Effect of varicocoelectomy on seminal fluid parameters.

BACKGROUND: Infertility can be a source of anxiety and marital disharmony to a couple. The male factor traditionally contributes 40%. Varicocoeles are a significant cause of male infertility. AIM: To assess the effect of varicocoelectomy on seminal fluid analysis parameters in sub-fertile males. METHODOLOGY: This was a prospective study of fifty four patients who presented with infertility to the urology clinic of University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria between January 2015. and January 2016 . Those who had clinically palpable varicocoeles as the only suspected cause of their infertility were enrolled. The varicocoeles were classified into right, left or bilateral and graded into grades 1, 2 and 3 using Dubins criteria. Each patient had two semen analyses done two weeks apart and underwent a bilateral varicocoelectomy via the inguinal approach. Seminal fluid analyses were done post operatively at four and six months. RESULTS: Of the 54 patients that underwent varicocoelectomy, 11 (20.4%) had azoospermia, 28 (51.9%) had oligospermia and 15 (27.8%) had counts greater than 20 million but less than 40 million. Following varicocoelectomy there was a statistically significant increase in overall motility (p=0.000), morphology (p=0.000), density (p=0.000) and semen volume (p=0.004). Assessing only oligospermic patients there was no significant improvement in morphology (p=0.160). Azoospermic patients showed statistically significant improvement in all parameters though the values were well below those accepted for spontaneous conception. CONCLUSION: Varicocoelectomy improves semen parameters in patients with varicocoele induced semen anomalies; it may provide an option for retrieving viable semen for patients with varicocoele induced azoospermia.

FRACTURE OF THE PENIS IN THE NIGER DELTA REGION OF NIGERIA.

BACKGROUND: Penile fracture is a surgical emergency which often frightens the patient and partner. Varying incident rates, precipitating mechanisms and outcomes of treatment have been reported from different parts of the world. AIM: To determine clinical presentation, aetiological factors and outcome of treatment of penile fracture in Port Harcourt, Niger Delta region of Nigeria. METHODS: This was a retrospective study of all patients who presented with penile fracture to our institution from 2007 and 2015. Data on age of patient, events leading to the injury, mode and time of presentation, mode and outcome and complications of treatment were collected and analysed with SPSS 20.0 software. RESULTS: Twenty one patients with a median age of 34.0 years (21-45) were treated within the study period. Nine patients (42.9%) were married. Overenthusiastic/ vigorous sex-related events were responsible for penile fracture in 17 patients (81.0%). Seven injuries were self inflicted while in 14 patients (66.7%), partners were involved. All the patients presented with pain, swelling, sudden detumescence and deviation of the penis. The right side was affected in 61.9% of the cases. The penile mid-shaft was the site of injury in 57.1% of cases. Six patients (28.6%) had associated urethral injuries. Eighteen patients (85.7%) had immediate surgery, 2 patients (9.5%) refused surgery and were treated conservatively. One patient who presented late was also managed conservatively. All but one patient had satisfactory penile erections with no significant complications. CONCLUSION: Overenthusiastic and vigorous sexual activities were the most common causes of penile fracture in this study. A third of the patients had associated urethral injuries. Early surgical repair led to satisfactory outcome.

Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center.

AIM: This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. MATERIALS AND METHODS: This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. RESULTS: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). CONCLUSION: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.

Weekend Versus Weekday Hospital Deaths: Analysis of In-Patient Data in a Nigerian Tertiary Healthcare Center

Aim: This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. Materials and Methods: This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95 confidence intervals.Results: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded; giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females; respectively was noted. The labor ward; followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 (P = 0.0461) and 1.41:1 (P = 0.1440); respectively. Weekend deaths were less in the other wards; with the gynaecological ward having the least ratio of 0.63:1 (P = 0.7360). Conclusion: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths; especially in the labor ward; in order to identify and prevent avoidable deaths

Management of prostate cancer in port harcourt, Nigeria: changing patterns.

