Multiple primary cancers: Simultaneously occurring prostate cancer and other primary tumors-our experience and literature search.

INTRODUCTION: Prostate cancer is a leading cause of death in men all over the world, and it is becoming an increasing public health burden in sub-Saharan Africa. In our practice, we identified that prostate cancer co-existed with other primary cancers even in noncontiguous regions of the body and this co-existence impacted on our management of these patients. MATERIALS AND METHODS: We retrospectively studied a 2-year period (June 2012-July 2014), the records of patients in our hospital with prostate cancer, who in addition, had other primary cancers; and studied the management and outcomes of these patients. We also reviewed the existing literatures for possible biologic links between prostatic carcinoma and other primary tumors. RESULTS: There were six patients with multiple primary cancers who had prostate cancers. The age range was 60-84 years and the mean age of 72.2 ± 0.4 years. The primary tumors co-existing with prostate cancer were colonic adenocarcinoma, rectal adenocarcinoma, urinary bladder transitional cell carcinoma, primary liver cell carcinoma, and thyroid follicular carcinoma in both synchronous and metachronous relationships. CONCLUSIONS: Prostate cancers often co-exist with other cancers. The precise mechanism by which prostate cancer co-exists with another primary cancer is yet to be clearly defined. With more study of the syndromic cancers involving the prostate, definite associations could be identified, and this may help in managing these patients better.

Angiomyolipoma presenting as renal abscesses: a consideration for further evaluation of renal abscess.

AIMS AND OBJECTIVES: This is to describe an usual presentation of renal angiomyolipoma as renal abscess CASE REPORT: This is a case report of a 51 year old man with clinical and radiological features suggestive of renal abscess. The patient had exploratory laparatomy and a simple nephrectomy for a non functioning kidney which was more like a bag of pus. The histological report however revealed renal abscess coexisting with angiomyolipoma supporting previous reports that renal abscess may be a harbinger of other renal pathologies. CONCLUSION: Abscesses are usually managed by drainage and the dictum of 'wherever there is pus let it out' holds generally but this does not always suffice in renal abscesses because renal abscesses are often found in the background of other diseases which may be of more clinical importance.

Urological complications from obstetrics & gynaecological procedures in ilorin, Nigeria - case series.

BACKGROUND: Despite the advances and improvement in science and surgical skills, post-surgical operation complications are oftentimes inevitable, although they could be minimized. Generally, complications occur because of several reasons including patient factors, the disease condition, management option, skills and expertise of the managing team as well as technical factors. Analysis of postoperative complications will help to understand their pathogeneses and identify ways of preventing such complications in the future. AIM & OBJECTIVES: To retrospectively analyse the urological complications arising from obstetrics and gynaecological procedures at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. METHODOLOGY: Retrospective analysis of available records of patients with urological complications following either obstetrics or gynaecological procedures between the year 2010 - 2012 managed by the urology unit of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The patients were identified from the unit and theatre records. From the patients' clinical records, the data retrieved included the biodata, presentation, details of the gynaecological operations (calibre of surgeons, notable events at operations) and the complications that were recorded. The urological interventions and outcomes were also recorded. RESULTS: There were 11 patients with urological complications during the three year period. Their ages ranged from 28 and 65years (mean 43.8 +/-0.05 years), about 60% had hysterectomy for uterine fibroids. Various complications such as urinary fistulae (45.5%), ureteric obstructions (36.5%), retained surgical foreign bodies (9%) and ureteric transection (9%) were recorded. Corrective urological interventions were successful in majority (72.7 %) of them. CONCLUSION: Urological complications associated with gynaecological and obstetrics procedures are sometimes inevitable but their occurrence could be reduced when standard practices are observed.

Bladder stone in a three-year-old Nigerian child with posterior urethral valve: a case report.

BACKGROUND: Stone in the bladder is an uncommon presentation in the tropics, especially in children. Its rarity makes the index of suspicion to be low. Patients presenting with it may be mistaken for urinary tract infection (UTI) because of the presence of frequency and dysuria. OBJECTIVE: To present a rare cause of urinary bladder stone in a child in the tropics. METHODS: The patient, a three-year-old boy, presented with recurrent episodes of dysuria and stragury for a duration of about one year. Work up included clinical evaluation and laboratory assessments, results of which informed surgical intervention. RESULTS: The child had been treated repeatedly for urinary tract infection. He was acutely ill with suprapubic tenderness dysuria and poor urinary stream. He was hypertensive. Micturating cystourethrography showed posterior urethral valves and a bladder stone. He had vesicolithotomy and valvotomy with improvement of his blood pressure. CONCLUSION: The coexistence of bladder stone with PUV coupled with delayed diagnosis may be a predisposing factor to hypertension in children. Conventional surgical treatment gives good results.

Caudal block anesthesia for transrectal prostate biopsy.

OBJECTIVE: Transrectal prostate biopsy is a potentially painful procedure. Our service has significant experience with caudal anesthesia for perianal procedures. This study is aimed to determine the effectiveness of caudal anesthesia for transrectal prostate biopsy. PATIENTS AND METHODS: Seventy consecutive patients undergoing transrectal prostate biopsy were entered into the study. The patients were requested to complete a questionnaire structured to assess the pain felt during the procedure using the visual analog score (VAS). The effectiveness of the caudal anesthesia was determined by the anesthesia of the perineum and the laxity of the anal sphincter. Complications from the procedures were recorded. RESULTS: All the patients completed and returned the questionnaire. The average age of the respondents is 65.8 years. Among the 34 patients with caudal block, effective anesthesia was achieved in 28 patients and ineffective in six patients. However, the mean VAS for the pain from transrectal prostate biopsy was 1.49 +/- 1.93 SD (range 0-6.0) for the patients with effective caudal anesthesia and 8.02 +/- 1.79 SD (range 5.0-10.0) for patients with no caudal anesthesia. There was a reduced requirement for analgesics after prostate biopsy for patients with effective caudal anesthesia. Three patients (8.8%) had minor complications (transient dizziness) following the injection of the anesthetic into the caudal epidural space. CONCLUSION: Satisfactory analgesia for transrectal prostate biopsy can be achieved with the use of CA and it results in better cooperation of the patient during the procedure.

