The transverse penile pedicled flap urethroplasty: description of a simplified technique for the dissection of the Fascio-cutaneous flap.

INTRODUCTION/OBJECTIVE: Urethroplasty is often required for long urethral strictures or urethral strictures that have recurred after repeated urethral dilatations or urethrotomy. The transvers penile skin pedicled flap is very versatile for the reconstruction of long urethral stricture. However the meticulous sharp dissection required to develop it takes a long time to do and may be associated with button hole injuries to the vascular pedicle and the penile skin. We describe a simplified technique of raising the flap which does not require sharp dissection and is very quick to accomplish. METHOD: Technique involves using a circumcising distal penile shaft skin incision to de-glove the penis by blunt dissection. The skin substitute, adequate to give appropriate urethra calibre is similarly dissected bluntly along with its vascular pedicle from the proximal penile skin. The techniques used to facilitate successful blunt dissection are described. RESULT: In 9 adults with long, multiple urethral strictures, the average time to develop the flap was 15 minutes and complication have been limited to temporary urethro-cutaneous fistula at the ventral part of the circular skin closure. These fistulae closed on conservative treatment. No patient suffered button-hole injuries to either the vascular pedicle or the penile skin. CONCLUSIONS: This modification to the standard sharp dissection is very quick to accomplish. It also avoids the creation of button-hole injuries to either the vascular pedicle or the penile skin. It should make the use of this versatile flap more attractive in the reconstruction of long urethral strictures in those who may wish to use this option for reconstruction of long urethral strictures.

Cutaneous metastasis from prostate cancer in a nigerian: a case report and literature review.

BACKGROUND: Prostate cancer is the most common male malignancy in Nigeria and most patients present with advanced and metastatic disease. Cutaneous metastasis from prostate cancer is rare worldwide and to our knowledge has not been previously reported in a native African. We hereby report a case in a 62-year-old Nigerian. CASE PRESENTATION AND MANAGEMENT: A 62-yr-old Nigeria man presented with 6 months history of lower urinary tract symptoms that culminated in urinary retention for which he was catheterized. He noticed multiple painless skin nodules about the same time on the neck and trunk. On examination, he had multiple cutaneous nodules on his neck, limbs and trunk. His prostate gland was enlarged, hard and irregular. Prostate biopsy revealed adenocarcinoma of the prostate. He had bilateral orchidectomy with progressive regression of the skin nodules. He had successful trial of voiding without a catheter 3 weeks after bilateral total orchidectomy. CONCLUSION: Cutaneous metastasis from prostate cancer is rare in native Africans despite the high incidence of the disease in this population. To our knowledge, this index case is the first report in a native African in the English literature.

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.

Diagnostic value of lipids, total antioxidants, and trace metals in benign prostate hyperplasia and prostate cancer.

BACKGROUND: Considerable overlap exists in the value of total prostate specific antigen (tPSA) in both prostate cancer (Pca) and benign prostate hyperplasia (BPH). Developing an effective biochemical screening test that will complement PSA assay could reduce the associated cost of care and give timely attention to prostate cancer patients even when they are still asymptomatic is therefore desirable. This work was therefore an attempt to evaluate the possible roles of lipids, antioxidants, and trace metals in breaking the diagnostic tie between Pca and BPH. MATERIALS AND METHODS: Anthropometric characteristics, total prostate specific antigen (tPSA), serum lipids (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), Vit. E, total antioxidant status (TAS), and trace metals (Se, Cu, Fe, Zn, and Mn) were determined in 40 patients with histopathological diagnosis of BPH and Pca. Forty age matched control subjects were also recruited from the same community. Informed consent was obtained from all the participants in the study. A P-value < 0.05 was considered significant. RESULTS: There were significant variations in the weight, hip circumference, and body mass index (BMI) across the group but the post hoc test did not show any difference between patients with prostate cancer and BPH. Among the biochemical parameters studied, only the total cholesterol and triglyceride differed significantly between patients with BPH and prostate cancer patients. Cut-offs from ROC for BPH and prostate cancer at 88.9 sensitivity and 66.7% specificity (95% CI) were 88.5 mg and 161 mg/dl for triglycerides and cholesterol respectively. Furthermore there were no significant variations in the mean levels of copper and tPSA, Vit E, and LDL cholesterol among the study subjects and the controls. CONCLUSION: Prior to prostate biopsy, serum lipid (especially, fasting triglycerides, total cholesterol) could help in early discrimination of patients with BPH from prostate cancer in adjunct to total PSA and other management protocol for diagnosis of prostate cancer. The use of trace metal or antioxidants may have limited advantages. Further studies in this regard will be very desirable to see if this pattern of triglyceride and total cholesterol values in BPH and Pca are sustainable.

