Urethral length and its relationship with anthropometric parameters in adult male Nigerians.

BACKGROUND: The available literature on urethral length in adult males is limited. To the best of our knowledge, such measurement has never been carried out amongst Nigerian and African men. This study aimed to document average urethral length as well as the relationship between urethral length and age, and anthropometric parameters amongst the Nigerian male adult population to add to the database for urethral length. METHODS: It was a prospective cross-sectional study amongst adult male Nigerians who had an indication for urethral catheterization as part of their regular treatment at the urologic clinics as well as male adult patients who required urethral catheterization in the theatre and the wards for various reasons. All patients had anthropometric parameters measured or calculated. The total usable length (A) of the catheter was measured before catheterization and the unused catheter length (B) was measured after catheterization for each patient. The calculated urethral length (C) was obtained by subtracting B from A. Data were analyzed using SPSS version 26.0. Mean urethral length was determined while the correlation between urethral length and age as well as anthropometric parameters were determined using Pearson Correlation. RESULTS: A total of 450 adult males were recruited. The mean age of subjects was 63.58 years with a range of 22-91 years. The average total usable and unused catheter lengths were 30.01 and 8.97 cm respectively. The mean urethral length among participants was 21.32 cm (8.4 Inches) with a range of 16.5 to 28 cm (6.5-11.0 Inches). There were no statistically significant correlations between urethral length and age ([r (450) = - 0.029, p = 0.546]) as well as with anthropometric parameters (height: r (450) = - 0.088, p = 0.61; weight: [r (450) = - 0.047, p = 0.324 and BMI: r (450) = - 0.082, p = 0.08) in adult males. CONCLUSION: This study suggests that there may be racial differences in adult male urethral length but no relationship with age and anthropometric parameters. Further research is needed to explore these findings.

A comparison of loupe-assisted and non-loupe-assisted subinguinal varicocelectomy.

Introduction: Varicocele is a treatable aetiology of male infertility. Magnification with surgical loupe has been associated with improved outcome and reduced morbidity than the conventional technique without magnification. Objective: To compare the outcomes of two techniques of subinguinal varicocelectomy, with a surgical loupe and without. Patients and Methods: This was a prospective randomised hospital-based study. Forty-six patients were randomised to two arms - Group A: loupe-assisted subinguinal varicocelectomy (LASV) and Group B: open subinguinal varicocelectomy without Loupe (OSV). They all had their semen and hormonal parameters compared preoperatively and at 3 and 6 months postoperatively. Post-operative complications were also assessed. P < 0.05 was considered statistically significant. Results: The mean age was 38.28 ± 4.55 years with a range of 27-46 years. The mean age in Group A was 37.35 ± 4.68 and 39.22 ± 4.33 years in Group B. There was an improvement in motility, sperm count and concentration in both the groups at 3 and 6 months (P < 0.05). However, there was no difference in these parameters on comparison of the two groups at 3 and 6 months (P > 0.05). Follicle-stimulating hormone decline was significant in the OSV group at 3 and 6 months, P = 0.010 and 0.021, respectively. There was no difference in other hormonal parameters both at 3 and 6 months (P > 0.05). The pregnancy rate in each arm of study was 4.3%. All complications occurred in Group B. Conclusion: Both techniques resulted in improvement in seminal fluid parameters. All complications occurred in the arm that had subinguinal varicocelectomy without loupe. Loupe-assisted subinguinal varicocelectomy is safe and effective.

Quality and appropriateness of uro-surgical referrals at a Nigerian teaching hospital.

Introduction: An effective referral system is crucial for a high-quality health system that provides safe medical care. Aim and Objectives: This study aimed at evaluating the appropriateness and adequacies of information in the referral letters of patients. Materials and Methods: A prospective study of referral letters of all new patients in the urology clinic. Information retrieved was socio-demographic characteristics, source of referral and presence or absence of important information in their letters. We compared the information provided to the new history taken to determine the appropriateness and adequacy using different domains of medical history. Referrals were adjudged appropriate if the diagnosis is urologic, while any referral lacking relevant information is adjudged inadequate. The results were displayed using the simple proportions in tables and charts. Results: A total of 1188 referrals were reviewed. There were 997 (83.9%) males and 191 (16.1%) females. Referrals from private hospitals were the most common in 627 (52.8%) cases. Of all new referrals, 1165 (98.1%) were adjudged to be appropriate, while 23 (1.9%) were inappropriately referred. Referrals from teaching hospitals had higher proportions of good-quality referrals than those from primary healthcare and private centres. The most common deficiencies were the lack of documentation of relevant examination findings (37.8%) and provisional diagnosis (21.4%). The majority, 956 (80.5%), of letters were narrative in nature, whereas 232 (19.5%) were structured. Structured letters were found to be more informative. Conclusion: A significant percentage of referral letters lacked completeness in many key areas. We recommend the use of structured forms or template letters to improve the quality of referrals.

