Paraneoplastic syndromes and oncological outcomes in renal cancer.

BACKGROUND: Paraneoplastic syndromes (PNS) have been defined as a constellation of symptoms and signs seen in patients with malignancy, which cannot be ascribed to the local or distant spread of the tumor. Renal cell carcinoma (RCC) is most commonly associated with PNS among urological malignancies. We describe the incidence of PNS and the association between the syndromes and oncological outcomes in our patients with RCC. SUBJECTS AND METHODS: A retrospective cohort study done at Lagos State University Teaching Hospital, Ikeja, Lagos. This was a retrospective review of our patients who had RCC over 11-year period (2006 to 2016). The incidence of PNS syndromes were hypercalcemia, Stauffer's syndrome, hypertension, anemia, elevated erythrocyte sedimentation rate (ESR), persistent leukocytosis, and its correlation to outcome of disease were analyzed. In addition, the age, gender, clinical features, and stage of disease were analyzed. Chi square, Fischer exact test, and Kaplan-Meier survival, curve and logistic regression. RESULTS: : In total, 101 patients were operated within the period. Age of the patients ranged from 11 to 81 years (mean of 45.17 ± 16.3). There were 46 males and 55 females with M:F ratio of 1:1.2. Majority of the patients, 74 (73%), had clear cell variant of RCC. Twenty-seven patients (26.7%) had triad of flank pain, flank mass, and hematuria. The incidence of PNS were hypercalcaemia 7 (6.9%), Stauffer's syndrome 12 (11.9%), hypertension 16 (15.8%), anemia 61 (60.4%), elevated ESR 56 (55.4%), and persistent leukocytosis 3 (3.0%). At a median follow-up of 6 months, 72 patients (71.3%) were alive, whereas 29 patients (28.7%) were dead. CONCLUSION: Among the PNS, only Stauffer's syndrome was significantly associated with poor outcome.

Clinical characteristics and outcome of management of Fournier's gangrene at the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.

BACKGROUND: Fournier's gangrene (FG) though a rare condition can be associated with significant mortality. There are few reports in our environment documenting the outcome of management of the condition. The aim of the following study was to describe the clinical characteristics and outcome of management of patients with FG in a tertiary hospital in Southwest Nigeria. PATIENTS AND METHODS: The clinical records of patients who presented with FG at a tertriary hospital over a 5 year period were reviewed. RESULTS: A total of 11 cases were reviewed and all patients were male. The scrotum alone was the most common site of involvement (54.5%). Late presentation was common with 9.6 days (range 1-21 days) being the average duration between the onset of symptoms and presentation at the hospital. Most of the patients (63.6%) did not have any identifiable systemic predisposing factor. There was no mortality or testicular loss recorded. CONCLUSION: Patients with FG still present late in our environment. However, appropriate aggressive treatment can help ameliorate the associated mortality and morbidity even in a resource poor setting.

Urethrocutaneous fistula complicating circumcision in children.

INTRODUCTION: Urethrocutaneous fistula is an unusual but preventable complication following circumcision. We describe our experience with the management of this potentially challenging condition. MATERIALS AND METHODS: We reviewed all patients who had surgical repair of post-circumcision urethrocutaneous fistula from September 2008 to September 2011 in our institution. RESULTS: Thirty-one cases presenting at age 4 weeks to 12 years were managed. Twenty-six (84%) had had circumcision in the neonatal period. Most circumcisions (81%) were carried out by nurses using the dissection method and without anesthesia. In 30 (97%) patients, the fistula was single. The fistula size ranged from 1.5 to 12 mm in the widest diameter. Modified Mathieu's flap procedure was used in the repair of 18 (56%) fistulae and 9 (28%) fistulae were by simple closure. Recurrence of the fistula was seen in 8 (25%) patients with large fistulae > 5 mm in diameter. The recurrent fistulae were small and were repaired by simple closure. CONCLUSION: Urethrocutaneous fistula post-circumcision is frequently seen in our practice and the surgical repair is challenging and associated with high recurrence rate in large fistulae. This preventable condition may be avoided by proper education and training of circumcisers.

