Effect of Perioperative Tranexamic Acid on Blood Loss following Open Simple Prostatectomy: A Prospective Review in Nigerian Men.

BACKGROUND: Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement. METHODOLOGY: This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented. RESULTS: Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups. CONCLUSION: The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve.

CONTEXTE: L'hémorragie est une complication courante après une prostatectomie simple ouverte et les patients doivent parfois recevoir une transfusion sanguine. Il a été démontré que l'acide tranexamique réduit la perte de sang après une résection transurétrale de la prostate et une prostatectomie radicale ouverte. Cette étude a évalué l'effet de l'administration intraveineuse périopératoire d'acide tranexamique sur les pertes sanguines et les taux de transfusion sanguine chez des patients ayant subi une PSO pour hypertrophie bénigne de la prostate. MÉTHODOLOGIE: Il s'agissait d'une étude comparative de patients dont la prostate de 60 g et plus était documentée et qui devaient subir une PSO. L'hématocrite de base a été effectué un jour avant la chirurgie. Les patients ont été répartis aléatoirement dans le groupe acide tranexamique, qui a reçu de l'acide tranexamique periopératoire par voie intraveineuse, et dans le groupe sans TXA, qui a reçu un placebo. Tous les patients ont subi une prostatectomie rétropubienne simple ouverte. L'hématocrite postopératoire a été évalué, et la perte de sang calculée à l'aide de la formule de Gross modifiée. Le taux de transfusion a été documenté. RÉSULTATS: Cinquante-six patients ont participé à cette étude et ont été randomisés entre le groupe avec acide tranexamique et le groupe sans acide tranexamique. L'âge moyen des patients du groupe acide tranexamique était de 66,07 ±7,08 ans et était comparable à celui du groupe sans acide tranexamique qui était de 66,50 ± 8,80 ans (P =0,842). La perte sanguine totale médiane était plus faible dans le groupe avec acide tranexamique (502 ml, IQR 613) que dans le groupe sans acide tranexamique (801 ml, IQR 1069). La différence de la perte de sang médiane entre les deux groupes était de 299 ml (U 275, P 0,055). Le taux de transfusion sanguine était inférieur dans le groupe acide tranexamique (6 patients, 21%) par rapport au groupe sans acide tranexamique (11 patients, 39%), (P =0,146). Il n'y avait pas de différence dans les taux de complication entre les deux groupes. CONCLUSION: L'utilisation de l'acide tranexamique chez les patients subissant une prostatectomie simple ouverte a montré une tendance à la réduction de la perte de sang peropératoire et un besoin moindre de transfusion sanguine. Mots clés: Hypertrophie bénigne de la prostate, Prostatectomie simple ouverte, Hémorragie, Acide tranexamique.

Simple Prostatectomy for Giant Benign Prostatic Hyperplasia in Sub-Saharan Africa: Case Series and Literature Review.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a common cause of bladder outlet obstruction in men worldwide. African men are known to have larger mean prostate volumes than other races. Giant benign prostatic hyperplasia (GBPH) is defined as prostate size greater than 200 grams. Management of GBPH is associated with several challenges which have been under-reported from the African sub-region. OBJECTIVE: To highlight the peculiarities of clinical presentation, surgical management and outcome of GBPH. PATIENTS AND METHODS: Men with BPH and trans-rectal ultrasound estimated prostate volume > 200 grams who were scheduled for open simple prostatectomy between January and December 2016 in our hospital were prospectively studied. RESULTS: Four patients with GBPH had simple prostatectomy during the period under review. Their ages ranged from 68 to 78 years with a mean age of 73.7 years.Three patients (75.0%) had transvesical prostatectomy while one (25.0%) had retropubic prostatectomy. The enucleated prostate specimen were found to weigh 312.1g, 396.4g, 420.8g and 450.0g respectively with mean weight of 394.8 ±50.2g and mean operation time of 111.7 ±19.7 minutes. They all had blood transfusion post-operatively with mean transfusion of 3±1.5 pints of blood per patient with relatively longer hospital stay (mean 10 days). CONCLUSION: The surgical management of GBPH can be quite challenging. Recalcitrant gross haematuria, chronic urinary retention and renal impairment are possible modes of presentation. Open simple prostatectomy is the best option for treatment in our environment. It is associated with improved quality of life and minimal morbidity in expert hands.

