The effect of unusual presentation on delayed diagnosis of prostate cancer: a case series.

BACKGROUND: Early diagnosis of prostate cancer is key to achieving a cure and its proper management leads to a good prognosis. In Ghana a large percentage of patients present with advanced disease and unusual presentations in these patients result in greater delay in the diagnosis thus worsening the outcomes. CASE PRESENTATION: We present three African males with advanced prostate cancer who had delayed diagnosis. The first patient, a 64 year old male presented with ascites of 2 years duration with weight loss and no lower urinary tract symptoms, the second, a 69 year old man with end stage renal failure of 6 months duration and was receiving dialysis, the third case, an 87 year old man was managed for pulmonary tuberculosis after he presented with chronic cough and lower urinary tract symptoms. All patients eventually had a prostate specific antigen done which were elevated. Further investigations including prostate biopsies, abdominopelvic CT scans for case 1, abdominopelvic ultrasound, prostate biopsies and blood urea and electrolytes for case 2, prostate biopsies, chest and lumbosacral showed a diagnosis of metastatic prostate carcinoma, and all patients were managed with androgen deprivation. The second patient received additional radiotherapy. CONCLUSION: A lack of knowledge of prostate cancer symptoms including unusual symptoms, can result in delayed diagnosis especially in regions of the world where a large number of patients present with advanced disease.

Surgical provider-reported reasons for utilization of the World Health Organization's Surgical Safety Checklist at a tertiary hospital in Ghana.

Despite the established positive benefits, LMICs' adoption of the WHO Surgical Safety Checklist (SSC) is inadequate, with as little as 20% use. This study assessed the utilization and beliefs that drive the non-utilization of the WHO SSC among surgical providers at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. A cross-sectional study was conducted among 186 surgical providers at the KBTH in Ghana. Data collected included the category of personnel, awareness of the SSC, training received, previously identified barriers, and staff perceptions. Utilization and drivers associated with non-utilization of the SSC were assessed using bivariate log-binomial regression. Out of 190 surgical professionals invited, 186 gave their consent and participated in the survey, giving a response rate of 97.9%. Respondents comprised 69 (37%) surgeons, 66 (36%) anesthetists, and 51 (27%) nurses. Only 30.4% of surgical professionals always use the SSC, as advised by WHO. The majority (67.7%) of surgical professionals had received no formal training on using the WHO SSC. The proportion was highest among surgeons (81.2%) compared to anesthetists (66.7%) and nurses (51%). Surgeons were perceived by other professionals to be the least supportive of checklist use (87.6%), in contrast to nurses (96.1%) and anesthetists (93.9%). Significant drivers associated with checklist usage among surgical professionals included the SSC taking too long to complete, poor communication between anesthetist and surgeon, checklist not covering all perioperative risks, difficulty finding a coordinator, poor attitude of team members toward questions, surgical specialty/unit and training status of professionals. The checklist was always used by only a small (30%) proportion of surgical professionals at the KBTH. Improving checklist use will necessitate its careful application to all surgical operations and a cycle of periodic training that includes context-specific adjustments, checklist auditing, and feedback from local coordinators.

Comparing the effectiveness and lubricity of a novel Shea lubricant to 2% lidocaine gel for digital rectal examination: a randomized non-inferiority trial.

This study compared the level of lubricity and pain reduction of a novel shea lubricant to 2% lidocaine gel during digital rectal examination (DRE). Our research group performed a 9-week single-blind non-inferiority trial at the Ho Teaching Hospital involving 153 patients. The primary outcome measure was the mean pain difference during the procedure using a Visual Analogue Scale. 75 and 78 patients were randomized to the shea lubricant and 2% lidocaine gel groups respectively. The analysis considered the per-protocol population. The mean pain difference at endpoint was Δ - 0.01. The 95% lower confidence interval was a -0.595 difference in means, above the non-inferiority (NI) limit of - 0.720, thus establishing non-inferiority (Δ - 0.01, 95% CI - 0.59 to 0.57, NI - 0.72). With secondary outcome measures, perianal pruritus (p = 0.728), discomfort (p = 0.446), bowel urgency (p = 0.077) and urinary urgency (p = 0.841) were similar during the procedure. Shea lubricant had better lubricity and ease of use (p = 0.002). While the novel shea lubricant achieved similar level of pain reduction as obtained with 2% lidocaine gel, it had better ease of performance and lubricity.

