Comparison of uropathogens and antibiotic susceptibility patterns in catheterized ambulant middle-aged and elderly Nigerian patients with bladder outlet obstruction.

OBJECTIVE: Advanced age is one of the notable risk factors for catheter-associated urinary tract infections (CAUTIs), and differences between middle aged and elderly men with CAUTIs is poorly understood. This study aimed at comparing the pattern of urinary pathogens and antibiotic susceptibility in ambulant catheterized middle-aged and elderly Nigerian men. MATERIAL AND METHODS: One hundred and fifty-four patients catheterized for >48 hours had provided clean catch mid-stream urine samples for microscopic analysis, culture and sensitivity tests. Eighty-two men aged <65, and 72 men aged ≥65 years matched for age, level of education, occupation and marital status were compared. RESULTS: Prevalence of CAUTIs among middle-aged men was middle-aged men was higher than the elderly (90.2% and 80.6% respectively) but this was not statistically significant (p=0.086). CAUTIs in middle-aged men with suprapubic catheters were significantly more frequent than those with urethral catheters (p=0.000). The prevalence of CAUTIs in middle-aged men with urethral stricture was different from other causes of bladder outlet obstruction (p=0.004). Men with indwelling catheters longer than 2 weeks had higher CAUTIs (p=0.000). Escherichia coli was the commonest pathogen in both groups while nitrofurantoin was the most sensitive drug. CONCLUSION: There are differential rates of CAUTIs in both the middle-aged men and the elderly with bladder outlet obstruction in our environment. The knowledge of the common pathogens and the antibiotic susceptibility will prevent irrational antibiotic use. Middle-aged men had higher prevalence of CAUTIs when Proteus spp. was the infectious agent. However, E. coli was the commonest pathogen of CAUTIs in all men. Also, middle- aged men with suprapubic catheters had higher rates of CAUTIs. Nitrofurantoin was the best drug in all men with CAUTIs but elderly men had higher rates of multi-resistance.

Erectile Dysfunction in Men with and without Lower Urinary Tract Symptoms in Nigeria.

PURPOSE: Much attention has been focused in recent decades on the effects of erectile dysfunction (ED) secondary to lower urinary tract symptoms (LUTS), potentially underestimating its effects in men without LUTS. This study aimed to compare the prevalence and predictors of ED in men with and without LUTS. MATERIALS AND METHODS: The International Index of Erectile Function questionnaire was administered to 303 patients between January 2014 and June 2016. Within this sample, 147 patients with LUTS (cases) were compared to 156 men without LUTS who were matched for age, level of education, and occupation (controls). RESULTS: The mean age was 66.03±9.64 years and 65.78±8.61 years for the cases and controls, respectively. The prevalence of ED was 64.6% and 73.7% (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.94~2.51) in the case cohort and controls, respectively (p=0.086). There was no difference in the prevalence of impaired erectile function (p=0.067), impaired orgasmic function (p=0.108), impaired sexual desire (p=0.291), impaired intercourse satisfaction (p=0.869), or impaired overall satisfaction (p=0.191). Multivariate logistic regression analysis showed that being currently employed was a significant predictor of ED both in men with LUTS (OR, 8.08; 95% CI, 1.51~9.27; p=0.004) and in men without LUTS (OR, 7.00; 95% CI, 1.49~14.51; p=0.008). Being married only predicted for impaired EF in men without LUTS (OR, 6.34; 95% CI, 1.40~15.20; p<0.05). CONCLUSIONS: ED was not found to be more prevalent in men with LUTS. Being employed was a predictor of ED in both groups of men, while being married was also a predictor of ED in men without LUTS.

Comparison of ease of induction of spinal anaesthesia in sitting with legs parallel on the table versus traditional sitting position.