INTRODUCTION: L'hyperplasie bénigne de la prostate (HBP) est une cause fréquente d'obstruction de la vessie chez les hommes du monde entier. Les hommes africains sont connus pour avoir des volumes de prostate moyens plus importants que les autres races. L'hyperplasie bénigne géante de la prostate (GBPH) est définie comme une taille de la prostate supérieure à 200 grammes. La gestion du GBPH est associée à plusieurs défis qui ont été sous-déclarés dans la sous-région africaine. OBJECTIF: Mettre en évidence les particularités de la présentation clinique, de la prise en charge chirurgicale et du résultat de la GBPH. PATIENTS ET MÉTHODES: Les hommes atteints d'HBP et d'une échographie trans-rectale d'un volume prostatique estimé> 200 grammes qui devaient subir une prostatectomie simple ouverte entre janvier et décembre 2016 dans notre hôpital ont été étudiés de manière prospective. RÉSULTATS: Quatre patients atteints de GBPH ont eu une prostatectomie simple au cours de la période sous revue. Leur âge variait de 68 à 78 ans avec un âge moyen de 73,7 ans). Trois patients (75,0%) ont eu une prostatectomie transvésicale et un (25,0%) une prostatectomie rétropubienne. L'échantillon de prostate énucléé pesait respectivement 312,1 g, 396,4 g, 420,8 g et 450,0 g avec un poids moyen de 394,8 ± 50,2 g et une durée opératoire moyenne de 111,7 ±19,7 minutes. Ils ont tous eu une transfusion sanguine postopératoire avec une transfusion moyenne de 3 ± 1,5 pintes de sang par patient avec un séjour à l'hôpital relativement plus long (10 jours en moyenne). CONCLUSION: La prise en charge chirurgicale de la GBPH peut être assez difficile. Une hématurie macroscopique récalcitrante, une rétention urinaire chronique et une insuffisance rénale sont des modes de présentation possibles. La prostatectomie simple ouverte est la meilleure option de traitement dans notre environnement. Elle est associée à une meilleure qualité de vie et à une morbidité minimale entre des mains expertes. MOTS CLÉS: Hyperplasie bénigne géante de la prostate, prostatectomie simple, Afrique subsaharienne.

HISTOMORPHOLOGICAL PATTERN OF UROLOGIC MALIGNANCIES IN ILE-IFE, SOUTH-WESTERN NIGERIA.

INTRODUCTION: The last decade witnessed a remarkable rise in the prevalence of several malignant diseases in Nigeria. Whether Urologic malignancies (UM) have followed the same trend remains to be studied. The pattern of UM diagnosed in a Nigerian tertiary hospital is hereby presented. Our aim was to determine the pattern and prevalence of histologically diagnosed UM in Obafemi Awolowo University Teaching Hospitals Complex. Ile-Ife, Nigeria. MATERIALS AND METHODS: A 10-year retrospective review of all patients diagnosed with UM was carried out between January 2005 and December 2014. Data was obtained from the patients' case files and the Ife-Ijesha Cancer registry. Information obtained included demographic characteristics, site of origin and histology. Data was analysed with Statistical package for Social sciences (SPSS) Version 20. RESULTS: A total of 4675 malignancies were histologically confirmed during the study period. UM accounted for 420 (8.9%) of total malignancies. Prostate cancer was the commonest UM with 315 (75%) cases. Others include renal tumours 62(14.8%), bladder tumours 29 (6.9%), testicular tumours 13(3.1%) and scrotal tumour 1(0.2%). UM were commoner in males (348, 88.8%) than females (47, 11.2%) and accounted for 13.8% and 2.18% of all tumours in males and females respectively. CONCLUSION: This study revealed a rising prevalence of UM most especially Prostate and Renal Cancers among other malignancies in Ile-Ife.

SCROTAL SQUAMOUS CELL CARCINOMA AND ASSOCIATED BLINDNESS: A CASE REPORT AND LITERATURE REVIEW.

