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.

Incidence of leaving against medical advice (LAMA) among patients admitted at the accident and emergency unit of the University of Calabar Teaching Hospital, Calabar, Nigeria.

BACKGROUND: The causes and incidence of the commonly observed phenomenon of leaving against medical advice (LAMA) in our hospitals have not been studied. This retrospective study was aimed at evaluating its incidence and pattern in order to suggest possible solutions. METHODOLOGY: The case files of patients who left against medical advice at the Casualty unit of the University of Calabar Teaching Hospital between July 2002 and December 2003 were retrieved from the Medical Records Department and information regarding age, sex, education/occupation, religion, diagnosis, reason(s) for leaving and duration of stay in casualty were extracted. RESULTS: A total of 3708 patients were seen at the casualty unit within this period. Ninety-seven patients left against medical advice but only ninety case notes were analyzable. Seven folders had incomplete information. Male/Female ratio was 2:1 and the ages ranged between 7 and 70 years (average 31.5 years). The average duration of stay in Hospital was 2.4 days (110 days). Sixty-five patients (72.2%) were those who had various forms of trauma while 8 (8.8%) had general surgical problems. 19% (17) patients had medical emergencies. CONCLUSION: The youths are the most vulnerable group and the principal causes in our environment are ignorance and poverty. Because of poor documentation in our centres, it was not possible to know where these patients go and the results of their treatments. There is therefore a need for further studies.

Changes in seminal quality following varicocelectomy in infertile Nigerian males.

Semen analysis in 116 subfertile and infertile patients with varicocele revealed oligospermia (counts less than 20 million/ml) in 66% of patients, asthenospermia (motility of less than 50%) in 59% of patients; and teratospermia (abnormal sperm morphology of greater than 50%) in 65% of patients. The sperm motility and morphology deteriorated with decrease in sperm concentration. After varicocelectomy 53% of all patients showed improvement in the overall semen quality. The best post-operative results were noted in patients who had pre-operative counts over 20 million/ml. Deterioration in semen quality was observed in 6% of all patients. Factors which possibly played a role in the response to varicocelectomy in our environment are discussed.

Seminal fluid changes after testicular torsion.

A study was undertaken to determine the changes in the seminal fluid of adult patients presenting with unilateral testicular torsion. There was beneficial effect from excising an infarcted torsive testis and a deleterious effect from retaining it.

Recovery of renal function after 33 days of complete bilateral ureteric obstruction.

Bilateral ureteric ligation is a rare complication of hysterectomy. We report a case of prompt recovery of renal function following release of bilateral ureteric ligation persisting for 33 days.

Transrectal biopsy of the prostate: a review of 186 biopsies.

A retrospective review of 186 transrectal needle biopsies of the prostate has revealed that repeated use of the TruCutTM needle until it is ineffective does not affect its accuracy. A diagnostic correlation of 96% between the clinically malignant prostate and histopathologic diagnosis was achieved. This correlation was 10.5% with benign prostatic hypertrophy associated with a suspected malignant nodule. Minimal rectal haemorrhage complicated the procedure in 5.9% of cases. No other complication was documented.

Aetiologic factors of male infertility in Ibadan, Nigeria.

In a retrospective review of the case notes of 510 infertile men, testicular failure of various types was the aetiologic factor in 61% of cases, chronic epididymitis in 32% and varicocoeles in 25%. Five patients had bilateral absence of the vas deferens. It is hoped that improved health-care delivery will benefit the group of patients with preventable and potentially curable aetiologic factors like varicocoeles, chronic epididymitis and testicular torsion.

Unusual relationship of multiple renal arteries.

An unusual cross relationship of two left renal arteries was demonstrated angiographically during the investigation of a young man presenting with painless, total hematuria after a traffic accident. The upper pole artery arose from the aorta caudal to the lower pole artery. In the absence of a malrotation a possible embryologic cause has been advanced. It also highlights the advantage of combining selective renal arteriography with aortography when multiple renal arteries are encountered.

Priapism complicating sickle cell disease in Nigerian children.

Forty-two out of a total of 45 children who presented with priapism in the University College Hospital Ibadan during an eight-year period had associated sickle cell disease (SCD). Conservative management was satisfactory in 35 out of 40 patients, but the outcome in all the five cases subjected to surgery was poor. Our findings suggest that associated SCD should be suspected in children presenting with priapism in areas of the world where SCD is endemic, and that conservative management is preferable to surgery.

Characterization of prostatic carcinoma among blacks: a comparison between a low-incidence area, Ibadan, Nigeria, and a high-incidence area, Washington, DC.

