Immediate outcome of transurethral resection of prostate at Muhimbili National Hospital

Abstract

ABSTRACT Background: Benign prostate hyperplasia (BPH) is a common cause of lower urinary tract symptoms in aging men. Histopathologically, it is characterized by an increased number of epithelial and stromal cells in the periurethral area of the prostate. Transurethral resection of the prostate (TURP) is considered to be the gold standard for surgical treatment of BPH. It is one of the most commonly performed surgeries by urologists. Complications of TURP that have been reported include: TUR syndrome, erectile dysfunction, irritative voiding symptoms, bladder neck contracture, bleeding that leads to the need for blood transfusion, UTI, hematuria, clot retention, failure to void. Despite TURP being one of the commonly performed surgical procedures in the department of urology at MNH and being associated with various short-term post-operative morbidities; still there is no available data about assessment of its immediate outcome. The study aims at providing data about intra-operative and immediate post-operative outcomes of TURP and factors related to the outcome. Objectives: To assess immediate outcome of Transurethral resection of prostate at MNH and factors associated with outcome. Methodology: Hospital based cross-sectional study. The study was conducted on 138patients at Muhimbili National Hospital (MNH) from April 2018 to January 2019 obtained by convenient sampling of patients who underwent TURP during the study period. The Inclusion criteria: All admitted patients with BPH who underwent TURP and follow up for 7days or until discharge whichever occurred earlier. Exclusion criteria: Patients with BPH who underwent TURP but had previous history of TURP. Data was collected using a standardized pre-tested English questionnaire that was filled by research assistants. Data was managed and analyzed by using SPSS program version 24 and association between variables was determined by using Chi-squared test or Fisher’s exact test. Ethical clearance was obtained from the MUHAS research and publication committee and MNH research and publication committee. Results: The study involved 138 patients with BPH who underwent TURP at MNH between April 2018 and January 2019. The mean, (range) age of patients was 68.95 ±8.66 years, (48 – 94 years). Incidence of co-morbidity was found to be 46.4%. The mean, (range) prostate size by abdominal pelvic ultrasound was 67.87 ± 32.14 grams, (21.1 – 270grams). The mean resection time, (range) was 60.65 ± 14.81 minutes, (30 – 105 minutes). Incidence of immediate post-operative morbidity and mortality was found to be 28.3% and 0.7% respectively. Majority of patients (93.5%) were able to void per urethra after trial of voiding. The average days with indwelling catheter was 3.52±1.32 days and the average hospital stay was 3.64±1.21 days. Hypertension and diabetes have shown to influence outcome of voiding post TURP by increasing the risk of failure to void with statistically significant difference. Conclusion: Despite TURP being the gold standard in management of obstructive BPH yet it is associated with a number of complications, Clot retention being the predominant one at MNH. Hypertension and diabetes have been shown to influence negatively immediate outcome of TURP. The presence of low rate of blood transfusion, low incidence of TUR syndrome, short hospital stay and duration of catheterization and high rate of successful voiding per urethra still make TURP surgery a good option for obstructive BPH at MNH. Key words: BPH, TURP, Outcome, Muhimbili Recommendations: • Surgeons should try their best to achieve homeostasis intra-operatively to reduce the complication of clot retention and decrease further the need of blood transfusion since blood is a scarce resource. • There is a need of having TURP protocol which will help to increase appropriate care to patients such as proper irrigation, duration of indwelling catheter among others. This will help to reduce unnecessary complications. The presence of TURP protocol will be of great help to those new to the department and patients as well since they will be in a good environment to get a proper care. • Patients with hypertension and diabetes who undergo TURP need a close monitoring in terms of their blood pressure and blood glucose level since these co-morbidities have shown to associate negatively with immediate outcome of TURP. • A long follow-up study should be done to assess long-term complications of TURP and the effect of hypertension and diabetes on BPH management.