Epidemiology of posterior urethral injury among adults with traumatic pelvic ring disruptions: a 10-year retrospective review from a trauma care centre in Southeast Nigeria.

Introduction: posterior urethral injuries can occur in polytrauma settings, and may contribute to morbidity post-trauma. The aim of this study is to determine the occurrence of pelvic fracture urethral injury (PFUI) in adult polytrauma patients who were successfully stabilized and to appraise the nature of associated injuries. Methods: the medical records of stabilized polytrauma patients≥ 18 years of age from January 2010 to December 2019 were retrospectively reviewed focusing on those presenting with bony pelvis disruptions. Injuries were categorized using the injury severity scale (ISS) while bony pelvis disruptions were classed according to the Young-Burgess classification. Data on the demography of the patient, mechanism of injury, nature, and severity of injuries, class of pelvic fracture-disruption, and urethral integrity were collected and analyzed accordingly. Results: of 111 patients with bony pelvis disruptions, 95 of them had adequate information and were included in our analysis. The mean age of participants was 37.3 ± 11.8 years and most of them were males (87.4%). Blunt pelvic trauma occurred in 96.8%. Lateral compression pelvic injuries were prevalent at 39.0%. In 54.7% of the patients, the injury severity score (ISS) was ≥ 27. At 25.3% and 24.2% respectively, the abdomen and the lower extremities most frequently sustained a grade ≥ 3 injuries (abbreviated injury scale (AIS) ≥3). At a rate of 2.1%, spinal cord injury was the least observed. In the 10 years, there were 6 PFUI among 83 stabilized polytraumatized men with mean ISS of 35.5 ± 8.3. The incidence rate of PFUI was 0.6 per 8.3 pelvic disruptions in men per year. Symphysis pubis disruption or fracture of the pubis or both was consistently seen in all PFUI. Higher ISS significantly relates to PFUI (p <0.001). The mechanism of bony pelvis disruption and the class of bony pelvis injury are determined by the severity and trajectory of the impact apparently relates to PFUI only through fracture-disruption of the pubic symphysis or the pubis. Conclusion: about 7.2% of men presenting with traumatic disruption of the bony pelvis in polytrauma setting sustain PFUI. In polytrauma settings, PFUI should be suspected in cases of fracture-disruption of the pubis or symphysis pubis from any mechanism.

Relationship between interviewer-assisted international prostate symptom score and other objective measures of bladder outlet obstruction in Southeast Nigeria: a cross-sectional study.

Introduction: there are concerns that interviewer-assisted administration of the International Prostate Symptom Score (IPSS) may introduce bias to the extent that values obtained may not correlate with the more objective measures of bladder outlet obstruction (BOO) in benign prostate enlargement (BPE). This study aims to determine the relationship between interviewer-assisted IPSS and the more objective peak urine flow rate (Qmax) and postvoid residual urine volume (PVR) in men with lower urinary tract symptoms (LUTS) due to BPE in a low-resource setting. Methods: a cross-sectional study from July 2020 to June 2021. Using systematic random sampling, men ≥ 40 years old with LUTS attributable to uncomplicated BPE were recruited. Participants completed the English-language IPSS questionnaire with the needed assistance from the interviewer. Thereafter, the Qmax was assessed using uroflowmetry while PV and PVR were assessed using ultrasonography. Age, serum total prostate-specific antigen (tPSA), body mass index (BMI), and the highest level of formal education attained were determined. Multivariate logistic regression analysis was used to examine the relationship between these variables and IPSS. Results: in all, 170 men of mean age 63.7±9.9 years participated. The mean PV, PVR, and Qmax were 70.84±39.50 cm3, 77.66±69.30 cm3, and 20.25±9.70ml/s, respectively. Of these 170 participants, 134 (78.8%) attained formal education beyond the primary level. Increasing points of interviewer-assisted IPSS have a strong relationship with worsening self-perceived quality of life due to LUTS (r: 0.76; p= 0.001), but a rather weak relationship with decreasing Qmax (r: -0.40; p= 0.009) and increasing PVR (r: 0.49; p= 0.005). Higher formal education was associated with lower IPSS at presentation and was statistically significant (p = 0.004). There were no predictable relationships between IPSS and age, tPSA, PV, and BMI (p > 0.05). Conclusion: interviewer-assisted IPSS can be relied upon, but with some caution, in low-resource, low-formal education settings to give clinical information consistent with the objective measures of BOO.

Prevalence of skeletal-related events in hormone-naive prostate cancer in a low resource setting.

Background: Presentation with symptoms of advanced prostate cancer is prevalent in developing societies. The objective of this study was to determine the rate of and factors associated with skeletal-related events (SREs) at presentation with hormone-naïve prostate cancer. Methods: Records of 331 consecutive prostate cancer patients from January 2009 to April 2018 were reviewed. The prevalence of SRE at the presentation was determined. In addition, the relationships between SRE and age of patient, duration of clinical features, serum total prostate-specific antigen (tPSA) and biopsy Gleason score (GS) at presentation were evaluated. Analyses were done with IBM SPSS® version 25. Results: Mean age was 69.8 ± 8.0 years. While 43.8% of patients had lower urinary tract symptoms (LUTS) only, 51.4% had LUTS and other features of disease progression. Only 2.1% of the cases were confirmed from screen detection of elevated serum tPSA. SREs were observed in 11.8% at first presentations with hormone-naïve prostate cancer. Symptom duration (odds ratio [OR] 0.94; 95% confidence interval [CI] 0.90-0.99; P = 0.02), anaemia that could not be attributed to gross haematuria or external blood loss (OR 9.6; 95% CI 3.12-29.52; P < 0.001) and transrectal biopsy GS (OR 1.61; 95% CI 1.17-2.22; P = 0.003 ) were significantly associated with SREs at presentation with hormone-naïve prostate cancer. Conclusions: Evidence exists that patients who present with SREs from more aggressive prostate cancers may have had more rapid symptom progression, but not a longer delay before presentation.

Application of blended integrated revision course in clinical surgery in West Africa in response to Covid-19 pandemic: perception of trainee surgeons.

Background/Objective: This study assessed the surgery residents' evaluation of blended delivery of the 2020 Integrated Revision Course in Clinical Surgery (IRCCS) of the West African College of Surgeons undertaken as a result of COVID-19 pandemic. Methods: We performed a cross-sectional survey of 234 participants of the 2020 IRCCS using self-administered questionnaire. The survey assessed the previous traditional course and various aspects of the novel blended course using 5-point Likert scale. Results: Overall, 186 (79.5%) responded. The blended course had overall mean rating of 4.92 (on a 5-point scale) compared to 4.05 for the previous traditional course. Of the virtual aspect of the blended course, didactic lectures had the best mean rating of 4.32, while unmanned OSCE had the least with mean rating of 3.30. Aspects of the multicentre component of the blended course were rated highly with conduct of manned OSCE receiving the best mean rating of 4.26. The major challenge of the blended course format was poor internet connectivity (n =102; 54.8%). Conclusion: Blended format of surgical training course is well rated by the surgery residents, and may be an effective means of delivery of clinical and non-clinical course contents during periods of disruption.