Transrectal Ultrasound Guided Prostatic Biopsy and its Complications: A Descriptive Cross-sectional Study.

INTRODUCTION: Transrectal ultrasound of prostate provides better visual for biopsy. Transrectal ultrasound guided prostate biopsy is usually performed in men with an abnormal digital rectal examination, and elevated prostate specific antigen (>4ng/ml) or prostate specific antigen velocity (rate of prostate specific antigen change) i.e., >0.4-0.75ng/ml/year. The aim of the study is to find out the complications of transrectal ultrasound guided prostatic biopsies. METHODS: This descriptive cross-sectional study was done among 50 patients who transrectal ultrasound guided prostatic biopsies in a tertiary care hospital, from July 2017 to July 2019 after receiving ethical approval from the Institutional Review Committee of Kathmandu Medical College and teaching hospital. Convenient sampling was done. All patients were informed about the potential benefits and risks of the transrectal ultrasound guided prostate biopsy and patients signed an informed written consent form. Statistical analysis was done by using Statistical Package for Social Sciences version 16. RESULTS: Mean prostate specific antigen was 34.571 and mean weight of prostate was 44.6gm. Moderate to severe pain was experienced by 15 (30%), 2 (4%) had hematuria with fever accounting for 3 (6%) patients. All were managed conservatively with no mortality related to the procedure and complication. Three patients was positive for malignancy on re-biopsy. CONCLUSIONS: Transrectal ultrasound guided biopsy of prostate is a pioneer experience in Nepal. It has proved to be an useful tool of diagnosis of suspected carcinoma of Prostate. Use of neurovascular block may reduce the pain during the procedure.

[Preoperative PSA levels and development of PSA after 180-W XPS greenlight laser treatment of the prostate: what is the reality in clinical routine practice?] / Präoperative PSA-Werte und PSA-Verlauf nach 180-Watt-XPS-Greenlight-Laserung der Prostata ­ wie ist die Realität im klinischen Alltag?

INTRODUCTION: The aim of this retrospective study was to evaluate preoperative levels of PSA (prostate-specific antigen) and the postoperative development after 180-W XPS™ greenlight laser treatment of the prostate under real-world conditions. METHOD: Preoperative PSA levels were evaluated in 749 patients undergoing a 180-W XPS greenlight laser procedure from 2012 to 2017 in Witten, Germany, in relation to age, volume of the prostate, urinary tract infection, Foley catheter and co-morbidities. The postoperative development of PSA was identified by retrieving PSA levels from general practitioners or urologists. RESULTS: The average age of the patients was 73.33 ±â€Š9.26 years. The prostate volume measured by rectal ultrasound was 42.42 ±â€Š18.33 ml. Median preoperative PSA was 2.59 ng/ml. In 268 patients (35.8 %), the PSA level was above 4 ng/ml. It was evaluated by prostate biopsy in 106 patients (39.6 %). 6 months after the surgical procedure (n = 86), PSA decreased to 1.25 ng/ml and increased slightly to 1.46 ng/ml after 12 months (n = 126). Logistic regression analysis demonstrated that a PSA level elevated to more than 4 ng/ml preoperatively is related to prostate volume (p = 0.001) the existence of a transurethral Foley catheter (p = 0.002), but not to age (p = 0.349), the existence of a suprapubic catheter (p = 0.207), an infection of the lower urinary tract (p = 0.966) and the number of co-morbidities mentioned in the discharge letter (p = 0.936). DISCUSSION: In line with expectations and clinical trials, there was a postoperative decrease of PSA by more than a half of the preoperative value. Significant factors related to preoperative elevation of the PSA level were prostate volume, a transurethral Foley catheter instead of the suprapubic type of catheter and a urinary infection. Although elevated PSA levels were seen in about one third of patients, evaluation by prostate biopsy was only performed in 39.6 % of these patients due to their performance status and other clinical issues.

Selenium Supplementation and Prostate Health in a New Zealand Cohort.