BACKGROUND: This is a follow up to a study done at the University of Port Harcourt Teaching Hospital (UPTH) 11 years ago on the management of prostate cancer. AIMS: To assess the current pattern in the management of prostate cancer in Port Harcourt, Nigeria and the impact of changes in diagnosis and treatment. METHODS: All the case notes of prostate cancer presenting in the University of Port Harcourt Teaching Hospital between January 2003 and December 2012 were reviewed. Data on demography, clinical presentations, co-morbidities, investigations, treatment, complications and outcome of treatment were extracted and analyzed using SPSS 20.0 0 RESULTS: A total of 294 histologically confirmed patients with cancer of the prostate were treated within the study period. Out of these, 216 (73.5%) case notes were analysed. The mean age was 69.9 years (51 -90 years). All the patients had lower urinary tract symptoms, 30 (14.0%) had haematuria while 19(8.8%) presented with paraplegia. The prostate specific antigen (PSA) ranged from 0.5 - 760ng/ml. Two hundred and five (95%) received androgen deprivation therapy. Of these, 123 (60%) had bilateral subcapsular orchidectomy and anti androgen, 3 (1.4%) had abiraterone. Five (2.3%) had radical prostatectomy, 22 (10.2%) had chemotherapy while 16(7.4%) had radiotherapy. Seventy-two (33.5%) died within 2 years of diagnosis while 49(30.2%) survived more than 5 years. CONCLUSION: There is rising prevalence of carcinoma of the prostate in this centre. Many patients presented late. There has been expansion in diagnostic and therapeutic capabilities with attendant improvement in patients' survival. Co-morbidities adversely affected the outcome of treatment.

Local application of tacrolimus in distal colitis: feasible and safe.

BACKGROUND: Tacrolimus is a potent immunomodulator that is effective in the systemic treatment of inflammatory bowel diseases (IBD). However, potential toxicity and systemic (side) effects after oral intake limit its use. We investigated the local applicability and safety of tacrolimus for distal colitis. METHODS: Patients with refractory left-sided colitis or proctitis were treated for 4 weeks with a daily tacrolimus 2-4 mg enema or 2 mg suppository. Safety of local tacrolimus treatment was assessed by measurement of whole blood tacrolimus trough levels by monitoring liver and kidney function and blood glucose levels. Efficacy of treatment was assessed by comparing the disease activity index (DAI) in ulcerative colitis (UC) patients and endoscopic and histologic appearances before and after 4 weeks of treatment. RESULTS: Nineteen patients with left-sided colitis (n = 7) or proctitis (n = 12) were treated. Two patients with left-sided colitis had Crohn's disease (CD), the other 17 patients had UC. None of the patients developed side effects. Blood trough levels of tacrolimus were too low to induce systemic immune suppression. Thirteen of 19 patients (3/5 left-sided UC, 0/2 left-sided CD, and 10/12 proctitis) showed clinical improvement of disease activity after 4 weeks of local tacrolimus treatment. Moreover, a significant improvement of histological appearance was observed in the suppository-treated group. CONCLUSIONS: This study demonstrates that local colonic application of tacrolimus 2-4 mg daily in patients with refractory distal colitis is feasible, probably safe, and potentially efficacious, and therefore opens the need for a further, randomized trial.

Development and validation of standardized clinical summary format.

BACKGROUND: The use of a structured guideline in medical education to reach a diagnosis provides accurate information which is relatively free from bias. The purpose of this paper is to assess the performance of medical students using unstructured and structured format in case summary. METHODS: One hundred and sixty- nine medical students in Part III MB; BS Programme in the University of Port Harcourt were studied. There were 83 students in Paediatics [SP] and 86 students in Obstetrics and Gynaecology [SOG] postings. The students had video recorded presentation of three clinical cases comprising of two paediatrics [PC1&PC2] and one surgical case [SC3]. The summary for the first case [PC1] was done using an unstructured format, while the second case [PC2] was done with both unstructured PC2a and structured PC2b format. The Surgical case [SC3] was done using only the structured format. The discrete pieces of important information in each case were quantified and scored by trained assessors. PC1and SC3 had a total of 16 points each while PC2 had a total of 24 points. RESULT: The pre-exposed SOG students scored significantly higher than none-exposed SPG students in PC1 and SC3; P<0.05. In PC2 75.1% students scored above 12 points using structured summary format compared to 38.5% students with unstructured format , P<0.05. The students had significantly higher score using structured format in SC3 than PC1. CONCLUSION: The use of structured summary format enabled better case summary than unstructured format, and it's transferable across different departments.

Spectrum of urological procedures in University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

AIM: To determine the relative frequencies of types of operations, age and gender distribution of the patients and the indications for operation in the Urology Unit over a 10-year period between 1989 and 1998. SETTING: The Urology Unit of the University of Port Harcourt Teaching Hospital. TYPE OF STUDY: Retrospective. METHODS: Patients' demographic data were collected from the Main Theatre registers of the Hospital, the Medical Records Department ward records patients' and case note. Those operations done in the Urology Unit were analysed. RESULTS: Urological operations (total 1875) formed 22.6% of all surgical operations in the hospital during the decade under review. There were 1847 males (98.5%) and 28 females (1.5%). The age distribution showed two peaks in the first decade and in the seventh decade. Frequencies of operations were least in the 4th decade and after the 9th decade. Circumcisions, surgery for prostate disease, procedures for urethral strictures, urological trauma and paediatric reconstruction formed the majority of operations. Endoscopic urological procedures were limited to the occasional cystoscopy. Some 67.6% of the operations were performed in the first half of the decade and 32.4% in the second half. A rapid decrease in the number of operations was noticed which compared with the same pattern in the Department of Surgery as a whole. CONCLUSION: We recommend the establishment and development of human and material resources for Urological service for basic procedures and endo-urological practice in keeping with contemporary trends and the allocation of more theatre space and out-patient Clinic time to the urology service.

