Complications of Prostatectomy in Patients Admitted to Kampala International University Teaching Hospital Between January-June 2013

CHAPTER ONE

1.1 INTRODUCTION Prostatectomy is the surgical removal of all or part of the prostate gland. Enlargement of the prostate, commonly through benign prostatic hyperplasia (BPH), but sometimes through abnormalities such as tumors, or from other causes, can restrict the normal flow of urine along the urethra, causing discomfort and difficulty voiding (Wikipedia June 2008). The indications for prostatectomy include symptoms or findings secondary to prostatic obstruction viz: acute urinary retention; recurrent or persistent urinary tract infections; recurrent gross hematuria; documented significant residual urine after voiding with or without overflow incontinence; pathophysiological changes of the kidneys, ureters, or bladder; abnormally low urinary flow rate; and normal flow rate with abnormally high intravesical voiding pressure and intractable symptoms such as nocturia, frequency, and urgency (journal of urology 2004). In a study to determine the appropriate indications of prostatectomy and to identify underlying clinical appropriateness in UK the panel identified agreed indications for prostatectomy expressed in terms of different combination of type of retention, severity of symptoms and level of co-morbidity 67% of these indications were explained (journal of epidemiology and community health 48, Feb 1994) According to WHO more than one half of men between 60-70yrs and as many as 90% between 70-90yrs undergo prostatectomy in their lifetime in USA. In a study conducted in Kenya at Kijabe hospital 20-50% of men in their 60’s had prostatectomy and averagely 200-250 prostatectomy were done in a year (East and Central Africa journal of surgery vol 20-Nov/Dec 2006). In Uganda the prevalence of prostatectomy is 30% in men in their 50s and 80% in men in their 70s (MOH). In an attempt to alleviate some of the complications associated with other approaches of removing the prostate, different types of prostatectomy exist (Wikipedia). The first operations for relief of urinary retention from prostatic enlargement were probably done through the perineum. Early medical writings contain references to division of the bladder neck through the perineum for this purpose (Couvillard 1639). Through the years, however; prostatectomy has undergone major revolution. To determine the early clinical outcome of modified retro pubic vstransvesical prostatectomy in the management of BPH in 68 samples in a non-blinded randomized controlled trial conducted in Mulago hospital - Kampala, the common complications included blood loss, wound sepsis and clot retention with a return to the operating theatre following (WHO-2008). However; an international group of researchers has reported that minimally invasive radical prostatectomy (MIRP), which encompasses laparoscopic and robot-assisted procedures, holds no advantage over open radical prostatectomy in terms of complication rates, (international researchers -Hamburg – Germany). Prostatectomy remains one of the most performed operations in the world..