Renal cell carcinoma in Ibadan: a 5-year clinicopathologic review.

BACKGROUND: To review all the cases of the patients with renal cell carcinoma seen during the study period and to determine the pattern of presentation, number of operable cases, histological types and outcome of treatment. MATERIALS AND METHODS: The data of the patients with renal cell carcinoma was retrieved from the Urology division audit book, theatre record books and case files from the health records department and pathology register in the department of pathology. The parameters studied were age, gender, pattern of presentation, number of patients who had surgery, histology types and the outcome of treatment. RESULTS: In total, there were 69 patients with renal cell carcinoma that accounted for 59.5% of all renal masses seen. The male to female ratio was 1:1. Their age ranged from 16 to 88 with a mean of 48 years and median of 50 years. The main clinical feature was loin swelling (100%) and others were loin pain (29%), hematuria (18.8%), weight loss (4%) and paraneoplastic syndrome (anaemia without haematuria) was seen in 2.9%. Ten percent of the cases had the classical triad of hematuria, loin pain and loin swelling. All cases were unilateral disease and 15 (21.7%) had metastasis at presentation. The pre-operative tests were abdominal ultrasound (94%), intravenous urography (45%) and CT-Scan (11.6%). Twenty eight patients (40.6%) had surgery of which 5 were unresectable. 37 of the patients (53.6%) were subsequently lost to follow-up. The 28 operative specimens were histologically confirmed and 85.7% were clear cell carcinoma. The 23 patients whose tumours were resected have remained symptom free, some up to 5 years. However the five patients with unresectable tumours died between 3 to 6 months of exploratory surgery. CONCLUSION: The patients with resectable tumour could remain disease free for a significant period afterwards despite late presentation. However, there is a high loss to follow-up rate.

Torsion of the testis and factors that determine the choice of orchidectomy and unilateral orchidopexy.

AIMS AND OBJECTIVES: To determine the age group affected by testicular torsion and the relationship with orchidectomy and unilateral orchidopexy. To determine if seasonal variation affects the incidence of torsion of the testis. MATERIALS AND METHODS: Data of confirmed patients with testicular torsion from July 1998 to June 2010 were retrieved. They were divided into two, group I (age<21 years) and group II (age e"21 years). The indices analyzed were the relationship of age group, occupation on orchidectomy and unilateral orchidopexy and seasonal variation and torsion. Cases of acute epididymo-orchitis, torsion of appendix testis, and testicular tumor were excluded from the study. RESULTS: A total of 169 confirmed cases of testicular torsion were analysed.The estimated incidence was 12.1 cases per 100,000 populations. Their age range from 9 months to 45 years and mean age 23.8±7.6 (SD). 62.1% of torsion occurred at e" 21 years. One hundred and twenty patients (71%) had bilateral orchidopexy, 32 (18.9%) had orchidectomy and 17 (10.1%) had unilateral orchidopexy. In group II; unilateral orchidopexy was significant (p<0.03) and there was a correlation between the occupation and orchidectomy (p<0.02). There was no statistical correlation between total torsion and humidity (r=0.321, p=0.309), or ambient temperature (r=0.248, p=0.437). CONCLUSIONS: Testicular torsion was commoner in men age e" 21 years and more students lost their testes. Unilateral orchidopexy should be considered in some cases. There was no relationship between torsion, orchidectomy, ambient temperature and relative humidity. The need for rigorous pre-school and pre-employment health education is advocated.

EFFICACY AND SAFETY OF LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE THERAPY FOR TREATMENT OF VASCULAR ERECTILE DYSFUNCTION IN NIGERIAN MEN: REPORT OF A STUDY IN IBADAN, SOUTH-WEST NIGERIA.

Background: Low Intensity Extracorporeal Shock Wave Therapy (LI-SWT) has been found to be effective in men with vascular erectile dysfunction (ED) but its efficacy and safety has not been investigated in a predominantly black population so we sought to study this. Materials and Methods: Men with vascular erectile dysfunction (ED) were assessed using the five-item International Index of Erectile Function (IIEF) score after which they were treated with 12 sessions of LI-SWT. Treatment efficacy was evaluated immediately after treatment, at 1 month and 6 months after using the IIEF questionnaire. 30 persons were recruited out of which 22 completed the study. Results: Mean IIEF score improved from 8.27±2.741 at baseline (pre-treatment) to 10.43±8.43 one month post treatment and was sustained six months post treatment at mean IIEF score of 10.70 ± 8.84. A larger no (86.4%) had an improvement of at least 5 in the IIEF score from baseline to 6 months -post treatment. None of the participants reported any adverse effects of treatment. Conclusion: Low intensity shock wave treatment is a useful addition to the medical armamentarium for the treatment of vascular ED.

