Circumcision-related tragedies seen in children at the Komfo Anokye Teaching Hospital, Kumasi, Ghana.

BACKGROUND: Circumcision is a common minor surgical procedure and it is performed to a varying extent across countries and religions. Despite being a minor surgical procedure, major complications may result from it. In Ghana, although commonly practiced, circumcision-related injuries have not been well documented. This study is to describe the scope of circumcision-related injuries seen at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. METHODS: The study was conducted at the Urology Unit of the Komfo Anokye Teaching Hospital in Kumasi. Consecutive cases of circumcision-related injuries seen at the unit over an 18 month period were identified and included in the study. Data was collected using a structured questionnaire. Data was entered and analysed using SPSS version 16. Charts and tables were generated using Microsoft Excel. RESULTS: A total of 72 cases of circumcision-related injuries were recorded during the 18 month period. Urethrocutaneous fistula was the commonest injury recorded, accounting for 77.8 % of cases. Other injuries recorded were glans amputations (6.9 %); iatrogenic hypospadias (5.6 %), and epidermal inclusion cysts (2.8 %). The majority of children were circumcised in health facilities (75 %) and nurses were the leading providers (77.8 %). The majority of circumcisions were conducted in the neonatal period (94.7 %). CONCLUSION: Circumcision-related injuries commonly occurred in the neonatal period. Most of the injuries happened in health facilities. The most common injury recorded was urethrocutaneous fistula but the most tragic was penile amputation. There is the need for education and training of providers to minimise circumcision-related injuries in Ghana.

Dorsal Onlay Oral Mucosa Graft Urethroplasty: A Case Report and Review of Literature.

The use of buccal mucosa grafts in urethral reconstruction for complex anterior urethral strictures has gained popularity over the years with very good outcomes reported in literature. We report on the successful repair of a complex anterior urethral stricture in a 14-year-old boy following catheterization using this method at the Komfo Anokye Teaching Hospital. The aim is to describe the method of dorsal onlay oral mucosa graft urethroplasty and to review the literature.

Predictors of the international prostate symptoms scores for patients with lower urinary tract symptoms: A descriptive cross-sectional study.

BACKGROUND: Lower urinary tract symptoms (LUTSs) can significantly reduce men's quality of life and may point to serious pathology of the urogenital tract. This study aimed at finding predictors of symptoms score on the International Prostate Symptom Score (IPSS) for patients with LUTS. MATERIALS AND METHODS: The study was cross-sectional conducted among 225 Ghanaian men visiting the urology clinic at Komfo Anokye Teaching Hospital. Trained interviewers used the IPSS, which adds a quality of life question to the American Urology Association symptom index to determine the extent to which patients are troubled by their symptoms. Five milliliters of blood was collected for total prostate-specific antigen (PSA) measurement. Transrectal ultrasonography was performed to evaluate the prostate volume (PV). RESULTS: The mean age of the participants was 67.96 ± 14.57. The average score obtained from the study participants using the IPSS scale was 17.52 ± 7.83. There was a significant association between bother score and IPSS symptoms grade (P < 0.0001). Regression plot of the participants' points for IPSS in relation to the age, PSA, and PV showed statistically significant positive associations (P < 0.05). However, the coefficients of determination (R2) were 0.156, 0.022, and 0.048, respectively. This means that each unit increase of age, PSA, and PV only influences 15.6%, 2.3%, and 4.8% of the change in the symptom score. There was statistically significant association between age and moderate-to-severe LUTS with age range of 75 years above recording the highest odds (adjusted odds ratio (AOR) = 18.72, (1.15-99.78), P < 0.0001). The PSA range 20.1-50 ng/ml was significantly associated with moderate-to-severe LUTS (AOR = 17.37 (2.19-223.45), P = 0.006). Moreover, other factors, which were significantly associated with moderate-to-severe LUTS, were smoking (AOR = 0.32 (0.11-0.94) P = 0.038) and being widowed (AOR = 0.05 (0.002-0.52), P =0.010) respectively. CONCLUSION: The study found a statistically significant correlation between age, PSA, PV, and IPSS scores; however, these influences were mild.

Intravesical migration of an intrauterine device.

BACKGROUND: Intrauterine contraceptive device is the most common method of reversible contraception in women. The intrauterine contraceptive device can perforate the uterus and can also migrate into pelvic or abdominal organs. Perforation of the urinary bladder by an intrauterine contraceptive device is not common. In West Africa, intravesical migration of an intrauterine contraceptive device has been rarely reported. In this report, we present a case of an intrauterine contraceptive device migration into the urinary bladder of a 33 year old African woman at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. CASE REPORT: A 33 year old African woman presented with persistent urinary tract infection of 7 months duration despite appropriate antibiotic treatments. An abdominal ultrasonography revealed a urinary bladder calculus which was found to be an intrauterine contraceptive device on removal at cystoscopy. She got pregnant whilst having the intrauterine contraceptive device in place and delivered at term. CONCLUSION: The presence of recurrent or persistent urinary tract infection in any woman with an intrauterine contraceptive device should raise the suspicion of intravesical migration of the intrauterine contraceptive device.