Lower urinary tract pathology evaluation in Nigeria: practice and limitations at a private urology centre.

OBJECTIVE: To review the pattern of lower urinary tract (LUT) pathology, showcase the evaluation and management of these conditions and identify if any, limitations to the evaluation and management of these conditions at a private urology centre in Nigeria. METHOD: We reviewed the medical records of all patients presenting with LUT pathology between February 2007 and March 2011. Data such as age, sex, patterns of presentation, findings from evaluation, and surgical pathology were extracted. RESULTS: In all, 412 patients were seen and evaluated. There were 398 males (age range = 40-86 years) with a mean age of 65 +/-12 yrs and 14 females (age range = 27-71 years) with a mean age of 45 +/-19 yrs. The commonest symptom seen in the female patients was urge urinary incontinence in (13, 92.8%) while the remaining female had stress urinary incontinence. All fourteen female patients were evaluated with cystoscopy and urodynamic studies. Pressure-flow studies revealed overactive bladder syndrome in only 4 patients (28.5%) with urge incontinence with no cause of incontinence found in the rest. The most common symptoms in the male patients included LUTS (352, 85.4%), hematuria, (21, 5%) and urinary incontinence (6, 1.4%). Evaluation consisted of uroflometry, post-void residual (PVR) urine measurement and International Prostate Symptom Score (IPSS) assessment respectively in 374 patients (90%), whereas 303 patients (73%) underwent PSA testing. Seventy five patients with LUTS who had PVR > 150 mls under went transrectal ultrasonography (TRUS) of the prostate, of whom 61(81%) underwent further TRUS-guided prostate biopsies. CONCLUSION: Evaluation of LUT conditions using modern medical technology is feasible in a developing country such as Nigeria. While there are no unique technological limitations, the costs of treatment in a private urology centre may present specific challenges to such comprehensive evaluation of patients. Additionally, we show in this study that lower urinary tract conditions are predominantly prostate-related and as in other parts of the world, screening with PSA increases the detection of organ confined prostate cancer.

The burden of specialist urologic care in abuja, federal capital city, Nigeria: a single surgeons 4-year case load.

BACKGROUND: Urologic surgery is believed to form a major part of the surgical workload in many centers but this volume of clinical workload has not been extensively reported. Abuja is Nigeria's capital with a population of about 4 million residents. There are a total of fourteen public general and specialist hospitals with 6 consultant Urologists working in only three of these hospital serving the population. It is not known what proportion of the total surgical workload in Abuja is urological. OBJECTIVE: To report a single Urologist case load in three hospitals in Abuja, Nigeria over a 4 year period. METHODS: The out-patient clinic register, the Medical Records Department register, the surgical wards register and all retrievable patients' case notes of the Urologic Surgery service of the three hospitals were reviewed for extraction of patient's demographic data and clinical records RESULTS: 2167 urological presentations were recorded within the study period. Of these there were 1903 (87.8%) adult males, 140 (6.5%) adult females,122 pediatric males (5.6%) and 2 pediatric females(0.1%) (with an age range of 18-72 years, 22-55 years, 1 month - 12 years and 11-12 years respectively). Mean ages for the adult male and female patients were 44.4 and 33.4 respectively. The mean ages for male children less than 1 year old was 6.9 months and 3.1 years for those older while the mean age the only 2 female children seen was 11 years. The commonest urologic condition seen were male factor infertility in adult males, possibly renal/ureteric calculi in adult females and communicating hydrocele in male children. CONCLUSION: A total of 2167 cases seen during the period under review by a single urologist is suggestive of a significant urology case load in Abuja. Further study is required to determine if this result is a reflection of the burden of specialist urology care in all the tertiary referral health facilities in Abuja, Nigeria's Federal Capital Territory.

An evaluation of the informed consent process for elective surgery at a university hospital.

BACKGROUND: To evaluate on a limited scale the process and quality of the consenting process in our local environment following the increasingly important issue of informed consent and its validity to most physicians and hospital administrators in the face of an emerging litigious Nigeria society. METHODS: A 22 item questionnaire was administered on 60 consecutive patients admitted for elective surgery into the general and specialty surgical wards of the University College Hospital over a one month period. RESULTS: No question in our study achieved the ideal standard of 100%. At the time of admission, 57 of the 60 patients knew their clinical diagnosis from the primary surgical team with 90% (n=54) of the subjects expressing varying degrees of satisfaction with the information they had on their condition. Only about 32% of the patients got additional information on the diagnosis and planned surgery from sources other than the admitting surgical team. In this group of participants there was no significant difference in the sufficiency of information obtained between the two sources (p > 0.05) Ninety percent of the subjects however preferred they had all the information about their operation much earlier than the pre-operation day. Patients satisfaction with overall information obtained during the consenting process was only 'very sufficient' in 35% of the cases. CONCLUSIONS: Notwithstanding the information derived by patients from their primary surgeons in addition to alternate sources, satisfaction with overall information obtained was marginal at 35%. There is a need to look into methods of improving the process, quality and validity of informed consent.

Preoperative analgesia in emergency surgical care in Ibadan.

Pain is the main complaint of patients presenting as surgical emergencies. However, preoperative analgesia has not been studied in developing countries. The adequacy of preoperative analgesia in 106 consecutive acute surgical cases admitted to the Accident and Emergency Department of The University College Hospital, Ibadan, was evaluated using the visual analogue scale and the verbal rating scale. In all, 58% of cases were trauma victims, and the male-to-female ratio was 2.5:1. Analgesia was not prescribed in 45.2% of the patients, 65% of whom were in severe pain. In addition, 81% who were given preoperative analgesia had 'moderate to severe' residual pain. The results showed that provision of preoperative analgesia is inadequate in emergency surgical cases in Ibadan.