Patients Undergoing Transvesical Prostatectomy and Retropubic Prostatectomy
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Date
2025
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Addis Ababa Uinverstiy
Abstract
Benign prostatic hyperplasia(BPH) has a wide range of management options,
from watchful waiting to minimally invasive and open surgical procedures. Although open
prostatectomy accounts for less than 5% of BPH surgeries globally, it remains a commonly
practiced approach in developing countries such as Ethiopia due to limited resources and a
shortage of trained personnel. Among open techniques, the transvesical approach is
predominantly performed in our setting, despite better perioperative outcome of the
retropubic approach.
Objective: To compare the perioperative outcomes of open simple prostatectomy performed
via the transvesical (suprapubic) approach and the retropubic approach for bladder outlet
obstruction secondary(BOO) to BPH among patients undergoing surgery at Menelik II
Hospital.
Methods: This was an institution-based, multi-operator, prospective comparative cohort
study employing a quasi-randomized allocation method. The study included patients with
BOO due to BPH presenting to Menelik II Hospital beginning in October 2024 to October
2025. Data were collected using a structured questionnaire covering preoperative,
intraoperative, postoperative (ward), and follow-up assessments, completed by resident and
intern physicians. Statistical analysis was performed using SPSS. Perioperative outcomes and
complications were compared.
Results: A total of 35 patients were included in the final analysis. Baseline demographics and
preoperative clinical characteristics were comparable between two groups.
The RPP group showed significantly lower overall complication rates (11.2% vs 55.5%, p =
0.005) and reduced blood transfusion requirements (5.8% vs 11.1%, p = 0.016). Multivariate
analysis adjusted for age and baseline hemoglobin (Hgb) showed that RPP was independently
associated with a significantly lower postoperative Hgb drop (adjusted mean difference: 1.48
g/dL less; p = 0.006).
Postoperative hospital stay was significantly shorter in the RPP group (adjusted mean
difference: 1.62 days shorter; p = 0.016), and surgical drains were removed earlier (adjusted
mean difference: 1.60 days earlier; p = 0.001). There was no significant difference in
operative time (p = 0.449).
Short-term patient-reported outcomes at 4–6 weeks, including patient satisfaction and LUTS
improvement, were similar in both groups (p > 0.1).
Conclusion:
Retropubic prostatectomy appeared to be associated with more favorable perioperative outcomes.
These findings support adopting RPP as the preferred open surgical technique for BPH in
settings where open prostatectomy remains the primary option.
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Keywords
Benign Prostatic Hyperplasia, Transvesical Prostatectomy, Retropubic Prostatectomy, Lower Urinary Tract Symptoms, Ethiopia