Early endoscopic realignment of traumatic anterior and posterior urethral disruptions under caudal anaesthesia - a 5-year review.

OBJECTIVE: We recently described early rigid retrograde endoscopic realignment of the disrupted urethra under caudal anaesthesia in the outpatient setting. This retrospective study was performed to evaluate our medium-term results. PATIENTS AND METHODS: A retrospective review of patients who had early rigid retrograde endoscopic realignment of traumatic urethral disruptions in our institution over a 5-year period was done and the relevant data extracted and analyzed. RESULTS: Fourteen acutely ruptured urethras (10 posterior and four anterior) were endoscopically realigned early in the study period. Nine (90%) of the posterior disruptions occurred at bulbo-membranous urethra (distal to the external sphincter mechanism). Thirteen of the ruptured urethras (93%) were successfully realigned (nine posterior and four anterior) and postoperative clean intermittent self-calibration (CIC) was instituted in 10 patients. The mean follow-up period was 36.6 months (range 18-54 months). The mean operating time and the median hospital stay were 22 min (range 8-68 min) and 3 days (range 1-10 days), respectively, and were shorter in patients with injuries of the anterior urethra than those with posterior urethral tears (p < or = 0.0001). Post-realignment, all 13 patients were potent and continent. Two patients required additional procedures (direct vision internal urethrotomy or urethral dilation) and one patient has remained on CIC i.e. a stricture rate of 21%. CONCLUSION: Early retrograde endoscopic realignment under caudal analgesia is suitable and cost-effective for patients with acute traumatic urethral disruptions and has good medium-term results. In addition, an early postoperative regimen of CIC significantly reduced stricture-formation in our series.

Inhibition of nitric oxide production and free radical scavenging activities of four South African medicinal plants.

INTRODUCTION: Traditional healing is often the preferred form of therapy especially in rural and resource-limited communities. The extracts of plants are used to treat many diseases such as arthritis and chronic pain. Four medicinal plant species, namely, Acokanthera oppositifolia, Plantago lanceolata, Conyza canadensis and Artemisia vulgaris used in Southern Africa to treat pain and inflammation-related diseases were selected for evaluation in laboratory-based experiments. METHODS: The selected plant species were evaluated for phytochemical content, antioxidant and anti-inflammatory activities, as well as cytotoxicity effects against mammalian cells in culture. RESULTS: The results indicated that the n-hexane and chloroform extracts of P. lanceolata had the best antioxidant activities with an IC50=0.41 µg/mL. Also, the acetone extracts of P. lanceolata had 93.76% nitric oxide (NO) inhibition. However, the chloroform and n-hexane extracts of C. canadensis produced NO inhibition of 98.53% and 99.2%, respectively, at 100 µg/mL with IC50=17.69 µg/mL. Furthermore, the ethyl acetate extracts also had promising NO inhibitory activity (96.33%), but the cytotoxicity results with cell viabilities of 5.31%, 5.7% and 5.89%, respectively, suggested that the observed activity was due to a cytotoxic effect. Acetone extracts of C. canadensis were also cytotoxic at 30 µg/mL with 6.07-6.67% cell viabilities compared with the acetone extracts of P. lanceolata (99.57%). CONCLUSION: The results partially validate the ethnomedicinal uses of the selected plant species used for inflammation-related conditions. However, because some of the extracts had potential cytotoxic effects, caution is advised in their use, especially those consumed orally.

EXPERIENCE WITH MANAGING CHILDHOOD URETHROCUTANEOUS FISTULA AT IBADAN.

