Surgical management of benign prostatic hyperplasia in the University Teaching Hospital, Lusaka

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Kachimba, John Sivah
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A prospective study of the surgical management of Benign Prostatic Hyperplasia (BPH) in the University Teaching Hospital (UTH), Lusaka was carried out over a St St period of one year ( 1 November 1996 to 31 October 1997). It aimed to study the efficacy of Transabdominal Ultrasonography (TAUS) in prostate weight determination in BPH and also to compare the operative outcomes of open prostatectomy and transurethral resection in the management of BPH. Eighty-two patients presenting to the Urology Clinic, in the UTH with symptoms of bladder outlet obstruction due to BPH were entered into the study. The inclusion criteria was as follows: symptoms of urinary retention or severe prostatism, (hesitancy, poor flow, intermittent stream, dribbling, frequency, nocturia , urgency, urge incontinence, enuresis), residual urine volume exceeding lOOmls, age not exceeding 85 years, absence of severe medical disease and prostate gland size ranging from 30-85 grams. The details of each patient were collected and entered on a proforma designed for the study. The information collected included name, and age of the patient, file number, date of admission, evolution of disease, physical examination results of investigations, mode of surgery and outcome of surgery. Each patient underwent suprapubic transabdominal ultrasound scanning for prostatic volume determination and evaluation of any abnormalities in the urinary tract. The ultrasonography was performed by a Consultant Radiologist. With regard to the prostate, the scan evaluated shape, size, symmetry, echogenicity and volume.Prostatic volume was determined using the formula V = 3/4 II x r3 and the weight was estimated on the fact that density of prostatic adenoma tissue is approximately equivalent to l.OOgram per millilitre. The patients were divided into two groups: 53 patients underwent open prostatectomy (49 Transvesical, 4 Retropubic) and 29 patients had TURPs. Prostatic adenomas enucleated by open operation were weighed. Prostatic weights determined from the surgical specimens were then compared with ultrasound estimated weights. Prostatic chips derived during TURP were collected and weighed. Fifty-three patients underwent open prostatectomy: 49 Transvesical and 4 Retropubic. In these patients prostate weight was estimated by TAUS and well correlated with the surgical specimen. In this open surgery group, complications encountered included: intraoperative haemorrhage (n=l), catheter blockage (n=5), urinary retention (n=l), epididymitis (n=l), persistent vesicocutaneous fistula (n=l) and urethral stricture (n=4).Twenty-nine patients underwent transurethral resection of the prostate. The weight of prostate tissue resected was not determined, neither was ultrasonography performed postoperatively. In this group of patients, one died in the immediate postoperative period following severe intraoperative bleeding. Other complications noted following TURP were: significant intraoperative bleeding (n=2), catheter blockage (n=5), urinary retention (n=2) and septic shock (n=l).Both modes of surgery were found to have a comparable incidence of complications, though the postoperative hospitalisation period was shorter following TURP. Based on the comparison of prostate weight estimated by TAUS preoperatively and weights of surgical specimens obtained at open prostatectomy, TAUS appears to be an accurate method of determining the size of the prostate gland in patients with BPH.
Prostate -- Hypertrophy