Chronic retention treatment

TREATMENT

Medication

Alpha blockers

These drugs relax the muscles of the neck of the bladder urine thus passes with ease

These drugs have a positive effect in 2/3 of the patients with BPS you have to start with a low dose

Finastride (proscar, Propecia) symptoms are relieved because these drug cause shrunkage of prostate

 It takes 2 months to show its positive effects

The aims of therapy are :

*     Eliminate infection by antibiotics

*     Relieve retention if present by catheterisation

*     And to remove the obstructing prostate by any of

      the following surgical procedure:

      -     Transurethral resection of prostate Fig. 26.7

(Fig 26.7)

      -     Open prostectomy i.e. transvesicle or retropubic

Transuretheral prostotectomy (TURP)

A resectoscope is used and passed through the urethra into the bladder

It allows you to view the bladder and the prostatc urethra

It has a tungsten wire loop and a high frequency current passing through this loop allows this loop to cut through the prostate from inside

Small fragment of prostate can be washed out

The urethra is enlarged bleeding points can be touched with diathermy

A catheter is left in the bladder

Suprapubic prastatectomy

A suprapubic vertical or transverse incision is required

This approach to prostate is through the bladder

The enlarged prostate is removed by blunt finger dissection by the surgeon. The enlarged prostate is delivered into the bladder

The bleed points in the remaining compressed capsule of the prostate are touched with diathermy

A suprapubic and urrethral cathera left for draining urine

The bladder is closed around the supropubic catheter

A retropubic drain is inserted

Retropubic Prostatectomy

A suprapubic incision

The bladder is identified

The prostate capsule is incised 1.5cm beyond the bladder neck

The adenoma is mobilized by finger dissection

Adenoma removed and bleeding points diathermy touched

The capsule is closed with a urethral a catheter in bladder

If hemostasis is less than perfect a suprapubic catheter can also be kept

The retropubic space is drained

The wound closed

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.otmanage.blogspot.com

www.surginstruatlas.blogspot.com           www.drmmkapur.blogspot.com

Also available now on android & smartphones same  internet addre