Background: Open prostatectomy is the most commonly available surgical procedure for benign prostatic hyperplasia and this is the case in most countries in West African even with all the limitations of the procedure. Objective: The objective is to determine the pattern and outcomes of open prostatectomy in Lomé. Patients & Methods: From December 2011 to November 2012, we conducted a descriptive cross-sectional study on a series of patients treated for prostate adenoma. Dysuria was assessed using the International Prostate Symptom Score (IPSS). The history of each patient was recorded, as well as paraclinical data. All patients were surgically treated via abdominal incision procedure. The data obtained included the patients’ demographics, clinical features, the IPSS scores, investigations, type of open prostatectomy, outcome and follow-up. The data were analyzed for means and frequencies using Epi Info version 3.5.3. Results: Fifty-four consecutive patients underwent surgery consecutively, their ages ranging from 40 to 92 years, with an average of 67.27 ± 12.50 years. In all, 46 (85.2%) patients presented with obstructive symptoms and 26 (48.1%) presented with urinary retention. The average prostate volume was 114.31 ± 20.11 cm3 with a range of 31 - 485 cm3. The average blood loss at surgery was 425.92 ± 38.2 ml with an average operating time of 66.05 ± 15.75 mins and the main complications were hemorrhaging and clot retention in 7 (13%), epididymo-orchitis in 9 (16.7%), and urinary incontinence in 6 (11.1%) patients. IPSS scores were under 7 in 92% of patients three months after surgery and the mortality rate was 3.7%. Conclusion: This study has shown that open prostatectomy in our environment is still the commonest surgical option for benign prostatic hyperplasia with good outcomes though with manageable complications.
Open prostatectomy is still a common option in developing countries while less invasive procedures with optimal outcomes are practiced in industrialized countries [
At the Sylvanus Olympio University Hospital Center, endoscopic methods are still in their infancy; prostatectomy via abdominal incision remains the surgical method of choice for treatment of benign prostatic hyperplasia. The aim of this study was to determine the pattern, morbidity and mortality rates and outcomes of open prostatectomy at the Sylvanus Olympio University Hospital Center in Lomé, Togo over a period of one year.
We conducted a retrospective and descriptive study of all patients undergoing open prostatectomy at Sylvanus Olympio University Hospital Centre, Lome, Togo between December 2011 and November 2012. The cases of our study were enrolled among patients treated in the urology department for benign prostatic hyperplasia (BPH). Inclusion criteria were the formal diagnosis of BPH and indication of prostatectomy. The sample size corresponded to an open prostate surgery activity conducted in a year in urology department. Each patient underwent a complete urological examination with digital rectal exam to assess the size and characteristics of the prostate after determining the international prostate symptom score (IPSS) followed by abdominal ultrasonography with emphasis on the kidney, ureter, bladder and prostate. Prostate specific antigen (PSA) levels were measured in the patients. Patients with high PSA greater than 10 ng/ml had their prostate biopsied transrectally to rule out carcinoma of the prostate. All those with histological evidence of carcinoma of the prostate were excluded from the study.
All the patients included in this study underwent preoperative evaluation testing including prothrombin time (PT), urea, electrolytes and creatinine, fasting blood glucose, full blood count, blood grouping, chest radiography and electrocardiography.
Open prostatectomy was performed on the patients under spinal anesthesia via a suprapubic subumbilical incision; the choice of the approach used was linked to the surgeon’s habit. The patients’ demographic and clinical data as well as the duration of surgery, blood loss and outcome were recorded in a proforma and analyzed for means and frequencies using Epi Info version 3.5.3. Postoperative patients were monitored on a daily basis up until hospital discharge and then once monthly for three months; the surgical specimens of the prostate were subjected to histopathological examination. Parameters studied during postoperative monitoring were: the quality of micturition as evaluated by the IPSS score, hemoglobin levels and post-operative complications.
Fifty-four patients were included in the study. Their average age was 67.27 ± 12.50 years with a range of 40 - 92 years. The most represented age group was 60 to 69 years in 23 (42.6%) patients; one patient was under 50 years of age as shown in
In all, 46 (85.2%) patients had severe dysuria with IPSS scores >20 and 26 (48.1%) patients had urinary retention. Prostate-specific antigen (PSA) measured in 43 patients had an average level of 20.33 ng/ml. This value was higher than normal (4 ng/ml) in 81% of patients. In eleven patients, the PSA could not be determine because of the lack of financial resources. The open prostatectomy was transvesically in 53 (98.1%) patients and retropubically in 1(1.8%) patient. Other patient characteristics are shown in
The post-operative complications included haemorrhage in 7 (13%) patients, epididymorchitis in 9 (16.7%), surgical site infection in 6 (11.1%), urinary incontinence in 6 (11.1%) and in the long run, 3 (5.6%) had recurrent mild dysurea. The follow-up of all the patients was three months and the prognosis was assessed on the micturition quality. The average hospital stay was 9.4 ± 3.5 days with a range of 7 - 30 days while 92% of the patient had an IPSS score below 7 as shown in
The histological test of pieces of prostatectomy showed in all cases an adenomyofibroma associate with a chronic prostatitis .We recorded 2 (3.7%) deaths in this study; 1 (1.8%) patient died of myocardial infarction four weeks after surgery and the other died of hepatic encephalopathy.
