Millin's retropubic prostatectomy: a clinical study

[Modified Denis's technique for hemostasis in transvesical prostatectomy for prostatic adenocarcinoma. 20 case reports]

The authors present modified Denis's technique for hemostasis in 20 suprapubic prostatectomy. The technique is based on the separation between the bladder and the prostatic fossa with a temporary purse-string suture around the bladder neck. The vacuum of the prostatic fossa leads to the retraction and hemostatis. This technique is very effective on intra and post operative hemorrhage, so economy of irrigating fluid; then easier post operative care.

Modified Denis technique: a simple solution for maximal hemostasis in suprapubic prostatectomy

OBJECTIVES

To describe our experience with a modified Denis technique for hemostasis in suprapubic prostatectomy.

METHODS

We reviewed the charts of 78 patients who underwent suprapubic prostatectomy using a modified Denis technique between September 1996 and June 2001. After adenomectomy, we performed a bladder neck removable partition purse-string suture, and the prostatic fossa was drained. Patients were followed up for hemorrhagic complications and bladder neck strictures for 12 months.

RESULTS

The mean intraoperative hemorrhage amount was 264 mL (range 160 to 510). The postoperative irrigating fluid volume was 2000 mL (range 500 to 4500), and the bladder irrigation duration was 24 hours in 70 patients (89.8%) and 48 hours in 8 patients (10.2%). Postoperative hemorrhage, measured by the prostatic fossa drain, was 0 mL in 48 patients and had a mean value of 55 mL (range 10 to 90) in 30 patients. No hemorrhagic complication was noted. None of our patients had transfusion, bladder clot formation, or late hemorrhage. One case (1.3%) of bladder neck stricture developed.

CONCLUSIONS

This modified Denis technique is very effective and easy to perform and to learn. It has solved all our hemorrhagic problems in suprapubic prostatectomy.