Prostatectomy outcomes for patients with benign prostatic hyperplasia and its associated factors in East and West Gojjam zones comprehensive specialized hospitals, Northwest Ethiopia

Background: Benign prostatic hyperplasia (BPH) is non-cancerous growth of the prostate gland which surrounds the urethra. For men with BPH who are older than 50, a prostatectomy is a common surgical procedure. Open prostatectomy is still more prevalent in regions with limited access to advanced surgical procedures like transurethral resection of the prostate and robotic-assisted laparoscopic prostatectomy. Determining prostatectomy outcomes for BPH and associated factors is essential to optimize patient care and improve awareness of this condition. However, the outcomes of prostatectomy and associated factors are not studied in Ethiopia.

Objectives: To assess prostatectomy outcomes for patients with benign prostatic hyperplasia and its associated factors in East and West Gojjam Zones, 2021.

Methods: A facility-based cross-sectional study was employed among 412 patients with prostatectomy using systematic sampling. Five-year secondary data from 2016 to 2021 data was extracted from patients' medical records using a structured proforma. The outcomes of prostatectomy for BPH are categorized into good outcomes if significant symptom relief such as reduced urinary frequency, urgency, and nocturia and preserved sexual function using International Prostate Symptom Scores and Sexual Health Inventory for Men. A poor outcome involves minimal symptom improvement, recurrence of symptoms, severe complications like urinary incontinence or retention, and erectile dysfunction. Besides this, logistic regression models were computed to assess the relationship between variables.

Results: Among 412 patients with prostatectomy, 68 (16.5%; 95% CI 12.9-20.1) had poor outcomes, and 344 (83.5%; 95% CI 79.9-87.1) had good outcomes. In addition, patients who took venous thromboembolism (VTE) prophylaxis were 80% less likely to develop good prostatectomy outcomes than those who did not take prophylaxis (AOR = 0.2; 95% CI 0.07-0.6). Good prostatectomy outcomes were 86% lower in those who did not obtain the proper wound care than in those who did (AOR = 0.14; 95% CI 0.03-0.6). Comparably, patients with hypertension comorbidity were 70% (AOR = 0.3; 95% CI 0.1-0.6) less likely to have good prostatectomy outcomes. On the other hand, patients who underwent transurethral resection of the prostate (TURP) had twice the odds of a good prostatectomy outcome compared to those who underwent transvesical prostatectomy (TVP) (AOR = 2; 95% CI 1.5-5.4). Moreover, patients who received preoperative oral medical therapy for benign prostatic hyperplasia (BPH) were twice as likely to experience poor prostatectomy outcomes compared to those who did not take preoperative medical therapy (AOR = 2; 95% CI 1.2-8.7). Similarly, patients with a prostate volume of 100-200 cm³ were five times more likely to develop poor prostatectomy outcomes compared to those with a prostate volume of 30-60 cm³ (AOR = 5; 95% CI 2.3-10).

Conclusions: A total of 16.5% of the participants experienced poor outcomes following prostatectomy. The factors associated with these outcomes included venous thromboembolism prophylaxis intake, appropriate wound care, hypertension as a comorbidity, surgical modality, preoperative oral medication therapy for BPH, and prostate volume.