Open prostatectomy for benign prostate hyperplasia: short-term outcome in 3000 consecutive patients

Abstract

The purpose of this study was to report the short-term results of open prostatectomy for benign prostatic hyperplasia (BPH). Patient charts were retrospectively reviewed from September 1988 to April 2004. A total of 3000 consecutive patients with bothersome lower urinary tract symptoms (LUTS) and complications of BPH underwent open prostatectomy in our center. We routinely used a retropubic, transcapsular approach with spinal anesthesia. Mean age was 69 years. Three hundred and sixty one patients were 80 years or older. Mean prostate volume was 71 ml. One thousand eight hundred and twenty five patients (60.8%) presented with and were operated on for acute urinary retention (AUR), and 350 patients (11.7%) presented with and were operated on for urge/overflow urinary incontinence. The main reasons for delayed presentation were poverty and absence of real medical insurance, because in Iran ‘insured’ patients pay at least 60% of their medical expenses personally. Reoperation in the same admission was needed in 29 patients (1%). Transfusions were needed in 99 patients (3.3%). Wound infection occurred in 37 patients (1.2%). Acute myocardial infarction (MI) occurred in 15 patients (0.5%), resulting in three deaths. Occurrence of AUR had significant negative correlation with duration of symptoms (P<0.05; odds ratio 0.5), and significant positive correlation with positive urine culture (P<0.05; odds ratio 2.7). Duration of hospital stay had significant positive correlation with positive urine culture (P<0.05; odds ratio 1.6) and advanced age (P<0.05; odds ratio 1.8), and significant negative correlation with prostate volume (P<0.05; odds ratio 0.6). Our results are representative of the current status of open prostatectomy. Whenever minimally invasive therapies are not affordable retropubic prostatectomy is a practical alternative.