Prevalence of Low Back Pain Among Specialist Medical Consultants at the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State.

Background: Low back pain (LBP) is the 5th leading cause of physician consultation and is a significant cause of lost workforce hours with tremendous economic implications in every society. These findings suggest that medical practice in Nigeria is a potential risk factor for developing low back pain. Few studies have attempted to evaluate the medical specialties as risk factors for LBP. This study evaluates the prevalence of low back pain among various Specialist Medical Consultants in a typical Teaching Hospital. Methodology: This is a descriptive cross-sectional study performed using self-administered questionnaires. The study population comprised Specialist Medical Consultants working at the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State. The questionnaires were distributed among consultant physicians regardless of their departments. Information about their age, sex, medical specialties, presence frequency and severity of LBP; interventions received, and outcome were obtained. Result: There were 98 respondents, 56 (57%) males and 42 (43%) females who participated in the study. The modal age of the respondents is the 41-50 years age group (45%). 44%, were from the surgical specialties (surgery, anaesthesia, oral and maxillofacial surgery, ophthalmology); 33% from the internal and family medicine specialties; (11) 11% pediatricians and (12) 12.2 % were pathologists. The prevalence of low back pain was 60.2%, slightly more prevalent in males (62%) than females (58%). Of those who have experienced low back pain, 35.6% suffered mild pain (VAS 1-4), 49% suffered moderate pain (VAS 5-7) while 17% suffered severe pain (VAS 8-10). The majority (57.6%) had suffered more than 3 episodes of LBP while 84.8% sought treatment for their symptom mostly using NSAIDS. Conclusion: LBP has a high prevalence among Specialist Medical Consultants in UPTH potentially affecting patient treatment and student education. Most consultants take NSAIDS as treatment for low back pain.

Surgical management of benign prostate hyperplasia in Nigeria: open prostatectomy versus transurethral resection of the prostate.

INTRODUCTION: transvesical (open) prostatectomy (OP), an invasive surgical procedure, is a common form of treatment offered to patients with benign prostatic enlargement in emerging economies. Recently, there has been an increase in the use of electrosurgical means in treating benign prostate hyperplasia in our environment, especially transurethral resection of the prostate (TURP). This study compares the perioperative, short-term outcomes and complications of open prostatectomy and TURP. METHODS: the records of men who had prostatectomies (OP and TURP) from Jan 2016 to Dec 2019 for prostate gland less than 80g were reviewed. The patients´ age, size of the prostate gland, duration of surgery (mins), blood transfusion, clot retention, length of catheterisation (days), hospital stay (days), postoperative infection, postoperative incontinence, reoperation, bladder neck stenosis and urethral stricture were analysed. RESULTS: fifty-nine patients were studied. Twenty-nine patients had OP, while 30 had TURP. Mean age for OP was 63.8 (SD 7.2) years, while for TURP is 68.5 (SD 8.0) years (p=0.019). The mean for length of catheterisation for OP vs TURP was 9.1 (SD 3.7) vs 3.3 (SD 1.03) days (p=0.001), mean hospital stay was 9.6 (SD 4.1) and 4.7 (SD 2.2) days (p=0.001) for OP and TURP while duration of surgery (mins) for OP and TURP was 106.7 (SD 15.2) vs 53.8 (SD 14.0) minutes (p=0.001). The blood transfusion rate was 13.8% and postoperative incontinence 13.8% in OP, while in the TURP group, the reoperation rate was 3.3% and urethral stricture at a rate of 3.3%. Overall complications showed no statistical difference (p=0.462) between the two groups. CONCLUSION: the patients who underwent TURP had shorter hospital stay, shorter duration of surgery and catheterisation, and less frequently required blood transfusion compared to those who had open prostatectomy. However, reoperation rate was higher compared to open prostatectomy. The overall complication was fewer with TURP, but this is not statistically significant; hence both forms of surgical therapy remain relevant in a poor resource setting.

The Outcome of Transurethral Electro-Endoscopic Resection of Orthotopic Single System Ureterocoeles in Adults Nigerians.

Background: Endoscopic transurethral electro-incision and resection are minimally invasive options for treating adult single system ureterocoele. Vesicoureteral (VU) reflux is frequently associated with ureterocoeles and can complicate the treatment. The literature on endoscopic management isscanty from sub-Saharan Africa. This study aimed to describe the technique and outcome of adult patients who had transurethral incision and or deroofing of orthotopic single system ureterocoele. Methodology: This was a prospective study on patients who presented with single system ureterocoeles. All were diagnosed either by computerized axial tomography urography or intravenous urography and were followed up and monitored for resolution of symptoms, development of urinary tract infection, and ureterovesical reflux. The patients' demographic information such as their age, sex, details of endoscopic treatments, complications on follow-up were entered into Excel and analyzed using SPSS version 21. Results: There were eighteen ureteric units managed in 10 patients with single system ureterocoeles. The male: female ratio was 3:2. The 30-39-year age group (four; 40%) and 60-69year age groups (four; 40%) had the highest frequency. Six (33.33%) had calculi, and 83.30% presented with lower urinary tract symptoms (LUTS). Nine (50%) of the ureteric systems had transurethral deroofing of ureterocoele (TUDU), while eight (44.4%) had transurethral incision of ureterocoele (TUIU). Urinary tract infection was the commonest complication. Ureterovesical reflux was present in two and two developed refluxes after TUDU. The patients with refluxes had antibiotics with the resolution of the ipsilateral symptoms. All had preserved renal function. Conclusion: VU reflux inpatients that underwent endoscopic incision or deroofing for single system ureterocoele is infrequent and can be managed conservatively. It is an effective treatment for single system ureterocoeles and has minimal complications.

