Transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defects: The outcomes of surgical management.

BACKGROUND: Currently, transperineal anastomotic urethroplasty approach is the reference standard in the surgical reconstruction of pelvic fracture urethral distraction defects. The approach is suitable for all but the most complex cases which might require abdominoperineal approach. AIMS: We reviewed our recent experience with transperineal anastomotic urethroplasty with respect to success rate and complications. PATIENTS AND METHODS: This was a retrospective descriptive study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defects within the study period were retrieved. Patients' demographics, cause and nature of pelvic fracture urethral distraction defects, the success rate, and complications were collected and subjected to statistical analysis using SPSS® version 22. RESULTS: Sixteen men with mean age of 29.6 ± 7.8 years had transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defect (PFUDD) during the study period. The mean defect gap length was 4.5 cm (range, 2-7 cm). Out of the 16 patients, 6 (37.5%) had simple transperineal urethroplasty, while 10 (62.5%) underwent a more extensive transperineal urethroplasty. Four patients (25%) had inferior pubectomy. A total of 7 (43.8%) patients had erectile dysfunction (ED) before and after the urethroplasty. Five (31.3%) patients had ED before the urethroplasty 2 (12.5%) patients developed ED after the surgery. After mean follow-up duration of 2 years (range, 1-4 years), 12 (75%) patients had satisfactory urinary stream. The mean Qmax for the 16 patients was 16 ml/s (range, 0-35 ml/s). The 12 (75%) patients that had no complaints of LUTS, had Qmax ≥ 15 ml/s at mean follow-up duration of 2 years. CONCLUSION: Transperineal anastomotic urethroplasty for PFUDD is considered suitable technique for treatment of PFUDD with good surgical outcome.

Knowledge and practice of prophylaxis of deep venous thrombosis: A survey among Nigerian surgeons.

BACKGROUND: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. OBJECTIVES: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT). MATERIALS AND METHODS: Eight Tertiary Institutions were selected from institutions in the geopolitical regions of the country by simple random sampling using balloting method. A semi-structured questionnaire was administered, and the response was obtained from 105 out of 254 surgeons. RESULTS: The mean knowledge score was 5.81 ± 1.67, and only 33.3% have good knowledge about DVT prophylaxis. No statistical difference was observed between the different groups of surgeons. The mean practice score was 5.19 ± 1.8 and only 20% of surgeons have a good practice of DVT prophylaxis. The majority (90.5%) have encountered DVT whereas 83.5% have encountered pulmonary embolism in their practice. Most commonly encountered risk factors include prolonged immobility, advanced age, and pelvic surgery. Only 13.3% have used Well's score in the clinical evaluation of their patients. The prophylactic modality adopted varies, but most surgeons (77%) utilized both the pharmacological and mechanical methods. Low molecular weight heparin is the commonly used chemoprophylactic agent while a combination of early ambulation and limb physiotherapy is the most commonly preferred mechanical method of thromboprophylaxis. CONCLUSION: There is a deficiency in the knowledge and practice of DVT prophylaxis among surgeons in Nigeria. There is a need to improve both the knowledge and practice by introducing institutional guidelines or protocol for DVT prophylaxis for surgical patients.

Motorcycle injuries in North-Central Nigeria.

BACKGROUND: The increasing use of commercial motorcycle as mode of transportation in urban cities in Nigeria has become important source of morbidity and mortality. This is coupled with poor helmet use, narrow roads, increasing traffic, and poor licensing of the motorcycle riders. The objectives of this study are to determine the pattern of injuries following accident involving motorcycles, the mortality rate, and the immediate causes of mortality. MATERIALS AND METHODS: This is a combined retrospective and prospective study spanning over 2 years (1 year each). Patient's records were retrieved to collate data for the retrospective study while all the patients presenting to the casualty unit of Jos University Teaching Hospital following involvement in motorcycle accidents between April 2006 and March 2007 were selected for the study. RESULTS: Out of 485 motorcycle injured patients, 295 and 190 were recruited from the retrospective and prospective study respectively. The male: female (M: F) ratio was 4.8:1. The ages ranged from 2.5 to 84 years with a peak at 21-30 years. The total number of injuries was 559 with 443 patients singly injured and 42 patients multiply traumatized. Head injury (40.1%) was the most frequently occurring injury followed closely by extremity injuries (38.1%). None of the patients wore protective helmet. Thirty-six (36) mortalities (7.4%) were recorded and all dead patients had head injuries. All deaths occurred within 24 h. CONCLUSIONS: Head injury represents a common cause of morbidity and mortality following motorcycle injuries in our environment. Therefore, strict enforcement of helmet laws from May 10, 2010 may reduce morbidity and mortality.