BACKGROUND: Carcinoma of the scrotum is a rare disease which has been linked with occupational exposure to certain industrial carcinogens. Scanty reports of scrotal carcinoma exist in literature but in very few places worldwide. To our knowledge, there has been one documented report of scrotal carcinoma in our country and this is the first report of scrotal carcinoma in over 45years existence of our tertiary Health institution. We present the clinical evaluation, investigations and surgical intervention of a blind elderly welder with squamous cell carcinoma of the scrotum at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. CASE PRESENTATION AND MANAGEMENT: A 65 year-old blind welder presented to us with a painless fungating scrotal mass of two years' duration. He had prior incision and drainage of the swelling in a primary health centre but this failed to heal, with copious purulent discharge. The mass measured 20cm x 15cm x 8cm and was inseparable from the right testis and cord structures, with infiltration of the root of the penis. The inguinal lymph nodes were not enlarged. CT scan confirmed localized scrotal tumour and biopsy confirmed squamous cell carcinoma.He subsequently had wide local excision of the scrotal tumour (with at least 2cm free margins), right total orchidectomy and advancement flap closure of scrotal defect. Histopathological reports corroborated the earlier findings and confirmed tumour free margins. He has remained well 18 months after surgery. CONCLUSION: Squamous cell carcinoma of the scrotum, though rare, is the commonest malignancy affecting the scrotum worldwide. Surgery still remains the mainstay of treatment and early intervention improves the chances of a favourable outcome.

Benign prostate hyperplasia: average volume in southwestern Nigerians and correlation with anthropometrics.

OBJECTIVES: To determine the prevalent age of symptomatic benign prostate hyperplasia (BPH), the average BPH volume, and the association between BPH volumes and the age, and anthropometrics in our immediate black community. PATIENTS, MATERIALS AND METHOD: Selected patients with lower urinary tract symptoms (LUTS) due to BPH with tissue diagnosis, and adult men of similar age group with no irritative or obstructive LUTS were prospectively studied from July 2003 to June 2009. The age, height and weight were recorded, prostate volumes determined with ultrasound, body mass index (bmi) calculated, and correlations determined between the prostate volume and the age, and anthropometrics. RESULTS: 105 patients aged 43-88 yrs (mean=64.4, 8.88 SD) managed for BPH were studied with 93 asymptomatic men aged 43-80 yrs (mean=56.15, 9.89 SD). The mean (SD) prostate volume, height, weight and bmi were 83.8 (37.7) ml, 1.67 (0.07) m, 63.6 (9.32) kg and 22.8 (3.03) kg/m2, and 24.5 (9.2) ml, 1.69 (0.06) m, 68.9 (10.6) kg and 24.2 (3.44) kg/m2 respectively for symptomatic and asymptomatic groups. In the symptomatic group, BPH volume showed significant positive correlation with the age (p=0.030), but no correlation with the weight (p=0.550), height (p=0.375) and bmi (p=0.840). In the asymptomatic group, prostate volume also showed significant positive correlation with the age (p=0.041), but no correlation with the weight (p=0.434), height (p=0.394), and bmi (p=0.203). CONCLUSION: The prevalent age of symptomatic BPH in our community is 43- 88 years with 83.79 (37.66) ml mean (SD) volume in symptomatic patients and 24.45 (9.21) ml in asymptomatic men. BPH volume correlates with age but not with anthropometrics. Lack of correlation with BPH volume suggests that anthropometrics may not be risk factors for development of BPH in our community.

Benign prostate hyperplasia: average volume in southwestern Nigerians and correlation with anthropometrics.

AIMS AND OBJECTIVES: To determine the prevalent age of symptomatic benign prostate hyperplasia (BPH), the average BPH volume, and the association between BPH volumes and the age, and anthropometrics. PATIENTS, MATERIALS AND METHODS: Selected patients with lower urinary tract symptoms (LUTS) due to BPH with tissue diagnosis, and adult men of similar age group with no irritative or obstructive LUTS were prospectively studied from July 2003 to June 2009. The age, height and weight were recorded; prostate volumes determined with ultrasound, body mass index (BMI) calculated, and correlations determined between the prostate volume, the age and anthropometrics. RESULTS: One hundred and five patients aged 43-88years (mean=64.4, 8.88SD) managed for BPH were studied with 93 asymptomatic men aged 43-80years (mean=56.15, 9.89SD). The mean (SD) prostate volume, height, weight and BMI were 83.8(37.7) ml, 1.67(0.07) m, 63.6(9.32) kg and 22.8(3.03) kg/m2, and 24.5(9.2) ml, 1.69(0.06) m, 68.9(10.6) kg and 24.2(3.44) kg/m2 respectively for symptomatic and asymptomatic groups. In the symptomatic group, BPH volume showed significant positive correlation with the age (p=0.030), but no correlation with the weight (p=0.550), height (p=0.375) and BMI (p=0.840). In the asymptomatic group, prostate volume also showed significant positive correlation with the age (p=0.041), but no correlation with the weight (p=0.434), height (p= 0.394), and BMI (p=0.203). CONCLUSION: The prevalent age of symptomatic BPH in our community is 43-88years with 83.79(37.66) ml mean (SD) volume in symptomatic patients and 24.45(9.21) ml in asymptomatic men. BPH volume correlates with age but not with anthropometrics. Lack of correlation with BPH volume suggests that anthropometrics may not be risk factors for development of BPH.

