Transvesical prostatectomy in the management of benign prostatic hyperplasia in a developing country

Abstract

Context: The surgical management of benign prostatic hyperplasia (BPH) is evolving away from open surgery. In developing countries however majority of cases are managed by transvesical prostatectomy (TP).
Aims: This study aims to describe our experience regarding the efficacy, complication profile and outcome of TP in the management of BPH in Nigeria.
Settings and Design: A descriptive, retrospective study carried out in three tertiary centers.
Subjects and Methods: Two hundred and ninety‑seven patients were studied. Parameters examined included age, clinical features, investigations, type of postoperative bladder irrigation, prostate gland volume, duration of hospital stay, complications and outcome.
Statistical Analysis Used: Simple means and percentages with SPSS 16.
Results: Mean age was 65.2 ± 6.8 years (range 47‑93 years). Presentation with severe lower urinary tract symptoms only occurred in 76 patients (25.7%); acute urinary retention was seen in 106 patients (35.7%). Chronic urinary retention, impaired renal function and haematuria occurred in 47 (15.8%), 37 (12.5%), and 31 patients (10.4%) respectively. On comorbidity, 63 patients (21.2%) were hypertensive and 24 patients (8.1%) had diabetes mellitus. Two hundred and twenty three patients (75%) had indwelling catheters at the time of surgery. Preoperative urinary catheter duration was 1 week‑35 months. Mean duration of hospital stay was 8.8 days. Complications were transient urinary incontinence 33 patients (11.1%), urinary tract infection 38 patients (12.7%), and acute epididymoorchitis 15 patients (5.1%). Clot retention occurred in 40 patients (13.5%). Mortality rate was 1%.
Conclusions: TP remains useful in developing climes. There is a need to emphasize effective preoperative workup so as to limit morbidity. Emphasis on variety of techniques for hemostasis is necessary.

Key words: Benign prostatic hyperplasia, management, Nigeria, transvesical prostatectomy