Successful management of multiple obstructing renal calculi in a 30-year-old patient with autosomal dominant polycystic kidney disease using Frequency-Doubled Double-Pulse neodymium: Yttrium - Aluminium garnet laser lithotripsy.

Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent genetic disorder that results in end-stage renal disease. Although ADPKD patients experience long disease trajectories, factors such as hypertension, proteinuria and renal calculi have been observed to lead to rapid renal function impairment in patients with ADPKD. Furthermore, due to the distorted anatomy that makes access to stone difficult, the management of nephrolithiasis in ADPKD patients is one of the several special situations in which urinary lithiasis presents management challenges. We report the case of a 30-year-old male with ADPKD and renal function impairment as a result of multiple obstructive calculi who was treated in Dialyser Medical Centre, Oshodi, Lagos, with Frequency-Doubled Double-Pulse Neodymium: Yttrium - Aluminium Garnet laser (FREDDY laser) lithotripsy, highlighting the possible advantage of FREDDY laser over other types of laser procedures given the minimal tissue-damaging potential of the laser type.

Parental Post-operative Telephone Follow-Up After Paediatric Day Case Surgery.

BACKGROUND: Paediatric day case surgeries (DCSs) are associated with minimal complications therefore the post-operative follow-up visit usually serves to calm anxious parents and is replaceable with a phone call. This study examines the safety and reliability of post-operative telephone assessment by caregivers and its acceptability to them. METHODS: Parents of DCS patients over a 9-month period were recruited for telephone follow-up on third post-operative day for wound assessment. The remote reports were compared with the finding during the in-person visit on fourth post-operative day to determine the reliability of parents' observation. The parents' acceptance of telephone follow-up was also studied. RESULTS: The parents of 112 children who had groin surgeries (84%), repair of umbilical hernias (4.5%) and excision of soft tissue masses (11.6%) were recruited. The M:F ratio was 10.2:1. The median age at surgery was 64 months (IQR 43.0-96.8) and median waiting time for surgery was 11.5 months (IQR 3.0-28.8). Most caregivers were mothers (83%) and had a minimum of secondary education (86.6%). The telephone and clinic assessments were matched in 98 of 101 assessed patients. Telephone follow-up would have sufficed for 104 (92.9%) patients and correctly identified those who needed clinic visits. Majority of parents found telephone follow-up acceptable in lieu of clinic visit but some preferred to be given a phone number to initiate the call if necessary. CONCLUSION: Telephone call is safe, feasible and acceptable for follow-up after paediatric DCS. A guided parents' assessment of the wound is reliable for determining those who need hospital visit.

A prospective randomized comparative study of targeted versus empirical prophylactic antibiotics in the prevention of infective complications following transrectal ultrasound-guided prostate biopsy.

Background: It is established that antibiotic prophylaxis prevents infection following transrectal ultrasound-guided prostate biopsy. This study compares the infective complications in transrectal prostate biopsy (TRPB) in empirical versus targeted prophylactic antibiotics. Patients and Methods: Urine and rectal swabs were obtained prior to TRPB. They were randomized into targeted antibiotic (TA) and empirical antibiotic (EA) groups. TA had prophylactic antibiotics according to rectal swab culture, whereas EA had the standard parenteral ciprofloxacin. They were followed up weekly for 4 weeks. Chi-square or Fisher's exact tests were used to compare categorical variables, Student's "t"-test was used to compare means of numerical variables, and P < 0.05 was considered statistically significant. Results: One hundred patients were studied, fifty in each group. The mean age was 66 years, with men aged 60-69 years accounting for 50% of the study population. Providencia stuartii, Escherichia coli, and Citrobacter freundii were the most predominant bacteria identified in the prebiopsy rectal swab culture, with resistance to ciprofloxacin (57%) being much more common than that to levofloxacin (21%). Postbiopsy infection occurred in one (2%) patient in the TA group and five (10%) patients in the EA group. Difference in the infection rate between the two groups was statistically significant (P = 0.042). Three of the patients with postbiopsy infection in the EA group had urosepsis and required hospitalization. Fluoroquinolone-resistant bacteria were responsible for infection in all the six patients. TA reduced the risk of postbiopsy infection by 5.6 folds. Conclusion: TA was associated with a decreased risk of infection in TRPB.

RésuméContexte: Il est établi que la prophylaxie antibiotique prévient l'infection après une biopsie transrectale guidée par une échographie de la prostate (TRPB). Cette étude compare les complications infectieuses liées au TRPB entre antibiotiques prophylactiques empiriques et ciblés. Patients et méthodes: Des écouvillons urinaires et rectaux ont été obtenus avant le TRPB. Ils ont été randomisés en groupes d'antibiotiques ciblés (TA) et d'antibiotiques empiriques (EA). TA avait des antibiotiques prophylactiques selon la culture sur écouvillon rectal, alors que EA avait la ciprofloxacine parentérale standard. Ils ont été suivis chaque semaine pendant quatre semaines. Les tests exacts du chi carré ou de Fischer ont été utilisés pour comparer les variables qualitatives, le test de l'étudiant a été utilisé pour comparer la moyenne des variables numériques et P <-0,05 a été considéré comme statistiquement significatif. Résultats: Cent patients ont été étudiés; 50 dans chaque groupe. L'âge moyen était de 66 ans, les hommes de 60 à 69 ans représentant 50% de la population étudiée. Providencia Stuartii, Escherichia Coli et Citrobacter Freundii étaient les bactéries les plus prédominantes identifiées dans la culture du prélèvement rectal avant biopsie, la résistance à la ciprofloxacine (57%) étant beaucoup plus commune qu'à la lévofloxacine (21%). Une infection après la biopsie s'est produite chez 1 patient (2%) du groupe TA et 5 patients (10%) du groupe EA. La différence de taux d'infection entre les deux groupes était statistiquement significative (p = 0,042). Trois des patients présentant une infection post-biopsie dans le groupe EA présentaient une urosepsie et devaient être hospitalisés. Des bactéries résistantes à la fluoroquinolone étaient responsables de l'infection chez les six patients. L'AT réduit le risque d'infection après la biopsie de 5,6 fois. Conclusion: L'AT était associée à une diminution du risque d'infection dans le TRPB.