BACKGROUND: There is variable reporting on the benefits of a 200 µg/d selenium supplementation towards reducing prostate cancer impacts. The current analysis is to understand whether stratified groups receive supplementation benefits on prostate health. METHODS: 572 men were supplemented with 200 µg/d selenium as selinized yeast for six months, and 481 completed the protocol. Selenium and prostate-specific antigen (PSA) levels were measured in serum at pre- and post-supplementation. Changes in selenium and PSA levels subsequent to supplementation were assessed with and without demographic, lifestyle, genetic and dietary stratifications. RESULTS: The post-supplementation selenium (p = 0.002) and the gain in selenium (p < 0.0001) by supplementation were significantly dependent on the baseline selenium level. Overall, there was no significant correlation between changes in PSA and changes in selenium levels by supplementation. However, stratified analyses showed a significant inverse correlation between changes in PSA and changes in selenium in men below the median age (p = 0.048), never-smokers (p = 0.031), men carrying the GPX1 rs1050450 T allele (CT, p = 0.022 and TT, p = 0.011), dietary intakes above the recommended daily intake (RDI) for zinc (p < 0.05), and below the RDI for vitamin B12 (p < 0.001). CONCLUSIONS: The current analysis shows the influence of life factors on prostate health benefits of supplemental selenium.

The impact of surgical duration on complications after transurethral resection of the prostate: an analysis of NSQIP data.

BACKGROUND: Transurethral resection of the prostate is the most commonly performed procedure for the management of benign prostatic obstruction. However, little is known about the effect surgical duration has on complications. We assess the relationship between operative time and TURP complications using a modern national surgical registry. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2006 to 2016 for patients undergoing TURP. Patients were separated into five groups based on operative time: 0-30 min, 30.1-60 min, 60.1-90 min, 90.1-120 min, and greater than 120 min. Standard statistical analysis, including multivariate regression, was performed to determine factors associated with complications. RESULTS: 31,813 patients who underwent TURP were included. The overall complication rate was 9.0% and increased significantly with longer surgical duration (p < 0.001). Longer operative time was associated with a greater risk of postoperative sepsis or shock, transfusion, reoperation, and deep vein thrombus or pulmonary embolism. Longer surgical duration was associated with increased odds of any complication and, specifically, blood transfusion after controlling for age, race, comorbidities, American Society of Anesthesia (ASA) class, type of anesthesia administered, and trainee involvement. The adjusted risk of each of the above complications remained significantly increased for surgeries lasting longer than 120 min. CONCLUSIONS: As surgical duration increases, there is a significant increase in the rate of complications after TURP. These data demonstrate that this procedure is safest when performed in under 90 min.

The prevalence of midline prostatic cysts and the relationship between cyst size and semen parameters among infertile and fertile men.

