✦ BPH Treatment

Open Prostatectomy (Millin's)

Q: When is Millin's prostatectomy preferred over HoLEP?

Open prostatectomy is preferred when the prostate exceeds 150–200 g, HoLEP morcellator equipment or expertise is unavailable, or simultaneous open bladder surgery is required.

Q: Does open prostatectomy affect potency?

Erectile function is generally preserved as the cavernous nerves lie outside the prostatic capsule. Retrograde ejaculation is expected in essentially all patients.

Q: What is the hospital stay and catheter duration?

Hospital stay is 4–6 days. The urethral catheter is removed at 5–7 days once the bladder neck has sealed. A retropubic drain is placed and removed on day 2–3 post-operatively.

Millin's retropubic open prostatectomy for very large prostates — complete adenoma enucleation under direct vision, near-zero retreatment rates, effectively permanent symptom relief.

90–150 min PROCEDURE

4–6 Days HOSPITAL STAY

>95% SUCCESS RATE

4–6 Weeks RECOVERY

What is Open Prostatectomy (Millin's)?

Millin's Retropubic Open Prostatectomy is performed through a lower abdominal incision providing direct access to the prostate via the retropubic space. The prostatic adenoma is digitally enucleated from its surgical capsule under direct vision — the most complete adenoma removal possible — mimicking the completeness of HoLEP but through an open incision. It is the treatment of choice for very large prostates over 80–100 g where endoscopic techniques become impractical, and provides near-zero retreatment rates with outcomes that are effectively permanent.

Suitable for men with very large prostates over 80–100 g, concomitant bladder pathology requiring open repair, failed endoscopic BPH treatment, or settings where advanced laser enucleation equipment is unavailable.

How the Procedure Works

Incision & Access

Pfannenstiel or lower midline incision; retropubic space of Retzius developed; prostate exposed anteriorly; stay sutures placed in prostatic capsule.

Capsulotomy

Transverse incision through anterior prostatic capsule exposes the adenoma; incision kept superficial to avoid venous plexus.

Digital Enucleation

Surgeon's index finger sweeps systematically to enucleate adenoma from surgical capsule — posterolaterally, then anteriorly, until median lobe freed.

Haemostasis

Adenoma delivered; empty capsular bed inspected; figure-of-eight sutures placed at 5 and 7 o'clock positions for haemostasis.

Closure & Drainage

22–24 Fr catheter with continuous irrigation placed; prostatic capsule closed; retropubic drain placed; wound closed in anatomical layers.

Outcomes

90–150 minDURATION

4–6 DaysHOSPITAL STAY

>95%SUCCESS RATE

4–6 WeeksFULL RECOVERY

Who Needs This Treatment?

→Men with very large prostates exceeding 80–100 g where endoscopic resection would be incomplete or impractically prolonged.
→Patients requiring simultaneous open bladder surgery — diverticulectomy, stone removal — in the same session.
→Those in settings without HoLEP equipment or expertise where open surgery remains the definitive large-prostate option.
→Men with urinary retention and massively enlarged prostates causing bilateral hydronephrosis.
→Patients who have failed endoscopic BPH treatment and have significant residual adenoma.
→Those wanting the most durable possible BPH treatment — effectively a permanent cure with near-zero retreatment rates.

"Open prostatectomy remains the most complete treatment for massively enlarged prostates. When performed well, the results are outstanding and effectively permanent — a true cure for obstructive BPH in patients for whom no endoscopic technique is sufficient."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

When is Millin's prostatectomy preferred over HoLEP?+

Does open prostatectomy affect potency?+

What is the hospital stay and catheter duration?+

Not sure which treatment is right for you?

Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.

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