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 comorbidity (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 presentationin many patients. The surgery is efficient and has relatively low morbidity and minimal mortality.
Holtgrewe, L. (1995) Transurethral Prostatectomy. Urologic Clinics of North America, 22, 357-368.
Salako, A.A, Badmus, T.A, Olajide, A.O, Takure, A.O. and Eziyi, A.K. (2005/2006) Early Experience with Transurethral Resection of the Prostate (TURP) in Ile-Ife, Nigeria. Nigerian Journal of Health Sciences, 5 & 6, 35-38.
Olapade-Olaopa, E., Adebayo, S., Takure, A., Shittu, O. and Okeke, L. (2014) Open Prostatectomy for BPH in Contemporary Urological Practice in Ibadan, Nigeria. African Journal of Urology, 2, 114-118. https://doi.org/10.1016/j.afju.2014.03.012
Oelke, M., Bachmann, A., Descazeaud, A., Emberton, M., Gravas, S., Michel, M.C., et al. (2013) EAU Guidelines on the Treatment and Follow-Up of Non-Neurogenic Male Lower Urinary Tract SYMPTOMS Including Benign Prostatic Obstruction. European Urology, 64, 118-140. https://doi.org/10.1016/j.eururo.2013.03.004
American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH) 2010. http://www.auanet.org/common/pdf/education/clinical-guidance/Benign-Prostatic-Hyperplasia.pdf
Carneiro, A., Sakuramoto, P., Wroclawski, M.L., Forseto, P.H., Den Julio, A., Bautzer, C.R., et al. (2016) Open Suprapubic versus Retropubic Prostatectomy in the Treatment of Benign Prostatic Hyperplasia during Resident’s Learning Curve: A Randomized Controlled Trial. International Brazilian Journal of Urology, 42, 284-292. https://doi.org/10.1590/S1677-5538.IBJU.2014.0517
Dindo, D., Demartines, N. and Clavien, P.-A. (2004) Classification of Surgical Complications: A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey. Annals of Surgery, 240, 205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Ugwumba, F.O., Ozoemena, O.F., Okoh, A.D., Echetabu, K.N. and Mbadiwe, O.M. (2014) Transvesical Prostatectomy in the Management of Benign Prostatic Hyperplasia in a Developing Country. Nigerian Journal of Clinical Practice, 17, 797-801. https://doi.org/10.4103/1119-3077.144402
Kiptoon, D.K., Magoha, G.A. and Owillah, F.A. (2007) Early Postoperative Outcomes of Patients Undergoing Prostatectomy for Benign Prostatic Hyperplasia at Kenyatta National Hospital, Nairobi. East African Medical Journal, 84, S40-S44.
Kyei, M., Mensah, J., Morton, B., Gepi-Attee, S., Klufio, G. and Yeboah, E. (2013) Surgical Management of BPH in Ghana: A Need to Improve Access to Transurethral Resection of the Prostate. East African Medical Journal, 89, 241-245.
Bruskewitz, R. (1999) Management of Symptomatic BPH in the US: Who Is Treated and How? European Urology, 36, 7-13. https://doi.org/10.1159/000052343
Ahlstrand, C., Carlsson, P. and Jonsson, B. (1996) An Estimate of the Life-Time Cost of Surgical Treatment of Patients with Benign Prostatic Hyperplasia in Sweden. Scandinavian Journal of Urology and Nephrology, 30, 37-43. https://doi.org/10.3109/00365599609182347
Lukacs, B. (1999) Management of Symptomatic BPH in France: Who Is Treated and How? European Urology, 36, 14-20. https://doi.org/10.1159/000052344
Malemo, K., Galukande, M., Hawkes, M., Bugeza, S., Nyavandu, K. and Kaggwa, S. (2011) Validation of Supra-Pubic Ultrasonography for Preoperative Prostate Volume Measurement in Sub-Saharan Africa. International Urology and Nephrology, 43, 283-288. https://doi.org/10.1007/s11255-010-9844-2
Badmus, T.A., Asaleye, C.M., Badmus, S.A., Takure, A.O., Ibrahim, M.H. and Arowolo, O.A. (2013) Benign Prostate Hyperplasia: Average Volume in Southwestern Nigerians and Correlation with Anthropometrics. The Nigerian Postgraduate Medical Journal, 20, 52-56.
Oranusi, C., Nwofor, A. and Oranusi, I. (2012) Complication Rates of Open Transvesical Prostatectomy according to the Clavien-Dindo Classification System. Nigerian Journal of Clinical Practice, 15, 34-37. https://doi.org/10.4103/1119-3077.94094
Suer, E., Gokce, I., Yaman, O., Anafarta, K. and Gogüs, O. (2008) Open Prostatectomy Is Still a Valid Option for Large Prostates: A High-Volume, Single-Center Experience. Urology, 72, 90-94. https://doi.org/10.1016/j.urology.2008.03.015
Abbiyesuku, F.M., Shittu, O.B., Oduwole, O.O. and Osotimehin, B.O. (2000) Prostate Specific Antigen in the Nigerian African. African Journal of Medicine and Medical Sciences, 29, 97-100.
Sowande, O., Takure, A., Salako, A., Badmus, T., Olajide, A., Banjo, O., et al. (2009) Day Case Urology in a Dedicated Day Case Surgery Unit in a Nigerian Teaching Hospital. Ambulatory Surgery, 15, 3-11.
Madsen, F.A. and Bruskewitz, R.C. (1995) Cystoscopy in the Evaluation of Benign Prostatic Hyperplasia. World Journal of Urology, 13, 14-16. https://doi.org/10.1007/BF00182659
Millin, R. (1945) Retropubic Prostatectomy: New Extravesical Technique: Report on 20 Cases. The Lancet, 2, 693-694. https://doi.org/10.1016/S0140-6736(45)91030-0
Elshal, A.M., El-Nahas, A.R., Barakat, T.S., Elsaadany, M.M. and El-Hefnawy, A.S. (2013) Transvesical Open Prostatectomy for Benign Prostatic Hyperplasia in the Era of Minimally Invasive Surgery: Perioperative Outcomes of a Contemporary Series. Arab Journal of Urology, 11, 362-368. https://doi.org/10.1016/j.aju.2013.06.003
Ibrahim, A., Aliyu, S. and Ali, N. (2013) Open Prostatectomy for Huge Prostates: Our Experience in a Developing Country. Tropical Medicine & Surgery, 2012, 1-4.
Ceylan, K. (2006) Open Prostatectomy—The Results of a Series of 320 Cases in Rural Area. European Journal of General Medicine, 3, 11-15.
Ngugi, P. and Saula, P. (2007) Open Simple Prostatectomy and Blood Transfusion in Nairobi. East African Medical Journal, 84, S12-S16.
Gratzke, C., Schlenker, B., Seitz, M., Karl, A., Hermanek, P., Lack, N., et al. (2007) Complications and Early Postoperative Outcome after Open Prostatectomy in Patients with Benign Prostatic Enlargement: Results of a Prospective Multicenter Study. The Journal of Urology, 177, 1419-1422. https://doi.org/10.1016/j.juro.2006.11.062
Ahmed Gadam, I., Nuhu, A. and Aliyu, S. (2012) Ten-Year Experience with Open Prostatectomy in Maiduguri. ISRN Urology, 2012, 1-4. https://doi.org/10.5402/2012/406872
Drinka, P.J. (2006) Complications of Chronic Indwelling Urinary Catheters. Journal of the American Medical Directors Association, 7, 388-392. https://doi.org/10.1016/j.jamda.2006.01.020