Traumatic catheterization as a precipitating factor for urethral prolapse in 4 years old child.

Urethral prolapse is a circumferential protrusion of the distal urethra through the external urethral meatus. The incidence of Urethral prolapse was reported to be one in 3000, and it occurs most often in prepubertal Black females and postmenopausal White women. The possible causes and precipitating factors are not clear. Instrumentation of the urinary tract was reported to be one of rare precipitating factor. We report a case of Urethral prolapse in a child which was precipitated by traumatic accidental removal of the transurethral catheter.

Waiting times for prostate cancer diagnosis in KwaZulu-Natal, South Africa.

BACKGROUND: There is currently no evidence in the South African (SA) literature to suggest how long patients with clinically suspected prostate cancer (an elevated prostate-specific antigen level or abnormal findings on digital rectal examination) wait to have a prostate biopsy. OBJECTIVES: To improve the overall efficiency of the prostate biopsy service offered at St Aidans Regional Hospital, Durban, SA, by quantifying the burden of disease and waiting times and to identify potential delays in management outcomes, thereby helping to alleviate patient anxiety during the stressful period of investigation. METHODS: We did a retrospective folder review of patients who underwent trans-rectal prostate biopsy at St Aidan's Hospital, where the vast majority of prostate biopsies in the KwaZulu-Natal state healthcare sector are performed, from January to June 2013. The Statistical Package for Social Sciences was used for data analysis. Results. One hundred and six patients (mean age 67.6 years, 69.8% black Africans) underwent biopsy during the 6-month study period; 49.1% were found to have adenocarcinoma, and of the 80.1% of these who had a bone scan, 73.8% had skeletal metastases (p=0.1379). The median period of time from referral to biopsy was 55 days, from referral to first follow-up date (when the diagnosis is given and treatment options discussed or instituted) 100 days, and from biopsy to first follow-up date (i.e. waiting period to retrieve histological diagnosis) 36 days. CONCLUSION: Despite the late presentation of prostate cancer in KZN, patients are waiting an average of 3 months from initial referral for a prostate biopsy to institution of definitive management.

Optical urethrotomy under local anaesthesia is a feasible option in urethral stricture disease.

The aim of our study was to assess the feasibility of performing optical urethrotomy for urethral stricture disease under local anaesthesia. A total of 33 patients with radiologically proven urethral stricture underwent optical urethrotomy by a single operator under local anaesthesia. Of these patients, 23 (70%) had stricture involving the corpora spongiosum and 18 (55%) of the patients were dependent on supra-pubic catheters. The procedure was successful in 30 cases (91%). The procedure was very well tolerated (average visual analogue pain score of 2/10) with an extremely low complication rate. The large number of patients with urethral stricture disease and the premium on operating time on formal theatre slates encouraged us to perform these procedures under local anaesthetic. Although most patients had severe stricture disease, the majority of cases were successful and very well tolerated. Optical urethrotomy under local anesthesia could be a viable option in the absence of formal theatre time and the facilities to perform general anaesthesia.

Metabolic risk factors in patients with renal stones in KwaZulu Natal: an inter-racial study (Asian and Whites).

OBJECTIVE: To identify any differences between Whites and Indians in KwaZulu Natal province, South Africa, in the metabolic risk factors which predispose them to urinary stone formation. PATIENTS AND METHODS: Urinary stone disease is often a manifestation of an underlying metabolic disorder in most patients. Intrinsic and extrinsic factors affect the susceptibility of an individual to develop urinary stones. Although South African-born Indians and Whites in KwaZulu Natal share some of the same extrinsic factors, diet and genetic factors differ between the groups. In a study from April 1999 until April 2001, 140 patients were included who had a radiological diagnosis of renal calculi; they were evaluated metabolically using previously recommended methods. RESULTS: All the patients had at least one identifiable metabolic risk factor; the prevalence of the common metabolic risk factors was similar in the two groups. The prevalence of complete renal tubular acidosis (type 1) was significantly higher in the Indian patients. The most common metabolic abnormalities were hypomagnesuria and hypocitraturia, followed by low urinary volume. Hypercalciuria was not significant in this population. While Indians had lower urine volumes than Whites, Whites had significantly higher urinary calcium excretion than Indians. CONCLUSION: There were a few variations in the metabolic risk factors between Indians and Whites, and the differences could be attributed to genetic or dietary habits. The high incidence of renal tubular acidosis in Indian patients could explain the higher prevalence of urinary stone disease in this group than in other racial groups.

Circadian phase-shifted rats show normal acquisition but impaired long-term retention of place information in the water task.

It is thought that circadian rhythms may influence learning and memory processes. However, research supporting this view does not dissociate a mnemonic impairment from other performance deficits. Furthermore, published reports do not specify the type of memory system influenced by the circadian system. The present study assessed the effects of phase shifting on acquisition and expression of place navigation in the water maze, a task sensitive to hippocampal dysfunction. The results showed that phase-shifting circadian rhythms in rats impaired the expression of place information on a retention test but not initial acquisition or encoding of place information. These results suggest that disruption of circadian rhythms may impair consolidation of previously encoded hippocampal place information.

Dissociation of hippocampal and striatal contributions to spatial navigation in the water maze.

Two experiments were conducted to compare the effects of fornix/fimbria and caudate-putamen lesions in Long-Evans hooded rats (Rattus norvegicus) trained on two water maze tasks that differed in the type of spatial localization required for optimum solution. In Experiment 1, the lesioned rats and surgical controls were trained on the standard place task in the water maze (Morris, 1981) and given two postacquisition tests (a platform removal probe and platform relocation test). In Experiment 2, rats with similar lesions and control rats were trained on a modified cue navigation task. Fornix/fimbria lesions impaired a late stage of place task acquisition but did not impair acquisition of the cue task. Caudate-putamen lesions resulted in a severe place acquisition impairment and a transient cue acquisition impairment, both of which were characterized by an initial tendency to swim near the wall of the pool. Post-hoc analyses of the direction and angles of departure from the start points suggested that rats with fornix/fimbria lesions used non-allocentric spatial strategies to solve the place task. These rats also demonstrated a significantly weakened spatial bias for the former training quadrant on the platform removal probe and reduced flexibility in navigating to a novel platform location on the platform relocation test. In contrast, rats with caudate-putamen lesions showed a significant spatial bias for the former training quadrant but failed to cross the exact location within the quadrant where the platform was formerly positioned. The results suggest that the hippocampus mediates the allocentric spatial component of the water maze place task while the dorsomedial striatum may play an important role in the acquisition of the procedural aspects of both place and cue versions of the task.