Suprapubic prostatectomy with and without continuous bladder irrigation in a community with limited resources

Abstract

Background: BPH is the commonest benign tumour in men Its incidence is age-related. Whereas suprapubic Transvesical prostatectomy (SPP) continues to be the main surgical approach in most parts of Africa, trans-urethral resection of the prostate (TURP), has become the gold standard in the West. Haemostasis is critical in prostatectomy. This study was aimed at comparing suprapubic prostatectomy with and without continuous bladder irrigation.
Methods: Between September 2004 and January 2006, the authors ran two surgical outpatient clinics. All the patients requiring suprapubic prostatectomy seen on a Tuesday underwent the traditional procedure using continuous bladder irrigation, while those seen in the Thursday clinic underwent the procedure without continuous bladder irrigation, using the modified Malement stitch.
Results: In resource-poor settings, the advantages of suprapubic prostatectomy without continuous bladder irrigation are highlighted, including a 12% bill reduction, a shorter hospital stay by 2 days, and with no increase in complications.
Conclusions: Suprapubic prostatectomy with a modified Malement stitch and without continuous bladder irrigation is simple to perform, safe and easy to learn. This procedure permits patient ambulation as soon as spinal anesthesia wears out, reducing the risk of the occurrence of deep venous thrombosis. With the radical removal of bladder infusion solutions and reduced need for nursing attention, it is easily adaptable to resource-poor environments, resulting in significant savings for the family, as well as the institution. Because of a reduction in post-operative bleeding, the need for re-operation for clot retention and transfusion is minimized. Early patient discharge home allows for a lower cost of hospitalization and earlier return home.