Urethroplasty Practices among Reconstructive Urologists in Nigeria.

OBJECTIVES: To determine the national practice patterns in the management of male urethral stricture disease by the open urethroplasty technique. MATERIALS AND METHODS: A questionnaire-based national survey of Nigerian urologists was performed during the 19(th) Annual General Meeting and Scientific Conference of the National Association of Urological Surgeons of Nigeria, held at Ibadan, Southwest Nigeria in 2013. RESULTS: A total of 55 respondents (67.1%) completed the questionnaire. About 43.6% were between the ages of 40 and 49 years. Almost 41.8% had between 5 and 9 years of experience as a reconstructive urologist, and 50.9% performed 1-9 urethroplasties/year. A total of 80 responders reported trauma as the most common etiology for their strictures. About 63.7% preferred to treat strictures after 3-6 months of diagnosis and 67.3% of respondents preferred the combination of retrograde urethrography and voiding cystourethrography for the diagnosis of urethral stricture. Stenting of the urethra was done after urethroplasty using size 16 Fr of 18 Fr silastic catheter; however, the duration of stenting varied among urologists. About 41.8% followed up their patients for a year, and uroflowmetry was used by 36.6% of the responders to follow-up their patients. Stricture recurrence was the most common reported complication by 36.4% of the respondents. CONCLUSIONS: In Nigeria, most urethral stricture diseases are treated by open urethroplasties. Very few of these surgeries are performed annually by young urologists. There is no uniformity in the method of diagnosis, stenting, and follow-up after treatment.

Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria.

BACKGROUND: Penile injuries are uncommon. The more severe injuries are often difficult to manage. OBJECTIVES: We report our experience with penile injuries from different causes and treatment options available. PATIENTS AND METHODS: We analyzed retrospectively 23 cases of penile injuries presenting to the Urology Unit of a tertiary hospital in the Southeastern part of Nigeria from January 2007 to December 2012. RESULTS: The management for each patient varied depending on the nature and extent of the injury. The mean age of the patients was 28.9 ± 14.4 years (range 3 weeks to 43 years). The mean duration before presentation was 22.7 ± 17.8 h (range 1-168 h). The causes of penile injuries were categorized as follows: Postcircumcision 3 (13.0%), genital mutilation (self-inflicted injury/attacks by assailants) 6 (26.1%), accident 4 (17.4%), penile fracture 8 (34.8%), and gunshot injury 2 (8.6%). Isolated blunt injuries to the corporal tissues as occurs in penile fractures was managed successfully with early exploration and closure of the tunical tear, while injuries to the penile skin was managed with dressing and secondary closure. Severe penile injuries resulting in partial or total phallic loss presented the most challenge to treatment. CONCLUSION: Traumatic penile injuries are not common. Severe penile injuries could be challenging because of the nature of the injuries, delayed presentation and unavailability of modern technological tools and experience required for the treatment of such severe injuries. Expertise in the use of flaps for a neophallus are still been developed, and penile prosthetic devices are not readily available in our setting.

Complication rates of open transvesical prostatectomy according to the Clavien-Dindo classification system.

BACKGROUND: Traditional open prostatectomies either transvesical or retropubic remains the reference standard for managing benign prostatic enlargement in some centers, especially in developing countries. The comparison of complication rates between the various types of open prostatectomies is usually a source of significant debate among urologists, most times with conflicting results. The Clavien-Dindo classification system is an excellent attempt at standardization of reporting complications associated with surgeries. MATERIALS AND METHODS: We reviewed retrospectively the records of patients who had open transvesical prostatectomy (TVP) in three specialist urology centers in Anambra state, Southeast Nigeria, over a period of 5 years (January 2004-December 2009), with the aim of documenting medical and surgical complications arising from open TVP. These complications were then categorized according to the Clavien-Dindo system. RESULTS: A total of 362 patients had open TVP over the period under review. Of this number, 145 had documented evidence of complications. The mean age of the patients was 66.3 years (SD 9.4 years; range 49-96 years). The mean follow-up period was 27.8 months (SD 12.6 months; range 6-33 months). The overall complication rate for open TVP in this study was 40.1% (145/362). Complication rates for grades i, id, ii, iiia, and iiib were 0.8%, 0.6%, 35.1%, 0.6%, and 3.0%, respectively. Most complications of open TVP occur in the early postoperative period. CONCLUSION: Open TVP still remains a valid surgical option in contemporary environment where advanced techniques for transurethral resection of the prostate and laparoscopic prostatectomy are unavailable. Most complications occur in the early postoperative period, with bleeding requiring several units of blood transfusion accounting for the commonest complication. This should be explained to patients during the preoperative counselling.

Diagnosis of prostate cancer with needle biopsy: should all cases be biopsied before treatment?

BACKGROUND: The triad of digital rectal examination (DRE), serum prostate specific antigen, and transrectal ultrasound-guided prostate biopsy is used in the detection of prostate cancer (PCa). It is recommended that all cases of PCa should be diagnosed with needle biopsy before treatment. The exclusion criteria for those that may not be suitable have not yet been defined. MATERIALS AND METHODS: We reviewed all the patients diagnosed with PCa at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast, Nigeria, from January 2007 to December 2010. Relevant biodata and method of diagnosis of PCa before treatment were reviewed. RESULTS: A total of 133 patients had bilateral orchidectomy over the period. 120 (90.2%) had their diagnosis confirmed by needle biopsy before bilateral orchidectomy (category 1), while 13 (9.8%) had bilateral orchidectomy before diagnosis was confirmed. The method of diagnosis for category 1 patients was with lower urinary tract symptoms (LUTS), abnormal DRE findings, elevated prostate-specific antigen (PSA), and transrectal needle biopsy. For category 11 patients, diagnosis of PCa was suspected based on LUTS, abnormal DRE findings, and elevated PSA. Of this number, 11 (84.6%) had, in addition, sudden onset paraplegia at presentation, while 2 (15.4%) had severe uncontrolled hematuria at presentation. All the patients in both categories had needle biopsy confirmation of their disease. The sensitivity of PSA was 99.2%. CONCLUSION: Needle biopsy of the prostate is the preferred method for the diagnosis of PCa in most cases before treatment is undertaken. There are valid reasons why all PCas will not be diagnosed in this fashion. Elevated PSA when combined with an abnormal DRE finding increases the predictive value for cancer. In areas where pathologists are lacking, abnormal DRE and elevated PSA results can be a guide to proceed to treatment especially, where there is severe compromise of patients' quality of life due to symptoms of advanced PCa while awaiting confirmation.

Schistosomal stricture of the ureter-diagnostic dilemma.

Chronic schistosomiasis of the urinary tract can present with symptoms unrelated to the disease. A 33-year-old man from Edo State Nigeria presented with recurrent left flank pain. Laboratory investigations did not reveal any cause. Radiological investigation revealed a stricture of the left ureter and hydronephrosis of the left kidney. Management included surgical excision and antischistosomiasis chemotherapy. Histopathological examination of specimen of the ureter obtained after surgical exploration revealed Schistosoma heamatobium ova in the wall of the ureter.