Methods of Haemostasis and Restore of Bladder-urethral Segment During Retropubic Prostatectomy in Patients with Benign Prostatic Hyperplasia


Viktor Gorovyi
Volodymyr Shaprynskyi
Ihor Baralo
Oleh Kapshuk
Andrii Dubovyi
Volodymyr Mudrytskyi


The objective: to estimate methods of haemostasis and restore of bladder-urethral segment during retropubic prostatectomy in patients with benign prostatic hyperplasia.

Materials and methods. Analysis of methods of haemostasis and restore of bladder-urethral segment during retropubic prostatectomy in patients with benign prostatic hyperplasia was performed.

Results. Open retropubic prostatectomy (like transbladder prostatectomy) was recommended by European Association of Urology (EAU, 2020) as operation of first choice for surgical treatment big size prostatic hyperplasias.

The authors gave such prevalences of retropubic prostatectomy over trans-bladder: operation is performed under visual control that gives haemostatic control of prostatic cavity and removing all parts of nodules; the bladder is not drainaged that avoids disuria in postoperative period, decreases postoperative bed-time and increases comfort for patients; urethra is cut by scissor in apical part of prostate that is prophylaxis tearing of urethra, trauma of exernal sphincter, stricture of memranaceas urethra and urine incontinence after operation; reconstruction of bladder-urethral segment is performed that is prophylaxis of stricture of bladder neck; surgeon can performed simultaneous hernioplasty and retropubic prostatectomy in case of inquinal hernia and benign prostatic hyperplasia.

Arterial and venous blood supplying of bladder and enlarged prostate were wrote. Places of arterial and venous bleeding after cutting of prostatic capsule and removing nodules, prophylaxis suturing of arterial and venous bleeding places were noted. Original own methods of restoring of bladder-urethral segment and haemostasis of prostatic cavity by using two or three П-like catgut sutures were shown.

For simplifying operation and decreasing time of performing operation and increasing haemostasis of prostatic cavity authors recommended performing passing haemostatic sutures throught prostatic capsule only once and linking of sutures on muscle peaces from rectus muscle (or pyramidal muscle). In case of absent bleeding from prostatic cavity the simplify method of bladder neck trigonisation by using two П-like catgut sutures or two V-like catgut sutures on bladder neck for prophylaxis of bladder neck stenosis was recommended (proximal trigonisation of bladder neck in prostatic cavity). Review of haemostatic merhods of prostatic cavity during retropubic prostatectomy was shown.

Conclusion. Analysis of methods of haemostasis and restore of bladder-urethral segment and own original methods during retropubic prostatectomy in patients with benign prostatic hyperplasia allow improve haemostasis of prostatic cavity, prophylaxis of bladder neck and urethra stenosis, decrease intraoperative bleeding and period of operation.


How to Cite
Gorovyi, V., Shaprynskyi, V., Baralo, I., Kapshuk, O., Dubovyi, A., & Mudrytskyi, V. (2021). Methods of Haemostasis and Restore of Bladder-urethral Segment During Retropubic Prostatectomy in Patients with Benign Prostatic Hyperplasia. Health of Man, (2), 38–48.
For practicing physicians
Author Biographies

Viktor Gorovyi, Vinnitsia Regional Clinical Hospital named after M. I. Pirogov

Viktor I. Gorovyi

Volodymyr Shaprynskyi, Vinnitsia Regional Clinical Hospital named after M. I. Pirogov

Volodymyr O. Shaprynskyi

Ihor Baralo, Vinnitsia Regional Clinical Hospital named after M. I. Pirogov

Ihor V. Baralo

Oleh Kapshuk, Vinnitsia Regional Clinical Hospital named after M. I. Pirogov

Oleh M. Kapshuk,

Head of Urological Department

Andrii Dubovyi, Vinnitsia Regional Clinical Hospital named after M. I. Pirogov

Andrii V. Dubovyi,

Urological Department

Volodymyr Mudrytskyi, Vinnitsia Regional Clinical Hospital named after M. I. Pirogov

Volodymyr B. Mudrytskyi,

Urological Department


Veliev EI Modified technique of retropubic adenomectomy (RMAPO technique). EI Veliev, AE Sokolov, AB Bogdanov, LV Ilyushin. Urology. 2012;4:65–8.

Vozianov AF Open prostatectomy in the surgical treatment of benign prostatic hyperplasia. AF Vozianov, SP Pasechnikov, Ya.N. Klimenko, VS Gritsai. Men’s health. 2008;1:196–205.

Acute bleeding in urology. BG Vedenko, VP Golovenko, VI Gorovy [etc.]. Vinnytsia: Mercury-Podillya. 1999. – 240 p.

Gursky BF Comparative assessment of different methods of adenomectomy. BF Gursky, PI Pivovarov. Current issues of urology: Abstracts. report. Lviv, 1983. – P. 107–9.

Zalobkova prostatectomy in the surgical treatment of benign prostatic hyperplasia. VI Gorovy, VO Shaprinsky, IV Baralo [etc.]. Vinnytsia: Writings. 2021. – 336 p.

