Evaluation of the Anatomopathological Result of the Anatomical Pieces Resulting from a Prostatic Adenomectomy by High Approach in Patients Operated for Benign Hypertrophy of the Prostate at the Hospital of Tanguieta Zone

Gayito Adagaba René Ayaovi1*, Chamutu Maheshe1,2, Nzuwa Nsilu Joel1, Gbotounou Nésaire1,2, Azakpa Assogba Leopold1, Aholou Renauld1, Agbegninou Pascal1, Agonhossou Ghislain1, Boisnard Oscar1, Duchnicz Laure1, Seynaeve Sophie1, Bourou Luc1, Hounwaye D Armand1, Avakoudjo Josue Dejinnin Georges2

1Department of General Surgery, Tanguiéta Zone Hospital, Benin

2Department of Urology Andrology, National Universitary Hospital Center, Benin

*Corresponding Author:
Gayito Adagaba René Ayaovi
Department of General Surgery, Tanguiéta Zone Hospital, Benin
Tel: 95612355
E-mail: gayito_castro@yahoo.fr

Received Date: December 27, 2021; Accepted Date: January 10, 2022; Published Date: January 17, 2022

Citation: Gayito Adagaba Ra, Chamutu M, Nzuwa Nj, Gbotounou N, Azakpa Al et al. (2022) Knowledge and Precautionary Measures of Healthcare Associated Infection among Patients in UNIOSUN Teaching Hospital, Osogbo. Arch Med Vol:13 No:1

Abstract

Objectives: To determine the correlation between digital rectal examinations, prostate volume, PSA level and pathological results after upper prostate adenomectomy indicated in the event of benign prostatic hypertrophy diagnosed and operated on at the Saint John of God Hospital in Tanguieta.

Patients and methods: This was a descriptive retrospective study from January 1, 2017 to December 31, 2020. Focusing on patients operated on for clinically diagnosed benign upper prostatic hypertrophy.

Results: 128 cases were retained. The average age was 65.29 ± 7.84 years. The most represented group was those aged 61 to 70 with a proportion of 54%. The average PSA level was 27.64 ± 70.14 g. The average prostate volume was 89.91 ± 44.72 g. After the pathological examination, 14% had prostate adenocarcinoma. PSA levels and pathological outcome would be related variables. Age had no influence on the patient's PSA level. The same is true for the patient's prostate volume. Only the prostate volume would have an influence on the PSA.

Keywords

Prostate-Adenoma-PSA

Introduction

Benign prostatic hyperplasia is a condition that affects a significant proportion of men, particularly those over 60 years of age [1].

While the efficiency of medical treatments is indisputable, the risk of Benign prostatic hyperplasia -related surgery beyond the age of 50 is estimated to be between 20 and 30% [2]. Endoscopic Prostate Resection (EPR) and upper adenomectomy (UAP) are the gold standard procedures for complicated BPH or the ones refractory to medical treatment [3,4].

Upper adenomectomy is the primary method of surgery for benign prostatic hyperplasia. It remains the most common method used by urologists in underdeveloped countries [5]. It represented 1.1% of the operative activity of the general surgery department in Benin in 2015 [6]. But what is the margin of error between the preoperative diagnosis and the anatomopathological diagnosis? In order to answer this question, we conducted this study with the objective of determining the correlation between the digital rectal examination, the prostate volume, the PSA level and the anatomopathological results after prostatic adenomectomy by the high route indicated in front of a benign hypertrophy of the prostate diagnosed and operated on at the Saint Jean de Dieu Hospital of Tanguiéta.

Patients and Methods

This was a retrospective and descriptive study from January 1, 2017 to December 31, 2020 conducted in the general surgery department of the Tanguiéta Zone Hospital. All cases of prostatic hypertrophy labelled as benign and treated as such were included in the study, and for which the results of the digital rectal examination, prostatic ultrasound and anatomopathological examination were available in the medical record. The exclusion criteria were: Unavailability of pathology result, no information on PSA or DRE results, and cases operated endoscopically.

The parameters studied were: age, consultation time, length of hospitalization in surgery, ultrasound volume of the prostate, prostate specific antigen and histology of the surgical specimen.

Data entry and analysis were done on Epi-info data 7.2.2.6, Microsoft Excell 2013.

Mean, percentage and Chi-square test were used for interpretation of results.

Results

During the study period, 135 patients were managed for benign prostatic hypertrophy. 7 files were excluded for lack of information on PSA. This represents a study population of 128 cases. The mean age was 65.29 ± 7.84 years. The most represented age group was 61 to 70 years with a proportion of 54%. The mean time before consultation was 649.08 ± 760.21 days. Renal function was disturbed in 28.45% of our patients. The digital rectal examination in all patients was in favor of benign prostatic hypertrophy.

The mean PSA level was 27.64 ± 70.14 g. Patients with a PSA level greater than or equal to 4 ng/ml were the most representative (83%) compared to 17% for those with a PSA level lower than 4 ng/ml. The mean prostate volume was 89.91 ± 44.72 g. Patients with a volume between 59 and 105 g were the most represented (47%).

Most patients had a pathological finding of nodular hyperplasia. Of the 128 patients, only 14% had been diagnosed with adenocarcinoma of the prostate, 86% with benign prostatic hypertrophy.

