Ultrasound guided percutaneous nephrostomy: Experience at ahmadu bello university teaching hospital, Zaria.

BACKGROUND: Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound-guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, affordable, and not associated with radiation exposure. We present our experience with ultrasound-guided PCN. PATIENTS AND METHODS: We studied all patients who had ultrasound-guided PCN in our center between January 2013 and January 2017. Information obtained included the patients' demographics, clinical details, primary pathology, indications, outcome, and complications within 30 days. Relevant data were extracted and analyzed using descriptive statistics. RESULTS: A total number of 35 PCNs were performed in 26 patients within the period of study. The median age was 44.5 years. There were 17 females and 9 males. About 88.2% of the females had ureteric obstruction from advanced carcinoma of the cervix while the predominant cause of obstruction in the males was advanced carcinoma of the bladder. Kidney access under ultrasound guidance required well dilated collecting systems for success and ease of puncture. The most common complication was hematuria, which resolved within 24-48 h in all patients uneventfully. CONCLUSION: PCN is an important and common procedure for temporary relief of upper urinary tract obstruction. While fluoroscopic guidance provides superior image guidance, ultrasound guidance is comparatively reliable, albeit with a longer learning curve. Adequate training, careful patients selection, and patience are key to success.

Rapid and complete decompression of chronic urinary retention: a safe and effective practice.

We carried out a prospective study of consecutive patients who presented with chronic urinary retention over a period of 2 years in order to determine the safety and effectiveness of rapid and complete decompression of chronic urinary retention. A total of 22 patients met the inclusion criteria. Although slow decompression is thought to reduce complications, it harbours the disadvantages of impracticability, time and labour demands and an increased risk of infection. Post-obstructive diuresis, haematuria and hypotension are relatively frequent in rapid and complete decompression of chronic urinary retention. However, they are mild, transient and clinically insignificant. Rapid and complete decompression of the chronically obstructed urinary bladder not only saves time, it is safe and effective and should be adopted as the standard practice.

Male urinary incontinence and dementia in Zaria, Nigeria.

BACKGROUND: Ageing population in all parts of the world has make dementia in the elderly an important public health issue. Behavioural and Psychological symptom of dementia like urinary incontinence seldom attract the attention of clinicians providing care for the elderly. OBJECTIVE: To determine the prevalence of dementia among elderly male patients presenting with urinary incontinence to a urology clinic. SUBJECTS AND METHOD: We recruited consecutive elderly patients and their caregivers presenting to the urology clinic of Ahmadu Bello University Teaching Hospital for the treatment of urinary incontinence. The patients were assessed using Socio-demographic data collecting sheet, Consortium to Establish Registry for Alzheimer's Disease (CERAD), Stick Design Test and physical examination. While the caregivers were interviewed using the Blessed Dementia Scale. A consensus diagnosis was made for each of the patients based on criteria for dementia in both Diagnostic and Statistical Manual 4th edition (DSM-IV) and International Classification for Diseases 10 edition( ICD-10). All test of statistics were carried out at 5%level of probability. RESULTS: A total of 121 patients participated in the study. The mean age of the patients was 70.58 ± 5.47 years (95% CI=69.10-71.55). A total of 11 patients (9.10%, 95% CI=3.98-14.22) have dementia based on the consensus diagnosis. Dementia among this cohort is significantly associated with advancing age and enuresis. CONCLUSION: Dementia is common among elderly patients with urinary incontinence in Africa but remains large undetected and unrecognised.

Epidemiological and aetiological factors of male infertility in northern Nigeria.

OBJECTIVE: To evaluate some epidemiologic and aetiologic factors for male infertility in our patients. METHOD: All male patients who presented with infertility in urology clinic of the department of surgery between 1991and2005 were retrospectively reviewed. Epidemiologic and aetiological factors of male infertility were studied. RESULT: There were 537 patients; age ranged 18 to 56 years with a mean of 34 +/- 9.0 SD years. Primary infertility was seen in 515 (96%) patients. About 70% were infertile for 2 to 6 years. Primary testicular insufficiency was seen in 260 patients (48.7%) mainly resulting from genitourinary tract infection. Azoospermia resulting from testicular pathology was seen in 18 (3.4%) and obstruction to the vas or epididymis was seen 75 (14.0%) patients. Two hundred and fourteen (45%) patients had oligospermia resulting from testicular insufficiency while 61 (11.4%) had oligospermia due obstruction. CONCLUSION: Infertility resulted mainly from preventable causes. This can be prevented by prompt and adequate treatment of genitourinary infection, testicular maldescent and testicular torsion.

Unusual giant prostatic urethral calculus.

Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed.

Acute scrotum in Nigeria: an 18-year review.

One hundred and seventy-eight patients presenting with an acute scrotum during a period of 18 years (1978-1997) were reviewed retrospectively. Fifty per cent had testicular torsion, with a mean age of 23 years (range 3 weeks-55 years). Torsion was significantly more common in the cold harmattan season (October-early March). The salvage rate of torted testes was 52%. Inguinoscrotal hernia was the cause of testicular infarction in 10% and is an important contributor to male infertility. Twelve per cent of cases of suspected torsion were found to have epididymo-orchitis, at exploration. Twenty-three (13%) patients presented with scrotal gangrene (Fournier's gangrene) which did not result in testicular loss. There was significant morbidity following intervention by non-doctors, and misdiagnosis from unsuspecting physicians. The acute scrotum affecting young patients is a significant cause of male infertility and morbidity in Zaria. Early recognition, prompt treatment and re-education of those who may provide the first line care for such patients will reduce the morbidity and pathologic consequences following neglect.