Open Prostatectomy in the Management of Benign Prostate Hyperplasia in a Developing Economy

Background: Open prostatectomy (OP) is still relatively common in developing countries and remains a useful benchmark against which the minimal access surgical techniques are compared. This study aims to document the indications and outcomes of OP in a typical developing economy. Method: The records of patients with benign prostate hyperplasia (BPH) who had OP in our university teaching hospital between July 2004 and June 2014 were retrospectively reviewed. Some analyzed parameters include the demographic characteristics, indications, pre-operative work-up, anaesthetic techniques, OP type, complications, histopathology results and follow-up duration. Results: A total of 247 cases were studied. Mean age was 67 years while the commonest surgery indication was recurrent acute urinary retention. Average prostate specific antigen (PSA) was 8.4 ng/ml while hypertension was the most common comorbidity (44.1%). Regional anaesthesia was mainly used (79.4%) while retropubic prostatectomy was the commonest OP type done (58.7%). The enucleated specimen weighed above 60 g in 91.9% of cases. All our patients were able to micturate spontaneously with urine stream above 20 mls/second on follow-up one week after discharge. Mean duration of hospital admission and follow-up were 7 days and 9 months respectively. Complications occurred in 90 patients (36.4%), of which surgical site infections were the commonest (9.8%). There was 0.4% mortality. Histopathology results showed BPH (95.5%), (incidental) prostate adenocarcinoma (2.4%) or prostatic intra-epithelial neoplasia (2.1%). Conclusion: OP remains an important therapeutic option for management of BPH in developing countries partly due to relatively large prostate size and presence of BPH complications from late presentationin many patients. The surgery is efficient and has relatively low morbidity and minimal mortality.

Experience with Open Prostatectomy in Lomé, Togo

Background: Open prostatectomy is the most commonly available surgical procedure for benign prostatic hyperplasia and this is the case in most countries in West African even with all the limitations of the procedure. Objective: The objective is to determine the pattern and outcomes of open prostatectomy in Lomé. Patients & Methods: From December 2011 to November 2012, we conducted a descriptive cross-sectional study on a series of patients treated for prostate adenoma. Dysuria was assessed using the International Prostate Symptom Score (IPSS). The history of each patient was recorded, as well as paraclinical data. All patients were surgically treated via abdominal incision procedure. The data obtained included the patients’ demographics, clinical features, the IPSS scores, investigations, type of open prostatectomy, outcome and follow-up. The data were analyzed for means and frequencies using Epi Info version 3.5.3. Results: Fifty-four consecutive patients underwent surgery consecutively, their ages ranging from 40 to 92 years, with an average of 67.27 ± 12.50 years. In all, 46 (85.2%) patients presented with obstructive symptoms and 26 (48.1%) presented with urinary retention. The average prostate volume was 114.31 ± 20.11 cm3 with a range of 31 - 485 cm3. The average blood loss at surgery was 425.92 ± 38.2 ml with an average operating time of 66.05 ± 15.75 mins and the main complications were hemorrhaging and clot retention in 7 (13%), epididymo-orchitis in 9 (16.7%), and urinary incontinence in 6 (11.1%) patients. IPSS scores were under 7 in 92% of patients three months after surgery and the mortality rate was 3.7%. Conclusion: This study has shown that open prostatectomy in our environment is still the commonest surgical option for benign prostatic hyperplasia with good outcomes though with manageable complications.

Trifecta Outcomes of Screening Detected and Patients with Lower Urinary Tract Symptoms after Open Radical Prostatectomy for Localized Prostate Cancer

