The use of Modified Technique in Freyer’s Prostatectomy to Achieve Hemostasis

Background: The ratio of open surgery to endoscopic resection varies greatly among different countries like India. Despite its reputation as the gold standard, TURP remains out of reach for the great majority of rural residents due to a lack of experience and equipment. Persistent bleeding from the prostate bed is one of the most serious side effects after open prostatectomy. This study aims to establish a strategy for achieving full hemostasis in open prostatectomy by applying traction to the Foley's catheter, compressing the venous plexus and avulsed prostate arteries at the bladder neck with the inflated balloon, and so minimising blood loss.

Methods: Freyer's suprapubic trans-vesicle prostatectomy was used to treat 130 patients of BPH. The bladder mucosa is repositioned beneath the balloon, which is filled with 60 mL of normal saline, and traction is provided to the catheter and maintained for 24-48 hours by strapping the catheter to the patient's thigh.

Results: The average blood loss was 20.9 ml, demonstrating that Foley's balloon pressure traction approach at the bladder neck is effective in attaining hemostasis in open prostatectomy patients.

Conclusions: In almost all of the patients treated, the balloon pressure approach is an efficient way to achieve hemostasis and avoid blood transfusion.