Epidemiological and aetiological factors of male infertility in northern Nigeria.

OBJECTIVE: To evaluate some epidemiologic and aetiologic factors for male infertility in our patients. METHOD: All male patients who presented with infertility in urology clinic of the department of surgery between 1991and2005 were retrospectively reviewed. Epidemiologic and aetiological factors of male infertility were studied. RESULT: There were 537 patients; age ranged 18 to 56 years with a mean of 34 +/- 9.0 SD years. Primary infertility was seen in 515 (96%) patients. About 70% were infertile for 2 to 6 years. Primary testicular insufficiency was seen in 260 patients (48.7%) mainly resulting from genitourinary tract infection. Azoospermia resulting from testicular pathology was seen in 18 (3.4%) and obstruction to the vas or epididymis was seen 75 (14.0%) patients. Two hundred and fourteen (45%) patients had oligospermia resulting from testicular insufficiency while 61 (11.4%) had oligospermia due obstruction. CONCLUSION: Infertility resulted mainly from preventable causes. This can be prevented by prompt and adequate treatment of genitourinary infection, testicular maldescent and testicular torsion.

Unusual giant prostatic urethral calculus.

Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed.

Mortality from burns in Zaria: an experience in a developing economy.

OBJECTIVE: To determine the cause of morbidity and mortality in burns patients managed over a period of eight years in our hospital. DESIGN: A retrospective study. SETTING: Ahmadu Bello University Teaching Hospital. SUBJECTS: Two hundred and seven patients admitted and treated for burn care between January 1980 and August 1987. RESULTS: There were 114 males and 93 females with male/female ratio 1.2:1. Fifty four percent of the admissions occurred during the harmattan period, which is cold and dry season of November to February, 52% of admissions were children below the age of five years. The severest injury was caused by petrol burn with a mean % BSA of 53 and range 23-100. Scalds accounted for 39% while flame accounted for 57% of the injuries. Clothing injury was a cause of extensive burns accounting for 12% of burn injury with % BSA of 36. Complications leading to morbidity and mortality include, wound infection leading to septicaemia and septic shock, hypovoleamia with hypovolaemic shock, which gave a mortality of 100% of those who developed shock state. Seventy three patients died giving a crude mortality rate of 35%. CONCLUSIONS: There is a need for health education to reduce incidence of burn injury. Since burn injuries are largely preventable, it is important to define clearly, the social, cultural and economic factors, which contribute to burn causation in order to combat them effectively.

Epidemiology of burn injury: experience in the Savannah region of Northern Nigeria.

Burn injury is a worldwide problem. We examine the epidemiological factors which cause conditions in which burns are more likely to occur. Seasonal variation influences (i.e. the cold dry harmattan period), certain cultural factors such as 'Wankan Jego', and using platforms with bedside fires, are contributing factors. The faulty storage of petroleum product has its toll. Poor architectural design and a low level of education in addition to poor socio-economic condition are factors that need to be addressed to reduce the incidence.

Haematuria in Africa: is the pattern changing?

OBJECTIVE: To study the aetiological factors and clinical presentation of haematuria as seen in a tertiary healthcare centre in a developing country in Africa. PATIENTS AND METHODS: The study comprised a retrospective review of the diagnostic indices and notes of patients with macroscopic haematuria presenting at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 7-year period from 1985 to 1991. RESULTS: Of a total of 2726 urology patients and 11 232 surgical patients, 482 had haematuria (17.7% and 4.3%, respectively, 387 males and 95 females, ratio 4.1 : 1, mean age 44.8 years, range 6-80). Many presented late with advanced malignant disease (T3, T4). Investigations useful in the diagnosis were urinary cytology, intravenous urography and cysto-urethroscopy. Common causes of haematuria were bladder carcinoma in 142 (31%), benign prostatic hypertrophy in 64 (14%) and urinary stones in 54 (12%). CONCLUSION: Recurrent haematuria in patients over 30 years of age in this environment should be considered or deemed to be caused by malignancy until confirmed otherwise. An educational programme is required to alert the population to the significance of haematuria as a symptom demanding a thorough investigation before treatment. This would need support by a haematuria service for accelerated diagnosis and treatment.

Influence of HIV infection on presentation of Kaposi's sarcoma.

