Bipolar Transurethral Resection of the Prostate (B-TURP) Including Large Prostate Glands in Kinshasa, DR Congo

Abstract

Context: In DR Congo, prostate adenoma was treated solely by open surgery till the practice of minimally invasive surgery in 2012. Surgical management of large prostate glands has greatly improved over the last years. Even if open adenomectomy is indicated for prostate glands > 80 ml, TURP is currently the gold standard. We report the resection time of TURP procedure, quality of life of the patients, the postoperative complications and outcomes of 152 patients with large prostate glands who went under Bipolar TURP from 2021 to 2022. Patients and Methods: This is a prospective and evaluative study of 152 patients who underwent surgery for benign prostatic hyperplasia (BPH) from January 2021 to December 2022 using bipolar transurethral resection of the prostate (TURP). The study variables were age, low urinary tract symptoms (LUTS), paraclinical parameters, prostate volume, resection time, length of hospital stay, results of histopathological analysis of resected tissues (prostate chips), complications and postoperative outcomes of the patients. All the patients underwent saline bipolar TURP. Results: The mean age of the patients was 66.5 ± 9.3 years. Dysuria and acute urinary retention were the most predominant symptoms, 46.1% and 23.03% respectively. Arterial hypertension was the most common medical history (29.7%), or associated with diabetes mellitus (18.4%). The most frequent surgical history was the repair of the inguinal hernia in 21.7% of cases. Most of the patients had a prostate volume ≥ 80 ml (n = 91) in a relative frequency of 60% of cases. The mean prostate volume was 104.8 ± 60.4 ml. The volume of the prostate was correlated with the age of the patients (r = 0.321; p < 0.001). Most prostate glands were resected within seventy-five (75) minutes. The resection time was correlated with the volume of the prostate (r = 0.467; p < 0.001). However, the largest prostate gland measured by intrarectal ultrasound weighed 350 ml and was resected in 110 minutes. There was no correlation between the volume of the prostate and the resected tissues by bivariate analysis (r = 1.000; p < 0.001). The average volume of the resected tissue in our series is 20 ± 68 g (Ranges: 12 - 45). Histopathological analysis revealed fibro adenomatous hyperplasia (FAH) in 70% of cases; BPH was associated with urothelial carcinoma of the bladder and carcinoma of the prostate in 4% and 2% respectively. Uroflowmetry revealed that 86.3% of the patients had a dysuric curve preoperatively, compared to only 4% of patients postoperatively. The difference is significant with p < 0.05. 119 patients (86.3%) had a Qmax < 15 ml/s preoperatively, with significant improvement, Qmax > 15 ml/s (96%) postoperatively. The post-void residual (PVR) was significant in the group of patients with prostate volume ≥ 80 ml (p < 0.008). Preoperatively, 70% of patients had severe symptoms that were improved three months after the Bipolar TURP (74%). The improvement in quality of life depended on the severity of the symptoms; it was faster for mild and moderate symptoms and slow for severe symptoms. After three months postoperatively, the International Prostate Symptom Score (IPSS) and the quality of life (QOL) index were improved in 112 patients (74%). Conclusion: Although conventional surgery (open adenomectomy) has been a standard treatment for large prostate adenomas, progress in minimally invasive techniques, mainly Bipolar TURP, seems to confer more advantages such as the low rate of complications, reduced length of hospital stay and improved quality of life for the patients.