Analysis of 87 Nephrectomies in a Tertiary Healthcare Center in Nigeria.

Background: Nephrectomy is one of the most frequently performed operations on the kidney. It is necessary for treatment of malignant as well as some benign renal conditions. Methodology: This was a five-year retrospective review of all adult patients who had open nephrectomy in Lagos University Teaching Hospital, Lagos, Nigeria between January 2014, and December 2019. The cases were traced using clinic, ward, and theatre records. The clinical and operative details of these patients were retrieved and analysed. Clinical information extracted included patients' demography, clinical presentations, diagnosis, procedures performed, complications and the immediate treatment outcome. Data were analysed using SPSS for Mac Version 25.0. Results were displayed in simple proportions using tables and charts. Results: A total of 87 patients' records were available for review. Age range was15-76years with a mean and median age of 49.415 and 52 years, respectively. Majority, 73(83.9%) of the patients presented with at least one symptom, whereas14(17.7%) were asymptomatic. Loin pain was the commonest presentation in 72(82.8%). Indication for nephrectomy were benign in 28(32.2%) and malignant in 59(67.8%) patients. Overall, renal cell carcinoma was the most common indication for nephrectomy accounting for 59.8% of all nephrectomies. A total of thirty-one morbidities occurred in sixteen patients with a complication rate of 18.4% while transfusion rate was 40.2%. Reoperation and mortality rates were 2.3 and 3.4%, respectively. Conclusion: Malignant renal tumors are predominant indications for nephrectomy in our institution. Though associated with a high transfusion rate, open nephrectomy remains a safe procedure with a good short-term outcome.

Management of a giant prostatic enlargement: Case report and review of the literature.

Giant prostatic enlargement often referred to as giant prostatic hyperplasia (GPH) is a rare condition described as a massive prostatic enlargement >500 g. Up until now, the total number of GPH reported worldwide in medical literature is < 30. To the best of our knowledge, only one case of a giant prostate has been reported in Nigeria. We report a case of a giant prostatic enlargement treated by open simple retropubic prostatectomy in a 73-year-old man who was suffering from lower urinary tract symptoms and persistent visible (gross) haematuria necessitating repeated blood transfusions. Transrectal ultrasound (TRUS) scan revealed a markedly enlarged prostate measuring 565 ml with a suspicious nodule and prostate-specific antigen level of 48.5 ng/ml. He had a 20-core TRUS-guided prostatic biopsy which showed benign prostatic hyperplasia. We performed a retropubic open simple prostatectomy for complete enucleation of the adenoma. Specimen weighed 512.5 g with dimensions of 17 cm × 16 cm and a volume of 528 ml. Histological examination showed prostatic fibromuscular hyperplasia with a focus of adenocarcinoma. The patient had an uneventful post-operative recovery and was discharged within a week post-surgery. Urethral catheter was removed after 2 weeks with satisfactory outcome.

Transabdominal repair of vesicovaginal fistulae: A 10-year tertiary care hospital experience in Nigeria.

BACKGROUND: Vesicovaginal fistula (VVF) is still a major cause for concern in many developing countries. Arguments continue as to the best approach for repair. This study aimed to present our experience with transabdominal VVF repair. SUBJECTS AND METHODS: This was a 10-year retrospective review of transabdominal VVF repair. Important data extracted from the case notes included patients' demography, aetiology, previous repair, operative findings, procedures and treatment outcome. Data were analysed using SPSS version 21. Bivariate analysis of factors affecting treatment outcome was carried out with the level of significance set at P < 0.05. RESULTS: Fifty-three VVF repairs were carried out in 51 patients. Mean age was 29.8 ± 15.4 years. Forty-five (84.9%) had previous repairs. The aetiologies of VVFs were prolonged obstructed labour in 41 (80.4%) and post-operative in 10 (19.6%). Forty-one repairs were through a transperitoneal transvesical approach whereas 12 had an extraperitoneal transvesical approach. The fistulae diameter ranged from 0.3 to 2.8 cm with an average of 1.64 cm. Six had ureteric re-implantation; (bilateral in two patients). Repair was successful in 47 (88.7%) cases, which translated to the overall success rate of 92.1% in the 51 patients treated. Success rate was higher (95.6%) for the subset of patients who had previous transvaginal repairs. Catheter blockage in the post-operative period was a significant factor that had effect on outcome (P < 0.015). CONCLUSION: Transabdominal repair recorded an excellent result in patients who had previously failed transvaginal repairs and may be considered as the first option in these patients.

Combined intrarectal lidocaine gel and periprostatic nerve block: A 'balanced' anaesthesia for transrectal ultrasound-guided prostate biopsy?

