Urethral stricture; etiology, presentation, complications, and outcome of management at Gezira state, central Sudan

The objective is to evaluate urethral strictures in term of etiological factors, presentations and management at GHRDS, Gezira State, Central Sudan. One hundred sixty patients, who were diagnosed as urethral stricture, were enrolled in this study. All patients were dealt with through a scientific stratum of a thorough work up and managed according to the EAU guidelines. The bio-data, etiological factors of strictures, presenting symptoms and signs, the pathological types and modalities of treatment were recorded and analyzed. The total number of patients was 160, only two females and the rest were males. The mean age was 46.2 +/- 2 years. The etiological factors were: post-surgical in 67 patients [41.9%], gonococcal urethritis in 48 patients [30%] followed by post traumatic stricture in 28 patients [17.5%]. Concerning the sites 41 [25.6%] patients had bulbar urethral stricture and 24 [15%] with membranous urethra strictures. One hundred forty two [88.8%] patients were treated with visual internal urethrotomy [VIU] and the outcome of treatment was comparable to the literature. The commonest etiological factors for urethral strictures in GHRDS were post-surgery followed by gonococcal urethritis. The outcome of management was comparable

Clinical presentation and histopathological patterns of renal cell carcinoma in Gezira hospital for renal diseases and surgery

Renal cell carcinoma [RCC] is the most common primary tumour of the kidney in adults, responsible for [80-85%] of renal tumours[1].Due to the absence of studies in Sudan in assessing the pattern and presentation of RCC, we conducted this retrospective study in Gezira Hospital for Renal Diseases and Surgery, in the period from January 2006 to January 2012. To determine the clinical presentation, pathological pattern and stages of RCC in patients who were treated in [GHRS] in the period of this study. A total of 60 patients were diagnosed as RCC in the period of six years. The disease was more common in males, with a peak incidence in the fifth and sixth decades. The classical triad were observed in 19 patients. Mean duration of symptoms was 4 months. Some patients had metastasis in the lung, bones or liver at diagnosis. Most of the patients presented with haematuria [66.6%], a small number with cervical lymphadenopathy [6.7%], lower limb edema [3.3%] and non reducible varicocele [5%]. A large number of patients presented with a palpable loin mass, in contrast incidentally diagnosed cases were few .The age of presentation is one decade earlier than that in the western world

Quality of life of Sudanese patients with benigan prostatic hyperplasia. The oblivious problem

Although the IPSS and QOL index are universally used, they can only quantify the severity of lower urinary tract symptoms suggestive of benign prostate hyperplasia [BPH] and evaluate treatment efficacy, but cannot fully reflect the overall quality of life. Moreover, because QOL scale depends on the culture background, it is necessary to develop a Sudanese version of the scale. To evaluate the impact of BPH on the quality of life by assessing the physical, mental and stress states among patients of BPH. This study was conducted on 424 patients with BPH in Gezira Hospital for Renal Disease and Surgery [GHRDS], Sudan. The study was cross-sectional, prospective small-scale hospital based study using simple random sampling technique. The subjects were limited to the Sudanese patients, who could hear and answer the questions of the questionnaire independently and that was done for accuracy and privacy. Taking the patient's educational level into account, all items were expressed in spoken language. The data collection tool was a questionnaire which was modified to twelve items from the BPH Quality of Life Index. The majority 386 patients, 91% were physically fit. The pattern of urination was bothering to their daily life of around 320 patients/75.5%, 225 patients/53.1% of patients were worried about the outcome of the disease, 259 patients/61.1% were not concerned of having prostate cancer and 332 patients/78.2% were satisfied with their sleep. The sexual life had been affected in 201 patients/47.4%. The physical state was assessed by the ability of the patient to pray Friday Jomaa at the mosque which was 85.8% and also by attending important Sudanese obliging social activities like condolence which was [91.9%] of the patients. The impact of BPH on quality of life was obviously significant in the three domains; physical, mental and stress state among patients of BPH in GHRD and S. There should be a validated scale for the BPH Quality of Life Index addressing the traditional strata for Sudanese patients

Hypertension among patients with end stage renal disease on regular haemodialysis at Gezira hospital for renal diseases and surgery