Clinical anatomy of the urogenital organs. VI Gorovy, VO Shaprinsky, BF Mazorkuk [etc.]. Vinnytsia: Writings. 2016. – 640 p.

Kobzin OL. Method of hemostasis and restoration of the vesico-urethral segment during zalon prostatectomy. ОL Kobzin, VP Golovenko, VI Gorovy, AO Sapsay. Questions of medical practice and theory. Vinnytsia, 2006. – P. 44–7.

Urgent urology in the practice of surgical doctors: a textbook. VI Gorovy, VO Shaprinsky, GV Chaika [etc.]. Vinnytsia: LLC. Writings. 2018. – 824 p.

Pereverzev A. Prostate adenoma. A.S. Pereverzev, N.F. Sergienko. Kiev, 1998. – 278 p.

Pereverzev AS. Will urologists keep open adenomectomy in the treatment arsenal? Men’s health. 2009;4:230–4.

Pivovarov PI. Hemostasis in extravesical retropubic adenomectomy. РI Pivovarov, BF Gursky, VD Maksimov. Urology. – Issue. 23.1989:65–7.

Pivovarov PI. On retropubic access in surgery of bladder outlet obstruction. PI Pivovarov, BF Gursky, VD Maksimov. Urology. – Issue 22.1988:47–51.

Pivovarov PI. Method of hemostasis in extravesical retropubic adenomectomy. PI Pivovarov, BF Gursky, VD Maksimov, VI Gorovoy. Urol. and nephrol.1991;2:37–41.

Increase MG. Intraorganic arteries of the prostate gland. MG Addition. Vestnik of venereology and dermatology. MG Prives. 1953;2:48–9.

Pushkar OM. Immediate results of optimization of one-stage extralon simple prostatectomy. Urology. 2000;1:22–5.

Pushkar OM. Modification of onemoment zalon prostatotomy: author’s ref. dis. on zdob. Science. stup. Cand. med. n .: spec. 14.01.06 Urology. Kyiv, 2001. – 18 p.

Ratner GL Arterial blood supply to the prostate gland in conditions of its hypertrophy. Urology. 1957;6:27–31.

Resolution of the Plenum of the Board of the All-Russian Society of Urologists on the problem «Diagnosis and treatment of prostate adenoma» (Kursk, May 27–28, 1993). Urol. and jade. 1994;5:53.

Romensky O.Yu. Intraorganic arteries of the human prostate. Archives of anatomy, histology and embryology. 1960;39(7):59–64.

Saidakova NO. Epidemiology of benign prostatic hyperplasia in Ukraine. NO Saidakova, VP Stus, SP Dmitryshyn [etc.]. Urology. 2018;4:5–12.

Saidakova NO. Basic indicators of urological care in Ukraine for 2016–2017: departmental publication. NO Saidakova, LM Startseva, GE Kononova [etc.]. Kyiv: Polium, 2018. – 216 p.

Sergienko NF. Extraurethral adenomectomy. M.: Patriot Publishing House, 2010. – 336 p.

Sergienko NF. Extracorporeal urethro- and vascular-preserving extraurethral adenomectomy. NF Sergienko, MI Vasilchenko, AV Shchekochikhin [et al.]. Urology. 2012;5:96–9.

Sernyak PS. Modification of suprapubic adenomectomy of the prostate. Adenoma of the prostate: Proceedings of the V International Congress of Urologists. PS Sernyak, Yu.A. Vinentsov, SN Shamraev, VG Kobets. Ed. prof. A.S. Pereverzeva. Kharkiv: Fakt, 1997. – P. 164–7.

Sernyak Yu.P. Our experience of surgical treatment of prostate hyperplasia. Yu.P. Sernyak, Yu.O. Vientsov, SM Shamraev. Urology. 1999;2:48–51.

Sernyak Yu.P. Comparative evaluation of prostatectomy and transurethral resection of the prostate in patients with benign prostatic hyperplasia. Yu.P. Sernyak, MV Kryshtopa, ID Kryzhanovsky. Transport Medicine of Ukraine. 2012;2:87–91.

Skiba VV. Experience of surgical treatment of benign prostatic hyperplasia. VV Skiba, OV Vitrenko, Yu.V. Burdym. Clinical surgery. 2017;7:75–6.

Sokolov AE. Modified retropubic adenomectomy: technical features and functional results: Author’s abstract. dis. ... Cand. med. Sciences. Moscow, 2017. – 21 p.

Hinman F. Operative urology: Atlas: Per. From eng. F. Khinman. M.: GEOTAR-MED, 2001. – 1192 p.

Shamrayev SM. A new method of formation of vesicourethral anastomosis after extraplastic prostatectomy. Urology. 1999;1:52–4.

Shamraev SN. Results of various methods of formation of urethrocystoanastomosis in retropubic prostatectomy. SN Shamraev, PS Sernyak, Yu.А. Vinentsov. Materials of scientific works of the VII International Congress. Kharkov, 1999. – 354–8 р.

