• Prostatectomy by the retropubic procedure has the advantage that the patient usually recovers more quickly than when other approaches are used, but surgeons have been reluctant to use it because of reports of excessive bleeding and subsquent osteitis pubis. The hemorrhage can be reduced by attention to the vessels coming from the prostaticovesical junction above and the penis below. The latter include branches from the internal pudendal arteries and sinuses related to the deep penile veins; most of these are controlled by 20 minutes of pressure on the perineum under the pubic arch. Hemmorrhage from branches of the inferior vesical artery can be checked by placing a forceps astride the prostatic capsule at the prostaticovesical junction during the dissection and by certain precautions as to ligatures and sutures after all the hyperplastic tissue has been removed. Osteitis pubis is probably related to the accumulation of pent-up serum in the retropubic space. As much as 200 cc. has been obtained by aspiration in one case. Careful drainage is now used to prevent this, with the result that no evidence of osteitis pubis has been seen after 410 retropubic prostatectomies.
Nelson OA. HEMOSTASIS AND PREVENTION OF OSTEITIS PUBIS IN RETROPUBIC PROSTATECTOMY. JAMA. 1957;163(9):721–723. doi:10.1001/jama.1957.02970440017005
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