We report a retrospective review of 57 patients with endemic Kaposi's sarcoma (EKS) seen between 1981 and 1990 and 40 prospectively diagnosed patients with and without human immunodeficiency virus (HIV) infection seen between 1991 and 1995. In the retrospective study 52 patients were males and five were females. Their ages ranged between 15 and 62 years with a mean of 39 years.Thirty-five (61%) patients had symptoms for more than 1 year. Nodular KS was seen in 75% of the patients. In the prospective study 26 patients had EKS while 14 had AIDS associated KS (AAKS). Among the patients with EKS 24 were males and two were females. The mean duration of symptoms was 20 months. The CD4 count done on nine patients ranged between 900 and 1300 cells/mm3 and there was no mortality within 1 year of presentation. Eleven of the patients with AAKS were males and three were females. Their ages ranged between 22 months and 41 years with a mean of 26. Nine patients had symptoms for less than 6 months. Ten patients had peripheral lymphadenopathy. CD4 counts done on 11 patients ranged between 200 and 800 cells/mm3. Five patients (35%) died within 6 months of presentation. Between 1991 and 1995, 486 patients were seen with HIV infection. Patients with AAKS present with fulminant disease which seemed quickly fatal.

Tuberculosis myocarditis: a case report.

A 35-year old man presented with fever, weight loss, drenching night sweats and symptoms of cardiac failure for three months. Examination revealed wasting, peripheral oedema, bilateral pleural effusion and constrictive pericarditis. A diagnosis of constrictive pericarditis with bilateral pleural effusion probably due to tuberculosis was made. Human immunodeficiency virus antibodies and six sputum for acidfast bacilli were negative. Electrocardiograph revealed low voltages globally and echocardiography showed global myocardial hypokinesia. He had pericardiectomy, pericardial and pleural histology was non-specific inflammatory reaction but myocardial histology showed granulomatous changes of tuberculous myocarditis. We suggest that in experienced hands myocardial biopsy could be useful in making the diagnosis.

Benign prostatic hyperplasia and prostate carcinoma in native Africans.

OBJECTIVE: To study the factors associated with morbidity and mortality in benign prostatic hyperplasia (BPH) and carcinoma of the prostate in native Africans. PATIENTS AND METHODS: A prospective study was conducted from 1993 to 1998 at the Ahmadu Bello University Teaching Hospitals, Zaria, Nigeria. During this 5-year period 686 patients were investigated and treated for symptoms and signs of prostatism. They were followed up for a mean (range) of 19.5 (1-60) months. RESULTS: BPH was found in 588 and clinical carcinoma in 98 patients. Adequate results, including a histological diagnosis, were available for 640 patients; there were 545 patients with BPH and 95 patients with histologically diagnosed prostate cancer. Treatment consisted of open prostatectomy for BPH, and subcapsular orchidectomy and/or open bladder-neck wedge resection for patients with prostate cancer and bladder neck obstruction. Within 6 months of surgery, four of 545 (0.7%) patients with BPH and 25 of 95 (26. 3%) with prostate cancer had died. Two-thirds of the patients with cancer presented with paraparesis or paraplegia. CONCLUSIONS: BPH and prostate cancer cause significant morbidity and mortality in African men. There is a need for health education about the early recognition of symptoms. Provision of facilities for transurethral prostatectomy would minimize the complications of surgery and ensure better use of the meagre resources available for health care.

Complications of traditional male circumcision.

The complications of traditional male circumcision were studied in 48 boys seen between January 1981 and December 1995. Their ages ranged from 3 days to 7 years (mean: 4 years). Haemorrhage, the commonest complication, was seen in 25 (52%) and infection in ten; one child had amputation of the penis. Other complications included meatal stenosis and urethro-cutaneous fistula. Sixty-four per cent of those with haemorrhage were neonates and their haemoglobin levels ranged between 6 and 15 g/dl. Three required blood transfusion, seven ligation of bleeding vessels and two required both. Overall, 21 patients required surgery and the average duration of hospital stay was 2-8 days. Most complications were seen between 1991 and 1995 when surgical fees had been introduced and the number of boys circumcized in our hospital decreased. We advocate the provision of adequate and safe facilities to cope with the increasing demand for circumcision in our society.

Urethral stricture at Ahmadu Bello University Teaching Hospital, Zaria.

