Assessment of Health-care Research and Its Challenges among Medical Doctors in Nigeria.

INTRODUCTION: Health-care research in Nigeria has been growing over the years but is constrained by many difficulties. This study aimed to identify the challenges encountered in health-care research and suggest policies to address these problems. MATERIALS AND METHODS: It was a cross-sectional study of medical doctors who have been involved in health-related researches. All participants filled a self-administered online questionnaire comprising 31 questions in five sections. The responses were analyzed using the Google forms and the Statistical Package for the Social Sciences software version 23. RESULTS: The mean age of the study participants was 41.0 ± 8.4 years. Three-quarters of the respondents (75.5%) worked in teaching hospitals. Nearly all (96.6%) carried out their studies using personal funds and only one in 10 had been involved in high-budget projects (≥₦1,000,000). The generation of quality researches was impeded by the restriction of literature review to free online journals (93.2%), incomplete health records (88.0%), limited access to research kits (65.7%), limited use of advanced statistical analysis (29.8%), and challenges with obtaining ethical approval (21.2%). Despite the average online visibility of these researches (52.2%), only 28.5% stated that it has been locally adopted to influence medical practice in their center. CONCLUSION: There is a wide disparity in research capacity among hospital tiers. It is important to leverage on and expand existing partnerships to provide institutional access to premium literature, offer robust, and assessable financial support for the conduct of high-quality researches and provide a framework to bridge the gap in the use of these works to influence practice change in Nigeria.

Management of catheter-associated urethral strictures

Background: Urethral stricture is an abnormal narrowing or loss of distensibility of any segment of the urethra surrounded by corpus spongiosum. In the last two decades, there has been a change in the pattern of aetiology of urethral stricture in urban centres in Nigeria with a shift away from post-infective strictures to the emergence of traumatic and iatrogenic causes.Objective: This study aims to present our observation of the occurrence of long-segment urethral strictures in patients after urethral catheter placement for various indications.Methodology: This is a descriptive, cross sectional report of patients who presented to and were managed at the Urology Unit of a tertiary hospital in North-Western Nigeria. Relevant information were retrieved from patients' case notes and the data was entered into a proforma and analysed using the SPSS 20 software.Results: The mean age of the patients was 45.4 ± 19.4 years, with a range of 11-80 years. Indications for urethral catheterization were acute urine retention 11 (43.8%), intra-operative urine output monitoring 9 (28.1%), following road traffic accident 10(31.2%), unconsciousness secondary to meningitis 1 (3.1%) and after urologic surgery 1 (3.1%). Urethral catheterization was carried out in peripheral hospitals in 19 (56.3%) patients; and from the hospitals operating room in 10 (31.2%), accident and emergency room 2 (6.3%) and trauma centre 1 (3.1%). Strictures were panurethral in 22 (68.75%), in the bulbar urethra in 6 (18.75%) and in the penile urethra 4 (12.5%). The length of strictures ranged from 1 cm to 20 cm. Treatments offered included substitution urethroplasty using oral mucosa grafts (OMG) urethroplasty 30 (93.8%), fasciocutaneous penile flap 1 (3.1%) and direct visual internal urethrotomy (DVIU)1 (3.1%). Satisfactory voiding was recorded in 28 (87.5%), voiding was unsatisfactory in 2 (6.3%), while one patient had stricture recurrence and another one is awaiting second stage repair.Conclusion: Urethral catheterization is an emerging cause of panurethral strictures in our practice and may occur even after relief of acute urine retention but more worrisome following short-term catheterization during surgery. There is need for evaluation of the quality of silicone-coated latex urethral catheters currently available

Use of transrectal ultrasound in the management of urologic diseases in a tertiary hospital in North-Western Nigeria.

