Open Prostatectomy in the Management of Benign Prostate Hyperplasia in a Developing Economy

Abstract

Background: Open prostatectomy (OP) is still relatively common in developing countries and remains a useful benchmark against which the minimal access surgical techniques are compared. This study aims to document the indications and outcomes of OP in a typical developing economy. Method: The records of patients with benign prostate hyperplasia (BPH) who had OP in our university teaching hospital between July 2004 and June 2014 were retrospectively reviewed. Some analyzed parameters include the demographic characteristics, indications, pre-operative work-up, anaesthetic techniques, OP type, complications, histopathology results and follow-up duration. Results: A total of 247 cases were studied. Mean age was 67 years while the commonest surgery indication was recurrent acute urinary retention. Average prostate specific antigen (PSA) was 8.4 ng/ml while hypertension was the most common co-morbidity (44.1%). Regional anaesthesia was mainly used (79.4%) while retropubic prostatectomy was the commonest OP type done (58.7%). The enucleated specimen weighed above 60 g in 91.9% of cases. All our patients were able to micturate spontaneously with urine stream above 20 mls/second on follow-up one week after discharge. Mean duration of hospital admission and follow-up were 7 days and 9 months respectively. Complications occurred in 90 patients (36.4%), of which surgical site infections were the commonest (9.8%). There was 0.4% mortality. Histopathology results showed BPH (95.5%), (incidental) prostate adenocarcinoma (2.4%) or prostatic intra-epithelial neoplasia (2.1%). Conclusion: OP remains an important therapeutic option for management of BPH in developing countries partly due to relatively large prostate size and presence of BPH complications from late presenta-#

Diagnostic performance of transrectal ultrasound for prostate volume estimation in men with benign prostate hyperplasia

“…As expected, the mean prostate volume encountered in our study is relatively higher than finding from a meta‐analysis in Caucasian men, but in the same range as values previously recorded in Afro‐Caribbean populations, consistent with earlier reports that men of African descent generally have above average prostate volumes 1,12,14,24 . The perfect agreement between the weight and volume of prostatic adenomatous tissue in our study confirms a prostatic tissue density of 1.0g/ml in sub‐Saharan African men.…”

“…The same team of blinded Radiologists carried out all our TRUS evaluations. We are also a high volume tertiary centre and have developed considerable expertise and proficiency in open simple prostatectomy 1,24 . The same team of experienced urologists carried out all the operations during which we meticulously palpated the prostatic fossa post‐enucleation and also carefully inspected the gross anatomy of the enucleated prostatic adenoma for completeness, thereby minimising the possibility of incomplete enucleation in our study.…”

“…Exclusion criteria were patients on 5α reductase enzyme inhibitors, those unable to have TRUS as a result of painful anal conditions or previous end colostomy; and those with incidental prostate cancer histology following surgery. A minimum sample size of 44‐patients was obtained based on the Leslie‐Fischer's formula with 95% confidence interval and 2.6% proportion of open simple prostatectomy in our practice 1 …”

“…Benign prostate hyperplasia (BPH) is a common urologic abnormality and remains a major source of morbidity, impaired quality of life, loss of man‐hours and rarely mortality in middle aged and elderly men worldwide 1 . Accurate determination of prostate volume is important for successful management of BPH because it predicts the risk of complications such as bleeding or urinary retention, guides choice of medical therapy, influences modality of surgery and has a role in monitoring following minimal invasive interventions such as prostate artery embolisation 2,3 …”

An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital

“…They are adverse surgical sequel which could lead to significant morbidity, patient discomfort and increased cost of surgical care, since they impose severe demands on the already meager health care resources2,3. Although transurethral resection of the prostate has become the gold-standard, open simple prostatectomy is however still carried out for treatment of patients with benign prostate hyperplasia (BPH) in our environment because of the relatively large prostate size encountered possibly due to genetic predisposition and/or late patient presentation4,5. In addition, open prostatectomy has the lowest failure rate among the different surgical options for BPH and can be used to simultaneously tackle complications such as bladder diverticulum during same surgery6.…”