INTRODUCTION: It is sometimes difficult for some patients to optimally flex their hips and knees making traditional position for induction of spinal anaesthesia difficult to achieve. The ease of induction of spinal anaesthesia was compared with patients in sitting position with legs remaining on the table (new sitting method) versus legs placed on the side stool (traditional sitting method). METHODS: One hundred eligible elderly patients, aged between 65 and 80 years, scheduled for open prostactectomy, were prospectively randomized to 2 groups, LS and LT. Patients in (LS group) had their spinal anaesthesia induced in sitting position with their legs placed on the stool while patients in (LT group) had their spinal anaesthesia induced in sitting position with their legs remaning on the operating table. The primary endpoint was correct needle placement. Numbers of attempts, needle redirections and patients' comfort were determined to compare outcome in the two groups. RESULTS: More patients in LS group (78%) than those in the LT group (64%) had successful placement of spinal needle at first attempt (P = 0.12, RR = 1.6, 95% CI = 0.863-3.102). Needle redirections were similar at first attempt (52% versus 40%; P = 0.22). The groups were equivalent with respect to 100% overall success rate (P = 1.000). It took longer time to induce spinal anaesthesia in patients in LS group (240 vs 125s, p < 0.001). Patients in LT were more comfotable. CONCLUSION: The 100% overall success rate was comparable. However, patients were generally more comfortable with their legs placed on the table.

Severity of Lower Urinary Tract Symptoms among Middle Aged and Elderly Nigerian Men: Impact on Quality of Life.

Objectives. To compare the severity of LUTS among middle aged and elderly Nigerian men and determine the influence of LUTS severity on QoL. Methods. This cross-sectional study was conducted among new patients presenting with LUTS attending Urology clinic between 2011 and 2015. Assessment of symptoms was based on IPSS and bother score completed by the eligible subjects on the same day of their clinic visits. Results. Four hundred patients were studied comprising 229 middle aged and 171 elderly men. Interquartile range (IQR) of IPSS scores for men <65 years and those ≥65 years was 14.0 (16.0) and 19 (15.0), respectively (p < 0.001). Mild LUTS was significantly associated with best, good, and poor quality of life while moderate LUTS was associated with poor QoL. Severe LUTS was significantly associated with all the categories of QoL (Best-Worst). Among the cohort of subjects with poor QoL, elderly patients had a significantly higher median IPSS score (p < 0.05). Conclusions. There is no level of severity of LUTS in which patients' QoL is not impaired although mild symptomatology may be associated with better QoL and severe symptomatology with poor QoL. Careful attention to QoL may help identify patients who require early and prompt treatment irrespective of the IPSS.

The likelihood of having serum level of PSA of ≥4.0 ng/mL and ≥10.0 ng/mL in non-obese and obese Nigerian men with LUTS.

OBJECTIVE: This study was undertaken to determine the likelihood of having serum total prostate specific antigen (PSA) levels ≥4.0 ng/mL and ≥10.0 ng/mL among a cohort of non-obese and obese Nigerian men with lower urinary tract symptoms (LUTS). METHODS: This was a prospective cross-sectional survey among men who presented with benign prostatic hypertrophy to the urology clinic of the Ekiti State University Teaching Hospital, Ado -Ekiti with LUTS between January 1 and December 31, 2014. One hundred and forty men who presented in the urologic clinic with LUTS were recruited. PSA was analyzed using standard method while other clinical variables were collected using a clinical case form. Multivariate logistic regression was used to estimate the odds of an abnormal PSA of ≥4.0 ng/mL or ≥10.0 ng/mL in these men. RESULTS: The mean ages of obese and non-obese men were 64.8 and 64.0 years respectively. The mean total serum PSA were 14.8 and 13.2 ng/mL for obese and non-obese men respectively. Univariate analysis showed no difference (p > 0.05) in the proportion of obese and non-obese men with LUTS who had a PSA threshold of at least 4.0 ng/mL. Multivariate logistic regression showed that, at a PSA threshold of 10.0 ng/mL, obese men had a statistically significant proportion (p < 0.05). Although not significant, non-obese patients were less likely to have PSA level of ≥4.0 ng/mL (OR 0.701; 95% CI 0.301-1.630) compared to obese men. In the same vein, non-obese men were less likely to have a PSA level of 10.0 ng/mL (OR, 0.686; 95% CI, 0.318-1.478) in a simultaneous context of age. CONCLUSION: Our study demonstrated that, in a sample population of predominantly native African men, there was a non-significantly higher likelihood of overweight/obese patients having a higher serum PSA level than the non-obese. A community based study is needed to further confirm this finding.