STUDY QUESTION: When is the investigation and treatment of midline prostatic cysts (MPC) of clinical value in the work-up of males of infertile couples? SUMMARY ANSWER: With a prevalence of 10.2% in infertile men, MPC should be investigated according to a seminal algorithm detecting a MPC volume >0.117 ml, which may impair semen parameters, and could be treated to improve sperm count and achieve natural pregnancy. WHAT IS KNOWN ALREADY: MPC are frequent and are considered a correctable cause of male infertility. However, they have been poorly investigated in an infertility setting. In addition, no study has investigated clinical and ultrasound (US) characteristics of men with MPC. STUDY DESIGN, SIZE, DURATION: A cross-sectional analysis was carried out of 693 consecutive subjects consulting for couple infertility from September 2012 to March 2017. As a control group, 103 age-matched healthy, fertile men were studied. Furthermore, a longitudinal evaluation of 11 infertile men undergoing trans-rectal ultrasonically-guided cyst aspiration (TRUCA), semen analyses 1 and 3 months after TRUCA and a follow-up 1 year after TRUCA to assess natural pregnancy were performed. PARTICIPANTS/MATERIALS, SETTING, METHODS: All subjects underwent, in our outpatient clinic, clinical, hormonal, scrotal and transrectal US evaluation and semen analysis within the same day. Of 693 males of infertile couples, 648 (37.1 ± 7.9 years, mean+SD) without genetic abnormalities were studied, along with 103 fertile men (36.6 ± 5.0 years). Eleven infertile men underwent TRUCA and were followed-up as reported above. MAIN RESULTS AND THE ROLE OF CHANCE: A MPC was present in 66/648 (10.2%) males of infertile couples and in 6/103 (5.8%) fertile men. MPC occurrence and volume were higher in patients with severe oligo- or azoospermia than in fertile men (all P < 0.05). Infertile men with a MPC showed a lower seminal volume and sperm count and a higher prevalence of azoospermia than the rest of the infertile sample or fertile men, and a higher frequency of US signs suggestive of ejaculatory duct obstruction. MPC volume was negatively associated with total sperm count (r = -0.452, P < 0.0001). In fertile men, the highest MPC volume was 0.117 ml, suggesting it as a biological threshold not compromising semen quality. In infertile men, using receiver operating characteristic curve analyses, a MPC volume >0.117 ml identified subjects with severe oligo- or azoospermia with an overall accuracy of ~75% (both P < 0.005). Eleven men with infertility, semen abnormalities and large MPC (>0.250 ml) underwent TRUCA, which led to sperm count improvement in all patients 1 month after surgery. Three months after TRUCA a lower sperm count and a higher MPC volume than 2 months before were observed (P < 0.005 and P < 0.05, respectively), although improved when compared to baseline. After TRUCA a natural pregnancy occurred in four couples. Finally, we propose an algorithm, based on semen parameters, useful in identifying a MPC in males of infertile couples. LIMITATIONS, REASONS FOR CAUTION: Although in line with the sample size of previous studies (n = 7-20), the number of infertile men with MPC evaluated longitudinally after treatment is limited (n = 11). In addition, although a MPC volume >0.117 ml can negatively affect the sperm count, only MPC > 0.250 ml have been treated in this study. WIDER IMPLICATIONS OF THE FINDINGS: First, the algorithm proposed is easy to use and useful for selecting patients who can benefit from a prostate US in the infertility work-up. Second, a MPC volume ≤0.117 ml may not impair semen quality, while a larger volume can lead to severe oligo- or azoospermia and could be treated. Third, TRUCA is effective, and simpler and less invasive than other surgical techniques for MPC treatment. Finally, since the MPC can increase in size and sperm count decrease over time after TRUCA, semen cryopreservation should be considered 1 month after TRUCA. STUDY FUNDING/COMPETING INTEREST(S): Grants from the Ministry of University and Scientific Research (SIR project to F.L., protocol number: RBSI14LFMQ). No conflicts of interest.

[Analysis of the prevalence and related risk factors of prostate diseases in traffic policemen].

Objective: To investigate the prevalence and related risk factors of prostate diseases in traffic policemen. Methods: A total of 848 traffic policemen who took part in the physical examination among August and September in 2016 were selected as research subjects, and a questionnaire survey was conducted to collect their information including smoking, alcohol drinking, biological and physiological indicators, as well as prostate disease etc. The relationship between the prevalence of prostate diseases and related risk factors was analyzed by Non-conditional Logistic Regression. Results: The total prostate disease prevalence rate was 40.2% in the study subjects, and there is statistical significance (P<0.05) of differences between prostate disease group and non disease group in age, work age, smoking, drinking and field work. Single factor analysis showed that age, work age, smoking, and field work are independent risk factors of prostate disease (P<0.05) . Multivariate Logistic regression analysis showed that increasing age (OR 1.03) , smoking (OR 1.92) and field work time (OR 1.47) significantly increased the risk of prostate disease in male police after age, smoking, drinking, BMI, systolic blood pressure, diastolic blood pressure, fasting blood glucose, blood lipids and other indicators were adjusted. Conclusion: age, smoking and field work time are risk factors of prostate diseases in the traffic police. There is great significance in publicizing the harmful effects of smoking and reducing the duration of field work.

Atrazine induced epigenetic transgenerational inheritance of disease, lean phenotype and sperm epimutation pathology biomarkers.

