The outcome of suprapubic prostatectomy: a contemporary series in the developing world.

OBJECTIVES: To assess the appropriateness of the technique of suprapubic prostatectomy using a removable bladder neck partition suture for use in a developing world hospital and to provide contemporary open prostatectomy outcome data currently lacking in the world's literature. METHODS: From 1984 to 1994, 240 consecutive patients presenting to a developing world hospital with acute urinary retention underwent suprapubic prostatectomy using a removable bladder neck partition suture. The average length of time from bladder decompression until operation was 2.5 months. The outcome of these cases was retrospectively analyzed. RESULTS: The overall early complication rate was 19.6%. There were no deaths. The transfusion rate was 4.6%. Clot retention occurred in 6.7%, and 2.9% required return to the operating room for evaluation. For the second half of the series, the early complication rate decreased to 8.3%, the clot retention rate to 0.8%, and the transfusion rate to 1.7%. Other early and late complications were minimal. The length of delay from decompression until operation did not affect outcome. CONCLUSIONS: The technique of suprapubic prostatectomy using a removable bladder neck partition suture is appropriate for use in developing world hospitals because of its low morbidity and mortality rates. The outcome in this contemporary series of open prostatectomy cases compares favorably with the outcome from reported contemporary transurethral resection of the prostate (TURP) series. These data demonstrate that suprapubic prostatectomy is an acceptable option when the patient's anatomy or the state of local medical facilities precludes TURP.

Perforated typhoid enteritis: operative experience with 108 cases.

A retrospective review of 108 consecutive patients with perforated typhoid enteritis managed operatively over a 4-year period at Baptist Medical Centre, Ogbomoso, Nigeria is presented. There were 75 males and 33 females with an average age of 19.7 years. Presenting symptoms were fever, abdominal pain, vomiting, and either diarrhea or constipation. One hundred patients (93 percent) underwent debridement of the perforation and two-layer bowel closure. Postoperative morbidity included intraabdominal abscess, wound dehiscence, and subsequent bowel perforation. Most of the 35 deaths (32 percent mortality) were attributed to overwhelming sepsis which progressed despite aggressive operative management and antibiotic administration. The key to improved survival in this deadly disease lies not in a better operation or improved perioperative care but in the prevention of typhoid fever by providing safe drinking water and improved sanitation methods for all of the global community.