Shamraev SM. Modification of gingival prostatectomy: author’s ref. dis. on zdob. Science. stup. сand. med. n.: spec. 14.01.06 Urology. Kyiv, 1999. – 20 p.

Shamraev SN. Post-pubic prostatectomy – a look into the past of prostatectomy. SN Shamraev, PS Sernyak, Yu.A. Vinentsov. Men’s health. 2013;4:178–9.

Shaprynsky VO. Application of simultaneous peritoneal plastic inguinal hernias with one-step groove prostatectomy. VO Shaprynsky, VI Gorovy, OM Kapshuk. Proceedings of the scientific-practical conference with international participation «Modern technologies in alloplastic and laparoscopic abdominal hernia surgery». Kyiv, 2019. – P. 119–21.

Shaprinsky VO. Improvement of the method of hemostasis when performing one-stage valvular prostatectomy and simultaneous peritoneal hernioplasty in patients with benign prostatic hyperplasia and inguinal hernia. VO Shaprinsky, VI Gorovy, OM Kapshuk, OO Vorovsky. Kharkiv Surgical School. 2020;1 (100):195–200.

Shkodkin SV. Methods for the prevention of hemorrhagic complications in retropubic adenomectomy. SV Shkodkin, DA Zolotukhin, Yu.B. Idashkin [et al.]. Kursk scientific and practical bulletin «Man and his health». 2018;1:40–5.

Asimakopoulos AD. Surgery illustrated-surgical atlas laparoscopic treatment of benign prostatic hyperplasia (BPH): overview of the current techniques. A.D. Asimakopoulos, C. Mugnier, J-L. Hoepffner [et al.]. BJU International. 2011;107:1768–82.

Bensimon H. Hemostatic retropubic prostatectomy. J. Urol. 1973;110(3):326–8.

Campbell-Walsh Urology. L.R. Kavoussi, A.C. Novick, A.W. Partin [et al.]. 11th ed. Philadelphia: Elsevier, 2016. – 4904 p.

Dalloglio M.F. An improven technique for controlling bleeding during simple retropubic prostatectomy: a randomized controlled study. M.F. Dalloglio, M. Spougi, A.A. Antunes [et al.]. BJU International. 2006;98:384–7.

EAU Guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). S. Gravas, N. Cornu, M. Gacci [et al.]. EAU, 2020. – 68 p.

Fitzpatrick J.M. Surgery illustrated-surgical atlas Millin retropubic prostatectomy. BJU International. 2008;102:906–16.

Flocks R.H. The arterial distribution within the prostate gland: its role in transurethral prostatic resection. J. Urol. 1937;7(4):524–48.

Gregoіr W. L`adenomectomie hemostatique. Acta Urologica Belgica. 1968;36(4):337–48.

Gregoіr W. Hemostatic adenomectomy. Urol. Int. 1969;24:426–38.

Hinmann’s atlas of urological surgery. Smith J.A. [et al.]. 4rd. ed. Elsevier Saunders, 2018. – 982 p.

Jain A.C. A new method of prostatectomy with preliminary ligation of the blood vessels. Acta. Urol. Belg. 1968;36(4):349–56.

Mansar S-E. Le drainage pelvien après adenomectomie prostatique transvesicale reste-il idispensable? (a propos de 100 cas). Universite Mohammed VRabat, 2018. – 166 p.

Netter F.H. Atlas of human anatomy. 5th ed. Saunders Elsevier, 2011. – 618 р.

Porpiglia F. Transcapsular adenomectomy (Millin): a comparative study, extraperitoneal laparoscopy versus open surgery. F. Porpiglia, C. Terrone, J. Renard [et al.]. Eur. Urol. 2006;49:120–6.

Pryor J.P. Retropubic prostatectomy. In: Roband Smith`s Operative Surgery. Urology. Butterworths. 1986. – P. 424–31.

Shaheen A., Quinlan D. Feasibility of open simple prostatectomy with early vascular control. BJU International. 2004;93:349–52.

Srougi M. An improved technique for controlling bleeding during simple retropubic prostatectomy. M. Srougi, M.F. Dall’Oglio, A.C. Bomfirm [et al.]. BJU International. 2003;92:813–7.

Sotelo R. Open adenomectomy: past, present and future. R. Sotelo, R. Clavijo. Current opinion in Urology. 2008;18:34–40.

Tubaro A. The current role of open surgery in BPH. A. Tubaro, C. Nunzio. EAU-EBU update series. 2006;4:191–201.

Walsh P.C. Improoved hemostasis during simple retropubic prostatectomy. P.C. Walsh, L.E. Osterling. J. Urol. 1990;143:1203–4.

Walz J. A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy: An update. J. Walz, J.I. Epstein, R. Ganzer. Eur. Urol. 2016;70:306–11.

Zargooshi J. Open prostatectomy for benign prostatic hyperplasia: short-term outcome in 3000 consecutive patients. Prostate Cancer and Prostatic Diseases. 2007;10:374–7.