Ancestral environmental exposures to a variety of environmental toxicants and other factors have been shown to promote the epigenetic transgenerational inheritance of adult onset disease. The current study examined the potential transgenerational actions of the herbicide atrazine. Atrazine is one of the most commonly used herbicides in the agricultural industry, in particular with corn and soy crops. Outbred gestating female rats were transiently exposed to a vehicle control or atrazine. The F1 generation offspring were bred to generate the F2 generation and then the F2 generation bred to generate the F3 generation. The F1, F2 and F3 generation control and atrazine lineage rats were aged and various pathologies investigated. The male sperm were collected to investigate DNA methylation differences between the control and atrazine lineage sperm. The F1 generation offspring (directly exposed as a fetus) did not develop disease, but weighed less compared to controls. The F2 generation (grand-offspring) was found to have increased frequency of testis disease and mammary tumors in males and females, early onset puberty in males, and decreased body weight in females compared to controls. The transgenerational F3 generation rats were found to have increased frequency of testis disease, early onset puberty in females, behavioral alterations (motor hyperactivity) and a lean phenotype in males and females. The frequency of multiple diseases was significantly higher in the transgenerational F3 generation atrazine lineage males and females. The transgenerational transmission of disease requires germline (egg or sperm) epigenetic alterations. The sperm differential DNA methylation regions (DMRs), termed epimutations, induced by atrazine were identified in the F1, F2 and F3 generations. Gene associations with the DMRs were identified. For the transgenerational F3 generation sperm, unique sets of DMRs (epimutations) were found to be associated with the lean phenotype or testis disease. These DMRs provide potential biomarkers for transgenerational disease. The etiology of disease appears to be in part due to environmentally induced epigenetic transgenerational inheritance, and epigenetic biomarkers may facilitate the diagnosis of the ancestral exposure and disease susceptibility. Observations indicate that although atrazine does not promote disease in the directly exposed F1 generation, it does have the capacity to promote the epigenetic transgenerational inheritance of disease.

Evaluation of dogs with macroscopic haematuria: a retrospective study of 162 cases (2003-2010).

AIMS: To retrospectively describe clinical features of dogs that were presented to a small animal clinic between 2003-10 with macroscopic haematuria, and investigate whether signalment of the dog and severity and duration of the haematuria at admission were associated with specific aetiologies. METHODS: Medical records were evaluated of 162 dogs with macroscopic haematuria admitted to a University-based small animal clinic in Thessaloniki, Greece, from January 2003 to December 2010. The inclusion criteria were discolouration of the urine sediment combined with abnormal numbers of erythrocytes, when examined microscopically. Data collected from the medical records included signalment, severity, frequency and duration of haematuria, and diagnosis. RESULTS: Between January 2007 and December 2010, 8,893 dogs were admitted to the clinic; of these 99 (1.1%) were admitted with haematuria. Of the 162 dogs with records of haematuria, 80 (49.4%) were aged between 5.1-10 years, presented with acute (96/162; 59.3%), constant (99/162; 61.1%) and mild/moderate (150/162; 92.6%) haematuria. Of 147 dogs with a recorded diagnosis, the commonest diagnoses were urinary tract infection (UTI, 42/147; 28.6%), urolithiasis (38/147; 25.9%), prostatic disease (25/147; 17.0%) and urinary tumours (13/147; 8.8%). The prevalence of UTI was higher in female (22/56; 39%) than male (20/91; 22%) dogs, and in medium sized (22/52; 42%) than small (6/40; 15%) dogs. Urolithiasis was most prevalent in small (21/40; 52.5%) dogs, and all dogs with urolithiasis presented with mild/moderate haematuria. The prevalence of prostatic disease was highest in large (11/46; 24%) and giant (3/9; 33%) sized dogs and in dogs aged >10 years (8/30; 27%). CONCLUSIONS AND CLINICAL RELEVANCE: In this retrospective study from one small animal clinic, UTI, urolithiasis, prostatic disease and urinary tumours predominated among the causes of canine haematuria. The consideration of sex, age, and size of the dog and characteristics of haematuria were found to be useful parameters when forming the list of differential diagnoses.

Postoperative Outcome in Patients with Pulmonary Hypertension Undergoing Elective Non-Cardiac Surgery.

