Diagnostic performance of transrectal ultrasound for prostate volume estimation in men with benign prostate hyperplasia.

BACKGROUND AND AIM: Despite transrectal ultrasound (TRUS) being regarded as gold standard for prostate volume estimation, concerns have been raised in the literature concerning its accuracy especially in men with above-average prostate volumes. We aimed to evaluate the performance of TRUS for prostate volume estimation in a cohort of sub-Saharan African men since they are known to have relatively large mean prostate volumes. METHODS: This was a prospective study of 77 sub-Saharan African men who had open simple prostatectomy for benign prostate hyperplasia (BPH). Pre-operative TRUS determined total prostate volume (TPV) and transition zone volume (TZV). Following surgical enucleation, the adenoma was weighed (EPW) and its volume (EPV) also determined by fluid displacement. TRUS was repeated six weeks post-operatively to calculate the TRUS-estimated specimen volume (TESV). RESULTS: The mean EPV, EPW, TRUS-estimated TZV, TRUS-estimated TPV and TESV were 79.1 ± 62.9 ml, 79.1 ± 62.9 g, 53.3 ± 28.5 ml, 93.1 ± 48.9 ml and 69.9 ± 44.6 ml, respectively. Pearson's correlation showed a perfect relationship between EPW and EPV with no difference in their mean values (r = 1.000; P < .001). Pearson's correlation between TRUS-estimated TPV vs EPV, TRUS-estimated TZV vs EPV, and between TESV vs EPV were 0.932, 0.865 and 0.930, respectively (P = .0000). TRUS significantly under-estimated the TZV and TESV by 25.8 ml and 9.2 ml, respectively; unrelated to the severity of prostate enlargement. CONCLUSION: TRUS underestimates prostate volume, independent of prostate size. We propose simple formulae that could be used to improve the prostate volume determination from TRUS, especially if magnetic resonance imaging is not readily available or contraindicated.

An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital.

BACKGROUND: Surgical site infections (SSI) are a potential cause of morbidity and increased cost of care after operations such as open prostatectomy. OBJECTIVE: To audit the occurrence of SSI after open prostatectomy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. METHODS: A review of all patients who underwent open prostatectomy over a ten-year period (July 2005 to June 2015). Data analysis was done using the statistical package for social sciences version 21. Association between variables was determined using Chi-square or Fisher's exact test as appropriate. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 247 open prostatectomy surgeries were reviewed, with the patients' ages ranging from 43 - 91 years and a mean age of 67.0 ± 8.8 years. Elective procedures were 98.8% while the remaining 1.2% were emergency cases. There were 24 (9.8%) surgical site infections. The duration of admission of the patients with SSI ranged from 6 - 15 days with a mean of 9.5 ± 3.2 days, as against 4 - 9 days (mean of 5.0 ± 2.1days) for those without SSI. All the patients with SSI were successfully managed with no resultant mortality. Risk factors identified for SSI were emergency surgery (p=0.001), obesity (p<0.0001), diabetes mellitus (p=0.008), smoking (p<0.0001), pre-operative catheterization (p<0.0001), excessive haemorrhage (p<0.0001) and post-operative suprapubic bladder drainage (p<0.0001). CONCLUSION: SSI is a recognized complication of open prostatectomy. Identified risk factors for its occurrence from this audit are emergency operation, obesity, diabetes mellitus, smoking, pre-operative catheterization, excessive haemorrhage and post-operative suprapubic bladder drainage. Age, approach to prostatectomy (retropubic vs transvesical), incision type (lower midline vs pfannenstiel), level of the surgeon, catheter type and modality of irrigation were however not significant risk factors for post-prostatectomy SSI in this study.

Unusual presentation of advanced prostate cancer in a black population of South-Western Nigeria.

There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria. A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of PCa and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations.

Experience with arteriovenous fistula creation for maintenance hemodialysis in a tertiary hospital in South-Western Nigeria.

