Open prostatectomy for benign prostatic hyperplasia: A critical analysis of patient presentation and surgical outcomes in a contemporary series.

Background: Open prostatectomy (OP) is still a valid treatment option for benign prostatic hyperplasia (BPH), but it needs to be constantly reevaluated in the context of minimally invasive treatments (MITs). Aim: Our purpose is to present contemporary data on patient presentation and surgical outcomes of OP with which other OP series and MITs can be compared. Methods: A retrospective study of all OP was carried out in our institution from January 2011 to December 2020. All patients had a thorough preoperative workup and optimization of comorbidities before surgery. Data were collected in a predesigned pro forma and analyzed. Results: The mean age of the 148 patients studied was 66.2 (±7.9) yrs. The mean duration of symptoms before surgery was 32.2 (±33.7) mos. The mean preoperative prostate volume was 118.0 (±67.1) cm3. There was a 54.4% comorbidity rate with diabetes mellitus (DM) topping the list (16.0%). An incidental prostate cancer rate of 6.1% was found. The overall complication rate was 45.3%. Perioperative hemorrhage requiring blood transfusion (BT) was the most common complication (26.1%). There was no significant difference in age, duration of surgery, and prostrate volume between subjects with and without BT (P > 0.05). Wound infection was significantly associated with diabetes (P = 0.043, OR = 3.507, 95% CI = 1.042-11.805). The reoperation rate was 1.4%, and mortality rate was 0.7%. The International Prostate Symptom Score (IPSS), quality-of-life (QOL) score, and post-void residual urine (PVR) volume were significantly improved (P < 0.001). Conclusion: OP was found to be a safe and effective procedure for the relief of bladder outlet obstruction (BOO) secondary to BPH. However, it was associated with high morbidity and low reoperation rate.

The modified suprapubic prostatectomy technique is associated with improved hemostasis and decline in blood transfusion rate after open suprapubic prostatectomy compared to the freyers technique.

Background: Open suprapubic prostatectomy is attended by significant perioperative haemorrhage and need for blood transfusion. Aim: To share our experience on how the adoption of a modified suprapubic prostatectomy technique has led to improved hemostasis and decline in the blood transfusion rate after open suprapubic prostatectomy in our center. Patients and Methods: This was a retrospective study comparing two open prostatectomy techniques. The patients in group 1 had Freyer's suprapubic prostatectomy while the patients in group 2 had a modified suprapubic prostatectomy technique. The groups were compared for the effectiveness of hemostasis using change in packed cell volume, clot retention, blood transfusion, and requirement of continuous bladder irrigation. Results: Both groups were similar concerning age, body mass index (BMI), total prostate-specific antigen (PSA), prostate volume, presence of comorbidities, duration of surgery, and duration of follow-up. The clot retention rate was 34% in group 1 versus 16.4% in group 2, P = 0.030. The clot retention requiring bladder syringe evacuation occurred in 32.1% of the patients in group 1 versus 14.8% in group 2, P = 0.048. The mean change in the packed cell volume (PCV) in group 1 was 8.0 ± 5.3 versus 6.9 ± 3.5 in group 2, P = 0.175. The blood transfusion rate in group 1 was 40.0% versus 13.3% in group 2, P = 0.040. The complication rate in group 1 was 67.2% versus 41.9% in group 2, P = 0.004. A general decline in blood transfusion was noted from January 2011 to December 2019. Conclusion: The modified suprapubic prostatectomy technique was associated with better hemostasis compared to the standard Freyer's prostatectomy technique. It should be a worthwhile addition to the numerous modifications of the original Freyer's suprapubic prostatectomy technique.

Malignant renal tumours in adults in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

BACKGROUND: Malignant renal tumour is the third commonest urological tumour after prostate and bladder cancer. It is however the urological tumour with the highest mortality/incidence ratio. OBJECTIVE: To review the frequency, mode of presentation and histological pattern of patients with malignant renal tumours in Nnamdi Azikiwe University Teaching Hospital. METHOD: A 7 year retrospective review of all our renal tumour folders in theinstitution. RESULTS: 19 patients qualified for the study with a male/female ratio of 1:2.8 and a mean age of 52.6 +/- 15.8 years. The peak age was in the seventh decade. Most patient present late (78.9%). Renal cell cancer was the commonest tumour type with the commonest mode of presentation being abdominal mass and pain. CONCLUSION: Malignant renal tumours present very ate in our environment and patients hesitate in accepting available treatment option which is surgery. There is need for increased patient awareness and high index of suspicion by the clinician, particularly during imaging procedures, as this would significantly enhance the early detection of these patients.

Malignant renal tumours in adults in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

BACKGROUND: Malignant renal tumour is the third commonest urological tumour after prostate and bladder cancer. It is however the urological tumour with the highest mortality/incidence ratio. OBJECTIVE: To review the frequency, mode of presentation and histological pattern of patients with malignant renal tumours in Nnamdi Azikiwe University Teaching Hospital. METHOD: A 7 year retrospective review of all our renal tumour folders in the institution. RESULTS: 19 patients qualified for the study with a male/female ratio of 1:2.8 and a mean age of 52.6 +/- 15.8 years. The peak age was in the seventh decade. Most patient present late (78.9%).Renal cell cancer was the commonest tumour type with the commonest mode of presentation being abdominal mass and pain. CONCLUSION: Malignant renal tumours present very late in our environment and patients hesitate in accepting available treatment option which is surgery. There is need for increased patient awareness and high index of suspicion by the clinician, particularly during imaging procedures, as this would significantly enhance the early detection of these patients.