title: A 30-year experience of Millin's retropubic prostatectomy: Has this classic operation derived by a President of the College in Ireland stood the test of time?
abstract: BACKGROUND
  In patients with large gland volume, open prostatectomy/adenoma enucleation remains a valuable surgical option in treating large obstructing prostates. We report our series of open prostatectomies spanning 32 years from a single institution.
  
  
  METHODS
  We retrospectively reviewed all patients who underwent open prostatectomy between 1980 and 2012. Patient demographical, clinical, pre- and postoperative data and final histology were retrieved from hospital in-patient enquiry system and chart review.
  
  
  RESULTS
  A total of 161 patients underwent Millin's prostatectomy by seven surgeons between 1980 and 2012. The mean blood loss was 1,381 mls (range 300-3,675 mls). One-third (34%) of patients (n = 55) received a blood transfusion. The mean weight of prostate tissue removed was 119 g (median 112 g, range 17-372 g). 6.6 % of pathological specimens revealed incidental prostate cancer, of which 78% were well differentiated (Gleason score ≤ 6). The mean weight of prostate tissue removed in patients who received a transfusion was 124 g. Trial of micturition (TOM) was performed at a mean of 9 days (median 9 days, range 5-25 days) with 94% of patients having a successful trial of voiding. 6% of cases early in the series failed to void initially, but did so at later removal of catheter while still in hospital. 45 patients (28%) of patients developed peri- or postoperative complications. There were three deaths (1.9%).
  
  
  CONCLUSIONS
  Open Millin's prostatectomy popularized over half a century ago continues to be a valuable option for the surgical treatment of high-volume prostate glands with excellent outcomes for patients.
authors.affiliation: Department of Urology, The Adelaide and Meath Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin 24, Ireland.
authors.forename: R M
authors.initials: RM
authors.lastname: Long
authors.forename: A Z
authors.initials: AZ
authors.lastname: Thomas
authors.forename: C
authors.initials: C
authors.lastname: Browne
authors.forename: M
authors.initials: M
authors.lastname: Alsinnawi
authors.forename: J
authors.initials: J
authors.lastname: Ul-islam
authors.forename: T E D
authors.initials: TE
authors.lastname: McDermott
authors.forename: R
authors.initials: R
authors.lastname: Grainger
authors.forename: J A
authors.initials: JA
authors.lastname: Thornhill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies
references.citation: BJU Int. 2004 Feb;93(3):349-52
references.pmid: 14764135
references.citation: Urology. 2002 Oct;60(4):623-7
references.pmid: 12385922
references.citation: J Endourol. 2000 Aug;14(6):529-31
references.pmid: 10954311
references.citation: J Postgrad Med. 1991 Jul;37(3):144-7
references.pmid: 1723756
references.citation: BJU Int. 2011 Sep;108(6):860-3
references.pmid: 21105987
references.citation: Lancet. 1945 Dec 1;2(6380):693-6
references.pmid: 21007347
references.citation: N Engl J Med. 1989 Apr 27;320(17):1120-4
references.pmid: 2469015
references.citation: Eur Urol. 2007 Nov;52(5):1465-71
references.pmid: 17498867
references.citation: Urology. 1999 Dec;54(6):1012-6
references.pmid: 10604700
references.citation: Eur Urol. 1998;33(1):69-72
references.pmid: 9471043
references.citation: Prostate Cancer Prostatic Dis. 2007;10(4):374-7
references.pmid: 17549069
references.citation: J Urol. 1989 Feb;141(2):243-7
references.pmid: 2643719
references.citation: Scand J Urol Nephrol. 2004;38(6):472-6
references.pmid: 15841780