Prevalence of chronic kidney disease and risk factors in North-Central Nigeria: a population-based survey.

BACKGROUND: Chronic kidney disease (CKD) is a growing challenge in low- and middle-income countries, particularly in sub-Saharan Africa. There is insufficient population-based data on CKD in Nigeria that is required to estimate its true burden, and to design prevention and management strategies. The study aims to determine the prevalence of CKD and its risk factors in Nigeria. METHODS: We studied 8 urban communities in Kwara State, North-Central zone of Nigeria. Blood pressure, fasting blood sugar, urinalysis, weight, height, waist circumference and hip circumference were obtained. Albuminuria and kidney length were measured by ultrasound while estimated glomerular filtration rate (eGFR) was derived from serum creatinine, using chronic disease epidemiology collaboration (CKD-EPI) equation. Associations of risk factors with CKD were determined by multivariate logistic regression and expressed as adjusted odds ratio (aOR) with corresponding 95% confidence intervals. RESULTS: One thousand three hundred and fifty-three adults ≥18 years (44% males) with mean age of 44.3 ± 14.4 years, were screened. Mean kidney lengths were: right, 93.5 ± 7.0 cm and left, 93.4 ± 7.5 cm. The age-adjusted prevalence of hypertension was 24%; diabetes 4%; obesity 8.7%; albuminuria of > 30 mg/L 7%; and dipstick proteinuria 13%. The age-adjusted prevalence of CKD by estimated GFR < 60 ml/min/1.73m2 and/or Proteinuria was 12%. Diabetes (aOR 6.41, 95%CI = 3.50-11.73, P = 0.001), obesity (aOR 1.50, 95%CI = 1.10-2.05, P = 0.011), proteinuria (aOR 2.07, 95%CI = 1.05-4.08, P = 0.035); female sex (aOR 1.67, 95%CI = 1.47-1.89, P = 0.001); and age (aOR 1.89, 95%CI = 1.13-3.17, P = 0.015) were the identified predictors of CKD. CONCLUSIONS: CKD and its risk factors are prevalent among middle-aged urban populations in North-Central Nigeria. It is common among women, fueled by diabetes, ageing, obesity, and albuminuria. These data add to existing regional studies of burden of CKD that may serve as template for a national prevention framework for CKD in Nigeria. One of the limitations of the study is that the participants were voluntary community dwellers and as such not representative for the community. The sample may thus have been subjected to selection bias possibly resulting in overestimation of CKD risk factors.

Autologous buccal mucosa harvest under local anesthesia: Feasibility, safety, and acceptance for substitution urethroplasty.

OBJECTIVE: The objective of the study is to report our experience with buccal mucosa harvest under local anesthetic agent infiltration for urethroplasty. MATERIALS AND METHODS: All patients who had buccal mucosa graft harvest under local anesthesia (1% Xylocaine) for repair of their urethral stricture, from January 2007 to December 2016, were retrospectively studied from two public urologic service centers. The demographic data of the patient, length of graft harvested, complications recorded, among other things, were entered into a pro forma and the data were analyzed using IBM SPSS Statistics version 16. RESULTS: A total of 102 patients underwent urethroplasty with buccal mucosa harvested under local anesthesia; however, only 88 patients had complete data for analysis. The mean age was 55.03 years (±12.30). The mean harvested graft length was 5.41 cm (±2.62 cm). There was no need for conversion to general anesthesia. The majority of them (94.3%) reported that it was "easy" or "very easy" to maintain the mouth opened during the procedure. Over 91% do not have difficulty opening their mouth after the harvest. Only a patient had bothersome primary hemorrhage that required gauze packing. No significant oral cavity pain was experience in 69.3% of patients; among those with pain, the perineal pain was more. Over 90% of the patients will be willing to undergo the procedure again under local anesthetic infiltration again. CONCLUSION: Buccal mucosa harvest under local anesthesia infiltration is feasible, safe, and acceptable among our patients who had urethroplasty for urethral stricture disease.

A novel slit-integration method of graft urethroplasty in the prevention of ring recurrence: Short-term results of a pilot study.

Purpose: To describe and evaluate the efficacy of the slit-integration method in the prevention of ring recurrence after graft substitution urethroplasty. Materials and Methods: This was a pilot study of selected patients with urethral stricture disease who required urethroplasty from January 2016 to December 2018. Patients were recruited into the study after they granted informed consent about the procedure. Results: A total of eight patients were involved in this pilot study. The mean age (±standard deviation, SD) of the patients and the mean stricture length (±SD) were 44.25 (±11.07) years and 3.88 (±1.25) cm, respectively. The peno-bulbar region was the most frequently involved. The majority of the patients, 7 of 8 patients, underwent buccal mucosal graft repair with a mean graft length of 5.88 cm (range, 4-8 cm). There was leak during pericatheter urethrography in one patient. The mean (±SD) urethral calibers of the distal and proximal urethral anastomotic sites following urethroplasty were 26.00 (±1.85) and 25.25 (±1.83) at 1 week after removal of the urethral catheter stent and 27.75 (±0.71) and 27.75 (±0.71) at 12 months postoperatively, respectively. The mean maximum flow rate (±SD) at the 6- and 12-month follow-up was 20.25 (±1.83) and 21.88 (±1.73) mL/s, respectively. Conclusions: A slit-graft appropriately quilted into the corresponding urethrotomy incisions at the proximal and distal summit of the urethral stricture segments appears to mitigate the occurrence of ring contracture after urethroplasty. A randomized controlled trial of this technique with additional outcome assessment will be required to validate this observation.

An appraisal of a technical modification for prevention of bladder neck stenosis in retropubic prostatectomy: An initial report.

OBJECTIVE: To report the experience with our technical modification of the trigone-bladder neck complex management in the prevention of bladder neck stenosis (BNS) following open simple retropubic prostatectomy. MATERIALS AND METHODS: It was a retrospective review of data of patients that underwent open simple retropubic prostatectomy with technical modification of the trigone-bladder neck complex in two Nigerian tertiary hospitals, by a single surgeon, from January 2007 to December 2011. The data analysed included the demographic variables, the modes of presentation, need for blood transfusion, duration of catheterization and the duration of hospital stay. The primary end-point was the development or otherwise of BNS. RESULTS: Eighty-seven patients' data were available for analysis from a total of 91 patients. The mean age (±standard deviation [SD]) was 65.14 years (±10.55). Preoperative urinary retention was present in 58% of the patients. The maximal flow rate (Qmax) was 12.05 ml/s among the 20 patients that had preoperative uroflowmetry. The transfusion rate was 35%, but almost two-third of them had only one unit of blood transfused. The mean weight (±SD) of the enucleated adenoma was 82.64 g (±36.63). Bladder irrigation was required in 14% of the patients, majority of the patients had urethral catheter removed after 96 h and the mean hospital stay was 6.52 days. No patient developed BNS after a mean follow-up duration of 16.39 months. CONCLUSION: Bladder neck stenosis can be a distressing complication of prostatectomy. The result of our technical modification of managing the trigone-bladder-neck complex looks promising for prevention or delaying the onset of BNS. A long-term observation and a prospective randomised control trial to ascertain this initial experience is needed.