BACKGROUND: Urethrocutaneous fistula could be a distressing condition to the child and parents alike. Its management could be challenging and requires adequate expertise. AIM: To review the characteristics and aetiology of urethrocutaneous fistula managed in our division over a ten-year period. METHODOLOGY: All children with urethrocutaneous fistulae from July 2006 to June 2015 were subject of this review. The demography, aetiology, type of fistula, operation performed and the outcome were retrieved from the division operation book and case notes of the patients. The data was analyzed using SPSS Inc. version 20 and odd ratio. RESULTS: Thirty-five children were managed over a period of ten tears. The age ranged from 6 months to 13 years with a mean of 4±1.9years. Seventy one percent of urethrocutaneous fistulae resulted from complication of childhood male circumcision procedures performed in private hospitals and by nurses. One child (3%) had isolated perineal urethrocutaneous fistula while 26% complicated hypospadias repair at these locations: glandular in 1% case, subcoronal in 3% cases, penile in 2% cases, and penoscrotal in 3% cases. Ten (29%) children with abnormal haemoglobin AC was noted in 3 (9%) patients and haemoglobin AS in 7 (20%) patients. The odd ratio between abnormal haemoglobin and normal haemoglobin was 3.8. The surgical repair of post-circumcision urethrocutaneous fistulae and post-hypospadias had a recurrent fistulae in 4 (16%) and 3 (33%) respectively. Majority of the fistulae were repaired by simple closure in 80% post-circumcision and in 44% post-hypospadias repair. in the more difficult cases, penile degloving with urethral mobilization was done in 16% post-circumcision fistula and 22% post-hypospadias fistula with no recurrence. CONCLUSION: in this study, post-circumcision urethrocutaneous fistula was the commonest cause of childhood urethrocutaneous fistula, the severe ones could require penile degloving to achieve repair without tension; recurrence was a major complication.

The knowledge, awareness, and acceptability of renal transplantation among patients with end-stage renal disease in Ibadan, Nigeria.

Renal transplantation is well established in the USA, Europe, India, and South Africa. However, it is still in its infancy in Nigeria. The objective of our study is to determine the knowledge, awareness, and acceptability of renal transplant among patients with end-stage renal disease (ESRD) and the factors which are responsible for the low level of transplantation in Ibadan, Nigeria. A 15-item pilot-tested questionnaire was administered to willing patients with ESRD seen at the medical outpatient clinic of the University Teaching Hospital, from January to December 2011. There was 81% participation rate of the respondents. Exactly 90.1% had formal education and 44% earned <50,000 naira per month. Seventy-nine percent of respondents was aware of renal transplantation, 70.4% would recommend it to others, and 66.7% accepted renal transplantation; 77.8% would maintain a close relationship with their donors. About 61.7% considered it very expensive, while 33.3% did not know the cost for transplantation. Of the reason for the low level of kidney transplantation in Nigeria, 39.5% had no idea and in 27.2% of the respondents, the fear of death by potential donors may be responsible. Eleven percent of responded that recipients had no money for kidney transplantation and another 11% thought the potential donors would like to be paid for donating their kidneys. Most of the respondents with ESRD were knowledgeable, aware of, and accepted renal transplantation as the next step to treat chronic renal failure. However, majority of these patients could not afford the cost for renal transplantation.

HISTOPATHOLOGIC PATTERN OF BLADDER CANCERS IN IBADAN SOUTHWEST NIGERIA: AN UPDATE.

BACKGROUND: A study from the University College Hospital, Ibadan, Southwest, Nigeria on bladder cancers had described an increase in the frequency of urothelial carcinoma compared to the earlier reported preponderance of squamous-cell carcinoma. AIM: To provide an update on the histopathologic pattern of bladder cancers in our community and to explore its implications for future health system policies. METHODS: The records of the Ibadan Cancer Registry from January 1997 to December 2014 were reviewed and the data analyzed for the histologic subtypes of bladder cancers diagnosed in the hospital. RESULTS: Two hundred and sixteen bladder tumours were recorded during this period with a male to female ratio of 3.2:1. Complete information was available in 195 cases of which 181 (96.8%) were bladder carcinomas whilst 14 were sarcomas. Of the bladder carcinomas, 68.5%, 19.9% and 11.6% were urothelial carcinomas, squamous cell carcinomas, and adenocarcinomas (AC) respectively. Urothelial carcinoma was more common in all age groups and its peak age of occurrence was in the 51-60 year age group. The peak age for squamous cell carcinoma was in the 41-50 year age group. Mean and median age of occurrence was significantly lower in females in the urothelial and squamous cell carcinomas, but lowest in squamous cell carcinoma [P = < 0.0001]. CONCLUSION: This population study has confirmed urothelial carcinoma as the predominant histotype of bladder cancer in Ibadan, Southwest Nigeria currently and that both urothelial and squamous cell carcinomas occur earlier in women.

