Background: Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our ...environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. Objective: The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. Materials and Methods: This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. Results: The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Conclusion: Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.
Background: Urological emergencies constitute a significant part of emergency presentations in various referral centers. Data on the prevalence of these emergencies in West African sub-region are ...sparse. Objective: The study is aimed at determining the pattern of urological emergencies in our center and is geared towards bridging the gap in knowledge of the epidemiology of urological emergencies in this sub-region as a means of achieving efficient use of scarce resources. Subjects and Methods: It was a retrospective study of all urological emergency cases that presented over six years in a Federal University Teaching Hospital in Nigeria. Data were collected from emergency register and theatre logs. Data analysis was done using SPSS version 25. Results: A total of 267 patients presented with urological emergencies during the period of study with 258 (96.6%) men and 9 (3.4%) women. The mean age of the patients was 50.6 ± 20.8 years. Urinary retention was the most common urological emergency accounting for 159 (59.6%) cases followed by Fournier's gangrene 23 (8.6%) and testicular torsion 23 (8.6%). Bladder and ureteral injuries accounted for 5 (55.6%) of the urological emergency presentations in women while both injuries accounted for only 4 (1.6%) in men (P = 0.000). Urethral catheterization was the most commonly performed procedure 139 (52.1%), followed by percutaneous suprapubic cystostomy (SPC) 31 (11.6%). Conclusion: Urological emergencies have varying presentations in both sexes. Urinary retention, and acute scrotum were the most common urological emergencies in our facility. This knowledge can be used in emergency preparedness planning which involves personnel training and resource allocation.
Nowadays, the practice of day case surgery (DCS) is an attractive and appealing one with widespread acceptability because of numerous benefits.
This study aimed at presenting our experience with ...urologic DCS in a tertiary healthcare center.
A 5-year review of all day-case urologic surgeries at our tertiary healthcare center was carried out. Data on patients' biodata including age and sex, diagnoses, indications and procedures performed, types of anesthesia, complications, admission and re-admission history were obtained from theatre records and patients' case notes. Data were analyzed using PASW Statistics version 18.0 and results presented in table and charts.
A total number of 1277 of the 1825 urologic surgeries which took place during the study period were performed as day cases giving a proportion of 67.8%. The age range was 11 days to 94 years. The most commonly performed DCS are prostate biopsy, cystoscopy and varicocelectomy in 368 (28.8%), 165 (12.9%) and 163 (12.8%) patients respectively. Local anesthesia with or without sedation was the most commonly used in 981 (76.8%) cases. Twenty-four (1.9%) patients required unplanned admission for complications, 18 (1.4%), delayed completion of surgery, 4 (0.3%) and delayed recovery from anesthesia, 2 (0.16%). Three (0.2%) of these patients were re-admitted for management of sepsis following prostate biopsy.
This study like numerous others demonstrated the feasibility, effectiveness and safety of DCS. To meet up with the global trends in DCS in Nigeria, there is need for investment in infrastructure and adoption of minimally invasive techniques to allow incorporation of more complex cases in the range of procedures offered as DCS.
Background and Aim: Periprostatic nerve block (PNB) which appears to be the gold standard for pain relief during transrectal ultrasound-guided prostate (TrusP) biopsy has been proven to be lacking in ...providing satisfactory anaesthesia during transrectal ultrasound (Trus) probe insertion into the anorectum necessitating the addition of another technique to produce a 'balanced' anaesthesia. The aim of this study was to determine whether combined intrarectal lidocaine gel and periprostatic nerve block (cGPNB) will provide adequate anaesthesia at all stages of TrusP compared with caudal block (CB). Patients and Methods: Data were prospectively collected from patients with indications for TrusP who were randomly assigned to either cGPNB (Group A) or CB (Group B). Comparative analysis of the numerical rating pain score (NRS) between two groups was done after administration of anaesthesia, Trus probe insertion, biopsy needle puncture of the prostate and 1 h after biopsy. Results: There were 56 patients in Group A and 53 in Group B. There was no significant difference in NRS grouping between the two arms of the study after administration of anaesthesia (P = 0.93), biopsy needle puncture of the prostate (P = 0.28) and 1 h after the procedure (P = 0.39). There was no statistically significant difference in the number of patients with no/mild pain between the two arms of the study during probe insertion (P = 0.65). None of the patients in both arms of the study had severe pain. Across Group A and B, 35 (62.5%) versus 40 (75.5%), 20 (35.7%) versus 11 (20.8%) and 1 (1.8%) versus 2 (3.8%) adjudged the procedure as very tolerable, fairly tolerable and intolerable respectively (P = 0.20). All the patients in Group A versus 49 (92.5%) in Group B will choose the same anaesthesia for subsequent biopsies (P = 0.11). Conclusions: cGPNB provides balanced anaesthesia at all stages of TrusP with excellent patient tolerability.
