Surgical Management Of Benign Prostate Hyperplasia In Nigeria: Open Prostatectomy Versus Transurethral Resection Of The Prostate

Introduction: transvesical (open) prostatectomy (OP), an invasive surgical procedure, is a common form of treatment offered to patients with benign prostatic enlargement in emerging economies. Recently, there has been an increase in the use of electrosurgical means in treating benign prostate hyperplasia in our environment, especially transurethral resection of the prostate (TURP). This study compares the perioperative, short-term outcomes and complications of open prostatectomy and TURP. Methods: the records of men who hod prostatectomies (OP and TURP) from Jan 2016 to Dec 2019 for prostate gland less than 80g were reviewed. The patients' age, size of the prostate gland, duration of surgery (mins), blood transfusion, clot retention, length of catheterisation (days), hospital stay (days), postoperative infection, postoperative incontinence, reoperation, bladder neck stenosis and urethral stricture were analysed. Results: fifty-nine patients were studied. Twentynine patients had OP, while 30 had TURP. Mean age for OP was 63.8 (SD 7.2) years, while for TURP is 68.5 (SD 8.0) years (p=0.019). The mean for length of catheterisation for OP vs TURP was 9.1 (SD 3.7) vs 3.3 (SD 1.03) days (p=0.001), mean hospital stay was 9.6 (SD 4.1) and 4.7 (SD 2.2) days (p=0.001) for OP and TURP while duration of surgery (mins) for OP and TURP was 106.7 (SD 15.2) vs 53.8 (SD 14.0) minutes (p=0.001). The blood transfusion rate was 13.8% and postoperative incontinence 13.8% in OP, while in the TURP group, the reoperation rate was 3.3% and urethral stricture at a rate of 3.3%. Overall complications showed no statistical difference (p=0.462) between the two groups. Conclusion: the patients who underwent TURP had shorter hospital stay, shorter duration of surgery and catheterisation, and less frequently required blood transfusion compared to those who had open prostatectomy. However, reoperation rate was higher compared to open prostatectomy. The overall complication was fewer with TURP, but this is not statistically significant; hence both forms of surgical therapy remain relevant in a poor resource setting.