Abstract:

Background: Benign prostate hyperplasia (BPH) is the most common prostate pathology in elderly men. Trans Urethral Resection of the Prostate (TURP) is still considered as the gold standard surgical management of BPH. TURP is the commonest endoscopic surgery performed for BPH in developing countries including Tanzania, however its outcome is not known. This study determined the clinical profile, outcome as well as predictors of outcome in patients with clinical BPH undergoing TURP at Bugando Medical Centre (BMC), a tertiary hospital in Mwanza, Tanzania.

Methods: This was a cross sectional longitudinal hospital based study to evaluate the clinical profile as well as the outcome of patients with clinical BPH treated by TURP at Bugando Medical Centre from November 2018 to April 2019. All participants with clinical BPH and scheduled for TURP and consented for the study were included, their international prostate symptom score (IPSS) with the 8th question for quality of life (QoL) was scored, their age, residence, renal status, PSA, size of the prostate, urinalysis as well as urine culture were recorded. They were admitted and prepared for the operation. Intraoperatively, experience of the surgeon, duration, weight of resected prostate, and complication/s were recorded. Progress in the ward was recorded and following discharge patient was scheduled for follow up at 6 and 12 weeks. During follow up, IPSS and QoL scores as well as complication was reported. Patients were deemed improved if follow up IPSS was either ≤7 or decreased by ≥50% and QoL score is <3. Univariate and multivariate logistic regressions were used to identify factors, which affects improvement of symptoms.

Results: A total of 210 participants met the inclusion criteria. The median age was 69 (IQR 63 – 75) years. Prostate size ranged from 15 – 200grams with median size of 77 (IQR 51 – 107) mls. Acute urine retention was the most common indication 69 (33%), followed by lower urinary tract symptoms 52 (25%). Urologist operated most of the patient 122 (58.1%) with the rest operated by either resident alone or finished up by urologist, and the median weight resected was 20 (IQR 13.5 – 28.3) grams. About 66 (31.4%) developed perioperative complication with majority having clot retention. During follow up, the median IPSS score was 9 (IQR 7 – 12) and 2 (IQR 0 – 6) and median QoL score of 3 (IQR 1 – 3) and 0 (IQR 0 – 1) with improvement in 93 (45.4%) and 184 (89.8%) on 1st and 2nd visits respectively. There were a total of 9 (4.3%) patients whom developed Tran’s urethral resection (TUR) syndrome out of which 1 (11.1%) died and overall mortality was 3 (1.4%) participants.

Conclusion: BPH is common from 6th decade of life onwards. Though most participants were operated because of either acute urine retention or disturbing LUTS, some presents late already with renal insufficiency. Despite the fact the most of the participants had severe symptoms and their quality of life was poor at presentation, TURP improved symptoms in most of the participants. The improvement is even better in the hands of experienced surgeon, for the participants with small prostate and in absence of UTI prior to surgery.