Testicular schistosomiasis: a case report.

AIMS AND OBJECTIVES: To report a case of testicular Schistosomiasis with a suspicion of testicular cancer. PATIENT AND METHODS: Hospital record of a 16 year old patient with histopathology confirmation of testicular Schistosomiasis was reviewed and summarised. The patient who had painless testicular nodules and ultrasound features of heterogenous echotexture and hypoechoic focus was diagnosed as testicular cancer and treated with radical orchidectomy. Histopathology confirmed testicular Schistosomiasis and the patient had additional praziquantel therapy. RESULTS: Patient was followed up for over 26months post-operative. CONCLUSIONS: Testicular Schistosomiasis can mimick malignant testicular tumour. Hard nodular testicular mass in a patient with recent past history of schistosomiasis should arouse suspicion of testicular Schistosomiasis. Awareness and early presentation will prevent unwarranted orchidectomy.

Primary Swenson's pull-through in children with chronic constipation: a preliminary report.

BACKGROUND: The discrepancy in diameters of the resected ends coupled with the heavy faecal loads in the colon of chronically constipated children with Hirschsprung's disease makes definitive primary pull-through procedure quite difficulty in this group. PATIENTS AND METHODS: Four consecutive patients (aged 5 months to 11 years) who presented with chronic constipation were given warm saline enema along with Castor oil per oram twice daily for 1 week before and 2 weeks after full-thickness biopsies that confirmed Hirschsprung's disease. All patients had intravenous Cefuroxime or Ceftriaxone plus Metronidazole at induction of anaesthesia. Intra-operatively, the levels of resections were 6-8 cm proximal to the most contractile part of the colon adjacent to the transition zone observed after complete division of mesenteric vessels. RESULTS: There were three males and one female, aged 5 months to 11 years. The levels of aganglionosis were in the rectosigmoid region, except one in the descending colon. There was one case each of anastomotic stenoses, mild enterocolitis and deep peri-anal excoriation. The bowel motions were two to four times daily within 1 month post-operatively. CONCLUSION: It can be concluded from this preliminary study that with pre-operative saline enema and oral Castor oil for about 3 weeks in chronically constipated children with Hirschsprung's disease primary pull-through procedures can be performed successfully. However, further prospective work is required with this method.

Laryngeal carcinoma: our experience at Obafemi Awolowo University Teaching Hospital complex, Ile-Ife, Nigeria.

OBJECTIVES: To determine the prevalent age, frequency, pattern ofpresentation, investigations and outcome of management of laryngeal carcinoma in our environment. DESIGN: 10 year retrospective study (January 1994 to December 2003). SETTING: Teaching hospital. SUBJECTS: 13 patients with tissue diagnosis managed for laryngeal carcinoma. MAIN OUTCOME MEASURES: The age, sex, occupation, presentation, use of cigarettes and alcohol, investigations, tissue diagnosis, outcome of management and duration of follow up were extracted from hospital records and analysed. RESULTS: The age of patients ranged 38 to 88 years (median 69, male: female ratio=12:1). The histopathology was squamous cell carcinoma in all. Common symptoms included hoarseness of voice and breathlessness in all the patients, cough and weight loss in seven patients and otalgia in six. Only one patient indulged in alcohol while two were regular cigarette smokers. All the patients presented in stage IV with respiratory distress necessitating emergency tracheostomy in all. Seven patients had total laryngectomy plus post-operative radiotherapy while two patients had pharyngo-laryngectomy, thyroidectomy and radical neck dissection plus post-operative radiotherapy and thyroxine supplement. Post operative complications included pharyngocutaneous fistula in two patients, pharyngeal stenosis, stoma stenosis, and hypocalcaemia with hypothyroidism in one patient each. The fistulae were management conservatively. Prognosis was good despite late presentation. CONCLUSION: Laryngeal carcinoma occurs predominantly in males. Presentation is late with hoarseness of voice and breathlessness in our community. Soft tissue neck X-ray is a useful diagnostic tool. Scarcity of radiotherapy centres, ignorance, local taboos, poverty and poor recognition by general medical practitioners negatively affected management of the patients. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma.