The prevalence of hypertension in patients with chronic kidney disease, ftom ail causes, increases iiueavly as veuai fuuctiou deteriorates, reaching approximately 95% as patients approach end-stage renal disease. To determine the incidence of hypertension in patients on haemodialysis and to evaluate the control of blood pressure among patients with end stage renal disease. This was a prospective cross sectional study, conducted at Gezira Hospital for Renal Diseases and Surgery, Wad Medani, in January 2010. 133 patients with end stage renal disease were enrolled in this study ,blood pressure was measured pre, intra and post dialysis sessions. Drug therapy and the complications of hypertension were recorded. 89% of all patients were hypertensive, 94.07% out of them were on antihypertensive. Blood pressure was not adequately controlled in 62.16% of the patients. Paradoxical hypertension was found in 12.78%. 14.41% of the hypertensive group admit to have poor compliance for their antihypertensive medications. Calcium channel blockers were used in 42.94%, angiotensin converting enzyme inhibitors 36.72%, beta-blockers 15.26%, angiotensin II receptor in 2.26%, Alpha blocker in 2.26% and diuretics in 0.07% of the cases. 35.58% of the patients were suffering congestive heart failure and 2.26% suffered from cerebrovascular accident. The prevalence of hypertension in patients on regular haemodialysis mounting to 90%

Sperm parameters and reproductive hormones among male sudanese worker exposed to high occupational heat

The hormonal function of the human testicle is temperature dependant. It requires a temperature 2 -4 C[degree sign] below body temperature. The frequency and time of heat exposure are capable of producing reversible or irreversible changes in human spermatogenesis. The aim of this study is to reconfirm or refute the previously tested hypothesis that the occupational heat exposure reduces both sperm output and quality in fertile men due to increases of scrotal and testicular temperature. Sperm quality was examined in 216 Sudanese workers in sugar factories, Bakeries and Khartoum Foundry center, their ages between 18-54 years old. A scrotal temperature range between 32-34 C [degree sign] was used as a control group. Venous blood [5-10 ml] and semen samples by masturbation were collected from them. Serum was prepared and analyzed for reproductive hormones by RIA techniques. Semen samples were analyzed by Computer Assisted Sperm Analysis [CASA] method. The results of this study indicated that sperms [count, motility and morphology] were assessed in both groups. The sperm density, motility and morphology were significantly affected in the test group P. value [000]. In the test group it was found that the longer the duration of exposure the more significant is the decline in all sperm parameters, and those who were exposed for more than 10 years may develop azoospermia. 20 volunteers were found to have primary infertility and 8 to have secondary infertility. FSH significantly increased in the azoospermic and oligospermic groups, while the other hormones, LH, Testosterone and Prolactin, remained within the normal range levels. High testicular temperature impaired spermatogenesis leading to oligozoospermia, asthenozoospermia, teratzoospermia and azoospermia. Therefore, the long term effects of hyperthermia adversely affect the sperm quantity and quality. Long term testicular hyperthermia may lead to primary and secondary infertility. The fasting baseline of FSH levels is negatively proportional with the sperm density. These results support the hypothesis that increases in heat exposure are associated with reduced semen quality

Prostate specific antigen versus digital rectal examination as screening for ca prostate in Sudanese patients

The aim of this study is to compare the value of digital rectal examination [DRE] and prostate specific antigen [PSA] determination in the detection of prostate cancer among Sudanese patients presenting with lower urinary tract symptoms [LUTS]. A prospective study was carried out in Gezira Hospital for Renal Diseases and Surgery in the period of June 2003- May 2005. Patients presenting with LUTS, had been screened for prostate cancer using PSA and DRE examination.. Serum PSA and DRE were measured in all patients. Trans rectal biopsy was performed if the PSA was over 4ng and /or abnormal DRE. A total of 124 elderly male pa3ents presenting with lower urinary tract symptoms [LUTS], 140 of them were at last diagnosed as benign prostate hyperplasia [BPH] and 54 patients were been confirmed with prostate cancer [PCa]. Their mean age was 65 years [range 45-20]. Elevated level of PSA [> 4 ng/ml] was found in all the patients with prostate cancer [n= 54] and 68.6% [n= 26] of 4PH patients. The rate of prostate cancer detection showed to be 25.7% for PSA > 4ng/ml, 13.31% for abnormal [positive] finding of DRE, and 27.8% for combination of the positive DRE and PSA > 4 ng/ml. The rate of 4PH detec3on showed to be 68.6% for PSA > 4ng/ml, 28.6% for positive finding of DRE, and 4.1% for combination of the positive DRE and PSA > 4 ng/ml. It was found that PSA determination detects a considerable proportion of tumors missed by DRE. And the combination of PSA and DRE escalates the probability of prostate cancer detection