BACKGROUND: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is considered as a standard of care for diagnosis of prostate cancer. The objective of this study was to document our experience in the use of TRUS in the management of urologic diseases in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. MATERIALS AND METHODS: This was a retrospective study of patients who had TRUS at UDUTH from December 2009 to November 2017. Relevant data were extracted from the procedure register, and case folders of the patients. Data analysis was performed using IPSS 20.0 version. RESULTS: A total of 844 patients had the procedure within the period of the study. The mean age of the patients was 65.6 ± 10.6 years with a range of 7-98 years. The main clinical diagnoses of the patients were benign prostatic hyperplasia in 528 patients (62.6%), prostate cancer in 285 patients (33.8%) and primary infertility + azoospermia in 17 patients (2.1%). Transrectal ultrasound-guided prostate biopsy was done for 807 patients (96%). TRUS only was done for assessment of seminal vesicle and ejaculatory duct in 17 patients (2.1%), prostate volume assessment in 10 patients (1.1%) and deflation of retained urethral catheter balloon in 9 patients (1%). There was self-limiting rectal bleeding in 600 patients (74.4%) and 3 patients (0.4%) each developed haematuria and postbiopsy infections. CONCLUSION: Prostate biopsy is the most common indication for TRUS in our practice. Other indications were estimation of prostatic volume, evaluation of azoospermia and deflation of retained urethral catheter balloon.

Safety and efficacy of ultrasound-guided percutaneous suprapubic cystostomy in resource-poor setting: A 7-year review.

INTRODUCTION: Percutaneous cystostomy techniques are usually done using disposable sets in developed countries which are not affordable in poor-resource settings. However, the percutaneous technique can be done using reusable trocar or selected big size surgical blades. This is simple, safe, and cost effective in poor-resource setting. The procedure is best done under ultrasound guidance but can also be done blindly in select cases. We present our 7-year experience in ultrasound-guided percutaneous suprapubic cystostomy. MATERIALS AND METHODS: This is a 7-year retrospective review of patients, who had ultrasound-guided percutaneous suprapubic cystostomy at Urology Unit of our institution from January 2010 to December 2016. Disposable cystostomy sets were used for the initial experience, but this was replaced with more cost-effective reusable metallic trocar or selected big size surgical blade methods in the later experience. Data were extracted from procedure register and patients' case notes and entered into pro forma and analyzed using Statistical Package for Social Sciences 20.0 version (2011) for windows (IBM, SPSS Incorporation, Chicago, IL, USA) 20.0 version for Windows. RESULTS: A total number of 135 patients had percutaneous cystostomy, which was ultrasound guided in 134 patients (99.3%). The mean age of the patients was 50.5 ± 23.3 years with a range of 2-90 years. The indications for the procedure include urine retention with failed urethral catheterization in 119 patients (88.1%), urethral injury in 14 patients (10.4%), and urethrocutaneous fistula in 2 patients (1.5%) with spinal cord injury. No major complication was recorded. CONCLUSION: Ultrasound-guided suprapubic cystostomy using reusable trocar or selected surgical blade is simple, safe, effective, and associated with minimal complications in poor-resource setting.

Patient Preference for Management of an Asymptomatic 15 mm Renal Calculus-Avoid Risk or Maximize Success?

INTRODUCTION: We evaluate patient preferences and the underlying factors determining decision making in the management of the asymptomatic 15 mm renal stone. METHODS: A survey was randomly distributed to 106 patients at our multidisciplinary stone clinic. Patients were given a hypothetical scenario of a 15 mm renal stone, and were asked to choose among the 3 treatment options of extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. The success rate, risk and morbidity associated with each treatment were provided to patients. Statistical analysis involved the Fisher exact and Wilcoxon signed rank tests. Analysis was performed using standard computer software with p <0.05 considered statistically significant. RESULTS: A total of 103 patients completed our survey, and 58 (56%) chose ureteroscopy, 26 (25%) chose percutaneous nephrolithotomy and 19 (19%) preferred shock wave lithotripsy as the treatment option. Patients who selected shock wave lithotripsy were increasingly concerned with risk rather than success rate (74% vs 16%, respectively). In contrast, patients who selected percutaneous nephrolithotomy were more concerned with the success rate rather than risk (81% vs 7.5%, respectively). Rates of success and risk were given approximately equal importance by patients selecting ureteroscopy (40% vs 48%, respectively). CONCLUSIONS: Patients who choose percutaneous nephrolithotomy are primarily motivated by a desire to maximize success while the choice of shock wave lithotripsy is primarily motivated by a desire to minimize risks. The majority of patients selected ureteroscopy as a procedure with a balance of moderate risk and moderate success. Understanding the factors driving patient decision making would allow urologists to more effectively manage expectations and provide counseling.