Adult nephrectomy: our experience at Ile-Ife.

OBJECTIVES: To determine indications for adult nephrectomy in our community and the outcome of the procedure in our Institution. MATERIALS AND METHOD: Records of adult patients scheduled for nephrectomy at Obafemi Awolowo University Teaching Hospital from January 1993 to December 2004 were reviewed. Information extracted and analysed included age of patient, sex, presentation, investigations, indication, type and outcome of nephrectomy, histopathology result and duration of follow up. RESULTS: During the period, thirty adult patients mean age 42.73 yrs (range 16-80 yrs, M:F = 2:1) were scheduled for nephrectomy. Indications included suspicion of malignancy in 19 (63.3%) patients, protracted loin pain in non-functioning kidney in 2 (6.7%), uncontrollable bleeding in a patient with bilateral polycystic kidney (3.3%), pyonephrosis with septicaemia in a patient (3.3%), kidney injury (grade 5) in 2(6.7%) and kidney donation for transplantation in 3(10%). Ultrasound and intravenous urography were useful in the patients' evaluation. Twenty-seven (90%) patients were operated upon, but only 25 (83.3%) had nephrectomy. Sixteen (53.3%) had radical nephrectomy, 5 (16.7%) had simple nephrectomy, 3 (10%) had nephro-ureterectomy, and one (3.3%) had partial nephrectomy. Major surgical complications included wound sepsis (18.5%) and primary haemorrhage (7.4%). The overall morbidity and mortality rates were 7.4% and 3.7% respectively. Postuninephrectomy, patients' renal function remained stable after an average of 34.05 months follow-up. CONCLUSION: Renal tumours constitute the main indication for adult nephrectomy in our community. Kidney injury, kidney donation, and pyonephrosis are relatively uncommon indications. Open nephrectomy, which remains our local practice, is safe and unilateral nephrectomy is compatible with normal life.

Complete recovery of renal allograft function after sixty days of delay following living related transplantation.

Delayed graft function (DGF), a term employed when a newly transplanted organ does not function efficiently is commonly observed following cadaveric renal transplantation but is very rare after living related transplants. We present a 31-year-old female recipient of a related donor kidney (mother) who had DGF following trans-plantation due to acute tubular necrosis, probably caused by partial allograft arterial thrombosis, which recovered function after 60 days. Appropriate use of allograft biopsy should be encouraged even in resource-limited settings lest the allograft be assumed to have failed irreversibly.

Malignant renal tumors in adults: a ten-year review in a Nigerian hospital.

This study was undertaken to determine the age, sex, pattern of presentation, histopathology and outcome of management of adult patients with malignant renal tumors (MRT) in Nigeria. Using hospital records, a retrospective study was performed covering the period between January 1997 and December 2006. A total of 18 adult patients had been diagnosed to have MRT during this period. Information extracted and analyzed included the age of the patient, sex, presentation, investigations, type of histopathology, management and duration of follow-up. The mean age of the study patients was 47.5 years (range 16-80 yrs). The male: female ratio was 13 : 5 and the mean duration of symptoms was 43.6 weeks (range 2-104 wks). Sixteen patients (88.9%) presented in advanced stage. Symptoms included loin pain in 17 (94.4%), abdominal swelling in 15 (83.3%), weight-loss in 13 (72.2%) and hematuria in nine (50.0%). Ultrasound and intravenous urography assisted greatly in making the diagnosis. Thirteen patients (72.2%) underwent radical nephrectomy, tumors were not resectable in two (11.1%) and three others (16.7%) were deemed unfit to undergo surgery. The average tumor mass removed at surgery was 1.884 Kg (range 0.48-3.82 Kg). Renal cell carcinoma (RCC) accounted for 13 of the tumors (72.2%). Surgical complications include primary-hemorrhage, septicemia and tumor recurrence in one patient each (7.6%). Morbidity and mortality rates were 7.6% each. The average post-operative hospital stay and follow-up duration were 9.3 days and 37.5 months respectively. Our study suggests that RCC is the major MRT in our community. Most cases still present late with loin pain and swelling, weight loss and hematuria. This late presentation and sarcomatous type of tumor have negative influence on prognosis. Radical nephrectomy is beneficial in operable, locally advanced, non-metastatic MRT.