BACKGROUND AND AIM: Periprostatic nerve block (PNB) which appears to be the gold standard for pain relief during transrectal ultrasound-guided prostate (TrusP) biopsy has been proven to be lacking in providing satisfactory anaesthesia during transrectal ultrasound (Trus) probe insertion into the anorectum necessitating the addition of another technique to produce a 'balanced' anaesthesia. The aim of this study was to determine whether combined intrarectal lidocaine gel and periprostatic nerve block (cGPNB) will provide adequate anaesthesia at all stages of TrusP compared with caudal block (CB). PATIENTS AND METHODS: Data were prospectively collected from patients with indications for TrusP who were randomly assigned to either cGPNB (Group A) or CB (Group B). Comparative analysis of the numerical rating pain score (NRS) between two groups was done after administration of anaesthesia, Trus probe insertion, biopsy needle puncture of the prostate and 1 h after biopsy. RESULTS: There were 56 patients in Group A and 53 in Group B. There was no significant difference in NRS grouping between the two arms of the study after administration of anaesthesia (P = 0.93), biopsy needle puncture of the prostate (P = 0.28) and 1 h after the procedure (P = 0.39). There was no statistically significant difference in the number of patients with no/mild pain between the two arms of the study during probe insertion (P = 0.65). None of the patients in both arms of the study had severe pain. Across Group A and B, 35 (62.5%) versus 40 (75.5%), 20 (35.7%) versus 11 (20.8%) and 1 (1.8%) versus 2 (3.8%) adjudged the procedure as very tolerable, fairly tolerable and intolerable respectively (P = 0.20). All the patients in Group A versus 49 (92.5%) in Group B will choose the same anaesthesia for subsequent biopsies (P = 0.11). CONCLUSIONS: cGPNB provides balanced anaesthesia at all stages of TrusP with excellent patient tolerability.

Bilateral subcapsular orchiectomy versus bilateral total orchiectomy: Comparison of the quality of life post-orchiectomy.

OBJECTIVE: Bilateral subcapsular orchiectomy (BSO) is said to be more aesthetic and psychologically satisfying when compared to bilateral total orchiectomy (BTO). This study compared the quality of life (QoL) of men with advanced prostate cancer who had BTO to those who had BSO, with an emphasis on their perception of self or identity as a man. SUBJECTS AND METHODS: Sixty-one patients with advanced prostate cancer opting for bilateral orchiectomy were recruited. Pre-orchiectomy and at 1 month and 3 months post-orchiectomy, the Functional Assessment of Cancer Therapy for Prostate cancer (FACT-P) questionnaires were administered and scored. RESULTS: Thirty (49.18%) patients had BTO (BTO group), while 31 (50.82%) patients had BSO (BSO group) for advanced prostate cancer. On comparison of the two groups, there were no statistically significant differences in FACT-P scores at 1 month and 3 months. The subscale scores also showed no significant statistical difference except for the physical well-being score at 3 months post-orchiectomy, which was lower in the BSO group (P = 0.041). The average scores of Item P5 (I am able to feel like a man) which were used to assess the sex-role identity declined on an average over 3 months with no statistically significant difference on comparison of the two groups. CONCLUSION: The QoL scores (FACT-P and FACT-G) assessed over 3 months post-orchiectomy did not differ on comparison of the BTO group and the BSO group. Performing a BSO in our region did not result in any psychological benefit when compared to performing a BTO.

Potential of telmisartan in the treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common health problem in ageing men. This study was carried out to investigate the protective effect of telmisartan on testosterone-induced BPH in rats. Fifty-four male Wistar rats (200-250 g) were randomly divided into nine groups (n = 6) and orally treated for 28 consecutive days: group 1 - vehicle normal, olive oil (10 mL/kg); group 2 - BPH model control (10 mL/kg); groups 3-5 - telmisartan (5, 10 or 20 mg/kg, respectively); group 6 - pioglitazone (20 mg/kg); group 7 - celecoxib (20 mg/kg); group 8 - combination of telmisartan (5 mg/kg) and pioglitazone (20 mg/kg); group 9 - combination of telmisartan (5 mg/kg) and celecoxib (20 mg/kg). Animals in groups 2-9 were given testosterone propionate in olive oil (3 mg/kg) subcutaneously 15 min after pretreatments. On day 29, blood was collected for the estimation of serum testosterone and prostate-specific antigen (PSA). The prostates were excised, weighed and subjected to biochemical and histological studies. Testosterone injection induced significant increase in prostatic index, serum testosterone and PSA suggesting BPH as well as increased prostate oxidative stress which were ameliorated with the pretreatment of rats with telmisartan or co-administration of celecoxib and pioglitazone. Histological examination showed that testosterone disrupted the morphology of the prostate epithelial cells evidenced in the involution of the epithelial lining of the acini into the lumen indicating BPH which was reversed by telmisartan. Findings from this study showed that telmisartan alone or in combination with pioglitazone prevented the development of testosterone-induced prostatic hyperplasia.

