Haemostasis in freyer’s prostatectomy by rectal mucosa reposition technique

Abstract

Background: This study was an attempt to develop a technique by which complete haemostasis can be achieved on table by reposition of the rectal mucosa in the prostatic fossa and applying traction to the Foley’s catheter.

Patients and Methods: A total of 170 cases of BPH were operated by Freyer’s Suprapubic Trans-vesicle prostatectomy All 170 patients presented with symptomatic BPH. They were all admitted and treated as in-patients. During Surgery, prostate was supported with a finger passed rectally and enucleation of prostate was done. After enucleation of prostate in addition to the index finger, middle finger was inserted and the rectum was pulled caudally. This helped to exert minimal pressure over the venous plexus. A Foley’s catheter three way size 22 – 24 was placed in the bladder and the bladder mucosa reposited below the balloon posteriorly, by the finger. The balloon was inflated to 60 ml of normal saline and kept at the bladder neck and traction applied to the catheter. No suprapubic and retropubic drains were kept. Study of intraoperative blood loss was calculated by weight of sponges pre- and post-operatively soaked with blood. This gave the amount of loss in the sponge (1gm = 1ml )³ to which the amount of blood in the suction bottle was added. Study of post operative blood loss was done by collecting the urine for 24hrs and calculating the urine hemoglobin by photoelectric calorimeter by sinemethhaemoglobin method.
Results: Four (4%) out of 170 patients developed wound infection. All the patients in the study group had blood loss ranging from 10 to 50 ml.The average blood loss was 18.9 ml which is significantly lower than that in other studies.
Conclusion: The balloon pressure traction technique is an effective method of achieving haemostasis and avoids blood transfusion in almost all of the patients thus treated.