We reviewed 556 male urethral strictures treated at Ahmadu Bello University Teaching Hospital, Zaria between 1980 and 1989. Their ages ranged from nine to 80 years with a mean of 40 +/- 12.9 SD years. Infection caused stricture in 66.5% while trauma accounted for 31.7%. Urethral injury associated with pelvic fracture from road traffic accident accounted for 68% of the traumatic causes. Inflammatory strictures were mainly located in the bulbar urethra (69.9%), while most traumatic ones involved membranous urethra (74.4%). Inflammatory strictures were mostly multiple (85%) while 90% of traumatic ones were single. Many patients with inflammatory strictures had more than one episode of urethritis. About 58% of the patients were treated by dilatation, 16% by visual internal urethrotomy and 26% by urethroplasty. Best results were obtained in patients treated by urethroplasty where 72% were satisfied with their treatment. Overall, 61% of the patients were satisfied with their treatment and were voiding urine without effort at two years. Re-stricture occurred in 21% and 23% of patients treated by urethroplasty and internal urethrotomy respectively. Urethroplasty is advocated upon less strict indications where the expertise is available.

Urethroplasty at Ahmadu Bello University Hospital, Zaria.

One hundred and forty three patients who had urethroplasty for urethral stricture between 1980 and 1989 were reviewed. Their age ranged from nine to 75 years with a mean of 39 +/- 10.2 SD years. Infection caused stricture in 51% and trauma in 46.9%. Urethral trauma resulted mostly from road traffic accidents. The inflammatory strictures were located in the anterior urethra, whilst traumatic ones were in the bulbomembranous region. Urethroplasty was indicated as the initial treatment in 80.4% because the strictures were impassable or complicated by perineal sepsis or fistulae. In 16% urethroplasty was employed as an alternative to frequent or complicated urethral dilatation. Sixty (42%) patients had anastamotic urethroplasty while 54.5% had island patch urethroplasty using scrotal, penile or preputial island skin flap. The commonest late complication was restricture which occurred in 20.9% of the patients. Overall, 72% were satisfied with their treatment. Urethroplasty is advocated upon less strict indications as it cures the stricture and prevent the complications of repeated instrumentation.

Burns in children under 3 years of age: the Zaria experience.

This is a retrospective study of 84 children aged 36 months and less who were admitted for burns care from January 1980 to December 1989. Fifty-four (64%) had scalds, 28 (33%) had flame burns and in two children the cause was not known. The upper extremities were most commonly involved. Sixty-five per cent of the children were admitted during the cool, dry Harmattan season. Associated factors included cooking at floor level, bedside fires, epileptic fits in the mothers and general architectural factors. Wound infection was the commonest complication. The overall mortality rate was 27.4%. Burns prevention demands improvement in the design of houses, cooking methods, treatment of epilepsy and abandoning puerperal bathing by mothers.

Clothing burns in Zaria.

From 1980 to 1989, 45 patients with clothing burn injuries were admitted into the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Children aged 15 years and below numbered 30 and adults aged 16 years and above totalled 15. There was a female preponderance in the ratio of 1.8:1. The cumulative monthly frequency between October and February recorded the highest number of admissions (77 per cent) with a peak in January (31 per cent). The involvement of women and children especially those below the age of 5 years is noteworthy. Eighty per cent of the patients had a major injury with a total mortality of 42 per cent. The improvement in the economic standard of the populace shown by the improvement in cooking methods, the proper use of gas cookers and kerosene lanterns, the avoidance of bedside fires during the night, the guarded use of loose indigenous garments, and the use of nursery schools for the care of children below 5 years of age will help to lower the incidence of clothing burn injuries in our environment.

Burn injuries in Zaria: a one year prospective study.

Fifty three patients admitted for burn care during a 12 month period from September 1987 to August 1988 were prospectively studied. There were 36 males (60%) and 21 females (40%) with ages ranging from 3 months to 60 years. Children aged 0-4 constituted 40% but 32 (60%) were younger than 16 years. Flame burns affected 26 (49%) patients, scalds in 22 (12%), electrical burns affected four patients and chemical burn was in one. Scald was the commonest injury among children aged 0-4 (70%). Flame, affected 33% of those aged 16 and above. Clothing fire was the commonest flame injury and it was a cause of very extensive injury (mean % BSA 45). Kerosene burn, gas and clothing burns caused the most extensive injury with a mean % BSA 46, 41 and 45 respectively. The commonest complication was burn wound sepsis most frequently by a gram-negative bacilli (65.63%) of which Pseudomonas aeruginosa were that commonest organisms. Pseudomonas and Staphylococcus aureus were about same frequency. Duration of hospital stay ranged from 6 days to 300 days with a mean of 46.52 days. 8 patients absconded, two were transferred to a hospital near their home and 9 died, giving a mortality rate of 17%. Since burn injuries are largely preventable, it is important to define clearly the social, cultural and economic factors which contribute to burn causation in order to combat them effectively.