Urologic daycase surgery: a five year experience.

BACKGROUND: Expectedly, daycase surgery (DCS) is today witnessing a boom in developing countries as a reasonable option in the face of global economic recession, although with limited scope. AIM: The aim of this study was to describe the urologic day surgery experience at the Lagos State University Teaching Hospital, Ikeja. MATERIALS AND METHODS: All day-case urologic surgeries done between January 2006 and December 2010 were retrospectively studied. Data obtained were patients' personal details, diagnoses, procedures performed, mode of anesthesia, and surgical complications as well as admission rate. RESULTS: A total of 1070 operations were performed. The patients were aged 7 days to 92 years. Local anesthesia was employed in 42.2% while general anesthesia was used in 1.7% of patients, mostly pediatric cases. Caudal block anesthesia (55.8%) was administered for transrectal prostate biopsy and urethrocystoscopic procedures. The diagnostic and therapeutic urologic procedures in adults were mainly prostate biopsy (n = 344, 32.1%), urethrocystoscopy (n = 218, 20.4%), varicocelectomy (n = 143, 13.4%), and orchidectomy (n = 93, 8.7%). Mohan's valvotomy was the most common pediatric operation (n = 19, 1.8%). Postoperative morbidities that warranted hospital admission were observed in 17 (1.6%) cases. CONCLUSION: Urologic day surgery is feasible with minimal morbidities. The provisions of a dedicated day-case unit or a mobile DCS service may further improve on the volume of cases that can be operated on a day-case basis and has the potential of further reducing the waiting time for surgery.

Effect of obesity on serum prostate-specific antigen in Nigerian men.

OBJECTIVE: Lower serum total prostate-specific antigen (PSA) levels (tPSA) have been reported in obese men. It has not been confirmed if this association truly exists in all ethnic groups. Thus, we evaluated the relationship between tPSA and obesity among Nigerian men. METHODS: Men aged ≥ 40 years with tPSA <20 ng/ml and no known prostatic disease were involved. Obesity was defined using the body mass index (BMI) and waist to hip ratio (WHR). Multivariate linear regression was used to investigate the relationship between tPSA and either BMI or WHR. The odds of having abnormal tPSA were estimated using logistic regression. RESULTS: A total of 3,191 men participated, and 3,049 (95.6%) were eligible for analysis. A BMI ≥ 25.0 and a WHR ≥ 0.9 were found in 47.7 and 64.6%, respectively. tPSA was significantly associated with age (p < 0.001) and digital rectal examination status (p < 0.001). Multivariate linear regression analysis showed no relationship between tPSA and obesity (BMI, p = 0.581; WHR, p = 0.160). Adjusting for age and digital rectal examination status, logistic regression showed no significantly observable trend of having a tPSA level greater than thresholds for men with a BMI ≥ 25 or a WHR ≥ 0.9 when compared with normal BMI or WHR, respectively. CONCLUSION: Although overweight and obesity were common among healthy Nigerian men, there was no associated tendency towards lower serum tPSA.

Delayed diagnosis of intersex state: surgical outcome of cases seen and review of current concepts.

BACKGROUND: Sexual ambiguity is said to occur when the gender of the baby cannot be determined at birth. The gender of an individual is in question because the genitals do not appear clearly as that of male or female. It is traumatizing to the family. It also causes confusion and problems in determining the sex, in which a child would be reared. The abnormality is relatively uncommon. Disorders of sexual differentiation can arise from abnormalities in chromosomes, gonadal development or hormonal production or activity. The orderly development process may also be affected by various environmental factors. Some of these factors may ultimately lead to the development of ambiguous external genitalia. CASE PRESENTATIONS AND MANAGEMENT: Three of such patients with ambiguous genitalia are presented, in which the initial diagnosis proved to be incorrect. The various investigations that were carried out and surgical management are discussed. CONCLUSION: Arguments which led to the ultimate choice of the sex of a child ranged from strict medical, to psychosocial and even cultural considerations. Expert examination shortly after birth would allow an early and definite decision, avoiding more serious problems with sexual ambiguity in later life.