Correlation between prostate volume and prostate-specific antigen in Nigerian men with symptomatic histologically-diagnosed benign prostatic hyperplasia.

Background: Prostate-specific antigen (PSA) is elevated in the serum of most men with prostatic diseases. Benign prostatic hyperplasia (BPH) is the commonest of these diseases. The degree of enlargement of the prostate may determine the amount of PSA elaborated. Several reports in some parts of the world have shown a significant correlation between prostate volume (PV) and PSA. However, only a few reports have been documented in Nigeria, especially in the South-South region. Aim: This research aimed to ascertain if there is any correlation between prostate volume (PV), total PSA (tPSA), and free PSA (fPSA) in men with histologically diagnosed BPH. This knowledge may help in the estimation of PV from a given PSA. Patients and Methods: This prospective hospital-based study was carried out in a southern Nigerian tertiary hospital between November 2017 and October 2018. Eighty (80) eligible and consenting patients participated in the study and were enrolled at first contact in the urology clinic. Each patient's blood was taken for PSA estimation. The prostate volume was estimated by transrectal ultrasound scan (TRUS). Those who had tPSA values greater than 4 ng/mL whose biopsy report showed prostate malignancy were excluded from the study. A proforma was used to collect patients' sociodemographic and clinical information. Data were entered and analyzed with Statistical Package for Social Sciences version 22 (SPSS Inc., Chicago, IL, United States). For all statistical tests, P < 0.05 was regarded as significant. Results: The mean age of the patients for this study was 68.03 years. The mean prostate volume was 87.9 mL with a range of 34 to 234 mL. The mean tPSA was 5.5 ng/mL with ranges of 1.1 to 21.1 ng/mL. There was a significant correlation between PV and tPSA with a P value of 0.0001. This correlation was also shown between PV and fPSA with a P value of 0.0001. Conclusion: There is a statistically significant correlation between PV and PSA (both free and total) in men with symptomatic histologically diagnosed BPH. This finding showed that larger benign prostate glands elaborated greater amounts of PSA. It may, therefore, be appropriate to say that it is not in all cases of elevated serum tPSA that the possibilities of malignancy or inflammation should be entertained.

Cost-effectiveness of extracorporeal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience.

BACKGROUND: The first extracorporeal shock wave lithotripsy (ESWL) used in Nigeria was at Igbinedion Hospital and Medical Research Centre (IHMRC), Okada in 1992 and it functioned for 6 consecutive years. The objectives of this study were to analyze the cost-effectiveness of the procedure and highlight the associated factors that led to its failure. METHODS: A retrospective study of medical records and publications associated with the use of ESWL at IHMRC, Okada, for the period of 1992 to 1998. The study was conducted between January 2003 and November 2008. Unclassified authentic information relating to the use of ESWL and treatment of upper urinary tract stones was obtained from the IHMRC Okada and some government hospitals on hospital bills. Relevant documents in public domains related to the national and international wages and emoluments of medical workers and socioeconomic development of Nigeria within the time the ESWL functioned were studied. RESULT: A total of 32 patients were treated with 51 treatment sessions which is an average of nine patients per year and an average of two treatment sessions per patient were involved. The reasons for the low patronage were the extremely low stone formation rate of Nigerians, poverty, and out-of-pocket payment system. In addition, each treatment session of ESWL at Okada cost an average of $681.8 compared to $227.3 for open nephrolithotomy in a nearby high profile teaching hospital. The IHMRC, Okada, paid an average annual salary of ₦180,000 ($8,181.8) for each medical consultant compared to ₦120,000 ($5,454.5) paid by federal teaching hospitals in Nigeria within the period. Expatriate consultant doctors from Europe and USA who initially manned the lithotriptor at IHMRC, Okada, were paid much higher salaries. Average annual income of $5,909 for each of the 6 years amounting to a total of $34,771.7 for the six years was realized which could not maintain staff salaries in the hospital leading to staff emigration, decline of the hospital services, and eventual closure of the ESWL procedure center in the hospital in 1998. CONCLUSION: ESWL at Okada was not cost-effective both to patients and the hospital management. Despite these, ESWL is desirable in poor-resource countries because of its noninvasiveness, low morbidity, and usability in patients who are unfit for open surgery. Purchasing high technological medical equipment as commodities by sub-Saharan Africans without considering the prevalence of diseases they are meant to cater for, their maintenance for steady function during useful lifespan, their cost-effectiveness and how to recoup the money spent on investments depletes the scarce foreign exchange reserve of the home countries and is eventually counterproductive as exemplified by this case.

Prevalence and characteristics of aquagenic pruritus in a young African population.

BACKGROUND: Aquagenic pruritus (AP) occurs during or after contact of the skin with water such as occurs in bathing. METHODS: This study aims to describe the prevalence of aquagenic pruritus in a young adult population and describe the circumstances of bathing.A Population-based cross sectional study involving administration of Questionnaires to young adult Nigerians on the occurrence of pruritus associated with bathing. RESULTS: The prevalence of bathing pruritus among respondents in this study was 23.8%. The commonest type of water respondents itch to was rain water (23%) followed by cold water (19%). 8.33% of respondents feels like avoiding bathing because of these. CONCLUSION: Bathing pruritus is a common finding among young adult Nigerians in the general population.

Management Of Urethral Strictures In The UCTH Calabar.

Forty-five consecutive cases of urethral stricture seen in a single unit over a three-year period (May 2000-April 2003) were studied to determine mode of presentation, symptoms on presentation, cause of the stricture, course of the illness and the outcome of treatment. Thirty-nine patients were treated while 6 were lost to follow up before definitive therapy could be given. Most of the patients were adult males in their prime of life. Strictures were as a result of urethritis in 24 (53.3%) cases, trauma in 16 (35.6%) cases, indwelling catheter in 3 (6.6%) cases and of uncertain aetiology in 2 (4.4%) cases. Three of the post-traumatic cases were post prostatectomy. Definitive treatment was by urethroplasty in 28 (62.2%) patients, bouginage in 11 (24.4%) patients.. Results of treatment were classified as 'GOOD' or 'POOR' based on patients' judgement of improved flow, observed improvement of flow and comparison of urethrogram results, before and after treatment. Of the 28 patients treated by urethroplasty, 21 (75%) had 'GOOD' outcome while in 7 patients (25%) the outcome was 'POOR'. In the bouginage group, outcome was 'GOOD' in 63.6% (7/11) of patients, 'POOR' in 27.3% (3/11), while one patient died from septic complications. It is concluded that urethroplasty gives overall, better results in management of strictures, but dilatation remains a viable option in carefully selected cases and that urethritis is still a foremost aetiological factor for urethral strictures in Calabar.