Correlation Between Serum Prostate-Specific Antigen and Testosterone Following Bilateral Total Orchidectomy for Patients with Advanced Prostate Cancer in Jos, Nigeria.

Background: Prostate cancer is a common malignancy affecting men beyond the middle age. Monitoring of treatment of the disease using serum testosterone and prostate-specific antigen (PSA) offers an index of treatment efficacy and a reflection of disease progression, respectively. The objective of this study was to determine the relationship between changing values of serum PSA and serum testosterone in patients with advanced prostate cancer following bilateral total orchidectomy (BTO). Materials and Methods: This was a prospective longitudinal study carried out over a 1-year period among patients who met the inclusion criteria. Each patient underwent detailed clinical evaluation including history, as well as physical examination with digital rectal examination of the prostate. Also, samples of serum PSA and testosterone were obtained and sent to the same chemical pathology laboratory before intervention with BTO, then at 2, 4, and 6 months. The values of serum PSA and testosterone were obtained and changes over this period were compared for both parameters. The analyses included independent inferential analysis of serum testosterone and serum PSA over a period of 6 months and a correlation of the two parameters over the same period. Results were analysed using SPSS version 23. P value of <0.05 was regarded significant. Charts and tables were used for data expression. Kruskal-Wallis and Wilcoxon tests were used for individual inferential analysis of serum testosterone and PSA. The Spearman ranked correlation coefficient test was used to determine the degree of correlation of serum testosterone and serum PSA levels while Pearson correlation coefficient test was used to determine the degree of correlation between the percentage changes in serum testosterone and PSA measured over the period of the study. Results: A total of forty-two men with mean age of 68.49 ± 8.86 years who had advanced prostate cancer were recruited. The histologic type of prostate cancer diagnosed for all the patients was adenocarcinoma. The mean Gleason score was 7.98 ± 1.09, while the modal Gleason grade group represented was grade group 5. There were statistically significant changes in serum testosterone and PSA levels in response to bilateral total orchidectomy with P value of <0.001. However, there was no statistically significant correlation between serum testosterone and serum PSA levels following bilateral total orchidectomy with p values of 0.492, 0.358, 0.134, and 0.842 at baseline, 2, 4, and 6 months, respectively. There was a significant correlation between the percentage changes in serum testosterone and PSA measured between baseline and 2 months with P value of <0.001. However, there was no statistically significant correlation between the percentage changes in serum testosterone and PSA measured between baseline measured against 4 months and 6 months with P value of 0.998 and 0.638, respectively. Conclusion: The study showed that reduction in serum levels of testosterone and PSA following BTO was significant. It also revealed no statistically significant correlation between serum testosterone and serum PSA measured over 6 months following bilateral total orchidectomy.

The predictive value of intravesical prostatic protrusion on the outcome of trial without catheter in patients with acute urinary retention from benign prostatic hyperplasia at Jos University Teaching Hospital, Nigeria: a prospective observational study.

Introduction: acute urinary retention represents a significant and painful event in the natural history of benign prostatic hyperplasia. This study was to determine the value of intravesical prostatic protrusion in predicting the outcome of trial without catheter in patients presenting with acute urinary retention from benign prostatic hyperplasia. Methods: this was a prospective observational study carried out over a one-year period among 78 patients with acute urinary retention from benign prostatic hyperplasia who presented at the Accident and Emergency Department of Jos University Teaching Hospital. They were clinically evaluated, and a urethral catheter was passed to relieve the retention. Trans-abdominal ultrasound assessment of intravesical prostatic protrusion, was performed after relief of acute urinary retention. Patients were placed on tamsulosin tablets 0.4mg daily for three days and they had a trial without catheter on the third day. A receiver operating characteristic curve was used to determine the predictive power of intravesical prostatic protrusion on the outcome of trial without catheter in patients with acute urinary retention from benign prostatic hyperplasia. A p value of <0.05 was considered as significant. Results: seventy-eight patients were enrolled in the study. The mean age and was 65.00 (SD 7.28) years. The mean intravesical prostatic protrusion, voided volume and maximum flow rate were 13.04 (SD 10.94) mm, 89.46 (SD 6.14) mls and 7.63 (SD 5.69) ml/s respectively. Intravesical prostatic protrusion (area under the curve= 0.843, p=0.001) predicted the outcome of trial without catheter with a cut off mark of <7.4, using the receiver operating characteristic curve. Conclusion: intravesical prostatic protrusion significantly predicted the outcome of trial without catheter in patients with benign prostatic hyperplasia presenting with acute urinary retention. It is a useful tool in the initial evaluation of patients with benign prostatic hyperplasia presenting with acute urinary retention.

