Suprapubic transvesical prostatectomy in a rural Kenyan hospital

Abstract

Objective: To evaluate the effectiveness, safety and complications of suprapubic transvesical prostatectomy in a rural Kenyan hospital. Design: A prospective audit of suprapubic transvesical prostatectomy. Setting: Africa Inland Church, Kijabe Hospital, Kijabe, Kenya. Subjects: One hundred and six men with lower urinary tract obstruction, clinically due to benign prostatic hyperplasia, undergoing suprapubic transvesical prostatectomy. Interventions: Suprapubic prostatectomy. Main outcome measures: Age, presentation, comorbidity, type of anaesthesia, pathology, bladder irrigation time, Foley time, post-operative stay, complications-mortality, blood transfusion rate, return to theatre for bleeding, incontinence, urine leak, urinary retention. Results: One hundred and six men entered the study with a mean age of 72.8 years. Seventy eight per cent were in retention and 25% had significant medical problems. Spinal anaesthesia was used in 94%. The mean prostate weight was 70.4g and 11% had carcinoma. The Foley's catheter was removed at a mean of 4.2 days after surgery and the mean post-operative stay was 6.0 days. The 30 day mortality was 0.9%, the blood transfusion rate was 4.7%, the return to theatre for bleeding rate was 0.9% and 4.7% of patients developed a urine leak. Conclusion: Suprapubic transvesical prostatectomy, performed under spinal anaesthetic, by general surgeons in rural Kenya, is a safe and effective way of managing benign prostatic hyperplasia and its complications.