Clinical profile and outcomes of patients with clinical benign prostate hyperplasia treated by trans urethral resection of prostate at Bugando Medical Centre, Mwanza, Tanzania

Abstract

Introduction: Benign Prostate Hyperplasia (BPH) is the most common prostatic pathology in elderly men with Trans Urethral Resection of the Prostate (TURP) still being considered as the gold standard surgical management. TURP is the commonest endoscopic surgery performed for BPH in developing countries including Tanzania, however its outcome in this part of the world has not been documented. Therefore, the study aimed to determine 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 BMC from November 2018 to April 2019. All participants scheduled for TURP for the diagnosis of clinical BPH who signed informed consent for the study were included, their international prostate symptom score (IPSS) with the 8th question for quality of life (QoL) was scored, social demographic data and clinical profile information were obtained from their files. Participants were followed in the theatre to document any intraoperative complications and other necessary data required by this study. 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 recorded. Results: A total of 210 participants met the eligibility criteria. The median age was 69 (IQR 63-75) years. Prostate size ranged from 15 – 200 grams with median size of 77 (IQR 51-107) grams. 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 of 93 (45.4%) and 184 (89.8%) on 1st and 2nd follow up visits respectively. There were a total of 9 (4.3%) patients whom developed Trans urethral resection (TUR) syndrome, with overall mortality of 3 (1.4%). Conclusion: BPH is common from 6th decade of life onwards. Though most participants were operated because of either acute urine retention or severe lower urinary tract symptoms (LUTS), some presents late already with renal insufficiency. Despite the fact that 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.