Transurethral resection of the prostate in Northern Nigeria, problems and prospects

Abstract

BackgroundBenign prostatic hyperplasia (BPH) is the commonest disease of the urinary tract afflicting the ageing male and is the commonest neoplastic disease in men aged 50 years and above.Transurethral prostatectomy (TURP) is the ultimate treatment of choice for benign prostatic hyperplasia (BPH) due mainly to the preference of minimally invasive surgery, long term relief of symptoms and cost effectiveness. It is however not available to the majority of Nigerians in need of prostatic surgery in Public Health Institutions.MethodsThe records of patients who underwent prostatectomy in Aminu Kano Teaching Hospital, over the period June 2001 to July 2007 were examined. The bio data of patients and laboratory investigations performed were retrieved.ResultsFive Hundred and forty two patients were operated upon, out of which 40 were excluded due to open prostatectomy (22 patients), bladder neck stenosis (16 patients) or bladder tumour around the trigon (2 patients). The age range of the patients was 47–110 years with a mean of 67.2 years. 289 patients (80.1%) had urethral catheter in situ at presentation and 11 (3%) patients had suprapubic cystostomy of which only 3 (0.85%) had combined urethral stricture and BPH.Only 131 (26%) had their PSA measured which ranged from 2–100 ng/ml out of which 39(29.8% n = 131) patients had more than 4 ng/ml and cancer of the prostate and 1(0.8%, n = 131) patient had a PSA level of 4 ng/ml and malignant prostate.Hospital stay was 1–32 days (mean 7.9) and the mean follow up period was 5.6 months (range 0–60) and there were 17.5% complications comprising of urinary tract infection (UTI) 7.2%, Orchitis 2.2%, urinary incontinence 0.6%, atonic bladder 1%, erectile dysfunction 0.6%, cerebrovascular accident 0.4%, myocardial infarction 0.4%, deep vein thrombosis 0.4% and disseminated intravascular coagulopathy (DIC) 0.6% and 1.2% mortality. The cost of treatment inclusive of pre-admission investigations was US$ 615.00 (range US$ 300–1,300)ConclusionDespite advances in minimally invasive therapy for LUTH/BPH, TURP is the optimum treatment of choice for the ageing male of sub-Saharan Africa. It is however not available to the majority of patients in this region due to poor health allocation and inadequate facilities and training.

Validation of supra-pubic ultrasonography for preoperative prostate volume measurement in sub-Saharan Africa

“…Advances in the surgical management of BPH such as transurethral resection of the prostate (TURP) have been not been widely adopted in hospitals in sub-Saharan Africa to date [9], mainly due to barriers in the availability of equipment, inadequate number of trained personnel conversant with the procedure, and lack of supportive diagnostic tools. Our referral center in urban Uganda currently performs open prostatectomy on most patients but is moving toward adoption of less-invasive techniques like TURP.…”

Post open prostatectomy bladder exteriorization mimicking “acquired bladder extrophy’’

“…The recognized complications include; retrograde ejaculation (75%), impotence (5%-10%), incontinence (1%), and transurethral resection (TUR) syndrome that tends to occur; 90 minutes after resection, resection of a prostate gland greater than 75 g and intestinal obstruction. 5,6 Recently holmium laser enucleation of the prostate (HoLEP) is said to be cheaper and more effective, when compared to open prostatectomy, and has minimal side effects, some of which include capsular perforation (9.6%), superficial bladder mucosal injury (3.9%), ureteric orifice injury (2.1%), blood transfusion (1.4%), and cystoscopy with clot evacuation (0.7%). The commonest complication after HoLEP is transient urinary incontinence (10.7%).…”

Complicaciones infecciosas después de prostatectomía abierta y resección transuretral de próstata en pacientes con hiperplasia prostática benigna

“…Se considera actualmente que la RTUP es el estándar de oro para el tratamiento quirúrgico de la HPB (2,(17)(18)(19). Implica la extirpación quirúrgica de la porción interior de la próstata por abordaje endoscópico a través de la uretra.…”

“…La Asociación Europea de Urología la recomienda cuando la próstata tiene entre 30 y 80 mL (12,20). Los resultados de las técnicas monopolar y bipolar para llevarla a cabo son muy similares, pero, al parecer, la bipolar tiene un perfil de seguridad más favorable, ausencia del síndrome de pos-RTUP, menos sangrado intraquirúrgico y posoperatorio y menor tasa de retención aguda de orina (RAO) por coágulos (17,(19)(20)(21)(22).…”

“…La RTUP tiene una mortalidad de 0,1% y una morbilidad del 11,1% al 17,5%, aunque han disminuido en el tiempo (12,15,18,19,24,25). Entre las complicaciones a corto plazo se encuentran RAO en 4,5 % de los pacientes, ITU en 4,1 %, sangrado que requiere transfusión en 2 % a 2,9 % y síndrome pos-RTUP en 1,1 %.…”