Outcome of Mainz II Pouch Urinary Diversion after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer: Our Experience.

INTRODUCTION: Mainz II pouch urinary diversion in patients with muscle-invasive bladder cancer is one of the options of continent urinary diversion following radical cystectomy (RC). We aim to report our experience and the outcome of our patients who had this procedure. PATIENTS AND METHODS: Patients who had RC and Mainz II pouch urinary diversion for muscle-invasive bladder cancer in our institution from 2007 to 2016 were evaluated. Variables analyzed included age, gender, stage of the disease, pathological grade and tumor types, complications, and survival status. RESULTS: There were 11 patients who had Mainz II pouch urinary diversion after RC for bladder cancer over a 10-year period. Four (36%) were male and 7 (64%) were female. The mean age of the patients was 58.6 (range, 52-65) years. The diseases were pT2, pT3, and pT4 in 2 (18%), 7 (64%), and 2 (18%) patients, respectively. Four (36%) had pelvic nodal metastasis. Nine (82%) had a histological diagnosis of transitional cell carcinoma, and two (18%) were squamous cell carcinoma (SCC). Ten (91%) patients had high-grade disease, whereas only 1 (9%) patient had low-grade disease. Short-term morbidities were electrolytes derangement, hypokalemia, and acidosis in 2 (18%) patients and pyelonephritis in 2 (18%) patient. The two patients with invasive SCC had recurrence and death within 12 months of surgery. At present, four of the patients are alive, and seven are dead. Survival till date ranged from 8 to 120 months (mean survival time was 48 months). All patients achieved day and night time continence, and there was no significant long-term morbidity from the method of urinary diversion. CONCLUSION: Mainz II pouch urinary diversion is safe and acceptable to most of our patients with good long-term results.

Use of Exogenous Testosterone for the Treatment of Male Factor Infertility: A Survey of Nigerian Doctors.

BACKGROUND: Though exogenous testosterone is known for its contraceptive effects in men, it is sometimes prescribed by medical practitioners for the treatment of male factor infertility in the mistaken belief that exogenous testosterone improves sperm count. The aim of this study was to evaluate the scope of testosterone use in the treatment of male factor infertility by medical practitioners in Lagos, Nigeria. METHODS: A survey using a structured questionnaire was carried out amongst doctors attending a regular Continuing Medical Education (CME) programme in Lagos, Nigeria. RESULTS: There were 225 respondents. Most of the respondents (69.8%, n = 157) indicated that exogenous testosterone increases sperm count. Only 22 respondents (9.8%) indicated (correctly) that exogenous testosterone decreases sperm count. Seventy-seven respondents (34.2%) had prescribed some form of exogenous testosterone in the treatment of male factor infertility. The vast majority of respondents who had prescribed testosterone (81.8%, n = 63) thought exogenous testosterone increases sperm count. There was no statistically significant difference in the pattern of prescription across the respondents' specialty (p = 0.859) or practice type (p = 0.747). CONCLUSION: The misuse of exogenous testosterone for the treatment of male infertility was common amongst the respondents, with most of them wrongly believing that exogenous testosterone increases sperm count.

Outcome of radical retropubic prostatectomy at the Lagos State University Teaching Hospital.

BACKGROUND: Prostate cancer is the most commonly diagnosed cancer in men in Nigeria and most cases present when the disease is already in an advanced stage. Radical prostatectomy for early prostate cancer is therefore not a commonly performed operation by urologists in Nigeria. We have had training and significant experience in radical retropubic prostatectomy. We, therefore, report the outcome of our initial experience. MATERIALS AND METHODS: We review the record of men with early prostate cancer who had radical retropubic prostatectomy in our institution from 2007 to 2015. RESULTS: There were 34 men who had radical retropubic prostatectomy in the 8-year period of review. The youngest and oldest patients were aged 50 and 71 years, respectively. The mean age was 64.2 years. All the patients were diagnosed following 12-core ultrasound-guided transrectal prostate biopsy for elevated serum prostate specific antigen (PSA). The mean serum PSA was 15.3 (range 8.5-100.3) ng/ml. The disease was pT1, pT2, and pT3 in 6, 20, and 8 patients respectively. General anesthesia was employed in 28 (82.4%) patients and combined epidural and subarachnoid block anesthesia for 6 (17.6%) patients. The total duration of operation was 128-252 min (mean = 160 min). No blood transfusion was given in 5 (14.7%) patients while each of the remaining 29 (85.3%) patients had 2-5 units of blood intra- or post-operatively. There was no perioperative mortality. Complications include operation-induced erectile dysfunction in 12 (35.3%), major urinary incontinence in 1 (2.9%), lymphocele in 2 (5.9%), and reoperation due to anastomotic leak and right ureteric injury in 1 (2.9%). After a median follow-up of 42 months, disease recurrence has occurred in 3 (8.8%) patients 1 (2.9%) of whom has died of diabetic renal failure. CONCLUSION: Radical prostatectomy can be safely performed in men with early prostate cancer in Nigeria and should be offered to suitable patients.