Bivariate analysis between PSA level and prostate volume showed that the two variables were related. With prostate volume significantly influencing the PSA level (P=0.001) (Table I)The bi-variate analysis between PSA level and anatomopathological result had shown that the two variables were related (Table II). However, this relationship was weak (cramer coefficient=0.18). The multivariate analysis showed that only one variable influenced the PSA level (Table III) No correlation between age and PSA level was found (p-value greater than 5%) (Table IV)The same was true for prostate volume, where the patient's age had no influence on prostate volume (p-value greater than 5%) (Table V).

Crossed Tabulation
  Portion Total
[13-59[ [59-105[ [105-151[ [151-197[ [197-243[
PSA < 4 Employees 11 5 2 0 0 18
% included in PSA 61,1% 27,8% 11,1% 0,0% 0,0% 100,0%
> 4 Employees 12 41 16 9 1 79
% included in PSA 15,2% 51,9% 20,3% 11,4% 1,3% 100,0%
Total Employees 23 46 18 9 1 97
% include in PSA 23,7% 47,4% 18,6% 9,3% 1,0% 100,0%

Table I: Distribution of patients by PSA levels according to prostate volume.

Crossed Tabulation
  Anatomopathological Result Total
Adenocarcinoma Nodular Hyperplasia
PSA < 4 Employees 0 21 21
% included in PSA 0,0% 100,0% 100,0%
> 4 Employees 17 83 100
% included in PSA 17,0% 83,0% 100,0%
Total Employees 17 104 121
% included in PSA 14,0% 86,0% 100,0%

Table II: Distribution of patients by PSA level according to the anatomopathological result.

Variables in the equation
  A E.S. Wald ddl Sig. Exp(B) IC pour Exp(B) 95%
Inferior Superior
Step 1a Volume 1,355 ,460 8,682 1 ,003 3,875 1,574 9,543
Result 19,088 10069,341 ,000 1 ,998 194874515,224 ,000 .
Constant -1,152 ,800 2,074 1 ,150 ,316    
a. Variable(s) included in step 1 : volum, Résult.

Table III: Multivariate analysis.

Chi-square test
  Value ddl Asymptotic significance (bilateral)
Pearson’s Chi-square 177,689a 184 ,617
Likelihood ratio 1,56,305 184 ,932
Linear association by linear ,237 1 ,626
Number of valid observations 119    
235 cells (100.0%) have a theoretical number lower than 5. The minimum theoretical size is .03.

Table IV: Bivariate analysis between age and PSA level.

Chi-square test
  Value ddl Asymptotic significance (bilateral)
Pearson’s Chi-square 271,822a 268 ,423
Likelihood ratio 1,99,318 268 ,999
Linear association by linear ,227 1 ,634
235 cells (100.0%) have a theoretical number lower than 5. The minimum theoretical size is .03.

Table V: Analysis between age and volume.

The average length of hospitalization after Upper Aapproach Prostatic Adenomectomy was 11.03 ± 3.15 days.

Discussion

The average age in our study was 65.29 ± 7.84 years. The most represented age group was 61-70 years. These results are almost the same of the ones of Luhiriri ND et al [7].

Renal function was impaired in 28.45% of our patients. This percentage is much higher than that of Massandé Mouyendi J et al. which was 9% [8] and Bagayogo NA et al. which was 11.11% [9]. This could be due to the delay in consultation in our study environment which is rural compared to the other two studies carried out in urban areas, with a shorter delay in consultation than ours.

A strong correlation between prostate volume and PSA level was found in our study. These same findings had already been made by several authors [10,11,12]. Our study shows that patients with a PSA level lower than 4 ng/ml do not exceed 104 g of prostatic volume whereas those with a PSA level higher than 4 ng/ml see their prostatic volume reach a peak between 59 and 104 g and progressively decrease until a volume equal to 242 g. This clearly shows the close relationship between prostate volume and PSA level. Patients with a larger prostate volume being more likely to have a PSA level greater than or equal to 4.

No correlation between age and PSA level was found in our study. These results are consistent with those of some authors in the literature [13] but not all [11]. The same is true for the relationship between age and prostate volume where no significant relationship was found between these two variables. This is similar to the results of Berroukche A et al [14], but contrary to those of Bo M et al [13] who found a slight correlation (p <0.05). The study shows that there is a strong correlation between the PSA level and the anatomopathological nature of the prostate. But it also shows that patients with a PSA < 4 do not have adenocarcinoma, whereas those with a PSA > 4 have either adenocarcinoma or nodular hyperplasia. This is a known fact in the literature [11-13]. Our mean time of hospitalization was 11.03 ± 3.15 days. These results are in agreement with many authors in the literature [15,16].

The margin of error between the preoperative diagnosis and the anatomopathological diagnosis after prostatic adenomectomy was 14%, corresponding to the number of cases in which prostatic hypertrophy was falsely evoked.

Conclusion

After prostatic adenomectomy indicated for benign prostatic hypertrophy, 14% of cases were prostatic adenocarcinomas after anatomopathological examination. Only an increase in the volume of the prostate could explain an increase in the PSA level. The interpretation of the digital rectal examination, the ultrasound assessment of the prostate volume and the PSA level are effective diagnostic tools for benign prostatic hypertrophy in practice.

References

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