The average age of our patients (67.27) is comparable to that reported in the literature regarding studies of open surgery for prostatic adenoma [
Inguinal hernia was the predominant surgical pathology in our subjects’ history. It is secondary for dysuric patients suffering from intra-abdominal hypertension caused by pushing efforts during micturition. In our regions, manual activities in populations constitute an aggravating risk factor for incidence of inguinal hernia.
Acute urinary retention constituted the most frequent indication for surgery in our series; this mechanical complication of prostatic adenoma is frequently the reason for the choice of surgical treatment in Sub-Saharan Africa, with frequencies ranging from 34.7% in Mali [
Characteristics | Average | Extremes |
---|---|---|
Age (years) | 67.27 ± 12.50 | 40 - 92 |
IPSS | 25.68 | 12 - 35 |
PSA (ng/ml) | 20.33 | 0.7 - 26.40 |
Prostate volume (cm3) | 114.31 ± 20.11 | 31 - 485 |
Duration of intervention (min) | 66.05 ± 11.75 | 50 - 120 |
Blood loss (ml) | 425.92 ± 38.20 | 100 - 800 |
Preoperative | M1 post op | M2 post op | M3 post op | |
---|---|---|---|---|
Average IPSS | 25.68 | 8 | 5.57 | 4.57 |
Infections (%) | 25.9 | _ | _ | |
Postoperative complications | Urinary incontinence (%) | _ | _ | 11.1 |
Obstructive symptoms (%) | _ | _ | 5.6 | |
Deaths (%) | 3.7 | _ | _ |
M1 post op: first month after prostatectomy; M2 post op: second month after prostatectomy; M3 post op: third month after prostatectomy.
principally due to economic reasons. The major current indication for prostatic adenomectomy via abdominal incision is a prostate volume greater than 60 ml [
Prostate-specific antigen (PSA) was above normal reference levels in 81% of the patients in our series. PSA level varies greatly according to prostate size and presence or absence of tissue inflammation. Large gland size and urinary tract infection are factors that increase PSA levels. These points explain the very high levels in our patients who had large prostate volumes; furthermore, dosages of this antigen were not made within the timeframe needed to avoid a skewed result, as any endo-urethral maneuver leads to an increase in total PSA.
Average prostate gland volume determined by suprapubic ultrasound in our patients was 114.31 cm3; this value is consistent with the results of previous studies, in particular Fall’s study, which reported an average volume of 95 cm3 [
The transvesical prostatic adenomectomy technique was the most used in our series as being the best mastered. It provides a better view of the adenoma, allows easier ablation of the median lobe, and guarantees avoidance of the ureteral meatuses during hemostasis of the prostatic cavity. It is also a rapid procedure when mastered. The duration of surgery was generally one hour; simultaneous treatment of inguinal hernia in three patients extended this duration. Fall [
The major early complication in our study was hemorrhaging from the prostatic cavity following adenomectomy. Contributing factors are preoperative prostate infection, a large prostate volume and a long operating time. In Reich’s series the rate of hemorrhaging was 2.9% [
Open prostatectomy can lead to a significant bleeding. Elshal [
Epididymo-orchitis was the most common infectious complication observed in 16.7% of patients. This rate is considerably higher than that found by Fall [
Approximately 17% of our patients still had complications three months after surgery; the main complication was urinary incontinence, observed in six patients. The rate of urinary incontinence following prostatic adenomectomy varies in the literature and its definition is still a problem, particularly in relation to the time after which it may be considered a definitive complication of prostate surgery. In his series, Doll had a 38% incidence of urinary leakage during the first postoperative trimester with a gradual reduction of this percentage during the first year [
Hospital stay was longer in cases where one or more complications had occurred, but it was globally comparable to the literature: 10 days for Fall [
Prostatic adenomectomy-related perioperative mortality has decreased over the last thirty years to roughly 0.25% in contemporary series [
Undoubtedly, our study concerns a limited number of cases but it has the merit to take stock of the therapeutic and progressive aspects of one of the most practical operations performed in our hospital. The weakness of our study resides in its limited aspect regarding trans-urinary catheterization, and this has not facilitated its comparison with most contemporary studies.
This study has shown that open prostatectomy in our environment is still the commonest surgical option for benign prostatic hyperplasia with good outcomes though with manageable complications.
Tchilabalo M. Kpatcha,Boyodi Tchangai,Kodjo Tengue,Fousséni Alassani,Gnimdou Botcho,Tchin Darre,Essomindedou Leloua,Komi H. Sikpa,Edoe V. Sewa,Tsipa Anoukoum,Komlan Gnassingbe, (2016) Experience with Open Prostatectomy in Lomé, Togo. Open Journal of Urology,06,73-79. doi: 10.4236/oju.2016.65014