INTRODUCTION: The impact of pulmonary artery hypertension on post-operative outcome in elective, non-cardiac surgery is incompletely understood. This study was designed to evaluate the post-operative outcome of patients undergoing elective, non-cardiac surgery with and without pulmonary hypertension. METHODS: The study was conducted in an inner-city hospital in Bronx, New York. A retrospective chart review was conducted on all patients who underwent elective, non- cardiac surgery from January 2000 to December 2010 and had echocardiogram within 30 days of surgery. Patients with systolic pressure of ≥35mm of Hg as estimated by echocardiogram were enrolled. Case matched peers with normal pulmonary pressures served as controls. Post-operative outcomes were compared between the two groups. RESULTS: A total of 66 patients were analysed, 33 cases and 33 controls. All patients were followed up to 30-day post-surgery. Heart failure, myocardial infarction, arrhythmia, stroke, delayed extubation and deaths were measured in both the groups. There were two deaths in the control group while there were three deaths in pulmonary hypertension group (statistically not significant, P >0.05). A total of three patients in pulmonary hypertension group had adverse outcome (one had a major arrhythmia, one had delayed extubation (>24 hours) and one had stroke). Whereas two patients in control group had adverse outcome (one had delayed extubation (>24 hours) and one had major arrhythmia). CONCLUSIONS: Pulmonary hypertension does not affect the post-operative outcome in the first 30 days for elective non-cardiac surgery.

A retrospective study of canine prostatic diseases from 2002 to 2009 at the Alfort Veterinary College in France.

A retrospective study was used to investigate the incidence of prostatic diseases in a large population of dogs at Alfort Veterinary Hospital and to clarify epidemiologic features, which might be of a great help to veterinarians in managing and discriminating prostatic disorders. During the investigation period, a total of 72,300 male dogs (coming mainly from the Ile-de-France region) were registered in the Alfort Veterinary College database, and 481 of them (0.7%) were found to have prostatic disorder. The diagnosis was carried out on the basis of clinical signs and ultrasound findings. Among dogs experiencing a prostatic disorder, most frequently recorded diseases were benign prostatic hyperplasia (45.9%) and prostatitis (38.5%), followed by abscesses (7.7%), cysts (5.0%), neoplasia (2.6%), and squamous metaplasia (0.2%). Our study revealed an incidence of 0.3% of prostatic disorders observed in intact male dogs, except in the case of prostatic neoplasia. The mean age of the dogs experiencing prostatic disorders was 8.6 ± 3.2 years. This was significantly different (P < 0.001). Large dogs were significantly more affected by prostatic disorders (P < 0.05), except for prostatic neoplasia. A breed predisposition was suspected in German Shepherd (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.5-2.9), Rottweiler (OR = 1.8; 95% CI: 1.2-2.7), American Staffordshire Terrier (OR = 3.8; 95% CI: 2.5-5.8), Berger de Beauce (OR = 3.7; 95% CI: 2.2-6.1), and Bernese Mountain Dog (OR = 2.5; 95% CI: 1.3-4.7).

[Evaliating men's health survey results within the framework of "men's health school"].

Within the framework of "Men's Health School" 571 men were examined in 2014. The mean age of the surveyed men was 49.66+/-14.5 years. 86% (227) of the surveyed men had PSA levels from 0 to 4 ng/ml. Prostate ultrasound scan showed prostate enlargement in 37.2%+/-6.0 of men. The disturbances of libido or sexual life were registered in 45.5% (221) of the surveyed men. 58% of patients reported insufficient penile rigidity for sexual intercourse, 50% reported a sharp decrease in the amount of ejaculate, and 10% - pain during erection. Detailed medical history showed that in many patients the disease was provoked by family discord. The study findings revealed the poor condition of the male reproductive system in Kazakhstan. Resolving this problem requires considerable logistical costs, and an integrated approach to the early detection of diseases of the male reproductive system. The reproductive health of men was found to be affected by somatic, psychological and sexual health factors. At present we can say about the need for such "Men's Health School" in all regions on a regular basis, especially with the training of the primary care physicians.

Prevalence of prostatic calcification subtypes and association with prostate cancer.

