Open radical prostatectomy in a context of limited resources: complications and barriers to optimal management - analysis of 35 cases in Southern Benin

Abstract

Introduction: Prostate cancer represents the most common urological malignancy in sub-Saharan Africa. Radical prostatectomy constitutes the gold standard treatment for localised disease; however, African data on its complications remain limited. This study aims to analyse the perioperative and functional complications of open radical prostatectomy in two Beninese university hospital centres and to compare our results with international standards.

Patients and Methods: A retrospective cohort study including all patients who underwent retropubic radical prostatectomy for localised prostate cancer between January 2018 and June 2022 (allowing a minimum follow-up of 6 months until December 2022) at CNHU-HKM in Cotonou and CHUDOP in Porto-Novo. Exclusion criteria comprised incomplete clinical documentation and postoperative follow-up of less than 6 months. Preoperative data (PSA, Gleason score, D’Amico classification), intraoperative and postoperative parameters were collected. Complications were classified according to the Clavien-Dindo classification. Statistical analysis was performed using Epi Info software version 7.2.5.0.

Results: Thirty-five patients were included (mean age: 65 ± 7.3 years). The majority presented with low-risk cancer according to D’Amico criteria (74.3%), with a Gleason score of 6 (77.1%) and median PSA of 14.6 ng/ml. All patients underwent retropubic radical prostatectomy with bilateral nerve-sparing under general anaesthesia. Ilio-obturator lymph node dissection was performed in 48.6% of patients. No major intraoperative complications occurred. Mean operative time was 187 ± 43 minutes. Mean blood loss was 520 ± 180 ml, with a transfusion rate of 11.4%. Mean length of hospital stay was 11.1 ± 7.1 days. Early postoperative complications (Clavien grade I-II) affected 68.6% of patients: lymphocele (8.6%), deep vein thrombosis (2.9%), wound infection and urinary tract infection (2.9% each). Two surgical reinterventions (Clavien grade IIIb) were required for anastomotic leak (5.7%). Functional complications at 6 months included: ejaculatory dysfunction (81.4%), urinary incontinence (66.6%), complete erectile dysfunction (48.1%).

Conclusion: This first Beninese series, although limited by its small sample size and retrospective design, provides preliminary data on the feasibility of open radical prostatectomy in a resource-limited setting. The absence of major intraoperative complications, while encouraging, must be interpreted with caution given the sample size and selection bias toward low-risk cancers. The observed functional morbidity underscores the imperative need to develop structured perioperative rehabilitation programs. In the absence of minimally invasive techniques, optimisation of perioperative management and improved patient selection represent the most realistic avenues for short-term improvement.