Transvesical prostatic adenomectomy: general or local anesthesia

Abstract

A transvesical prostatic adenomectomy is defined as an “open-sky” surgical procedure performed to remove a benign prostatic nodule that, growing up, could represent an obstacle to the normal emptying of the bladder. This operation can be carried out under general or loco-regional anesthesia conditions: the second option, however, does not provide the curarization of the patient, and could result in a higher endoabdominal pressure, which could significantly reduce the surgeon's visual field. Nevertheless, this technique allows for a complete analgesia and anesthesia during the first postoperative hours, avoiding the occurrence of abdominopelvic contractions and pain-linked hypertension, which can cause dangerous postoperative bleedings.

As opposed to this, during surgery under general anesthesia conditions, the curarization ensures a wider operating field, free from abdominopelvic contractions, but with important postoperative pain, the main cause of which is the continuous bladder washing; this kind of pain is very difficult to treat even with oppioids: it is certainly the most important cause of bleedings, resulting in patient's discomfort, risk of blood transfusion or even reoperation. The two techniques have been compared in a randomized study on 40 patients: the subarachnoid technique seems definitely to be more favorable, with its optimal antalgic effect even during the first postoperative hours, with no need to use high doses of antalgic iv drugs, and, most important, with no subsequent postoperative hypertension and bleedings.