Open prostatectomy experience in management of benign prostatic hyperplasia in a Kenyan rural facility

Abstract

Introduction: Open prostatectomy is the main management of Benign prostatic hyperplasia in developing countries and in poor resource setting health centres.
Objective: To audit pre-operative evaluation, surgical procedure and outcome of open prostatectomy in a Kenyan rural health facility.
Methodology: A surgical audit was carried out where records of patients who had undergone open prostatectomy over the period January 2012 to October 2015 were reviewed. Patient characteristics, co morbidities, preoperative evaluation, operation time, associated post operative complications, and incidental cancer of the prostate on histology were documented and analyzed.
Results: The average age at presentation was 72.82+/- 7.1 years with 60% of the patients having associated co-morbidities. The average PSA level was 15.11+/-68.1 ng/ml while mean estimated prostatic size was 79.35g +/- 26.42g. The average duration of the procedure was 95.71 min +/- 24 min with a mean blood loss of 734 ml. Post-op complications include blocked catheter (18%), surgical site infection (5.3%), urinary tract infection (2.6%) and hemorrhage (2.6%). Duration of hospital stay ranged from 3 days to 46 days, with a median of 4 days. Five (13.9%) of patients developed incontinence, two (5.3%) had persistent pain at incision site, two (5.1 %) developed poor urinary flow/strictures. Incidental cancer of the prostate was 2.6%.
Conclusion: Open prostatectomy remains a safe and relevant procedure in the management of Benign prostatic Hyperplasia, especially in low income countries, and is associated with low morbidity and mortality.