Bobrowski Adam, Nayan Madhur, Heimrath Olivier, Goche Duncan, Ludzu Enok, Singal Rajiv K
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Urology, Department of Surgery, University of Toronto, ON, Canada.
Can Urol Assoc J. 2021 May;15(5):E261-E266. doi: 10.5489/cuaj.6576.
Despite the high prevalence rates of urinary retention in sub-Saharan Africa, regional deficiencies in urological care have culminated in inadequate medical management and a backlog of urology cases. Our study examined the efficacy and safety of a surgical camp enlisting local non-urologists performing simple open prostatectomy on the rate of chronic catheter usage secondary to urinary retention.
We reported on a prospective case series of patients with chronic indwelling catheters who underwent open simple prostatectomy during a one-week urology camp in the Machinga District of Malawi. All operations were performed by a locally trained general surgeon and a clinical officer.
Twenty-three (47.9%) of 48 male patients with urinary retention assessed for eligibility for open simple prostatectomy were deemed eligible and underwent the procedure. Of the patients who underwent an open simple prostatectomy, histopathological findings demonstrated benign prostatic hyperplasia in 19 patients (82.6%), while six patients (26.1%) had coincidental malignancy. At postoperative followup, the entire cohort was catheter-free and reported regular sexual activity and the ability to return to work, while 87.0% noted improvements in social integration and 34.8% cited higher self-esteem. Two patients required treatment for infection and one patient experienced fascial dehiscence. Two months following prostatectomy, all patients were catheter-free and able to void independently.
Local surgical practitioners without formal urology training can successfully perform open simple prostatectomy to relieve patients of chronic indwelling catheters and assist in addressing the disease burden in a low-resource setting.
尽管撒哈拉以南非洲地区尿潴留的患病率很高，但该地区泌尿外科护理的不足最终导致医疗管理不善和泌尿外科病例积压。我们的研究考察了一个外科营地的疗效和安全性，该营地招募当地非泌尿外科医生进行简单开放性前列腺切除术，以治疗因尿潴留而长期使用导尿管的情况。
我们报告了一组前瞻性病例，这些慢性留置导尿管患者在马拉维马钦加区举行为期一周的泌尿外科营地期间接受了开放性简单前列腺切除术。所有手术均由一名当地培训的普通外科医生和一名临床官员进行。
48名因尿潴留而接受开放性简单前列腺切除术资格评估的男性患者中，有23名（47.9%）被认为符合条件并接受了该手术。在接受开放性简单前列腺切除术的患者中，组织病理学检查结果显示，19名患者（82.6%）为良性前列腺增生，而6名患者（26.1%）同时患有恶性肿瘤。术后随访时，整个队列均不再使用导尿管，并报告有规律的性活动以及能够重返工作岗位，87.0%的患者表示社会融合得到改善，34.8%的患者称自尊心增强。两名患者需要接受感染治疗，一名患者出现筋膜裂开。前列腺切除术后两个月，所有患者均不再使用导尿管，能够自主排尿。
未经正规泌尿外科培训的当地外科医生能够成功进行开放性简单前列腺切除术，使患者摆脱慢性留置导尿管的困扰，并有助于在资源匮乏地区应对疾病负担。
