eMedicine Specialties > Urology > Benign Prostatic Hypertrophy

Simple Prostatectomy: Workup

Author: Brian J Miles, MD, Medical Director, Chief of Urology Service, Director of Education, Associate Professor, Department of Urology, St Luke's Episcopal Hospital; Program Director, Baylor College of Medicine
Coauthor(s): Mohit Khera, MD, MBA, MPH, Assistant Professor of Urology, Scott Department of Urology, Baylor College of Medicine; Robert J Cornell, MD, Staff Physician, Department of Urology, Baylor College of Medicine; John S Colen, MD, Resident Physician, Department of Urology, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Aug 17, 2009

Workup

Laboratory Studies

  • Exclude prostate cancer before performing a prostatectomy in patients with symptomatic bladder outlet obstruction. All men should undergo preoperative prostate-specific antigen (PSA) determination and routine digital rectal examination (DRE). Suspicions evoked by either screening modality should prompt a transrectal ultrasound-guided needle biopsy of the prostate to exclude the presence of carcinoma before open (simple) prostatectomy is performed.
  • A urinalysis and urine culture, electrolyte study, complete blood cell count, coagulation studies, and at least a type and screen should be obtained in all patients prior to proceeding with an open (simple) prostatectomy.

Imaging Studies

  • Although transrectal ultrasonography may help document prostatic size, it is not indicated preoperatively and does not assist in the preoperative screening for prostatic malignancy.
  • Imagery of the upper urinary tract is not performed routinely in patients with outlet obstruction unless it is indicated for other reasons (eg, evaluation of hematuria).
  • Chest radiography is indicated to investigate potential complications of possible preexisting conditions in patients older than 60 years.

Other Tests

  • ECG is indicated to investigate potential complications of possible preexisting conditions in patients older than 60 years.

Diagnostic Procedures

  • Cystoscopy is useful for identifying the presence of urethral stricture disease, bladder calculi, diverticula, and a large median lobe. This information is useful in deciding whether to perform a suprapubic versus a retropubic prostatectomy.
  • Preoperative lower urinary tract studies may include a urinary flow rate with documentation of postvoid residual and, possibly, a cystometrogram and pressure or flow evaluation in patients with more complex conditions who may have coexisting bladder instability or detrusor function abnormalities.

More on Simple Prostatectomy

Overview: Simple Prostatectomy
Workup: Simple Prostatectomy
Treatment: Simple Prostatectomy
Follow-up: Simple Prostatectomy
References
Further Reading
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References

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  26. Williams G, Coulange C, Milroy EJ, et al. The urolume, a permanently implanted prostatic stent for patients at high risk for surgery. Results from 5 collaborative centres. Br J Urol. Sep 1993;72(3):335-40. [Medline].

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Keywords

simple prostatectomy, open prostatectomy, retropubic prostatectomy, simple retropubic prostatectomy, Millin prostatectomy, enucleation of a hyperplastic prostatic adenoma, suprapubic prostatectomy, simple perineal prostatectomy, benign prostatic hyperplasia, BPH, transurethral resection of the prostate, TURP, lower urinary tract obstruction, bladder outlet obstruction, urinary tract infections, recurrent hematuria, bladder calculi, renal insufficiency, laparoscopic simple prostatectomy, perineal enucleation prostatectomy

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Contributor Information and Disclosures

Author

Brian J Miles, MD, Medical Director, Chief of Urology Service, Director of Education, Associate Professor, Department of Urology, St Luke's Episcopal Hospital; Program Director, Baylor College of Medicine
Brian J Miles, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Association of Military Surgeons of the US, Society of Urologic Oncology, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Mohit Khera, MD, MBA, MPH, Assistant Professor of Urology, Scott Department of Urology, Baylor College of Medicine
Mohit Khera, MD, MBA, MPH is a member of the following medical societies: American Medical Association, American Urological Association, and Texas Medical Association
Disclosure: Auxilium Honoraria Speaking and teaching; Coloplast Honoraria Speaking and teaching; American Medical Systems Honoraria Speaking and teaching

Robert J Cornell, MD, Staff Physician, Department of Urology, Baylor College of Medicine
Robert J Cornell, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

John S Colen, MD, Resident Physician, Department of Urology, Baylor College of Medicine
John S Colen, MD is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Michael Grasso, MD, Chairman, Department of Urology, Saint Vincent's Medical Center; Professor and Vice Chairman, Department of Urology, New York Medical College
Michael Grasso, MD is a member of the following medical societies: American Medical Association, American Urological Association, California Medical Association, and Endourological Society
Disclosure: Karl Storz Endoscopy Consulting fee Consulting; Boston Scientific Consulting fee Consulting; Cook Urologic Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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