Background: Many studies have reported on trifecta outcomes after radical prostatectomy. There is however paucity of studies that compares the trifecta outcome between screen detected and patients presenting with lower urinary symptoms with localized prostate cancer after radical prostatectomy. This study compares the trifecta outcomes between these two groups after an open retropubic radical prostatectomy. Methodology: This is a retrospective study, on the trifecta outcomes (urinary continence, erectile function, and cancer control) of consecutive patients that had open radical retropubic prostatectomy for localized prostate cancer by a single surgeon. Patients were grouped into screen detected and presentation with lower urinary symptoms or retention of urine. The parameters considered were the age of the patients, the total prostate specific antigen (tPSA) at presentation, the clinical T stage, the Gleason score of prostate biopsies, the risk categories using the D’Amico risk groups and the trifecta outcomes after the procedure. Results: In all, 119 patients met the criteria for inclusion. The median follow up was 63.5 months (range 12 - 156 months). Of these 40.3% of the patients were diagnosed through screening with elevated PSA while 59.7% had presented with symptoms of lower urinary tract obstruction. The mean age for the patients was 60.8 ± 6.5 years, median PSA 12.6 ng/ml (IQR 8.6 - 19.7) and median prostate weight of 50.0 (IQR 40.0 - 60 g). The urinary continence rate after the procedure was 93.3%, erection rate of 81.5%, cancer control rate of 71.4% and trifecta achieved in 57.1%. Comparing the screening and the symptomatic cases, the urinary continence rate was 91.7% vrs 94.3%;erectile function rate was 79.2% vrs 83.1%;cancer control 68.8% vrs 73.2% and trifecta achieved in 58.3% vrs 56.3%. There was no statistically significant difference between the two groups in terms of urinary continence p = 0.564, erection function p = 0.588, cancer control p = 0.595, and achieving trifecta p = 0.829. Conclusion: Patients with localized prostate cancer presenting with lower urinary symptoms compared to screen detected patients have similar outcomes in terms of urinary Continence, erectile function, cancer control and trifecta after open radical retropubic prostatectomy.

Effect of surgical procedures on prostate tumor gene expression profiles

Current surgical treatment of prostate cancer is typically accomplished by either open radical prostatectomy （ORP） or robotic-assisted laparoscopic radical prostatectomy （RALRP）. Intra-operative procedural differences between the two surgical approaches may alter the molecular composition of resected surgical specimens, which are indispensable for molecular analysis and biomarker evaluation. The objective of this study is to investigate the effect of different surgical procedures on RNA quality and genome-wide expression signature. RNA integrity number （RIN） values were compared between total RNA samples extracted from consecutive LRP （n= 11） and ORP （n= 24） prostate specimens. Expression profiling was performed using the Agilent human whole-genome expression microarrays. Expression differences by surgicat type were analyzed by Volcano plot analysis and gene ontology analysis. Quantitative reverse transcription （RT）-PCR was used for expression validation in an independent set of LRP （n=8） and ORP （n=8） samples. The LRP procedure did not compromise RNA integrity. Differential gene expression by surgery types was limited to a small subset of genes, the number of which was smaller than that expected by chance. Unexpectedly, this small subset of differentially expressed genes was enriched for those encoding transcription factors, oxygen transporters and other previously reported surgery-induced stress-response genes, and demonstrated unidirectional reduction in LRP specimens in comparison to ORP specimens. The effect of the LRP procedure on RNA quality and genome-wide transcript levels is negligible, supporting the suitability of LRP surgical specimens for routine molecular analysis. Blunted in vivo stress response in LRP specimens, likely mediated by CO2 insufflation but not by longer ischemia time, is manifested in the reduced expression of stress-response genes in these specimens.

The effects of social distancing and self-isolation on functional outcomes after radical prostatectomy during the coronavirus disease 2019(COVID-19)pandemic

Background:This study is aimed to analyze the effect of social distancing on functional outcomes(potency,continence recovery,and quality of life)on patients undergoing open radical prostatectomy(ORP)and robot-assisted radical prostatectomy(RARP)during the coronavirus disease 2019(COVID-19)pandemic.Materials and methods:We retrospectively assessed functional outcomes of 55 consecutive patients who underwent radical prostatectomy during the COVID-19 pandemic(group A:12 ORP and 15 RARP)and compared these data with patients from the previous year(group B:13 ORP and 15 RARP).Propensity-score matching was performed to analyze variables associated with potency,continence recovery and compared between the groups at 1 and 3months.Results:Patients from group A were less interested in postsurgical rehabilitation compared to those from group B(95.7%vs.56.2%,p=0.042).Continence recovery among group B patients also tended to be higher for RARP(p=0.06)and ORP(p=0.08)at 1 month,although statistical significance was not reached.The cumulative continence recovery at 3months among group B patients was higher and statistically significantly advantageous for RARP(p=0.00)and ORP(p<0.01).Potency rates among younger group B patients following bilateral nerve-sparing procedures were statistically significantly advantageous for RARP(p=0.026)and ORP(p=0.011).Conclusions:Our results highlight the large impact of the COVID-19 pandemic on functional outcomes following radical prostatectomy.Future design and planning of home-based models for improved post-operative care should consider this evidence.