Correlation between Uroflowmetry and International Prostate Symptoms Score in the evaluation of Nigerian men with Benign Prostatic Enlargement.

Background: Benign prostatic enlargement (BPE) may obstruct the urethra, reduce urine flow, and cause Lower Urinary Tract Symptoms (LUTS). Patients with LUTS can be evaluated with the International Prostate Symptom Score (IPSS) and uroflowmetry for diagnosis, treatment selection, and monitoring. There are challenges, especially in developing countries with these two investigative modalities. A level of education is needed to fill the IPSS form while most centres do not have a uroflowmeter. Studies to evaluate the relationship and compare the beneficial value of IPSS and uroflowmetry are few.This study aims to assess the correlation between IPSS and uroflowmetry in adult patients who present with LUTS secondary to BPE and compare their beneficial values. Methodology: The study was a hospital-based, descriptive prospective cross-sectional study of patients with LUTS secondary to BPE. Ethical committee approval and informed consent were obtained. Every patient had the study questionnaire and IPSS questionnaire completed. Each patient also had uroflowmetry performed. The researcher filled out the study questionnaire. Data were coded and entered using Microsoft Excel version 2010 and transferred into Statistical Package for Social Sciences Version 20 for analysis. Results: Two hundred eighty-six patients were evaluated, but 100 met the inclusion criteria and were included in the study. The ages ranged from 48 to 93years with a mean age of 64.71± 9years. The 60 to 69 years age group had the highest frequency, 43(43%). The mean Total Prostate Volume (TPV) was 83±32.28ml. Most patients (65 patients) presented with severe LUTS (p=0.001).There was a statistically significant inverse relation between IPSS and Maximum Flow Rate (p=0.001; r= -0.624) and Average Flow Rate (p= 0,001; r= -0.578), indicating that the higher the degree of bother, the lower the Mean and Average Flow Rates. This suggests that the more the degree of bother from BPE as assessed by IPSS, the lower the urine flow rates on uroflowmetry. Conclusion: There was a strong negative correlation between IPSS and MFR a moderate negative correlation between IPSS and AFR, showing that the higher the IPSS, the poorer the urine flow. IPSS can be used instead of the uroflowmetry to evaluate patients with BPE if a uroflowmeter is unavailable.

Cigarette Smoking, Alcohol Consumption, and the Risk of Prostate Cancer-A Retrospective Analysis of Prostate Cancer Patients in Southern Nigeria.

Background: Tobacco contains harmful carcinogens that have been associated with cancers. Some studies have associated tobacco smoking with prostate cancer (PCa). The relationship between alcohol consumption as a risk factor for prostate cancer has been debated. Some studies associated alcohol consumption with increased risk of PCa, associating alcohol consumption with higher-grade cancers and poorer prognosis. Other studies have found a minimal relationship with PCa, with some even suggesting that alcohol consumption may even be protective. This study evaluates the association between smoking and alcohol consumption in prostate cancer patients. Methodology: This is a retrospective study on one hundred and fifty-two patients diagnosed with prostate cancer with a known history of both smoking and or alcohol consumption managed over a 9year period from January 2012 to December 2020 from three Urology referrals hospitals. Patients with incomplete history were excluded. Their data such as age, a history of cigarette smoking, prostate-specific antigen level, prostate biopsy histopathology reports, and Gleason's grade were extracted. This was coded into Microsoft Excel and analyzed with SPSS version 20. The results were analyzed and presented in tables and charts. Results: One hundred and thirty-five patients had a premorbid history of smoking and alcohol consumption with a mean age of 69 years and a modal age in the 70-79-year age group. Fifty-three (39.3%) of the patients had a history of cigarette smoking, ninety-four (69.6%) had a history of alcohol consumption. In comparison, fifty-one (37.8%) had a history of cigarette smoking and alcohol consumption. The high-risk Gleason's 8-10 prostate cancer was commoner among smokers than nonsmokers. There was no statistically significant association between cigarette smoking and alcohol consumption alone and combined with PCa. Conclusion: The high-risk Gleason's 8-10 prostate cancer was commoner among smokers than nonsmokers. There was no statistically significant association between cigarette smoking and alcohol consumption and the risk of prostate cancer.