Giant renal oncocytoma masquerading as infiltrating renal cell carcinoma: case report and literature review.

Renal oncocytomas (RO) are tumours containing a population of cells with highly differentiated eosinophilic granular cytoplasm, extremely rich in mitochondria. It is estimated they account for about 3 to 7% of all solid renocortical tumours that were previously regarded as renal cell carcinoma. Based on their clinical behaviour and distinct pathologic features they are now regarded as benign renal tumours, often less than 5cm in diameter. We present a case of giant renal oncocytoma in a patient with synchronous bladder tumour, with pre-operative clinical, urographic and ultrasound features of locally advanced renal cell carcinoma (RCC). Findings at surgery included huge right renal tumour with infiltration to the duodenum; hepatic colic flexure; gall bladder; liver capsule and the greater omentum with small indurations at the base of the bladder. There was no tumour extension to the renal vein, no peritoneal seedling, no nodal metastasis and no ascites. Radical nephrectomy was carried out with good prognosis and without recurrence 52months post nephrectomy. This presentation, besides highlighting the possible giant nature of RO, also illustrates the malignant potential of RO to infiltrate contiguous structures and mimics infiltrating RCC. In view of the difficulties at establishing pre-operative diagnosis in this disease and because nephron-sparing surgery is curative, especially for the well-circumscribed tumours, RO should be considered in the management of patients with features of infiltrating RCC. A review of literature is also presented.

Priapism in southwestern Nigeria.

OBJECTIVES: To determine the aetiology, pattern of presentation, treatment regimen and outcome of management of priapism in our environment and to compare our findings with previous studies in this country and elsewhere. DESIGN: A 10-year retrospective study from January 1991 to December 2000. SETTING: Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. PATIENTS AND METHODS: Hospital records of 16 patients managed for priapism over 10 years (January 1991 to December 2000) were analysed. Information extracted included the age, occupation, duration of symptoms, precipitating factors, past medical history, haemoglobin genotype, drug and social history, physical findings, treatment regimen, outcome of treatment, complications and duration of follow up. Eighteen patients were treated for priapism during the period but only sixteen case files available for analysis were reviewed in this study. RESULTS: The mean age of the 16 patients under review was 20.4 years (range: 2.5-38 years). Thirteen patients (81%) were single and 10 (62.5%) were students. All the patients presented late with pain and woody hard penis with mean duration of eight days (range; 7 hrs-30 days). Eleven patients (68.7%) had previous episodes of priapism. Fourteen patients (87.5%) had sickle cell disease (SCD) and two (12.5%) were psychiatric patients on oral chlorpromazine. Associated medical conditions include urinary tract infection, malaria, acute urinary retention, bone pain crises and acute psychosis. All the patients received initial conservative management. Six patients had needle aspiration with irrigation plus injection of 2 ml of adrenaline solution (1 ml 1/1000 adrenaline in 200 ml saline) in both corpora cavernosa. One (16.7%) out of the six patients achieved full detumescence with normal erection. The remaining five patients later had cavernotomy with full detumescence and normal erection in three (60%) and weak erection in two (40%). Eight patients had Cavernosa-glandular shunt, full detumescence and normal erection was achieved in five patients (62.5%) while three (37.5%) became impotent. Two of the three patients with impotence presented with the longest duration of symptoms (14 and 30 days respectively), while the third patient reported earlier after five days, but he had suffered more than six (>6) previous attacks of priapism. Duration of hospital stay was 3-10 days and the average duration of follow up was 80.7 weeks. CONCLUSION: Sickle cell disease account for 87.5% of priapism in our community. Late presentation and previous episodes of priapism, which are common features in most of these patients, are associated with poor prognosis with higher risk of impotence. Conservative management and aspiration with intracavernous adrenaline therapy appears ineffective in late case. However, good results obtained with surgery indicate that late presentation should not be a deterrent to surgical intervention. Surgeries in form of cavernotomy or cavernosa-glandular shunt, when carefully done, are effective and safe.