OBJECTIVE: To evaluate the prevalence and to classify prostatic calcification on transrectal ultrasonography (TRUS) and correlate the findings with histology. METHODS: A prospective, blinded study of men undergoing TRUS and prostatic biopsy was designed. A standardized reproducible technique was used with a BK 7.5- to 12.5-MHz multiplanar probe. Representative images of the calcification in the sagittal and transverse planes were captured. Blind analysis by an experienced observer was performed. TRUS findings were categorized using a novel classification and correlated with histologic data. RESULTS: A total of 274 patients (58.8%) had prostate cancer, 88 patients (18.9%) inflammation, and 104 patients (22.3%) had benign pathology. Interface calcification was present in 42.3% of patients. Peripheral or transitional zone calcification was unusual (6.8% and 9.0%, respectively). Of the peripheral zone calcification group patients, 78.1% had cancer on histology examination (P = .020). CONCLUSION: Prevalence and characteristics of prostatic calcification have been described using this novel and practical classification. Although interface calcification is common and not associated with any particular pathology, peripheral zone calcification appears to be strongly associated with prostate cancer.

Smoking, occupation, history of selected diseases and bladder cancer risk in Manisa, Turkey.

The aim of the study was to identify and quantify the reasons for the high bladder cancer rates in Turkey. We conducted a case-control study in Manisa, Turkey, in 2011. The study included 173 patients with incident, histologically confirmed bladder cancer and 282 controls who were frequency matched by age, sex and geographic area, admitted to the main hospital of Manisa for a wide range of acute diseases. Adjusted odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were derived from multiple logistic regression models. Compared with never smokers, the OR was 2.9 (95% CI 1.5-5.4) for moderate (<20 cigarettes/day) and 4.0 (95% CI 1.7-9.6) for heavy smokers. The association was stronger for unfiltered black tobacco (OR=5.4) and for longer duration of smoking (≥40 years, OR=5.3). There was a strong inverse correlation with social class indicators, with ORs of 0.2 (95% CI 0.1-0.4) for more-educated compared with less-educated individuals. There was no significant association with a group of five occupations a priori defined as being of high risk (OR=1.3), nor with farming (OR=1.2). Bladder cancer risk was directly related to the history of urinary tract infections (OR=1.9, 95% CI 1.2-3.1) but not to diabetes (OR=0.7) or kidney (OR=0.7) and prostate (OR=1.3) diseases. Tobacco is the major risk factor for bladder cancer in Manisa, being responsible for 56% of cases; urinary tract infections account for 19% of cases, whereas the role of occupational exposure is limited in this, predominantly rural, population.

Male reproductive health disorders among Aboriginal and Torres Strait Islander men: a hidden problem?

OBJECTIVE: To better understand help-seeking behaviours and reproductive health disorders among Aboriginal and Torres Strait Islander men. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional mixed-methods study conducted from 1 May 2004 to 30 April 2005 of 293 Aboriginal and Torres Strait Islander men aged 18 years and over from urban, rural and remote communities in the Northern Territory and Queensland. MAIN OUTCOME MEASURES: Subscale of the International Index of Erectile Function, self-reported help-seeking behaviours for erectile dysfunction (ED) and prostate disease, thematic analysis of semi-structured interviews and focus groups. RESULTS: The prevalence of moderate-to-severe ED increased across age groups, from about 10% in younger men (under 35 years) to 28% in men aged 55-74 years. Moderate-to-severe ED was strongly associated with reporting a chronic condition (odds ratio [OR], 3.67) and residing in a remote area (OR, 2.94). Aboriginal and Torres Strait Islander men aged 40-59 years showed similar low levels of help-seeking behaviours compared with non-Indigenous men from a comparable population-based study. About half of the men with ED saw a doctor or received treatment for ED in each population. While prostate cancer rates were low in both studies, testing for prostate problems was less frequent in Aboriginal and Torres Strait Islander men (11.4%) than in non-Indigenous men (34.1%, P < 0.001), despite similar levels of concern about prostate cancer. Barriers to help-seeking included shame, culturally inappropriate services and lack of awareness. CONCLUSION: This study, the first to investigate reproductive health of Aboriginal and Torres Strait Islander men, found low levels of help-seeking behaviours for reproductive health disorders, with implications for missing a predictor of chronic disease and late diagnosis of prostate disease.

