irrigated and 60 mL of normal saline was instilled into the balloon port. The catheter was placed on mild traction.
CBI was then initiated using normal saline. A 10 flat Jackson-Pratt drain was then placed and brought out through a separate stab incision in the lower abdomen. The drain was secured in place using 2-0 silk. The wound was then closed using #1 PDS loop. The skin was then closed with skin staples. The patient tolerated the procedure well. There were no immediate complications. Sponge and instrument counts were reported to be correct. The patient received broad-spectrum antibiotics. Estimated blood loss was 300 mL.