Accidental injuries and cutaneous contaminations during general surgical operations in a Nigerian teaching hospital.

OBJECTIVE: To determine the prevalence of accidental injuries and body contaminations among the operating personnel during general surgical operation, those involved, the circumstances surrounding the injuries or body contaminations and the factors affecting the prevalence in a unit of a teaching hospital in Nigeria. DESIGN: Patients operated for general surgical conditions in a unit of a Teaching Hospital Complex during a period of two years (1997-1998) were studied. A proforma was designed to enter personal biodata, preoperative and intra-postoperative clinical information of all the patients. SETTING: Wesley Guild Hospital a unit of teaching hospital complex serving the large agrarian rural and semi-urban Nigerians. PATIENTS: Five hundred and eighty nine consecutive general surgical patients. All types of general surgical operations were included, emergency or elective, major or minor, carried out during the day or at night. INTERVENTION: All the patients were operated and operating personnel observed for sharp injuries and body contamination. MAIN OUTCOME MEASURES: Incidence of sharp injuries and cutaneous contamination and personnel at risk determined. RESULTS: Operating personnel sustained 62 sharp injuries (10.5%), these were caused by suture needle in 57 cases (92.0%), towel clips in three (4.8%), knife cut in two (3.2%). Operating physicians sustained 56 cases of sharp injuries (90.3%) and Scrub Nurses in six (9.7 %). Self-inflicted sharp injuries in 49 (79 %) and in 12 cases (21%) injuries were inflicted by the surgeons or their assistants. Left hand was injured in 39 cases (63%) and right in 23 (37%). Cutaneous or mucosa membrane contamination with blood or body fluid occurred in 232 cases (39.4 %). These were made up of wet gown contamination in 124(53.5 %), glove failure in 72(31%) and splashing of blood or fluids into the face or eyes in 36 cases (15.5 %). Contamination occurred in more than one operating personnel in more than half of the cases. Operating surgeons were affected in 211 cases (91%). The risks of accidental injuries and blood and body fluid contamination were significant, if the duration of the operation was more than one hour, among the operating surgeons and if the operation was major (p<0.05). CONCLUSION: This study has demonstrated that cutaneous, percutaneous, and mucous membrane exposure to patients blood and body fluids are common events during general surgical operations. Most accidental injuries were due to solid suture needle-sticks, mostly injured personnel were the primary operating surgeons, injuries occurred predominantly on the left hand. This may poses a significant risk of infection with blood borne pathogens when operating on infected patients.

Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria.

OBJECTIVE: To determine the incidence, pattern and outcome of obstructed abdominal wall hernia in a semi-urban and rural community. DESIGN: A proforma was drafted to study all consecutive patients operated for obstructed anterior abdominal wall hernia over a period of five years. Clinical findings, preoperative treatment, operative findings and postoperative outcome were documented. SETTING: Teaching hospital located in a semi-urban community comprising mostly agrarian population. PATIENTS: A total 110 adult patients with obstructed anterior abdominal wall hernia who had operative intervention and other postoperative management. RESULTS: There were 110 patients with 111 obstructed hernias, accounting for 26.4% of all abdominal wall hernias. The age ranged from 19-79 years with mean of 49.7 years. Males accounted for 81%. Inguinoscrotal hernia was the commonest occurring in 75.7%, 16.2% patients presented with inguinal hernia and five patients with femoral hernia. The greater proportion of inguinal hernia occurred in female. Eighty seven patients (79%) had emergency operations and elective in 23 patients (21%) who had spontaneous reduction while awaiting surgery. Ninety two percent of inguinoscrotal/inguinal hernia were indirect. Omentum was trapped in 52 hernias (47.%), while in 15 patients (13.6%), gangrenous bowel segments were discovered. Scrotal oedema was the commonest complication accounting for 21%, while wound infection occurred in 20%. There were three deaths in elderly men with clinical symptoms and signs of acute intestinal obstruction and gangrenous bowel segments, accounting for 2.7% of the patients. Twenty eight per cent of patients were discharged within the first and second postoperative days. Two patients spent 36 and 56 days each in the hospital. CONCLUSION: This study showed that 26.4% of abdominal hernia presented with obstruction. With inguinoscrotal hernia predominating: male accounted for 81% and 13.6% of the obstructed hernia contained gangrenous bowel segments. Post-operative complications were common, mortality occurring mainly in elderly patients with late presentation.