End-stage renal disease (ESRD) is prevalent in our region. A major mode of treatment is by maintenance hemodialysis, and reliable vascular access is paramount for this to be successful. Arteriovenous fistula (AVF) creation offers permanent vascular access in patients with ESRD. We present our experience on AVF creation over a 10-year period. Our objective was to retrospectively review the outcome of all cases of AVF that have been created for ESRD patients at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between January 2006 and December 2015. The demographic characteristics, indications, clinical and intraoperative findings, operative complications and outcomes were filled into a pre-designed proforma. A total of 80 cases were reviewed. The age range was 17-80 years, with a mean of 49.03 ± 16.34 years. Males (85%) were more common than females (15%). Chronic glomerulonephritis and hypertension accounted for about 77.5% of etiology of ESRD in these patients. The left (non-dominant) upper limb was used in 88.1% of cases whereas 11.9% were created on the right upper limb. The distal radio-cephalic AVF (76.3%) was most commonly performed; with either the end (vein) to side (artery) (68.8%) or side-to-side (31.2%) anastomotic techniques employed. There was a primary failure in six patients (7.5%). Primary failure was more common in diabetics and thrombosis (7.5%) was the most common cause for primary failure. AVF creation has very good outcome in well-selected patients.

Bellini duct carcinoma of the kidney masquerading as an iliac bone tumour in an adult Nigerian.

Bellini Duct Carcinoma (BDC) of the Kidney is a rare type of Renal Cell Carcinoma. It usually presents with features of local advancement or metastasis and rarely diagnosed incidentally. We present a case report of a young man who was found to have BDC of the Right Kidney following presentation with an iliac bone tumour. A 40 year old man presented to the Orthopaedic outpatient clinic on account of right sided pelvic pain and limping following a trivial fall at home. There was no antecedent history of loin pain, loin mass or haematuria. On evaluation, he was found to have a huge right iliac bone tumour invading the contiguous muscles. An incidental hypodense central ipsilateral renal mass with enlarged peri-hilar lymph nodes were found. He subsequently had right radical nephrectomy via a right sub-coastal approach and wide local excision of the Iliac bone tumour in two separate procedures. The resection margins were negative for tumour cells. Histology of the resected specimens were consistent with a metastatic right BDC of the kidney. He had a smooth post-operative recovery. One third of BDC of the kidney presents with metastasis. A high index of suspicion is required in order to diagnose BDC following such unusual presentations.

Determinants of hypercalcemia and hypercalciuria in immobilized trauma patients.

Hypercalcemia and hypercalciuria secondary to immobilization can be occasionally severe, producing an array of symptoms. This study looked at possible determinants of hypercalcemia and hypercalciuria in immobilized trauma patients. This is a prospective observational study carried out over a period of 7 months. Fifty-five immobilized trauma patients were evaluated weekly for 4 weeks for symptoms of hypercalcemia, total serum calcium and 24-h urinary calcium. The number of limbs immobilized had a significant relationship with hypercalcemia at the end of week 1 (P<0.001) and week 4 (P=0.008) and with hypercalciuria at the end of week 1 only (P<0.001). The number of bones fractured also had a significant relationship with hypercalcemia at the end of week 1 (P=0.005) and week 4 (P=0.019), as well as with hypercalciuria at the end of week 1 (P<0.001) and week 2 (P=0.036). Weight loss was significantly associated with hypercalcemia at the end of week 4 (P=0.014) and with hypercalciuria at the end of week 3 (P<0.001) and week 4 (P<0.001), whereas polyuria and polydipsia had a significant association with hypercalciuria at the end of week 2 (P<0.001) and week 3 (P=0.030). The number of limbs immobilized and bones fractured showed an early significant relationship with the development of hypercalcemia and hypercalciuria. Weight loss showed late association with hypercalcemia and hypercalciuria, whereas polyuria and polydipsia showed early association with hypercalciuria.

Comparison of serum and urinary calcium profile of immobilized and ambulant trauma patients.

BACKGROUND: Hypercalcemia occurs more frequently than is recognized in patients who are immobilized, but most of these patients are asymptomatic. This study is to determine serum and urinary calcium levels, incidence of hypercalcemia and hypercalciuria in immobilized and ambulant trauma patients. METHODS: A prospective comparative study was carried out over a period of seven months. Total serum calcium level and 24-hour urinary calcium output were measured weekly over 4weeks in 55 immobilized trauma patients as study group and 51 ambulant trauma patients as control group. RESULTS: Mean total serum calcium of immobilized patients increased progressively (on admission: 2.315±0.056mmol/l and week 4: 2.552±0.231mmol/l, p<.001) while that of ambulant patients did not change significantly (on admission: 2.306±0.041mmol/l, and week 4: 2.300±0.028mmol/l, p=.348). There is a significant difference in overall mean total serum calcium between immobilized and ambulant patients (p<.001). In immobilized and ambulant patients, mean 24-hour urinary calcium increased progressively from baseline (3.044±0.480mmol/day and 3.056±0.540mmol/day respectively), till the end of the study (8.543±2.142mmol/day and 6.783±1.372mmol/day respectively). Overall mean 24-hour urinary calcium is significantly different between immobilized and ambulant patients {multivariate Pillai F (5,100)=883.124, p<.001}. Incidence of hypercalcemia increased progressively in immobilized patients (end of week 1=7.27% and end of week 4=29.09%) while none of the ambulant patients had hypercalcemia. Incidence of hypercalciuria also increased progressively in immobilized patients (end of week 1=7.27% and end of week 4=63.64%) while ambulant patients only had hypercalciuria at the end of week 3 (9.8%) and week 4 (21.57%). CONCLUSION: Mean total serum calcium increased with increased duration of immobilization in trauma patients. Both immobilized and ambulant trauma patients developed hypercalciuria but it is worse and earlier in the immobilized trauma patients.

