Open simple prostatectomy (Millin / Freyer)

How the operation is performed

Under general anaesthesia, an incision is made in the lower abdomen. Depending on the technique:

• Freyer (transvesical) approach - the bladder is opened and the adenoma is enucleated with a finger through the bladder neck.
• Millin (retropubic) approach - the prostate capsule is opened directly and the adenoma is enucleated with the bladder left intact.

In both techniques the adenoma is removed as whole lobes. A catheter is left in for several days, and hospital stay is typically 5-7 days.

Open prostatectomy vs HoLEP

• Surgical principle. Both remove the adenoma along its natural anatomical plane. HoLEP does so through the urethra with a laser; open surgery does so through an abdominal incision with a finger and scissors.
• Bleeding. Significantly higher with open surgery. Randomised data show less bleeding and lower transfusion rates with HoLEP.^{4, 5}
• Hospital stay. Typically 5-7 days for open surgery versus 1-3 days for HoLEP.^{4, 9}
• Abdominal wound. HoLEP avoids it entirely.
• Functional outcomes. Equivalent in randomised trials out to 24 months (prostates over 70 g) and 5 years (prostates over 100 g).^{4, 5}

Open simple prostatectomy remains appropriate in a small number of patients where HoLEP is not feasible, such as men with a huge bladder diverticulum that also needs to be removed. For the great majority of very large glands, HoLEP is now the preferred option.