Mgbakor Anthony Chukwura
Department of Surgery, Anambra State University Teaching Hospital, Amaku, Awka, Nigeria.
Arch Ital Urol Androl. 2012 Sep;84(3):123-8.
Benign prostatic hypertrophy forms the bulk of urology workload in many sub-Saharan African hospitals. However, its management in secondary hospitals encounters specific problems that are rarely seen in the bigger tertiary institutions. We have tried to describe these difficulties across an account of open prostatectomy in regional secondary referral hospitals in the Côte d'Ivoire.
This is a retrospective account of the specific difficulties encountered in the management of 327 consecutive cases of open prostatectomy carried out between August 1991 and September 2007 mainly in two secondary referral hospitals in the Côte d'Ivoire.
The difficulties were at different levels: late presentation with 309 (94.5%) of the patients having experienced at least an episode of acute retention of urine, surgery while most patients were still carrying a catheter, minimal investigations carried out, scoring the patients in the IPSS scale, shortage of funds in the course of the management, and surveillance in the immediate postoperative period. The overall results were relatively satisfactory given our conditions of work. The most frequent complications were wound infection (14.7%), bleeding requiring transfusion (8.6%) and re-operation for clot retention (4.3%). We had a case (0.3%) of the rare prostato-rectal fistula which was managed conservatively. There were 4 deaths (1.2%).
Open prostatectomy is the only surgical option for the management of benign prostatic hypertrophy in most of the urology centers of sub-Saharan Africa. Concerning its management away from the Tertiary Institutes, the surgery team is faced with specific problems which demand precise adaptations. Despite difficult working conditions, the results are sufficiently encouraging and gratifying to justify its pursuit while Urologists await the availability of equipments for transurethral resection of the prostate and other novel techniques.
在许多撒哈拉以南非洲医院，良性前列腺增生构成了泌尿外科大部分工作量。然而，其在二级医院的治疗遇到了一些在大型三级医疗机构中罕见的特殊问题。我们试图通过描述科特迪瓦地区二级转诊医院开放性前列腺切除术的情况来阐述这些困难。
这是一项回顾性研究，描述了1991年8月至2007年9月期间主要在科特迪瓦两家二级转诊医院连续进行的327例开放性前列腺切除术治疗中遇到的特殊困难。
困难体现在不同层面：就诊延迟，309例（94.5%）患者至少经历过一次急性尿潴留；手术时多数患者仍带着导尿管；检查极少；未用国际前列腺症状评分量表对患者进行评分；治疗过程中资金短缺；术后即刻监测不足。鉴于我们的工作条件，总体结果相对令人满意。最常见的并发症是伤口感染（14.7%）、需输血的出血（8.6%）以及因血块残留需再次手术（4.3%）。我们有1例（0.3%）罕见的前列腺直肠瘘，采用保守治疗。有4例死亡（1.2%）。
在撒哈拉以南非洲的大多数泌尿外科中心，开放性前列腺切除术是治疗良性前列腺增生的唯一手术选择。在远离三级医疗机构进行治疗时，手术团队面临特殊问题，需要进行精确调整。尽管工作条件困难，但结果仍足够令人鼓舞和欣慰，足以证明在泌尿外科医生等待前列腺经尿道切除术设备及其他新技术可用时继续开展该手术的合理性。
