TRANSURETHRAL RESECTION OF THE PROSTATE IN COMMUNITY OUTREACH: WHAT ARE THE LESSONS?

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A.O. Takure

Division of Urological Surgery, Department of Surgery, College of Medicine, University of Ibadan and University College Hospital, Ibadan. Nigeria

Abstract

Background: Transurethral resection of the prostate is the gold standard for treating benign prostate enlargement that presents with complications or worsening lower urinary tract symptoms despite medical treatment. We report the experience of transurethral resection of the prostate in indigenous community in the sub-Saharan Africa.

Methods: Arrangements were made with selected communities for transportation of endoscopic instruments by road. Medical officers were taught on the inclusion and exclusion criteria for men suitable for transurethral resection of prostate. Scheduled visits were arranged between January 2016 and December 2019.

Results: Fifty-five men age range 45-98years underwent TURP. The mean prostate volume, preoperative infection rate, operation time, hospital stay, postoperative day of catheter removal, and incidental prostate cancer were 52.5 cm3, 9%, 41.3 minutes, 2 days, 5 days, and 5.5% respectively. There was an increase in TURP per year from 4 to 20 patients. The postoperative complication rate was 4%.

Conclusion: TURP in the indigenous and pensioners community is feasible, accessible, with satisfactory outcome. The government needs to support this initiative of scheduled community outreach to ensure modern day treatment is brought to the doorstep of her citizens.

Keywords: single surgeon, community TURP, lessons.

Introduction

Benign prostate enlargement is common in men with increase in age. About 50% of men less than 50 years and 80% of men above 80 years are likely to have lower urinary tracts symptoms due to benign prostate enlargement.¹ The common indications for surgery include worsening lower urinary tract symptoms or the presence of complications such as recurrent acute urinary retention, recurrent urinary tract infections, recurrent haematuria and renal impairment.^2,3

The gold standard of treatment is transurethral resection of prostate (TURP). Others which depend on the environment and the available facility include open prostatectomy, transurethral vaporization, holmium laser enucleation of the prostate, laser diode prostatectomy and bipolar vaporization of prostate.^4,5 About 93% of sub-Saharan Africa lacks access to safe, affordable, and timely surgical care, compared with less than 10% in high-income countries. The implication is that such treatment modalities are often available in the urban centres.⁴ However, TURP was performed safely among rural dwellers in India with good outcome.⁶

We therefore looked at the ways we could get to the rural sub-Saharan Africans by scheduling urological outreach to a hospital in northern Nigeria patronize by pensioners and their families as well as in missionary hospital in Eleta, an indigenous area in Ibadan located in southwest Nigeria. We report the outcome of TURP in these environments in sub-Saharan Africa.