A comparison of carcinoma of the prostate gland in a low-incidence Nigerian (Ibadan) population and a high-incidence U.S. Afro-American (Washington, D.C.) population was the purpose for this study, initiated in 1973. The frequency of carcinoma (micro- and invasive) was determined in consecutive necropsy cases from hospitals in Ibadan, Nigeria, Accra, Ghana and Washington, D.C. The results of these clinical, epidemiologic and morphologic studies are reported. Clinically, the peak incidence of carcinoma of the prostate in Nigerian males in Ibadan and in American males in Washington, D.C. was in the 65-74 age group. The median age of patients was 66.4 years in Ibadan and 69.2 years in Washington, D.C. Seventy-five percent of Nigerian and 49% of American patients were in stages III and IV. Overall, the distribution by grade of neoplasms in surgical material from Ibadan and Washington, D.C. was similar. Plasma testosterone and estrone levels were significantly higher (p < 0.05 and p < 0.001) in U.S. patients than in U.S. controls and higher (p < 0.001 and p < 0.05) in U.S. patients than in Nigerian patients with prostatic carcinoma. Plasma testosterone levels were significantly lower (p < 0.05) in Nigerian patients than in Nigerian controls. Estrone levels were not significantly different in Nigerian patients than controls. Nigerian patients were more sexually active throughout their lives than American patients; however, they reported a higher incidence of impotence than U.S. patients in the immediate 5 years preceding the diagnosis of prostatic carcinoma. Nigerian respondents (patients and controls) arrived at puberty later than their American counterparts. Within each of the two population groups, the factor with the highest relative risk ratio was lower urinary tract symtoms occurring 10 years or longer before the onset of the present complaints which led to the diagnosis of prostatic carcinoma. Nigerian and U.S. patients were more sexually active than controls. Microcarcinoma (incidental, latent) of the prostate gland occurred with a frequency of 11.8% and at an age-adjusted incidence rate (world standard) of 40.6 per 1000 necropsies in the sampled U.S. black male population. The age-adjusted incidence rate (world standard) for microcarcinoma in the combined West African (Accra and Ibadan) series (36.7/1000) was almost equal to the rate (40.6/1000) in the Washington, D.C. series.

Eosinophilic cystitis.

4 cases of eosinophilic granulomatous cystitis are reported. The clinical presentation of this rare entity is disucssed. It is suggested that the lesion is probably akin to eosinophilic enteritis or eosinophilic granuloma of the gastrointestinal tract and represents a local intense allergic reaction of eosinophilic type. The causative agents are yet to be identified. Management by an allergist is suggested as a first line of treatment as it appears that the bladder lesions are usually too extensive for local resection.

Urogenital rhabdomyosarcoma in Nigerian children.

Four cases of urogenital rhabdomyosarcoma in Nigerian children are reported. One of the patients is alive and well six years after surgical excision of a stage 1 tumour. The remaining three children had more advanced neoplasms and died soon after surgery despite adjuvant therapy with one or more cytotoxic agents. The probable value of combination chemotherapy with vincristine, actinomycin D and cyclophosphamide in this tumour type is discussed.

Characterization of prostatic carcinoma among blacks: a continuation report.

A clinical and pathologic comparison of carcinoma of the prostate in a high-risk US (Washington, DC) black population and in a low-risk Nigerian (Ibadan) black population is presented. Fifty-two percent of American patients were in clinical stages I and II, whereas only 10% of Nigerian patients were in the same stages. Testosterone and estradiol blood levels were significantly lower (P less than 0.05) in patients with carcinoma of the prostate from Ibadan compared with American black prostate cancer patients from Washington, DC. Age-standardized incidence rates (world standard) for 1000 autopsies for micro (incidental)-carcinoma were approximately equal in American and African black men. The incidence rate of invasive carcinoma was, however, even after adjustment for age, higher in American black men than in African men.

Schistosomiasis and carcinoma of the bladder: a critical appraisal of causal relationship.

The pathology of 154 cases of carcinoma of the urinary bladder diagnosed in surgical specimens in Ibadan is reviewed. Schistosoma haematobium-infections are found in association with all varieties of urothelial carcinoma. The majority of tumours in this and previously reported series from bilharzial and nonbilharzial underdeveloped regions presented in advanced stages. It is suggested that the preponderance of squamous cell carcinoma in these regions is a reflection of late clinical presentation. The evidence so far presented to support a causal relationship between schistosomiasis and carcinoma of the bladder is reviewed. It is concluded that such relationship is probably not true.

Phyllodes type of atypical prostatic hyperplasia.

A prostatic lesion characterized by atypical epithelial hyperplasia and pleomorphism of the stromal elements is presented. The features bear a strong resemblance to cystosarcoma phyllodes of the female breast and probably represent a comparable lesion. Such atypical hyperplasia has not been described previously.

Characterization of prostatic carcinoma among blacks: a preliminary report.

This study was designed to compare United States (Washington, DC) black prostatic carcinoma patients (high-risk group) with Nigerian (Ibadan) black prostatic carcinoma patients (low-risk group). Although the material is meager, preliminary analyses suggest that carcinoma of the prostate is a common disease in both US black men (196 of 1000 autopsies) and in Nigerian black men (67 of 1000 autopsies). The tumor tends to be of a higher histologic grade (less well differentiated) and the carcinomatous foci are more numerous in the Nigerian patients. Fifty-three percent of US patients are in stages I and II when the disease is first discovered. Plasma testosterone, estrone, and estradiol concentrations did not differ significantly between US patients and controls. A statistically significant positive association is indicated between carcinoma of the prostate and the following epidemiologic variables: racial admixture, age of puberty, and age of first coitus. The median age of necropsy cases with carcinoma was 50.0 years in Nigeria and 68.3 years in the US.