Traumatic urologic injuries in Ile-Ife, Nigeria.

BACKGROUND: In a developing country with limited healthcare resources, traumatic injuries and their management pose a significant challenge to healthcare delivery. AIM: To highlight the challenges in the management of traumatic urologic injuries in patients in our setting. SETTING AND DESIGN: Patients presenting with traumatic injuries to the urinary tract, between January 1996 and December 2005, in a University Teaching Hospital in Southwestern Nigeria were the subjects of this study. PATIENTS AND METHODS: Clinical records of patients who had such injuries were reviewed. RESULTS: Ninety injuries occurred in 86 patients including 77 males and 9 females aged 14-68 years. Fourteen (15.5%) of the injuries involved the kidneys, urinary bladder was involved in 23 (25.6%) and the male urethra in 53 (58.9%) injuries. The mechanisms of injury were road traffic accidents in 52 (60.5%) patients, straddle injuries in 18 (20.9%), trauma to the back in 8 (9.3%), falls from a height in 6 (7.0%) and gunshot injuries in 2 (2.3%) patients. Associated injuries include pelvic fractures in 33 (38.4%) patients, limb bone fractures in 13 (14.1%), intestinal injuries in 12 (13.0%) and spinal injuries in 8 (8.7%) patients. In most patients, diagnosis was made based on clinical suspicion and minimal investigations such as abdominal ultrasound, urethrocystoscopy and/or urethrocystography. The outcome was good in most patients and mortality was recorded in only 2 (2.3%) patients who had concomitant spinal and burns injuries. CONCLUSION: Prompt management instituted on clinical suspicion of injuries presents a good outcome in patients in a limited resource setting.

Burden of prostate cancer in southwestern Nigeria.

OBJECTIVES: To determine the pattern of presentation, prevalent age, hospital incidence, and outcome of management of prostate cancer in our environment. METHOD: Patients with histopathology evidence of prostate cancer managed between January 1991 and December 2007 were studied. Information entered into a pro-forma sheet and analyzed included the age of patients, clinical features, investigations, histopathology diagnosis, outcome of management, and duration of follow-up. RESULTS: During the period, 189 patients aged 46-99 years (mean, 68.0; 9.8 SD) confirmed and managed for prostate cancer were studied. The average hospital incidence (2002-2004) was 182.5 per 10(5) male admissions with 15.1-month mean duration of symptoms. Most 178 (94.2%) patients presented with advanced diseases, with 1 or multiple complications in 172 (91.0%), obstructive lower urinary tract symptoms 156 (82.5%), distant metastasis 97 (51.3%), lower back pain 95 (50.3%), weight loss 95 (50.3%), hematuria 86 (45.5%), anemia 77 (40.7%), renal failure 74 (39.2%), and inability to walk 42 (22.2%). Eighty-nine (47.0%) patients were farmers, 111 (58.7%) indulged in alcohol, and 46 (24.3%) smoked cigarettes. Mean prostate-specific antigen results available in 53 patients was 106.0 ng/mL (187.2SD) and digital rectal examination was valuable in diagnosis. Adenocarcinoma (186 [98.4%]) was the main histopathology type and most patients 136 (71.9%) had bilateral orchidectomy with or without antiandrogens. Mean duration of follow-up was 83.7 weeks. CONCLUSIONS: The burden of prostate cancer in our developing community is worrisome. It is prevalent between 46 and 99 years in our community. Presentation is late, often with urinary retention and other complications. In our setting, treatment is still essentially palliative with orchidectomy, which we found to be beneficial, acceptable, and the most affordable to our patients.