Suprapubic prostatectomy.

England, 1930.

1 encoded moving image (26 min.) : silent, black and white

00:26:04

Segment 1 The intertitles give the 80-year-old male patient's history and current condition. They also show the results of his renal function tests and resistance to infection. The patient is shown being prepared for surgery, and being anaesthetised through the spine. The patient is brought into the operating theatre. A catheter is passed into the penis, and the bladder emptied and refilled. A median suprapubic incision of 4 or 5 inches is made, the skin undercut on each side of the wound. The rectus sheath is incised and recti separated. The peritoneum is drawn up. Time start: 00:00:00:00 Time end: 00:06:47:20 Length: 00:06:47:20

Segment 2 The bladder wall is held with forceps and incised. A suprapubic tray is applied and the bladder emptied of fluid. The enucleation of the prostate is described by the intertitles and demonstrated on a model. The prostate is raised into the bladder and removed. The bladder base and prostatic bed are exposed. A catgut sling is passed through each lip of the bladder wound. The patient is placed in the Trendelenburg position. A self-retaining ladder retractor is introduced and slings attached to the flynuts of the arms. The bladder base is exposed. Time start: 00:06:47:20 Time end: 00:12:41:08 Length: 00:05:53:13

Segment 3 The next stage is the toilet of internal meatus and prostatic bed. The nodule of prostatic tissue is dissected and removed. A wedge is removed from the overhanging ledge at the posterior segment of internal meatus. Tags of mucous membrane are removed. A continuous stitch is made including the bladder mucous membrane, torn edge of sphincter, free edge of pathological capsule, and is introduced around two-thirds of the circumference of internal meatus. The next stage is drainage. A tube is placed in the bladder and the bladder wound closed. A small rubber drainage tube is inserted in the prevesical space. Time start: 00:12:41:08 Time end: 00:19:35:14 Length: 00:06:54:06

Segment 4 The next stage is the repair of the abdominal wall. Two mattress catgut sutures are passed through the rectus sheath and muscles, and tied. The skin wound is closed with interrupted silkworm gut sutures, the patient replaced in a horizontal position and a catheter tied into the urethra. A dressing is applied and the patient removed on an inclined plane trolly. The removed prostate is displayed to the camera, and captions point out its different parts. It is also shown dissected. Time start: 00:19:35:14 Time end: 00:26:04:05 Length: 00:06:28:16

Produced by Sir John Thomson Walker, filmed by the Medical Department of Kodak Ltd., London.

British Medical Association.