Patient discomfort secondary to an indwelling urethral catheter in the post operative period can be very distressing. These symptoms resemble the overactive bladder (OAB) syndrome. Muscarinic ...receptor blockers have been successful in the management of OAB. However, information on the use of these drugs in the management of the postoperative catheter-related bladder discomfort (CRBD) in sub-Saharan Africa is still relatively sparse.
To assess the efficacy of preoperative oral tolterodine in the management of CRBD in surgical patients in the immediate postoperative period.
This was a double-blind placebo-controlled study consisting of 56 patients in each arm who underwent general anesthesia. Each patient was given oral tolterodine or placebo 1 hour before the induction of anesthesia. The patient was later assessed at the recovery room at intervals after recovery from anesthesia. The presence of CRBD was noted and graded.
The overall incidence of CRBD in both the tolterodine group and the control were 85.7% and 91.1%, respectively. Overall, tolterodine prophylaxis (TP) was associated with an absolute risk reduction (ARR) of 5.4%, relative risk reduction (RRR) of 5.8%, and a number needed to treat (NNT) of 19. The incidence of moderate-to-severe CRBD in the tolterodine and control groups were 10.7% and 78%, respectively, with an ARR of 74.5% with TP.
TP does not significantly reduce the incidence of CRBD in the immediate postoperative period but appears to be efficient in the reduction of the severity of postoperative CRBD.
The human immunodeficiency virus (HIV) infection has become a pandemic with more than 40 million infected people worldwide. The virus attacks the immune system of the host thus exposing them to ...opportunistic infections in various systems of the body. The use of highly active anti-retroviral therapy (HAART) has converted a previously lethal condition to a chronic condition with relatively benign cause. This has allowed infected patients to live longer than before. Though beneficial, however, this has been associated with increased incidence of complications seen in these patients involving many systems. Urogenital system is not an exception to this and indeed is a common site for these complications. Urological symptoms or signs are often seen in HIV patients and sometimes appear as the first indicator of the disease. These manifestations can be benign or malignant, infective or non-infective, disease or drug-related. Their appearance may also be a pointer to the deterioration of the infection into a full blown AIDS. It is therefore important that every doctor has a good knowledge of the possible urological manifestations of the disease. Early recognition and prompt treatment of these complications may be of prognostic significance as they may produce significant morbidity and mortality if left untreated. This article highlights the clinical features and management of common urological manifestations of HIV.
To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance.
We studied 125 men who were ...being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson's Chi square test with level of significance set at <0.05.
The overall cancer detection by the extended technique was 61 (48.8%) cases while the sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04)
Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE.
To compare the cancer detection rates of sextant and ten- core biopsy protocol amongst patients being evaluated for prostate cancer.
This is a prospective study involving 125 men with suspicion of ...prostate cancer. They all had an extended 10-core transrectal digitally-guided prostatic biopsy using Tru-Cut needle. Indications for biopsy were presence of one or more of the following: elevated Prostate Specific Antigen (PSA), abnormal Digital Rectal Examination (DRE) findings and abnormal prostate scan. Sextant biopsies were collected first, followed by four lateral biopsies in all patients. Both groups of specimen were kept and analyzsed separately by the same pathologist. The cancer detection rates of sextant and extended (combination of sextant and lateral) 10-core biopsy protocols were determined and compared. Pearson's Chi square and McNemar tests at two degrees of freedom with level of significance set at 0.05 ( P <0.005) were used to determine the statistical significance.