Detection of serum prostate specific antigen in lactating, pregnant, and advanced breast cancer Sudanese women

Although prostate-specific antigen [PSA] is the most valuable tumor marker for the diagnosis and management of prostate carcinoma, it is widely accepted that PSA is not prostate specific. The aim of this study is to address the possibility of using the PSA as marker for the sex assignment in different categories and relevance of this test in women problems. We have evaluated the measurement of serum total PSA for differentiation between Sudanese women with advanced breast cancer [n= 10], and those lactating [n=10], pregnant [n= 10] compared with 20 healthy women as control group. Serum total PSA [TPSA] was measured using immuno-radiometric assay [IRMA]. In this study the mean age was significantly higher in advanced breast cancer groups compared with lactating group [P<0.01]. The mean serum PSA levels in the healthy control women examined [n=20] was 0.72 +/- 0.55 vs. 1.18 +/- 0.92, 1.42 +/- 2.43 and 0.51 +/- 0.13 ng/ml in serum from advanced breast cancer [n=10], pregnant [n=10] and lactating women [n=10] respectively. A significant high level of total PSA in serum of advanced breast cancer compared with the normal group [P< 0.05]. These results indicated the possible use of total PSA to distinguish between healthy women and/or women with advanced breast cancer

Urological injuries during pelvic surgery in women, Gezira, central Sudan

Injuries to the ureter and bladder are common in female pelvic surgery, sometimes extremely common to be considered as traditional, This is a retrospective study conducted in Gezira Hospital for Renal Disease and Surgery, Medani Teaching Hospital and Medani Maternity Hospital, Wad Medani, Sudan. We included 82 patient's with urological injuries following obstetrical gynecology intervention in the previous 5 years. The interaoperative injuries constituted 20/82[24%], while the remote injuries were 62/82 [75.6%]. We conclude that the urological injuries are common complications during pelvic surgery, associated mainly with abdominal hysterectomies and Cesarean section

Prostate volume and PSA cutoff values as predictive indices for success of doxazocin treatment in BPH in GHRDS

Benign prostatic hyperplasia [BPH] is a non malignant enlargement of the prostate. This study was conducted to determine the pattern of presentation of BPH with and without acute urinary retention [AUR] and to determine the risk factors for acute urinary retention, in addition, to assess the results of doxazosin in the treatment of BPH with and without AUR. Ninety two patients were enrolled in this study. All patients presented to the emergency department and the referred clinic of the Gezira Hospital for Renal Disease and Surgery [GHRDS] with lower urinary tract symptoms with and without acute urinary retention suggestive of BPH were evaluated according to the European guidelines. All of them underwent transrectal ultrasound and measurement for the prostatic volume. Serum PSA level was estimated. Doxazosin was given to all patients and they were followed for twelve weeks. A trial without a catheter at the end of the first week was attempted for patients with acute urinary retention. The patients' mean age +/- SD at baseline was 67.8 +/- 7.7 and 69.4 +/- 9.9 for Non-AUR/BPH and AUR/BPH respectively. Comparing baseline clinical parameters of patients with and without acute urinary retention revealed that IPSS, prostate volume and PSA level are significantly different between the two groups with P< 0.01, 0.01 and 0.00 respectively. In the TWOC, 65% of patients passed urine spontaneously. By the end of the study, the overall response of patients showed 78.9% successful rate [n = 73] and 21.1% failure rate [n = 19]. Prostatic volume and PSA level were found to affect doxazosin treatment significantly. With cutoff values of 41cc and [3.45] ng/ml, prostatic volume and PSA level influenced doxazosin treatment failure. Serum PSA and prostate volume are powerful predictors of the risk of AUR. Alpha blockers are efficacious in treating retaining and non-retaining BPH patients. Knowledge of baseline serum PSA and/or prostate volume are useful tools to aid physicians and decision makers in predicting the risk of BPH-related outcomes and choosing dexazosin as therapy for BPH