Assessment of Health-care Research and Its Challenges among Medical Doctors in Nigeria.

INTRODUCTION: Health-care research in Nigeria has been growing over the years but is constrained by many difficulties. This study aimed to identify the challenges encountered in health-care research and suggest policies to address these problems. MATERIALS AND METHODS: It was a cross-sectional study of medical doctors who have been involved in health-related researches. All participants filled a self-administered online questionnaire comprising 31 questions in five sections. The responses were analyzed using the Google forms and the Statistical Package for the Social Sciences software version 23. RESULTS: The mean age of the study participants was 41.0 ± 8.4 years. Three-quarters of the respondents (75.5%) worked in teaching hospitals. Nearly all (96.6%) carried out their studies using personal funds and only one in 10 had been involved in high-budget projects (≥₦1,000,000). The generation of quality researches was impeded by the restriction of literature review to free online journals (93.2%), incomplete health records (88.0%), limited access to research kits (65.7%), limited use of advanced statistical analysis (29.8%), and challenges with obtaining ethical approval (21.2%). Despite the average online visibility of these researches (52.2%), only 28.5% stated that it has been locally adopted to influence medical practice in their center. CONCLUSION: There is a wide disparity in research capacity among hospital tiers. It is important to leverage on and expand existing partnerships to provide institutional access to premium literature, offer robust, and assessable financial support for the conduct of high-quality researches and provide a framework to bridge the gap in the use of these works to influence practice change in Nigeria.

Dorsal onlay buccal mucosa graft urethroplasty for bulbar urethral stricture: a single centre experience.

INTRODUCTION: the successful treatment for urethral strictures demands not just attention to surgical details but careful selection of the reconstructive technique. For long segment urethral strictures substitution urethroplasty is required. This study sought to determine the success rate and complications of dorsal onlay buccal mucosal graft (BMG) urethroplasty for long segment urethral strictures in our hospital. METHODS: this was a retrospective study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had dorsal onlay buccal mucosal graft urethroplasty for long segment bulbar urethral stricture within the study period were retrieved. Patients´ demographics, cause and nature of urethral strictures, duration of follow up, the success rate and complications were collected and subjected to statistical analysis using SPSS® version 22. RESULTS: twenty-four men with mean age of 45 years (range 14-67 years) had dorsal onlay buccal mucosal graft urethroplasty during the study period. The mean stricture length was 4.5cm (range, 2-7cm). After a mean follow up duration of 2 years (range, 1 4 years), 21(87.5%) patients had a successful urethroplasty as they were able to pass urine at one year post urethroplasty without lower urinary tract symptoms, while 3(12.5%) had recurrence of the urethral stricture. At the recipient site, 2(8.3%) patients had primary bleeding that did not require blood transfusion. Also, 2(8.3%) patients had superficial wound infection which was treated with antibiotics. At the donor site, 4(16.7%), 2(8.3%), 4(16.7%) had donor site swelling, transient bleeding and soreness respectively. CONCLUSION: dorsal onlay BMG urethroplasty has a good success rate and minor complications and therefore suitable for long segment bulbar urethral strictures.