Cancer of the penis: case report.

Two patients with penile carcinoma are presented after management at a district hospital in Kenya. Both had undergone ritual circumcision as teenagers and presented late. HR was a 73 year old who presented with a fungating penile mass for which a partial penectomy was performed after wedge biopsy confirmed malignancy. He thereafter declined to have the surgical specimen sent for histology and took the amputated stump for burial in his compound to avoid bad omen. GK was 25 years old and presented with a fungating mass and underwent partial penectomy after a histological diagnosis was made. He absconded from follow-up after being informed of the need for further surgery due to tumour infiltration of the surgical margins. The history and clinical images are presented and we discuss the difficulties of cancer management at a rural district hospital.

Early postoperative outcomes of patients undergoing prostatectomy for benign prostatic hyperplasia at Kenyatta National Hospital, Nairobi.

OBJECTIVE: To describe early postoperative complications of prostatectomy. DESIGN: A descriptive prospective study. SETTING: Kenyatta National Hospital between 6th October 2003 and 21st June 2004. SUBJECTS: Eighty five men undergoing prostatectomy for the relief of lower urinary tract obstruction due to benign prostatic hyperplasia. Procedures included suprapubic transvesical prostatectomy, retropubic prostatectomy and transurethral resection of the prostate (TURP). MAIN OUTCOME MEASURES: Co-morbidity, intra-operative and early postoperative complications, need for re-operation, 30-day mortality, duration of postoperative catheterisation, and duration of postoperative hospital stay. RESULTS: Eighty five patients were included in the study and their age range was 46-85 years (mean 66 years). Sixty nine (81%) of the patients underwent open prostatectomy, and sixteen (19%) underwent TURP. Twenty six patients had co-existing medical conditions, the most common being hypertension (29%) and diabetes mellitus (13%). The most common intra-operative complication during prostatectomy was haemorrhage which occurred in ten patients (11.8%). One patient had perforation of the bladder during transurethral resection and required a laparotomy to repair the bladder. Wound sepsis was the most common postoperative complication following open prostatectomy (35%, n = 69), and an association was found between wound sepsis and diabetes mellitus. Complications common to both open prostatectomy and TURP were urinary tract infection (15%), clot retention (10%), pyrexia (10%) and pneumonia (8.2%). Three patients (4.4 %) required re-operation due to complications related to wound sepsis. The duration of postoperative catheterisation ranged from 1-14 days (mean 6.66 days) while postoperative hospital stay ranged from 3-24 days (mean 8.16 days). There was no postoperative mortality at 30 days. CONCLUSIONS: Open prostatectomy is the most performed procedure for the relief of lower urinary tract obstruction due to benign prostatic hyperplasia at Kenyatta National Hospital. Wound sepsis is the commonest early postoperative complication and the presence of diabetes mellitus significantly increases the risk of development of wound sepsis.