Treatment of penile fracture. Description of three new cases and review of the literature

We report three cases of penile fracture treated in the Department of Urology of the National Hospital of Lamorde [Niger] between January 2003 and April 2006. The mean age of the patients was 32.6 +/- 7 years. Two of them were married, while one was single. The patients presented within 3 hours, 7 and 15 days,. respectively, after the penile fracture. The lesion was caused by injury during sexual intercourse in two and by manipulation of the erect penis in the third case. All patients underwent emergency surgery consisting of an incision at the site of the fracture, debridement and primary suturing of the tear in the tunica albuginea. Mean hospitalization was 16.4 [range 7 to 28] days

Is prostate cancer more common and more aggressive in African men?

The highest prostate cancer incidence and mortality rates in the world have been reported among Black African-American men [AAM] living in the United States of America. These rates are significantly higher for AAM compared to White [Caucasian] American men [CAM]. However, prostate cancer is not the only malignancy which is more common in AAM compared to White American men or women. Although prostate cancer has the highest Black / White mortality ratio, it is not the only malignancy which has a higher mortality in AAM compared to CAM. Numerous reports have shown that AAM present with higher grade and stage tumors, higher serum PSA levels, and that they are less likely to receive definitive or curative treatment and have a worse prognosis compared with CAM. It has been suggested that prostate cancer is not only more common, but also more biologically aggressive in AAM compared with CAM. Hypotheses attempting to explain this include genetic differences, dietary factors, higher testosterone levels or increased androgen receptor activity. However, the majority of reports from the USA indicate that, when controlled for major prognostic factors, the outcome for clinically localized as well as advanced prostate cancer does not depend on race. Several studies have indicated that socio- economic factors, decreased awareness of prostate cancer and limited access or decreased utilization of health care contribute to the poorer outcomes in AAM. Earlier studies have suggested that prostate cancer is relatively rare among indigenous Black men living in Africa. However, cancer incidence data in Africa are likely to underestimate the true rates because of underdiagnosis and underreporting. The frequency distribution of cancers in African countries, as well as more recent data indicate that prostate cancer is not rare among Black men living in Africa and that the incidence is probably similar to that of White men, although not as high as that reported for Black men living outside Africa. It is well documented that African men with prostate cancer present with more advanced disease and that palliative rather than curative treatment is used in the majority of patients. There are no reliable age-adjusted prostate cancer mortality rates available for African countries. However, there is as yet no evidence that prostate cancer in Black men living inside Africa is biologically more aggressive than in other populations

Pattern, clinical presentation and management of wilms' tumor in Moshi, Tanzania

The aim of this study was to audit the treatment outcome of children with Wilms' tumor in East Africa, at a Urology referral center with limited access to imaging modalities and chemotherapeutic drugs, and no radiation facility. This is a retrospective analysis of the hospital records of children with a diagnosis of Wilm's tumor treated from June 1996 to May 2005 at the Association of Surgeons of East Africa [ASEA] Institute of Urology, Kilimanjaro Christian Medical Centre [KCMC], Moshi, Tanzania. In total, 50 patients were diagnosed with Wilms' tumor in the 9 years study period, but only 39 files contained sufficient information for analysis. The average age at presentation was 44.7 months [median 36, range 8 to 120 months]. 25.6% of the children were >60 months old. The male:female ratio was 1.4:1. All of the children presented with an abdominal mass detected by the parents. The hemoglobin was < 100gm/L in 21 [53.8%] and the platelet count was >450,000/ml in 8 [20.5%] cases. Ultrasound imaging was obtained in all cases, but CT imaging was not taken. Intravenous urography was done in 38 children and showed non-visualization of the involved kidney in 16 [42.1%]. Fine needle aspiration cytology [FNAC] was performed in 25 cases and was diagnostic in 23 [92%]. Preoperative vincristine and dactinomycin was given to 23 patients [59%] with marked tumor shrinkage in 20 [87%], while 3 [13%] showed no response. Radical nephrectomy was performed in all patients, and 3 patients [7.7%] died within 24 hours of surgery. Pathologic analysis showed favorable histology in 35 [89.7%] and unfavorable histology in 4 [10.3%] patients. Based on the pre- and intra-operative findings. NWTS stage 1,2,3,4 and 5 was present in 25.6%, 17.9%, 15.4%, 38.5% and 2.6%, respectively. Postoperative dactinomycin and vincristine was given monthly for one year in all patients, while doxorubicin and cyclophospamide were reserved for those with no response to the first-line drugs, or recurrent tumor. Radiotherapy was not available. At 12 months' follow-up the overall disease-free survival was 35.9%, recurrence had occurred in 38.6%, death in 15.4%, and 10.3% were lost to follow-up. Children with Wilms' tumor in East Africa still have a dismal prognosis, with treatment outcomes at levels where it was before the advent of chemotherapy and radiation therapy in more advanced centers

Penectomy with simultaneous compared to deferred bilateral inguinal lymph node dissection for squamous cell carcinoma of the penis - evaluation of surgical complications