THE PROFILE AND UROLOGICAL SERVICE NEEDS OF OUTPATIENTS ATTENDING A TERTIARY CENTRE IN WESTERN KENYA.

BACKGROUND: Urological service needs cut across varied ages and related conditions. The outpatient attendance is a reflection of the common conditions constituting the urological burden of a given population (1). The urological burden in turn has implications on access to care and treatment (2) since it will determine the skills needed, mode of treatment, amount of time and other resources required to meet these needs. There is, therefore, a need to have a local data base on the profile of our urological patients and their needs with regard to modes of treatment. This study strives to and meets this important objective. OBJECTIVE: To establish the epidemiology of outpatient urology patients and their service needs as seen in a tertiary centre in the Western region of Kenya. DESIGN: Hospital based observational, descriptive, prospective, cross sectional study. SETTING: The Urology Outpatient clinic of Moi Teaching and Referral Hospital (MTRH), a 750 bed tertiary centre in the Western region of Kenya catering for approximately half of the Kenyan population. SUBJECTS: Ninety-four first time attendees to the urology clinic seen in the year 2011. MAIN OUTCOME MEASURES: The primary outcome measures were the demographic data and diagnosis while the secondary outcome measure was the urological service needs of the patients in terms of treatment as to whether surgical or medical at presentation. RESULTS: Ninety-four patients attended the urology clinic for the first time in the year of study. The male to female ratio was 14.7: 1. Age ranged from one year to 97 years with a mean ± standard deviation of 48.0 ± 25.3 years. Half were below and half were above 50 years of age. Males had longer durations of symptoms compared to females but the difference was not statistically significant (p = 0.131). The top three urological problems were urethral strictures, prostate diseases and Urinary Tract Infections. There was an overall 70.2% need for surgical interventions with twenty-six point one percent of the prostate disorders being managed medically while all urethral strictures were planned for surgery. The odds ratio for surgery after one year compared to within first year of symptoms was two. CONCLUSION: The urological patients attending this tertiary outpatient clinic are predominantly males and are widely spread out in terms of age and diagnosis. The clinical burden of urethral strictures has overtaken that of prostate diseases in this tertiary centre.

Autopsy study of prostatic weight and lesions in LUTH: a 12 month prospective study.

BACKGROUND: Diseases of the prostate are common among adult Nigerians with some, clinically asymptomatic during life. OBJECTIVE: The study is to determine the prostatic weight and document the histopathologic patterns, frequency, and age distribution of clinically asymptomatic prostatic lesions seen at autopsy in LUTH, Lagos, Nigeria over a 12 month period (January to December 2009). METHODS: Consisted of hospital case files and prostate glands harvested en bloc from all autopsies in men aged 20 years and above who died of other causes other than clinically diagnosed prostate disease in LUTH within the study period. After en block removal, the prostate glands were fixed in formalin, weighed, sectioned at 3-5mm intervals, processed and embedded in paraffin. Whole mount serial sections were stained with H& E and examined. RESULTS: Only 145 prostate glands were suitable for histological evaluation. There was an increasing prostatic weight with age. The distribution of identified prostatic lesions showed 75 (51.7%) having no histological diagnosis. Acute and chronic prostatitis accounted for 2 (2.9%) each, benign prostatic hyperplasia alone, 52 (74.2%) while benign prostatic hyperplasia (BPH) associated with chronic prostatitis accounted for 7 (10%). Latent prostate cancerwas found in 7 (10%) of the cases. CONCLUSION: Prostate weight increased with age. Acute prostatitis was found to be commoner in the younger age groups, particularly below 50 years while chronic prostatitis was seen more in the older men and was largely associated with BPH. BPH was found to be the commonest lesion. Latent carcinoma showed a prevalence of 10%, which is significant and in keeping with similar studies done elsewhere.

