Undescended testis at Nnamdi Azikiwe Teaching Hospital; Nnewi; Nigeria : a ten year audit

Introduction: Undescended testis is a global problem; and late diagnosis and treatment can lead to disastrous consequences. We undertook this study to evaluate our management protocol and see how it fits into changing trends in management and compare our results with those obtained in other centers. Material and Methods: A retrospective study of all patients with undescended testes seen and operated at Nnamdi Azikiwe Teaching Hospital; Nnewi; Nigeria during a 10-year period (1993-2003) was carried out. Results: Twenty-seven patients were analysed. 66.7of them were above 2 years of age. Eighteen patients had unilateral crypt-orchidism and 12 patients (44.4) had associated inguinal hernia. The undescended testis was found predominantly in the inguinal region (17 patients) and orchidopexy was done in 16. Half of our patients (51.7) were lost to follow up immediately after the intervention. Conclusion: The late presentation and inability to follow up these patients make the monitoring of such patients very difficult. We suggest that thorough examination of the external genitalia should form part of the normal post-natal check up and that a mass education campaign be undertaken

Skin closure after groin hernia repair in children : a comparative study of three suture materials and two suture techniques

Objective The surgical scar is of great importance both to the patient and surgeon. For the patient an ugly scar may not only present a cosmetic problem but in some cases it may also impair function; and the surgeon is always confronted with the problem of possible litigation. This study was undertaken to evaluate the effect of different suture materials and skin suture techniques on surgical scars. Patients and Methods Three suture materials (chromic catgut 3/0; silk 3/0 and nylon 3/0) and two skin closure techniques (transcutaneous interrupted mattress and subcuticular continuous running sutures) were compared in a randomized partially blinded fashion using a groin skin crease incision. The resulting scars were graded after two years using a conceived three-level scale. Results Subcuticular nylon sutures gave the best cosmetic results followed by subcuticular chromic catgut. Transcutaneous interrupted mattress silk sutures left the worst scars followed by subcuticular continuous running silk sutures. Conclusion The use of suture materials for skin closure is still the norm in developing countries. We therefore suggest that for any particular suture material; the subcuticular continuous running technique should be used and whenever possible the suture material of choice should be nylon

Circumcision-related complications in the male : experience amongst the Igbo's of Southeast Nigeria

Objectives To evaluate male circumcision and the complications associated with it amongst the Igbo people of Southeast Nigeria. Patients and Methods This study was a prospective review of male circumcision and its complications amongst the Igbo's of Southeast Nigeria carried out over a period of six months. It was conducted in three centers (public; private and a mission hospital) in Anambra State (a core Igbo state) of Nigeria. Circumcision was done after birth at any convenient time; and the babies were followed up at the post natal clinic (six weeks after birth) for possible complications. A questionnaire is usually filled at the time of circumcision and completed at the post natal visit. Results A total of 141 circumcisions were performed during the study period. Most of the circumcisions (73.8) were done between 7 and 9 days after birth. The plastic bell method was used more extensively than the traditional method (68.1and 31.2; respectively). The method preferred by the mothers was not statistically different from the method used. The overall complication rate in this study was 24.1. A higher complication rate was recorded with the use of the traditional method compared to the plastic bell method (43.2vs. 15.6; P0.01); and when circumcision was performed by midwives instead of physicians (30.6vs. 14.5; P0.01). Conclusion Two factors were responsible for a high complication rate: the use of the traditional method of circumcision and the competence of the performer. It is therefore suggested that circumcision be done by the use of the plastic bell and only by qualified and trained personnel