Infant Feeding Tube as Urinary Tract Stent

Background: The infant feeding tube is a cheap and readily available device with many uses in the urinary tract. Many types of stents are available in the market but among other factors; cost and affordability limit their use in developing countries and remote areas. Aim: To document experience with infant feeding tubes as stents in the urinary tract. Methods: Data from the hospital records of patients who required stents at the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria were obtained from their case notes from May 2003 to May 2006. Information extracted from these case notes included: age and sex of patient; indications for stenting; stent-related complications and outcome of surgery. The data were analysed using Microsoft Excel Software. Results: Thirty-three patients who required stents within the period were included in the study. In nineteen patients (57.6) feeding tubes were used as urethral stents while in 14 (42.4) as ureteric stents. Operations requiring stents include: dismembered pyeloplasty 9.1 (3); ureteric re-implantation 24.3 (8); ureterolithotomy 9.1 (3); and urethroplasty 57.6 (19). The stents were left in situ for 2-3 weeks depending on the indication. Ureteric stents were left for 3 weeks while urethral stents were usually left for 2 weeks. However; where a significant complication was noted; the stent was removed. Complications noted in 4 patients (12.1) which were probably stent-related include: bladder spasm; infection and wound dehiscence. Conclusion: Infant feeding tubes can be used as suitable urinary tract stents where expensive stents are not available

Infant feeding tube as urinary tract stent

Background: The infant feeding tube is a cheap and readily available device with many uses in the urinary tract. Many types of stents are available in the market but among other factors; cost and affordability limit their use in developing countries and remote areas.Aim: To document experience with infant feeding tubes as stents in the urinary tract.Methods: Data from the hospital records of patients who required stents at the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria were obtained from their case notes from May 2003 to May 2006. Information extracted from these case notes included: age and sex of patient; indications for stenting; stent-related complications and outcome of surgery. The data were analysed using Microsoft Excel Software.Results: Thirty-three patients who required stents within the period were included in the study. In nineteen patients (57.6) feeding tubes were used as urethral stents while in 14 (42.4) as ureteric stents. Operations requiring stents include: dismembered pyeloplasty 9.1(3); ureteric re-implantation 24.3(8); ureterolithotomy 9.1(3); and urethroplasty 57.6(19). The stents were left in situ for 2-3 weeks depending on the indication. Ureteric stents were left for 3 weeks while urethral stents were usually left for 2 weeks. However; where a significant complication was noted; the stent was removed. Complications noted in 4 patients (12.1) which were probably stent-related include: bladder spasm; infection and wound dehiscence. Conclusion: Infant feeding tubes can be used as suitable urinary tract stents where expensive stents are not available

Obstructive uropathy in childhood : a Review

Background: Obstructive uropathy is any affection of the urinary tract characterized by impairment of urine flow through the tract and which; if left untreated; will cause progressive renal damage.Aim: To present an update on obstructive uropathy in children with emphasis on the situation in Nigeria.Methods: Contemporary information on the management of obstructive uropathy was obtained by searching the Medline and adding information from the authors' experience.Results: Obstructive uropathy causes renal impairment in all age groups. The causes in children may be congenital or acquired. The congenital causes include pelvi-ureteric junction obstructions; posterior urethral valves (PUV); urethral atresia; phimosis and meatal stenosis. Associated anomalies include imperforate anus and ver tebral malformations. Acquired causes include calculi; post-traumatic and post-inflammatory strictures and meatal stenosis. Some specific manifestationsare prune-belly syndrome; hydronephrosis and renal failure. Diagnostic investigations include ultrasonog raphy; intravenous urog raphy; cystography and renography. Recent technological advances have impacted on the treatment of the different lesions. These include in utero vesico- amniotic shunt and endoscopic valve ablation for PUV and minimally invasive techniques for urolithiasis. Nephrectomy may be indicated in a unilateral damaged kidney. Not all lesions require treatment. Criteria to select patients for treatment require definition. Occasionally treatment fails because of pretreatment irreversible renal damage. The resulting end-stage renal failure is an indication for renal transplantation.Conclusion: Obstructive uropathy is an important cause of renal impairment. Contemporary advances in the management are yet to become available in developing countries. Compromise treatment options therefore prevail. Adequate treatment is essential to prevent end-stage renal failure

Neologisms in medical practice: their potential to be 'useful', 'useless' or 'misleading'.