Acquired male urethral diverticulum: case reports.

Urethral diverticulum is a localised out pouching or fusiform dilatation of the urethra. It is an uncommon clinical entity affecting both males and females. Although, the diagnosis could be straightforward in the males, it may present as a diagnostic puzzle in the female because it often presents with non-specific symptomatology and diagnosis may not be easily made with common investigation techniques. Two cases of urethral diverticulum are presented to highlight the aetiopathogenesis of urethral diverticulum.

Intestinal obstruction: a rare complication of channeling transurethral resection of the prostate (TURP): a case report.

INTRODUCTION: Channeling transurethral resection of the prostate is a recognized form of adjunctive treatment in the treatment of patients with prostate cancer. Despite the fact that complications arising from the procedure have been on the decline, rare complications like intestinal obstruction may occur. CASE PRESENTATION: This is a case report of a 56 year old man who developed mechanical intestinal obstruction few days after a channeling TURP for advanced CaP. CONCLUSION: The report highlights the possibility of intestinal obstruction as a secondary event following a silent urinary bladder perforation during channeling TURP. Early recognition and intervention were responsible for the good outcome in this patient.

Knowledge and practice of urethral catheterisation by newly qualified medical interns.

BACKGROUND: Urethral catheterisation is a procedure which is daily performed in clinical practice. Though, interns are expected to be proficient in this, the situation is always not so and complications have occurred due to inadequate knowledge of safe urethral catheterisation. AIMS AND OBJECTIVES: The study is intended to assess the knowledge and the practice of urethral catheterisation of prospective interns with a view of making suggestions for improvement in the teaching of this procedural skill to medical students and interns. METHODOLOGY: Questionnaires were administered to all prospective interns who had applied to do their compulsory one year internship in the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The data were analysed using SPSS 11 statistical package. RESULTS: There were 96 respondents 65 (69.9%) of these were males. They graduated from 6 medical schools in Nigeria and 1 in the Sudan and they were aged between 23 and 36 years. They all had observed urethral catheterisation before while 92.5% have performed urethral catheterisation: 78.5 % under supervision and 14% under no supervision and 7 (7.5%) have not. Only 19.4% had good knowledge of the indications for urethral catheterisation and 53.9% had knowledge of appropriate list of materials for safe urethral catheterisation. Only 29.1% could describe well the steps of safe catheterisation and 31.2%.could list well the possible complications of catheterisation. Less than half had good knowledge of appropriate catheter sizes. CONCLUSION: Urethral catheterisation is yet to be well mastered by many newly qualified interns and improvement in the teaching of procedural skills in medical schools may likely improve the situation.

Andropause: an emerging world health problem.

Andropause is an emerging clinical concept that is gaining an increasing recognition, as the world becomes more aging. The clinical features though subtle are easy to identify and appropriate treatment of diagnosed cases will to a goodextent alleviate a lot of age-related complaints and improve the general quality of life in the elderly men. Low level of clinical suspicion secondary to inadequate knowledge about this clinical entity remains the major obstacle to appropriate treatment. In this review, the literature has been perused and the definition, epidemiology, pathophysiology, clinical features, diagnosis and treatment are outlined.

Andropause: An emerging world health problem

Andropause is an emerging clinical concept that is gaining an increasing recognition; as the world becomes more aging. The clinical features though subtle are easy to identify and appropriate treatment of diagnosed cases will to a good extent alleviate a lot of age-related complaints and improve the general quality of life in the elderly men. Low level of clinical suspicion secondary to inadequate knowledge about this clinical entity remains the major obstacle to appropriate treatment. In this review; the literature has been perused and the definition; epidemiology; pathophysiology; clinical features; diagnosis and treatment are outlined

Rigid retrograde endoscopy under regional aneasthesia: a novel technique for the early realignment of traumatic posterior urethral disruption.

Traumatic disruption of the posterior urethra usually occurs in association with pelvic fractures and may result in significant morbidity. The management of this injury remains difficult and controversial. Recently, early restoration of urethral continuity in these patients using either both antegrade and retrograde cystoscopy (with or without fluoroscopy), or flexible retrograde urethroscopy alone under general aneasthesia, has been reported with good results. These procedures have been proposed as an improvement over the traditional teaching of placement of a suprapubic catheter followed by delayed open repair (urethroplasty). We now describe a novel method of restoration of urethral continuity by rigid retrograde endoscopy alone under caudal aneasthesia in the early post-trauma phase. This procedure can be carried out in an outpatient endoscopic suite with standard (endoscopic)optical urethrotomy equipment and is suitable for most patients with prostatomembranous urethral disruptions. A 'high-riding' prostate is however a relative contraindication for this procedure. To date, we have carried out this procedure successfully in 4 of 5 patients with traumatic prostato-membranous disruption (a success rate of 80%). We recommend that early retrograde rigid endoscopic realignment under regional analgesia should be considered as a management option in patients with traumatic disruption of the posterior urethra.