Open Prostatectomy for Benign Prostatic Hyperplasia: A Critical Analysis of Patient Presentation and Surgical Outcomes in a Contemporary Series

Abstract

Background: Open prostatectomy (OP) is still a valid treatment option for benign prostatic hyperplasia (BPH), but it needs to be  constantly reevaluated in the context of minimally invasive treatments (MITs).

Aim: Our purpose is to present contemporary data on  patient presentation and surgical outcomes of OP with which other OP series and MITs can be compared.

Methods: A retrospective study  of all OP was carried out in our institution from January 2011 to December 2020. All patients had a thorough preoperative workup  and optimization of comorbidities before surgery. Data were collected in a predesigned pro forma and analyzed.

Results: The mean age  of the 148 patients studied was 66.2 (±7.9) yrs. The mean duration of symptoms before surgery was 32.2 (±33.7) mos. The mean  preoperative prostate volume was 118.0 (±67.1) cm3 . There was a 54.4% comorbidity rate with diabetes mellitus (DM) topping the list  (16.0%). An incidental prostate cancer rate of 6.1% was found. The overall complication rate was 45.3%. Perioperative hemorrhage  requiring blood transfusion (BT) was the most common complication (26.1%). There was no significant difference in age, duration of  surgery, and prostrate volume between subjects with and without BT (P > 0.05). Wound infection was significantly associated with  diabetes (P = 0.043, OR = 3.507, 95% CI = 1.042–11.805). The reoperation rate was 1.4%, and mortality rate was 0.7%. The International  Prostate Symptom Score (IPSS), quality-of-life (QOL) score, and post-void residual urine (PVR) volume were significantly improved (P <  0.001).

Conclusion: OP was found to be a safe and effective procedure for the relief of bladder outlet obstruction (BOO) secondary to   BPH. However, it was associated with high morbidity and low reoperation rate.