BACKGROUND: The advances in human endeavours have led to changes in technology. New words, neologisms, have been creeping up and are coined with astounding speed. While these terms are fascinating etymologically, their impact needs to be appreciated from a realistic perspective to keep one aware of the collateral changes we are importing into common language, particularly in medical practice. The aim of this paper is to identify some of such neologisms, outline their current use and then discuss their potential to be 'useful' 'useless' or 'misleading'. METHODS: Terminologies in medical practice and information technology have been selected by the authors and their meanings have been analysed. RESULTS: The terminologies of our present interest include: Computer literacy; Surfing the web; Networking; Information technology; Medical informatics; Telemedicine; Capacity building; Problem-based learning; Mentoring; Learning curve; Evidence-based medicine; Impression; Comorbid conditions; Family medicine; Andropause; Surgical site infection; Confidence interval. CONCLUSION: Neologisms are inescapable in the face of rapid advances in knowledge, equipment and information dissemination to and through diverse cultures and languages. In their assimilation, we should be considerate in discarding familiar terms that have served time.

Urethral prolapse in a woman in her reproductive age--a very rare occurrence.

BACKGROUND: Urethral prolapse is a rare condition occurring in prepubertal girls and postmenopausal women. Even most rare is that occurring in the reproductive age grade. METHOD: A report of a woman in her reproductive age who presented in the gynaecology clinic of a private hospital is presented together with a brief review of the literature. RESULTS: Urethral prolapse associated with uterovaginal prolapse, lower abdominal pain and dysuria in a 48-year old grand multiparous (para 8 + 0) farmer who is still observing her monthly menstrual cycle was seen. Her pregnancies and deliveries were unsupervised. A urine culture revealed moderate growth of Escherichia coli sensitive to ciprofloxacin. The urethral prolapse resolved satisfactorily on this. CONCLUSION: It is advocated that antenatal care, education and women empowerment be made a priority. This will almost eradicate this very rare condition in our society.

HIV positive patients and the surgeon.

BACKGROUND: Guidelines for the surgical treatment of HIV infected patients are lacking in Nigeria. The Social stigma of the infection and fears of contracting the disease discourage healthcare providers from treating the patients. OBJECTIVE: To present cases treated by surgeons and thereby stimulate interest on the need to offer these patients needed treatment. METHODS: A written questionnaire was sent to surgeons based in the University of Port Harcourt Teaching Hospital who have operated on patients known preoperativly to have HIV. Information sought included age, gender, indication for surgery, operation done, outcome of operation, indication for HIV test and information given to the patient after the test. RESULTS: a total of 26 HIV infected patients received surgical treatment in private and company clinics and there were 18 females and 8 males aged between 8 and 48 years. Most of these were in the 2nd to 4th decades. The operations were elective, emergency or urgent. Pregnancy-related indications predominated. Three patients volunteered their status. One when told she was HIV positive declined a planned right nephrectomy for hypernephroma. Nineteen patiens were discharged from hospital well. Three patients and parents of two were informed by the surgeons that they were HIV positive preoperatively. Five patients died postoperatively. CONCLUSION: There is need to promote awareness on the obligation of suregeons to offer these patients surgical treatment. A protocol and adequate facilities for prophylaxis for health care workers exposed to infection from patients should be established in Nigeria.

Chronic pyonephrosis associated with renal neovascularisation.

The spectrum of renal tract infections is wide. When the kidney has been severely damaged, the radiological findings may suggest a malignancy. To report a case of chronic pyonephrosis, which even at exploration appeared to be a malignancy. The case record of the patient as well as the literature were reviewed and reported. A 25 year-old woman presented with a 5-year history of left lumbar pain, urinary frequency and intermittent total haematuria. The intravenous urography showed non-function in the left kidney harbouring a calculus. Treatment was delayed for poor finances. At laparotomy a huge renal mass invading the colonic mesentery and showing neovascularisation was removed. The final diagnosis was chronic pyonephrosis. She recovered from postoperative septicaemia. Neovascularisation is a feature of malignant disease mediated by angiogenesis factors. These factors are probably present in chronic inflammation. It is suggested that for nephrectomy, prophylactic antibiotics should be used. There is also a need for histopathological examination of every specimen removed at operation.