The overall cancer detection rate of 10-core prostate biopsy was 48.8%. Of all positive biopsies, the sextant biopsy protocol detected 52 cancers (85.2%) while the lateral biopsy protocol detected 58 cases (95.1%). Three (3) cancers were detected by the sextant protocol only while the lateral protocol detected nine (9) cancers where sextant technique was negative for malignancy. Ten-core extended protocol showed a statistically significant increase of 14.8% over the traditional sextant. (P=0.046). The overall complication rate of ten-core biopsy was 26.4% and the procedure was well tolerated in most patients.
We conclude that a ten-core prostate biopsy protocol significantly improves cancer detection and should be considered as the optimum biopsy protocol.
Background and Objective: Despite a decent efficacy and safety profile, α1 - blockers (A1B) and the 5α - reductase inhibitors (5ARI), the conventional drugs used in the treatment of the symptoms of ...Benign Prostatic Hyperplasia (BPH), are commonly associated with adverse effects including sexual dysfunction and postural hypotension. Phytotherapy for the treatment BPH symptoms has been used for centuries. However, scientific data on their efficacy are sparse. Procin-X and Celloid-S (PC) are powdered plant material products with acclaimed anti- BPH properties. This study assessed their usefulness in the management of BPH. Materials and Methods: This was a single blind, randomized, placebo-controlled study conducted at our hospital involving 80 patients (divided in to 2 equal groups) with the clinical diagnosis of BPH. The study group were given PC while the controls were given multivitamin Capsules daily for a period of 14 weeks. All patients were evaluated at intervals for severity of symptoms, flow rates, prostate size, prostate specific antigen (PSA) and possible adverse effects including erectile function. Test of significance between the means was done using the Students Paired t-test. A P < 0.05 was considered significant. Results: At the end of 14 weeks there was an reduction in symptom score by 5.7 and 1.6 in subjects and controls respectively (P < 0.05) and an increase in flow rate by 4.0mls/s and 1.1mls/s respectively (P < 0.05). There was a 60% and 14% reduction in PSA in the subjects and control respectively. There was also statistically significant increase in the erection score in the subjects. Conclusion: PC appear to be effective and in the management of the symptoms of BPH. The positive effects of PC on erectile function may however give them an advantage over the A1B and 5ARI drugs while the reduction in PSA may also give it a role in chemoprevention of prostate cancer. A large scale cohort study is needed to confirm these findings.
Organ transplantation program in developing countries is still significantly dwarfed. Health workers are undeniably important in the success of transplantation.
To assess the knowledge and attitude ...of health workers toward organ donation in South-West Nigeria with a view to explaining reasons for these shortcomings.
In a cross-sectional study conducted on 850 health care workers, self-administered questionnaires were used to obtain information from participants.
Of 850 participants, 766 (90.1%) returned their completed questionnaires. The mean±SD age of participants was 36.7±9.2 years. Majority (93.3%) of participants had heard of organ donation; 82.5% had desirable knowledge. Only 29.5% and 39.4% would be willing to donate and counsel potential organ donors, respectively; 36.5% would consider signing organ donation cards. Only 19.4% believed that organ transplantation is often effective and 63.4% believed they were permitted by their religion to donate. Permission by religion (OR 3.5; 95% CI 2.3 to 5.3), good knowledge (OR 2.9; 95% CI 1.4 to 5.7), readiness to sign donation cards (OR 2.6; 95% CI 1.7 to 3.8), discuss organ donation (OR 2.7; 95%CI 8.0 to 63.8), and knowing somebody who had donated (OR 2.9) independently influenced willingness to donate organ.
There is disparity in knowledge of organ donation and willingness to donate among health care workers. Efforts should be intensified to give comprehensive and appropriate education to health care workers about organ donation to bridge this gap.
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