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Background: Open prostatectomy is an important treatment modality for prostate disease in resource-constrained settings, where access to minimally invasive surgery is limited. We conducted a review of open prostatectomies at a South African hospital. Methods: We reviewed the medical charts of 54 patients who underwent open prostatectomy at St. Aidan’s Hospital in South Africa between 2015 and 2019. Data collected for each patient included demographic characteristics, comorbidity, prostate-specific antigen measurements, prostate volume measurements, preoperative catheterisation, indication for surgery, surgical approach, duration of surgery, postoperative length of stay, histological findings, and postoperative Clavien-Dindo complications. We analyzed the collected data with descriptive statistics. Results: The median age was 68.5 years old. Most patients were Black Africans (57.4%). Hypertension was the most common comorbidity (50.0%). Most patients (83.4%) had prostate-specific antigen levels of 10 ng/mL or less, and prostate volumes of 60-100 mL (57.4%). Preoperative catheterisation was common (77.8%). Lower urinary tract symptoms and failed medical therapy (74.1%) was the most frequent indication for surgery. All patients had surgery via the suprapubic approach, with surgery lasting >120 minutes for two-thirds of patients. Postoperative length of stay was 6-9 days for nearly half of the study sample (48.1%). Almost all patients had a histological diagnosis of benign prostate hyperplasia (94.4%). Postoperative complications were frequent and mostly minor (infection or blood transfusions). Conclusion: We confirm that open prostatectomy is still a relevant, safe, and effective method for managing prostate disease in resource-constrained settings. We recommend that open prostatectomy still be considered a primary treatment modality for prostate disease in developing countries until minimally invasive methods become more widely available.

Abstract Background Laparoscopic nephrectomy is the standard of care for nephrectomy in most developed countries. Its adoption in our setting has been limited due to lack of equipment and expertise. This paper sets out to show that laparoscopic nephrectomy is technically feasible in the state sector in South Africa. Methods A retrospective chart review was performed of all patients having undergone nephrectomy over a five-year period at two state hospitals in KwaZulu-Natal Province, South Africa. Demographic information, pre-operative imaging findings, operative information and post-operative outcomes were analysed. Results Nephrectomy was performed in 196 patients. Open nephrectomy (ON) was the intended surgical approach in 73% (n = 143) and laparoscopic nephrectomy (LN) in 27% (n = 53). The conversion rate from LN to ON was 11% (n = 6). For malignancies, there was no difference in surgical resection margin status across the ON, LN and conversion groups; however, tumour size was larger in the conversion group compared to the LN group. Estimated blood loss and transfusion rates were lower in the LN group. The average length of hospital stay was shorter in the LN group (5 vs 10 days). High dependency unit (HDU) admission rate was lower in the LN group (12.1%) compared to the ON group (50%) and the conversion group (40%). No difference in high-grade complications was noted between the ON and LN groups, and more patients in the LN group (82.5%) had no complications compared to the open group (9.9%). Conclusion LN is non-inferior to ON in terms of operative time, oncology outcomes and high-grade complications. LN is superior in terms of blood loss, transfusion rate, length of hospital stay and overall complication rate. LN appears to show technical feasibility in the state sector and highlights the need for laparoscopic training.

Abstract Background Holmium laser has been used primarily for lithotripsy, and on soft tissue and tumor. Its effect on wood has never been described in the literature. Here-in case we were able to successfully laser intravesical wood particles in a young male. Case presentation A 12-year-old boy was referred to our urology center following a history of recurrent urinary tract infection to which an intravesical foreign body was picked up upon investigation. Imaging studies of an abdominal ultrasound had revealed an intravesical foreign body. He was found to have a piece of wood in the bladder that was too big to be extracted through the cystoscope and was lasered into fragments. Conclusion Our case showed a more versatile use of the holmium laser and concluded that it can be used successfully on wood.