Does Stone Removal Help Patients with Recurrent Urinary Tract Infections?

PURPOSE: We evaluated the impact of surgical extraction of nonobstructing asymptomatic stones on recurrent urinary tract infections and identified predictors of patients who may be rendered infection-free. MATERIALS AND METHODS: We retrospectively reviewed charts to identify patients with recurrent urinary tract infections who underwent surgical stone extraction and were rendered stone-free. Demographic variables as well as procedure, infectious etiology, stone composition and the systemic inflammatory response syndrome rate were also recorded. Patients were divided into 2 groups. Group 1 had no evidence of recurrent infection following surgery while recurrent infection developed in group 2. Univariate analysis was performed using the Wilcoxon signed rank and Fisher exact tests. Logistic regression was used for multivariate analysis. RESULTS: We identified 120 patients with recurrent urinary tract infections and a nonobstructive renal stone. Surgical management included shock wave lithotripsy in 32% of cases, ureteroscopy in 7% and percutaneous nephrolithotomy in 61%. Of the 120 patients 58 (48%) remained infection-free after surgery while 62 (52%) experienced recurrent infection. Factors associated with a higher risk of recurrent infections included type 2 diabetes mellitus (OR 1.73, p = 0.01), hypertension (OR 2.8, p = 0.007) and black ethnicity (OR 13.7, p = 0.009). Escherichia coli infections were more likely to resolve (OR 0.34, p = 0.01). In contrast, Enterococcus infections were more likely to persist (OR 2.5, p = 0.04). On multiple logistic regression analysis only race, hypertension and E. coli infections were significant predictors of infection clearance. CONCLUSIONS: Of patients with recurrent urinary tract infections and asymptomatic renal calculi 50% may be rendered infection-free following stone extraction. Patients with risk factors for recurrent infections after surgery should be counseled that stone extraction might not eradicate the infection.

Techniques of male circumcision.

Male circumcision is a controversial subject in surgical practice. There are, however, clear surgical indications of this procedure. The American Academy of Pediatrics (AAP) recommends newborn male circumcision for its preventive and public health benefits that has been shown to outweigh the risks of newborn male circumcision. Many surgical techniques have been reported. The present review discusses some of these techniques with their merits and drawbacks. This is an attempt to inform the reader on surgical aspects of male circumcision aiding in making appropriate choice of a technique to offer patients. Pubmed search was done with the keywords: Circumcision, technique, complications, and history. Relevant articles on techniques of circumcision were selected for the review. Various methods of circumcision including several devices are in use for male circumcision. These methods can be grouped into three: Shield and clamp, dorsal slit, and excision. The device methods appear favored in the pediatric circumcision while the risk of complications increases with increasing age of the patient at surgery.

Vesical calculus 10 years post missing intrauterine contraceptive device.

Intravesical migration of intrauterine contraceptive device (IUCD) is rare. Early diagnosis of this rare entity is difficult because of its non-specific manifestations and very low index of suspicion. We present this case of bladder stone following intravesical migration of IUCD found to have been missing since insertion 10 years earlier. Lower abdominal discomfort and a missing vaginal string may be the only pointer to this unfortunate event in the immediate post insertion period. It is pertinent to consider the possibility of an intravesical migration of a missing IUCD in a patient presenting with lower abdominal discomfort, urinary frequency, and missing IUCD string on vaginal examination.