[Comparison of self-estimation of disuric disorders gauged IPSS scale and qualities of lives QoL with self-estimation of sexual life gauged by IIEF-5 scale]. / Porównanie samooceny dolegliwosci dysurycznych mierzonych przy uzyciu skali IPSS i jakosci zycia QoL z samoocena zycia plciowego mierzonego skala IIEF-5.

Evaluation of men with a point scale is a simple method that can be used both in primary care and specialist in-patient treatment. Although its use is not widespread. International scoring system for evaluation of symptoms of the prostate is common in Poland (IPSS). Responses to the questionnaire are the basis of IPSS scale. Quality of life form (QoL) is in addition to the scale of IPSS. It defines subjective assessment of patient well-being in case of symptoms of lower urinary tract at the same level as at the time of the study. 5-point questionnaire IIEF-5 has been used in Poland since 1999 to assess men's sexual life. The aim of the study is to compare the assessment of disuric disorders measured using the International Prostate System Score (IPSS) and Quality of Life scale versus scale of men's sexual self-esteem IIEF-5 in men at the age of 50-70. The study included 1746 randomly selected residents of the district Cracow-Downtown, at the age of 50-70. Medical interview was carried out (including complaints of lower urinary tract symptoms (IPSS), quality of life (QoL) and sexual dysfunction (IIEF-5); physical examination with assessment of individual systems with particular emphasis on genitourinary system, physical examination of the prostate (DRE), PSA level in total and free fractions, a biopsy of the prostate under ultrasound control if necessary. For the analysis qualified 1746 men. The men were divided into groups called groups of disease: a suspicion of prostate cancer, can not rule out prostate cancer, prostate cancer confirmed, probable benign prostatic hyperplasia (BPH), no lesions. The largest was the group with probable benign prostatic hyperplasia 64.89% of the total respondents, followed by a group of men without lesions, 26.29%, a group of probable prostate cancer was 6.41% of the respondents, a group with whom you can not rule out prostate cancer was 1.89%, the smallest was the group with confirmed prostate cancer, 0.52% of all male respondents. The age groups were: 498 respondents aged 50-54 years and 391 aged 55-59, 397 aged 60-64 and 460 aged 65-70. Mean age was 59.24 years. Ppicked up data were processed and analized by STATA- 5,0. Differences between groups relative to answers for the questions of scales: IPSS, QoL and IIEEF5 questionnaire were analized by Mann-Whitney, Kruskal- Wallis, Scheffe's and chi2 tests. Homogeneity of the IPSS were analised by a Cronbach coefficient test. Accordance of each questions of the scale to whole scale were analised by correlation and line regression tests. Based on the analysis of the total scale score by IPSS and QoL scale and quality of life questionnaire IIEF-5 showed that in the process of aging in the population more frequently in older than in younger men, there are complaints from the urinary tract and deteriorating quality of life of self-esteem and quality of life of sexual self-esteem. After analyzing the result of scale: IPSS, QoL, and IIEF-5 in the disease groups, it was found that the total score of IPSS differentiates men in the group with probable benign prostatic hyperplasia, from a group of men without lesions and men with suspected prostate cancer. Statistically significant reduction in quality of life (QoL) in patients with confirmed prostate cancer and in the group with probable benign prostatic hyperplasia compared with men without lesions. The highest self-esteem sex life (IIEF-5) was found in men without lesions and the lowest in the group with known prostate cancer. The scale of quality of life (QoL) was significantly positively correlated with the results of IPSS scale, as well as with each of its questions. Deterioration in the quality of life occurred as a crescendo pain of lower respiratory tract. With the increase in the incidence and severity of each symptom on a scale IPSS worsening of self-esteem was examined using a scale IIEF-5. U of men with the deterioration of the quality of life measured by the scale of QoL, worsening their sexual self-esteem scale IIEF-5. In the process of aging are growing complaints from the lower urinary tract, self-esteem deteriorates the quality of life, including sexual life, which is especially marked in men with enlarged prostate. The scale of quality of life (QoL) is significantly positively correlated with the results of IPSS scale. With the increase in the incidence and severity of symptoms on a scale IPSS had decreased self-test using the IIEF-5 scale. The deterioration of quality of life measured with QoL was associated with decreased sexual self-esteem scale IIEF-5.