Early postoperative complications of bipolar transurethral resection of the prostate at Kenyatta National Hospital

Abstract

Background: Bipolar TURP is the gold standard for surgical management of BPH because it uses a physiologic irrigating solution with better hemostasis. Its plasmakinetic tissue management system makes it applicable for small, medium and large-sized prostates. This technique is recently introduced at KNH but data on early postoperative complications is unknown. This information would be useful in the surgical management of patients with BPH. Study objective: To find out the early postoperative complications of Bipolar TURP at KNH. Materials and methods: This was a prospective observational study of 72 patients undergoing bipolar TURP at KNH following ethical approval from KNH Ethics and Research Committee. Patients were obtained from general surgery and amenity wards and recruited into the study by consecutive sampling after consent. Patients’ data: pre-operative (age, IPSS score, PSA, PVR, indication for surgery, Hb, urinalysis, comorbidities), intra-operative (resection length, weight of prostate resected) and post-operative (duration of irrigation, catheterization & hospitalization, and early postoperative complications) were obtained. Data was analyzed using SPSS version 22. Frequencies, means and standard deviation was obtained for the pre-, intra-& post-operative features. A p value of ≤ 0.05 was considered significant at 95% confidence interval. A comparison of means of pre-op characteristics was done using Independent Student’s T-test between the group that developed complications and those who didn’t. Chi-square and Fisher’s exact test were used to determine factors associated with early postoperative complications for categorical variables such as age, urine infection, comorbidities and indications of surgery. Results: The mean age of the patients was 70.4 years. The most common indication for TURP was failed medical therapy. Most patients had severe urinary symptoms (mean IPSS score =24), prostate size >75g and an average postvoid residue of >200cc. Over 70% of the patients had one or multiple comorbidities. The overall complication rate was 54.9%, however majority of the complications were minor (Clavien-Dindo grade I and II). The most common early postoperative complications were failure to void after catheter removal and prolonged hematuria. TURP syndrome occurred in 2 patients. Majority of the patients were catheterized for 2-3 days after surgery. On Chi-square analysis, presence of positive urine culture and age >70 years were significantly associated with early postoperative complications and failure to void after catheter removal (p= 0.002, 95% CI; Fishers exact test). Conclusion: Bipolar TURP is a relatively safe procedure albeit with minor complications. The most common early postoperative complications were failure to void and prolonged hematuria. Presence of preoperative positive urine culture and age >70 years were significantly associated with early postoperative complications. This category of patients requires due diligence in the immediate postoperative period.