Open Ureteric Exploration in Aminu Kano Teaching Hospital: Indications and Outcome.

Background: Open ureteric exploration is an important procedure in urology employed in the management of ureteric obstruction from various causes. Ureteric obstruction is a common urological problem leading to significant morbidity and may lead to obstructive nephropathy in patient with bilateral obstruction or obstruction in a solitary kidney. Objective: The study aims to determine the demographics of patients who underwent open ureteric exploration, indications, and complications associated with open ureteric exploration. Materials and Methods: This is a retrospective review of all patients who had open ureteric exploration between January 2012 and September 2015. A total of 41 patients had the procedure within this period. Their case notes were retrieved; relevant information was collected with a structured proforma and analyzed with SPSS version 17. Result: In the 41 patients reviewed, the age range was 3 to 70 years with mean age of 33.1 ± 12.14. The commonest age group was 21 - 30years accounting for about 32% (n = 13). Male patients account for 68% (n = 28) while females 32% (n = 13). The indications were ureteric stone 58%, ureteric stricture 23% and external compression 19%. The commonest site of obstruction was the distal ureter 84% (n = 36). Ureterolithotomy was the predominant definitive procedure performed in 58% (n = 24). About 24% (n = 9) of patients developed complications, which includes urinary tract infections (UTI), post-operative intestinal obstruction and surgical site infections. Conclusion: The distal ureter was the commonest site of obstruction while the commonest procedure was ureterolithotomy. Open ureteric exploration is still an important option in the management of ureteric obstruction especially in resource constrain areas.

Investigation of confocal microscopy for differentiation of renal cell carcinoma versus benign tissue. Can an optical biopsy be performed?

OBJECTIVE: Novel optical imaging modalities are under development with the goal of obtaining an "optical biopsy" to efficiently provide pathologic details. One such modality is confocal microscopy which allows in situ visualization of cells within a layer of tissue and imaging of cellular-level structures. The goal of this study is to validate the ability of confocal microscopy to quickly and accurately differentiate between normal renal tissue and cancer. METHODS: Specimens were obtained from patients who underwent robotic partial nephrectomy for renal mass. Samples of suspected normal and tumor tissue were extracted from the excised portion of the kidney and stained with acridine orange. The stained samples were imaged on a Nikon E600 C1 Confocal Microscope. The samples were then submitted for hematoxylin and eosin processing and read by an expert pathologist to provide a gold-standard diagnosis that can later be compared to the confocal images. RESULTS: This study included 11 patients, 17 tissue samples, and 118 confocal images. Of the 17 tissue samples, 10 had a gold-standard diagnosis of cancer and seven were benign. Of 118 confocal images, 66 had a gold-standard diagnosis of cancer and 52 were benign. Six confocal images were used as a training set to train eight observers. The observers were asked to rate the test images on a six point scale and the results were analyzed using a web based receiver operating characteristic curve calculator. The average accuracy, sensitivity, specificity, and area under the empirical receiver operating characteristic curve for this study were 91%, 98%, 81%, and 0.94 respectively. CONCLUSION: This preliminary study suggest that confocal microscopy can be used to distinguish cancer from normal tissue with high sensitivity and specificity. The observers in this study were trained quickly and on only six images. We expect even higher performance as observers become more familiar with the confocal images.

Men with sickle cell disease experience greater sexual dysfunction when compared with men without sickle cell disease.

Recurrent ischemic priapism is a common complication of sickle cell disease (SCD). We assessed the burden, characteristics, and types of priapism, including sexual dysfunction, in a cohort of men with and those without SCD, to test the hypothesis that sexual dysfunction is more prevalent in men with SCD. In Kano, Nigeria, we conducted a comparative cross-sectional survey that included 500 and 250 men 18 to 40 years of age, with and without SCD, respectively. The survey used the Priapism Questionnaire and the International Index of Erectile Function for sexual function assessment. All eligible participants approached for the study gave informed consent and were enrolled. Stuttering and major priapism were defined based on the average duration of priapism experiences that lasted ≤4 and >4 hours, respectively. The prevalence of priapism was significantly higher in men with SCD than in those without it (32.6% vs 2%; P < .001). Stuttering priapism accounted for 73.6% of the priapism episodes in men with SCD. Nearly 50% of the participants with SCD-related priapism had never sought medical attention for this complication. The majority of the men with SCD-related priapism used exercise as a coping mechanism. Priapism affected the self-image of the men with SCD, causing sadness, embarrassment, and fear. The percentage of the men with SCD who had erectile dysfunction was more than twofold higher than that of those without SCD who had erectile dysfunction (P = .01). The men with SCD had a higher prevalence of priapism and sexual dysfunction than the men without SCD.

Traumatic penile amputation in a 15-year-old boy presenting late in northwestern Nigeria.

Traumatic penile amputation is a serious urological emergency, although rare whenever it happens, there is a need to refer the patient early to urologist within 24 h, with the stump wrapped in saline; unfortunately, our patient presented late and as such could not benefit from penile reimplantation.