In men with advanced squamous cell carcinoma of the penis, inguinal lymph node dissection is usually deferred for 6 weeks after primary penectomy. The rationale is that the penile lesion is usually infected and immediate lymphadenectomy may lead to a higher surgical complication rate. However, some patients do not return for deferred node dissection and then present much later with incurable metastatic disease. The main of this study was to compare the complication rates of simultaneous versus deferred bilateral inguinal lymph node dissection. From October 1999 to September 2006, 29 men with histologically confirmed squamous cell carcinoma of the penis were treated. Penectomy with simultaneous bilateral inguinal lymph node dissection was performed in 18 patients with locally advanced primary lesions [cT2 in 8, cT3 in 10] and palpable inguinal nodes. The complications were compared with a previous study of 34 men who underwent bilateral inguinal lymph node dissection at a mean of 72 days after penectomy at Tygerberg Hospital during the period November 1983 to April 1995. Post-operative complications occurred in 11 of 18 patients [61.1%]: lymphocele formation in 8, lymph leak in 1, wound dehiscence and skin edge necrosis in 5, wound sepsis in 1, lymphedema of the legs in 2, scrotal edema in 1 and cellulitis in 2 patients [more than one complication occurred in some patients]. In the previously reported comparison group who had undergone deferred inguinal lymph node dissection at a mean of 72 days after penectomy, complications occurred in 26 of 34 [76.5%] patients: wound sepsis in 12, wound dehiscence in 7, lymphocele in 7, lymph leak in 4, wound abscess in 3, necrosis of wound edges in 2 and hematoma formation in 1. Penectomy with simultaneous bilateral inguinal lymph node dissection in men with squamous cell carcinoma of the penis does not lead to a higher complication rate compared with primary penectomy and deferred inguinal lymph node dissection performed at a mean of 10 weeks after the primary procedure

prospective, randomized study of periprostatic lignocaine injection versus intrarectal lignocaine or placebo gel for pain relief during transrectal ultrasound [TRUS] guided needle biopsy of the prostate

Objective: The aim of our study was to compare the efficacy and complications of periprostatic lignocaine injection with transrectal instillation of lignocaine gel or placebo for the relief of pain associated with transrectat ultrasound [TRUS] guided needle biopsy of the prostate

Patients and Methods: Between March 2003 and January 2004, 210 patients were prospectively randomized to recieve periprostatic injection of 10m12% lignocaine [Group 1, n = 83], intrarectal instilation of 15ml 2% lignocaine gel [Group 2, n = 64] or intrarectal instilation of l0mI water-souluble gel [placebo] [Group 3, n = 63]. The degree of pain experienced during and 15 minutes after completion of the biopsy was recorded by the patient himself, using a visual pain score [VPS] with a scale from 0 [no pain] to 10 [the most severe pain possible]. Statistical evaluation was performed using analysis of variance [ANOVA] with post-hoc analyses using the Bonferroni correction

Results: There were no statistically significant differences between the groups with regard to the mean number of biopsy cores, serum PSA or prostate volume. The mean VPS during biopsy was 2.02, 3.05 and 5.16 in Groups 1, 2 and 3, respectively [all differences statistically significant]. The mean VPS 15 minutes after biopsy was significantly lower in Group 1 [1.43] compared to Group 3 [3.28, p<0.001] but not Group 2 [2.17, p = 0.086], and it was significantly lower in Group 2 compared to Group 3 [p=0.006]. With regard to complications, there were no statistically significant differences between the groups, except for rectal bleeding which occurred more frequently in Group 3 [23.2%] than in Groups 1 [7.9%, p 0.033] and 2 [11.5%, p=0.l86]. There was no significant difference with regard to the percentage of patients who would be willing to return for a repeat biopsy [95.7%, 87% and 91.7% in Groups 1, 2 and 3 respectively]

Conclusions: For pain relief during and after TRUS guided needle biopsy of the prostate, periprostatic injection of 10 ml 2% lignocaine was significantly more effective than intrarectal instillation of 15 ml 2% lignocaine gel, which in turn was more effective than intrarectal lubricant [placebo] gel. The incidence of complications was not increased after periprostatic lignocaine injection. Although the greater pain experienced by the patient during biopsy without anesthesia did not result in a significantly greater unwillingness to return for repeat biopsy, considerations of human compassion dictate that all patients undergoing TRUS guided prostate biopsy should routinely be offered local anesthesia

Profile of prostate cancer in the Western Cape Province, South Africa

Little has been published about the epidemiology or profile of prostate cancer in African countries. We analyzed computerized data on 1749 men with histologically proven adenocarcinoma of the prostate seen at our institution between 1976 and 1996. Overall, 51% of the patients were older than 70 years. The race distribution was 51% mixed, 44% white and 5% black, reflecting the population distribution of our referral area. The tumor stage was locally advanced in the majority of patients [T3 in 24% and T4 in 42%] and localized [T1-2] in only 34%. Differentiation of the tumor was grade 1 in 29%, grade 2 in 26%, grade 3 in 33% and unknown in 12%. In those patients where the lymph node status was determined histologically, 45% were N1. The vast majority of patients had a radionuclide bone scan, and 45% were M1. Stage T1-2 tumors comprised 45% in white, 24% in mixed race and 42% in black patients, while T4 tumors comprised 26% in white, 55% in mixed race and 45% in black patients. In localized tumors [T1-2], the initial treatment was radiotherapy in 38%, while surveillance was elected in 34%, and radical prostatectomy was performed in 6%. In T3 and T4 tumors, the primary treatment was androgen deprivation in 60% and 86%, respectively. Hormonal therapy consisted of bilateral orchidectomy in 88% of cases, whereas estrogen was used in 5% and flutamide in 5% of patients. There was a positive correlation between locally advanced disease and poorly differentiated as well as metastatic tumors. Although only 18% of our patients were known to have died, the mean follow-up in those with T4 tumors was 28 months, compared to 47 months in those with T1-2 tumors, indicating that our patients were lost to follow-up because of death. The need for education of patients and primary health care providers is illustrated by this study. At present, serum prostate specific antigen [PSA] is not available to patients at primary care level in South Africa, and probably in most parts of Africa. This situation will have to be changed, if there is to be any hope for early detection and cure of prostate cancer in our part of the world