A 6-year retrospective clinical review of iatrogenic ureteric injuries repaired in a resource-deprived setting.

BACKGROUND: Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost. OBJECTIVE: The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting. PATIENTS AND METHODS: This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015-2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients' demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0. RESULTS: Twelve patients aged between 24-54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention. CONCLUSION: Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.

Solitary kidney functional damage due to caesarean ureteric injury monitored for 2 years after acute management: A case report.

Caesarean section with associated ureteric injuries that damage kidney function is uncommon. Such injury in women with a solitary kidney has far-reaching effects if the diagnosis is delayed. The case report describes the successful acute management with stenting of ureteric damage after caesarean section in a woman with a solitary kidney. A 29-year-old woman presented with anuria, hypertension (174/101 mmHg) and flank pain 3 days after caesarean section. Physical examination was significant for peri-orbital oedema, left flank tenderness, pallor and delirium. A diagnosis of acute kidney injury was confirmed by elevated blood urea and creatinine levels. An ultrasound scan revealed a solitary hydronephrotic left kidney. She had successful acute management at a resource-deprived facility, with normal renal function at a 2-year follow-up. Proteinuria lasted for about three months after surgery. Recovery of solitary kidney function with acute kidney injury due to caesarean section ureteric injury may be associated with prolonged proteinuria without evidence of further functional deterioration.

Penile carcinoma: a report of two cases treated by partial penectomy, its effects on quality of life and review of literature.

Penile cancer is a rare malignancy worldwide except in parts of Africa, Asia and Latin America where higher incidences have been reported. The disease leads to serious physical disfigurement of the male genitalia which can have debilitating consequences, thus it may alter micturition patterns and impair penetrative sexual intercourse. The lack of cancer registries and epidemiological surveillance programs in Ghana makes estimation of the prevalence in Ghana difficult hence to advance the course of knowledge, awareness and prevention of penile cancers, it is imperative that such cases are brought to the fore and discussed. We report two cases of penile cancer that had partial penectomy and inguinal lymphadenectomy at the Korle Bu Teaching Hospital. Clinical findings and intervention of these reported cases highlight the management process and it further assessed the psychological impact of intervention. The two patients presented to our outpatient department with penile lesions which were confirmed to be penile cancer. The first patient presented with a 30 year history with recurrent ulceration while the other presented with just 1 (one) year history of penile lesion. Both patients required partial penectomy and inguinal lymphadenopathy in the treatment of their condition. The major risk factors as reported in this case study, include uncircumcision, previous treatment for sexually transmitted infections, multiple sexual partners and smoking. Treatment is associated with reduction in sexual function although quality of life may remain satisfactory. Strong family and psychological support are key cornerstones for good treatment outcomes.

Household treatment cost of breast cancer and cost coping strategies from a tertiary facility in Ghana.

Breast cancer is the number one cause of cancer death in women globally. According to the Global cancer registry, there were 2.3 million new cases of breast cancer diagnosed in 2020 worldwide, accounting for 25% of all cancer cases in women. The data on the cost burden of breast cancer on households is limited in Ghana, it is therefore imperative that it is estimated to ensure effective planning and provision of adequate resources for breast cancer treatment. This cost-of-illness study estimates the household treatment cost of breast cancer and the cost coping strategies used by patients. This cost-of-illness study was conducted at the surgical unit (Surgical unit 2) of the Korle Bu Teaching Hospital (KBTH), with 74 randomly selected patients and their accompanying caregiver(s). Data was collected using structured questionnaire on direct, indirect and intangible costs incurred and coping strategies used by patients and their households. The results are presented in descriptive and analytic cost statistics. Most of the patients were aged 40-69 years and were married with moderate education levels. Nearly 57% of patients earn an income of USD 370 or less per month. The average household expenditure was USD 990.40 (medical cost: USD 789.78; non-medical cost: USD 150.73; and indirect cost: USD 50). The publicly provided mechanism was the most utilized cost coping strategy. The direct, indirect and intangible costs associated with breast cancer treatment had significant financial and psychological implications on patients and their households. Moreover, poorer families are more likely to use the publicly provided strategies to cope with the increasing cost of breast cancer treatment.