Malament stitch and increased risk of bladder neck stenosis: any association following open prostatectomy in Enugu Southeast Nigeria

Okwudili Calistus Amu,Emmanuel Azubuike Affusim,Okezie Mbadiwe,Ugochukwu Uzodimma Nnadozie

doi:10.1186/s12894-021-00944-y

Okwudili Calistus Amu, Emmanuel Azubuike Affusim + Show 2 more

Open Access

https://doi.org/10.1186/s12894-021-00944-y

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Abstract

BackgroundMalament stitch is one of the effective techniques employed to minimize bleeding in simple open prostatectomy but concerns about possibility of increased risk of bladder neck stenosis has limited its routine use.AimWe studied patients who had open prostatectomy with Malament stitch to determine the incidence of bladder neck stenosis amongst them.Material and methodsThis was a prospective study of 72patients who had simple open prostatectomy in which malament stitch was applied from 2010 to 2020. A proforma was designed to collect data. Pretreatment variables were transrectal ultrasound (TRUS) volume of prostate, pretreatment IPSS value, postvoidal residual urine volume before surgery, weight of enucleated prostate adenoma, time to removal of Malament stitch. Outcome measures were done with post treatment IPSS and PVR at 6 weeks, 3 months and 6 months. Cystoscopy was done at 3 months or 6 months for patients with rising outcome measures to determine presence of bladder neck stenosis.ResultsThe mean age of patients in this study was 68.3 years (SD = 7.1, range 52–82). The mean of the pretreatment score for IPSS was 30.7 (SD = 3.9, range 18–34) and 5.9 (SD = 0.2) for QOLS. The mean weight of prostate estimated with ultrasound was 169.5 g and mean weight of enucleated adenoma of the prostate was 132.5 g. The mean time of removal of Malament stitch was 23.1 h. Only 3 (4.2%) patients required cystoscopy because of increasing IPSS and PVR at 3 months postprostatectomy. 2 (2.8%) patients out of 72patients were confirmed to have bladder neck stenosis at cystoscopy.ConclusionMalament stitch did not lead to significant incidence of bladder neck stenosis in this study.

Highlights

Benign prostatic hyperplasia remains a common disease of aging men [1]
Malament stitch did not lead to significant incidence of bladder neck stenosis in this study
We studied prospectively patients who had transvesical prostatectomy with Malament stitch applied in an attempt to determine if there was an increased risk of bladder neck stenosis in such patients in our own environment

Summary

Introduction

Benign prostatic hyperplasia remains a common disease of aging men [1]. Over the years, improvements in its evaluation and treatment have continued to be witnessed. Laser- based surgeries is gaining grounds as a possible improvement on TURP [3, 4], simple. We are often faced with large prostates [6, 7] and increased likelihood of complications of LUTS like bladder stones, diverticulum that will definitely necessitate an open transvesical prostatectomy [5]. One of the complications of simple open transvesical prostatectomy is bleeding which may be intraoperative or postoperative. One of the haemostatic stitch developed was the Malament stitch which significantly stopped or reduced postoperative bleeding and incidence of clot retention [8,9,10,11,12,13]. Malament stitch is one of the effective techniques employed to minimize bleeding in simple open prostatectomy but concerns about possibility of increased risk of bladder neck stenosis has limited its routine use

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