Delayed primary realignment of posterior urethral rupture.

The treatment of acute posterior urethral rupture is controversial. Twelve patients who presented with acute posterior urethral rupture over a five-year period were treated by delayed primary realignment of the injury. The technique of this procedure and the outcome are the subject of this presentation. Eight patients had successful realignment without strictures. Two patients with strictures responded to simple dilatations with bougies and the other two had formal urethroplasty.

EUTUBS: a mnemonic for the complete endoscopic examination of the lower urinary tract.

Urethrocystoscopy is now routinely done in standard Urological practice. The availability of the flexible cystoscope for outpatient procedures has further increased the number of cystoscopists. However, there are currently no formal training schedules for urethrocystoscopy. This mnemonic has been developed to serve as a template for complete endoscopic examination of the lower urinary tract to which the cystoscopist may refer when undertaking this operation. It focuses on the common abnormalities that the endoscopist may encounter, and is not intended to be an exhaustive list of all abnormalities of the lower urinary tract. Furthermore, it is not meant to obviate the need for practical training of those wishing to carry out the procedure as part of their clinical practice.

Rigid retrograde endoscopy under regional aneasthesia: a novel technique for the early realignment of traumatic posterior urethral disruption.

Traumatic disruption of the posterior urethra usually occurs in association with pelvic fractures and may result in significant morbidity. The management of this injury remains difficult and controversial. Recently, early restoration of urethral continuity in these patients using either both antegrade and retrograde cystoscopy (with or without fluoroscopy), or flexible retrograde urethroscopy alone under general aneasthesia, has been reported with good results. These procedures have been proposed as an improvement over the traditional teaching of placement of a suprapubic catheter followed by delayed open repair (urethroplasty). We now describe a novel method of restoration of urethral continuity by rigid retrograde endoscopy alone under caudal aneasthesia in the early post-trauma phase. This procedure can be carried out in an outpatient endoscopic suite with standard (endoscopic)optical urethrotomy equipment and is suitable for most patients with prostatomembranous urethral disruptions. A 'high-riding' prostate is however a relative contraindication for this procedure. To date, we have carried out this procedure successfully in 4 of 5 patients with traumatic prostato-membranous disruption (a success rate of 80%). We recommend that early retrograde rigid endoscopic realignment under regional analgesia should be considered as a management option in patients with traumatic disruption of the posterior urethra.

Caudal block anesthesia for transrectal prostate biopsy.

OBJECTIVE: Transrectal prostate biopsy is a potentially painful procedure. Our service has significant experience with caudal anesthesia for perianal procedures. This study is aimed to determine the effectiveness of caudal anesthesia for transrectal prostate biopsy. PATIENTS AND METHODS: Seventy consecutive patients undergoing transrectal prostate biopsy were entered into the study. The patients were requested to complete a questionnaire structured to assess the pain felt during the procedure using the visual analog score (VAS). The effectiveness of the caudal anesthesia was determined by the anesthesia of the perineum and the laxity of the anal sphincter. Complications from the procedures were recorded. RESULTS: All the patients completed and returned the questionnaire. The average age of the respondents is 65.8 years. Among the 34 patients with caudal block, effective anesthesia was achieved in 28 patients and ineffective in six patients. However, the mean VAS for the pain from transrectal prostate biopsy was 1.49 +/- 1.93 SD (range 0-6.0) for the patients with effective caudal anesthesia and 8.02 +/- 1.79 SD (range 5.0-10.0) for patients with no caudal anesthesia. There was a reduced requirement for analgesics after prostate biopsy for patients with effective caudal anesthesia. Three patients (8.8%) had minor complications (transient dizziness) following the injection of the anesthetic into the caudal epidural space. CONCLUSION: Satisfactory analgesia for transrectal prostate biopsy can be achieved with the use of CA and it results in better cooperation of the patient during the procedure.