Experience with open prostatectomy in Bingham University Teaching Hospital, Jos: the need for a modern safer and cost effective surgical techniques

Abstract

Background: Benign prostatic hyperplasia is the most common cause of lower urinary tract symptoms in the elderly male and commonly treated by open prostatectomy in this environment despite newer safer options. The standard of care for benign prostatic hyperplasia is still the open prostatectomy procedure carried out by either the retro -pubic or transvescical route particularly in health institutions in developing countries where the resources for modern methods are not readily available. The authors' place of practice has practiced this method of managing BPH since the establishment of the institution over fifty years ago and has continued to do so despite becoming a University Teaching Hospital. Huge number of patients with BPH flock our Outpatient Clinics seeking for management of their BPH. The number of those embarking on medical tourism is also on the increase to have more modern techniques of treatment like TURP in view of its better outcome, thus further depleting our scarce foreign reserve. We therefore reviewed retrospectively the open prostatectomies (OP) carried out in the institution looking at the cost effectiveness, surgical complications and quality of life thereafter.

Objective: To assess the outcome of OP carried out in Bingham University Teaching Hospital (BHUTH), between January; 2011 to January; 2017 in order to recommend options for improved outcome in terms of quality of life, cost effectiveness and patient safety.

Design: A retrospective study of open prostatectomies done at Bingham University Teaching Hospital, formerly ECWA Evangel Hospital, Jos looking at the cost effectiveness, post-operative morbidity outcomes, length of hospitalization and quality of life thereafter.

Setting: Bingham University Teaching Hospital, Jos, Nigeria.

Methods: After obtaining ethical clearance from the BHUTH Health Research Ethics Committee for this study, we reviewed the medical records of 80 open prostatectomy patients from January 2011 to January; 2017 in order to document both medical and surgical complications arising from the surgeries. We also classified the complications documented using the modified Clavien method of classification for surgical operations.

Results: We found a total of 108 OP that were carried out over the review period. Of the number only 80 cases were analysed. Those excluded were either due to incomplete documentation or existing comorbidities. Of the 80 OP patients analysed, statistical analysis showed that the mean age of the patients was 62+10 years and a range of 53 – x years. In this study 8% of the subjects had one form of complication or the other. Most complications were found to have occurred in the immediate post-surgery period. Other complications of OP that occurred in the early postoperative period were re-operated within 2 and 5 years respectively. Length of hospital stay ranged between five and twenty days.

Conclusion: We conclude that OP procedure is still accompanied with substantial perioperative morbidity and mortality and this correlated well with the grade of the complication, particularly for high-grade complications. Open prostatectomy is still a valid operative procedure in a contemporary society, even where advanced techniques for transurethral approach to prostatectomy and laser and assisted robotic radical prostatectomy are available. However, where the human resources for modern techniques such as the transurethral Prostatectomy (TURP) are available, the armamentarium should be acquired to further reduce the occurrence of morbidity and even mortality recorded in this study. We also note that possible complications should be well explained to the patient at the preoperative encounter and documented.

Keywords: Open prostatectomy, benign prostatic hyperplasia, Complications, Assisted robotic radical prostatectomy