Erectile Dysfunction

Open prostatectomy can have an adverse impact on sexual performance. The review conducted by McConnell and associates revealed postoperative erectile dysfunction in 32 , 16 , and 18 in patients undergoing perineal, retropubic, and suprapubic prostatectomy, respectively (21). In theory, leaving an intact and nonviolated prostatic capsule should mitigate against the development of either incontinence or erectile dysfunction. It has been assumed that preexisting erectile dysfunction may be more...

Benign Prostatic Hyperplasia

Prevalence Bph 2012

Urinary obstruction resulting from benign prostatic disease was described in the earliest days of medicine. Initially formalized by Riolan in the 17th century, the relationship between BPH and urinary obstruction was further elucidated by Morgani in the mid-18th century he provided one of the earliest descriptions of BPH and its sequelae 23 . More specific recognition of the pathologic process has been credited to Virchow in the last quarter of the 19th century. Despite a greater understanding...

Androgen And Prostate Growth

Pseudohermaphrodites

The prostate gland is dependent on androgens that are produced exogenously by the testicles to facilitate normal development and to maintain normal structure and function 1 . Briefly, the testes are stimulated to produce and secrete testosterone and other steroids by an exogenous protein, luteinizing hormone, which is made in the pituitary gland. Testosterone T is converted to its reduced form, dihydrotestosterone DHT , by the enzyme 5a-reductase in the prostate. Both T and DHT bind to and...

Long Term Complications

Long-term complications following TURP primarily include urinary tract infection, obstruction, incontinence, and erectile dysfunction, although there is debate about whether the latter is truly associated with the procedure. Interestingly, despite the use of prophylactic and perioperative antibiotics, delayed genitourinary infection is still a significant problem after TURP, accounting for nearly half of long-term complications 4 21 . This is probably not a result of persistent bacteriuria from...

Simple Perineal Prostatectomy

Prostate Adenoma Enucleation

Currently, adenomectomy for the treatment of BPH is rarely performed by means of the perineal route. Previously, this approach was associated with significantly lower mortality than the abdominal route. However, this latter advantage has disappeared in the modern era as the mortality from all forms of prostatectomy has decreased to exceedingly low levels 18 . Resurgence of interest in the radical perineal prostatectomy has resulted in an increasing number of urologists becoming familiar with...

Indications For Turp

Cystoscopy Image Bladder Infection

Patients selected for TURP should have clinical symptoms and signs caused by bladder outlet obstruction from BPH, because this procedure is thought to work by removal of obstructing prostate tissue. Most patients 90 who undergo TURP do so because of the bothersome irritative and obstructive symptoms associated with BPH, termed prostatism, or more recently, lower urinary tract symptoms LUTS 3 . Other patients, however, are treated for increased postvoid residual urine, urinary retention, urinary...

Indications For Open Prostatectomy

There are a number of factors that should prompt the serious consideration of suprapubic transvesical prostatectomy. These include the following 1 adenomas gt 75 g 2 transition zone hyperplasia associated with a large, prominent subtrigonal component 3 presence of a physiologically relevant diverticulum 4 multiple large bladder calculi 5 confounding orthopedic problems such as severe spinal stenosis and fusion ankylosis of the hip joints 6 large scrotal hernia or massive hydrocele 7 rigid or...

Suprapubic Transvesical Prostatectomy

Suprapubic Transvesical Prostatectomy

Following the induction of satisfactory general or regional anesthesia, the operating table should be gently flexed in the modified Trendelenburg position. Care must be taken to avoid injudicious flexion that might induce a sacral stretch injury. When properly performed, this simple position change facilitates exposure within the narrow male pelvis and permits more facile mobilization of the peritoneal reflection. At this point, thigh-high anti-embolism stockings should be placed along with...