Renal cell carcinoma in a horseshoe kidney: Report of a rare disease.

A horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. HSKs are more likely than normal kidneys to have associated problems of stones, ureteropelvic junction obstruction, stasis and infection. However, they do not have an increased incidence of renal cell carcinoma when compared to normal kidneys. Due to its rarity, accurate diagnosis may be difficult. Of similar significance is the fact that problems may arise during surgery on these kidneys due to altered anatomy and aberrant blood supply. We report a case of HSK with a renal tumour in a 69-year-old woman and highlight our challenges in the management of the case. To the best of our knowledge, this is the first reported case of a tumour in an HSK in West Africa.

Extraperitoneally Ruptured, Everted, and Prolapsed Bladder: A Very Rare Complication of Pelvic Injury.

Traumatic rupture of the bladder with eversion and protrusion via the perineum is a rare complication of pelvic injury. We present a 36-year-old lady who sustained severe pelvic injury with a bleeding right-sided deep perineal laceration. She had closed reduction of pelvic fracture with pelvic banding and primary closure of perineal laceration at a private hospital. She subsequently had dehiscence of repaired perineal laceration with protrusion of fleshy mass from vulva and leakage of urine per perineum five weeks later. Examination revealed a fleshy mucosa-like mass protruding anteriorly with a bridge of tissue between it and right anterolateral vaginal wall. Upward pressure on this mass revealed the bladder neck and ureteric orifices. She had perineal and pelvic exploration with findings of prolapsed, completely everted bladder wall through a transverse anterior bladder wall rent via the perineum, and an unstable B1 pelvic disruption. She had repair of the ruptured, everted, and prolapsed bladder, double-plate and screw fixation of disrupted pelvis and repair of the pelvic/perineal defect. She commenced physiotherapy and ambulation a week after surgery. Patient now walks normally and is continent of urine. We conclude that the intrinsic urethral continent mechanism plays a significant role in maintaining continence in females.

Dorsal Island Penile Fasciocutaneous Flap for Fossa Navicularis and Meatal Strictures: Short and Intermediate Term Outcome in West African Men.

PURPOSE: The aim of this study was to evaluate the use of a dorsal island penile fasciocutaneous flap in the man­agement of resistant fossa navicularis strictures in circumcised West African men. MATERIALS AND METHODS: From January 2004 to December 2013 there were twenty-one patients with fossa navic­ularis strictures (FNS) with or without meatal stenosis who underwent urethroplasty using a previously described technique and a dorsal island penile fasciocutaneous flap. The average patient follow-up was 25.9 months. RESULTS: Urethral catheterization was the most common cause of FNS. All of the patients had successful urethral function and acceptable cosmetic results. One patient had partial dorsolateral skin necrosis that healed with con­servative measures. All patients, including the five patients with meatal stenosis, retained the natural shape of the external meatus and had a natural urine stream. CONCLUSION: The penile cap technique uses a dorsal island fasciocutaneous flap and provides satisfactory function­al and cosmetic outcomes in the management of fossa navicularis and meatal strictures.

Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up.

OBJECTIVES: To present treatments for kidney preservation in the management of emphysematous pyelonephritis (EPN), and to evaluate the functional outcome of preserved kidneys during the follow-up. PATIENTS AND METHODS: The computerized files of patients with EPN from 2000 to 2010 were reviewed. After initial resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage of infected fluid and gas. A radio-isotopic renal scan was done after stabilization of the patients' condition. Preservation of the affected kidney was attempted when the differential function was >10%. A renal isotopic scan was taken during the follow-up to evaluate renographic changes in preserved kidneys. RESULTS: The study included 33 kidneys in 30 consecutive patients (mean age 51.7 years, SD 10.9). Kidney preservation was applicable for 23 kidneys (20 patients). Preservation methods included percutaneous nephrostomy for 12, percutaneous tube drain for two and conservative treatment for nine kidneys (six patients). Nephrectomy was performed for 10 kidneys (emergency in three and delayed in seven). The frequency of post-treatment septic shock after kidney preservation (10%) was significantly lower than after nephrectomy (20%, P = 0.005). The overall mortality rate was 7% (two patients). The follow-up was completed for 13 patients with 15 preserved kidneys for a mean duration of 21 months. During the follow-up, differential renographic clearance of the affected kidney was stable in 13 of 15 while two kidneys showed improvement. CONCLUSIONS: Kidney preservation should be the primary goal in the treatment of EPN when the differential renal clearance is >10%. It was associated with fewer complications than nephrectomy and the follow-up showed a favourable functional outcome of the preserved kidneys.