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.

A variant epidermal growth factor receptor protein is similarly expressed in benign hyperplastic and carcinomatous prostatic tissues in black and white men.

BACKGROUND AND OBJECTIVE: Anti-epidermal growth factor receptor strategies are now established in cancer treatment We have recently described the presence of EGFRvIII (a variant EGFR) in prostatic tumours from UK white men and this is now a target for anti-prostate cancer treatments. However, there has been no report on the expression of this abnormal protein in black men. MATERIALS AND METHODS: We determined EGFRvIII expression in sections of normal, benign hyperplastic (BPH) and carcinomatous (CaP) prostatic archival tissues from Nigerian men and UK white men using streptavidin immunohistochemical techniques. The EGFRvIII immunoreactivity was scored visually using a semi-quantitative method and the results compared statistically. RESULTS: EGFRvIII expression increased with increasing malignancy in both study populations (CaP > BPH > Normal p, <0.0001). Furthermore, EGFRvIII expression was similar in both BPH and CaP tissues in black and white men (p, 0.86 and 0.31 respectively). CONCLUSION: These results demonstrate that EGFRvIII immunoreactivity in prostatic tumours in black men is similar to that in white men. Anti-cancer treatments directed at the EGFRvIII should be equally effective in men from both subpopulations.

Anti-PSA immunoreactivity in primary prostatic tissues from black African men.

Prostatic specific antigen (PSA) immunoreactivity is the most commonly used histological marker to identify epithelial cells of prostate origin. Unlike tissues from white men in which grade-related variability has been reported, the pattern of PSA immunoreactivity in prostatic tissues from black African men is presently unknown. This study was done to evaluate the pattern of PSA staining in sections of normal, benign hyperplastic and malignant prostatic glands from men from this sub-population. PSA immunostaining was done on 4-microm serial sections from archival specimens of benign prostatic hyperplasia (BPH) and carcinoma of the prostate (CaP) obtained from black African men using standard immunoperoxidase techniques. The intensity of PSA immunoreactivity of the glands was scored using a semi-quantitative method. PSA expression decreased with increasing de-differentiation of the tissue histotype with poorly differentiated tumours staining least. PSA immunoreactivity was strong in 100% of normal glands and 84% of BPH glands and moderate in the rest. In contrast, PSA immunopositivity was strong in 32% of CaP glands, moderate in 26%, weak in 34% and absent in 8%. Statistical comparison revealed that PSA expression was significantly higher in benign tissues (normal/ atrophic and BPH) than in CaP glands [p = < 0.0001]. Our findings show that PSA immunoreactivity is grade-related in prostatic tissues from black men and this has implications for clinical diagnosis and research. It also confirms the limitations of PSA-testing in diagnosing CaP, and indicates that newer immunohistochemical tests for malignant prostatic cells should be acquired by Sub-Saharan laboratories.

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.

Serum and seminal plasma hormonal profiles of infertile Nigerian male.

Male infertility constitutes a worldwide problem, especially in Nigeria where most men do not readily accept that they may contribute to the couple's infertility. In order to assess hormonal disturbances in the male infertility we compared male reproductive hormonal levels in human serum and seminal plasma and evaluated the hypothalamic-pituitary-testicular-axis in infertile Nigerian males. The biophysical semen parameters were assessed by W.H.O. standard manual method. Serum and seminal plasma male reproductive hormones (Leutinizing hormones, Follicular stimulating hormone, Prolactin and Testosterone) were measured by Enzyme Immunoassay (EIA) technique of W.H.O. in sixty (60) infertile adult male Nigerians (Oligospermic; n = 40 and azoopermic; n = 20) and forty controls of proven fertility (Normospermic subjects; n = 40). The results show that the serum concentrations of gonadotropins (LH and FSH) were significantly higher (P<0.05) in infertile subjects than controls. Patterns of serum prolactin levels were similar. The values of gonadotropins in serum were significantly higher (P<0.05) than those of seminal plasma. Seminal plasma testosterone in infertile subjects was significantly higher (P<0.005) than that of controls but the serum levels of testosterone were significantly higher (P<0.05) in azoospermic than oligospermic subjects and controls. There was no significant correlation between serum hormonal level and seminal plasma hormonal level in all the groups (P<0.05). We concluded that male infertility in Nigerians is characterized by hyperprolactinaemia, raised serum gonadotropins (LH, FSH), and raised seminal plasma testosterone. Hormonal profiles in serum and seminal plasma were not significantly correlated, and hence cannot be used as exclusive alternative in male infertility investigations. The observed spermogram in spite of significant elevation of seminal plasma testosterone in infertile males investigated suggests Sertoli cells malfunction.

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.

Selenium status of idiopathic infertile Nigerian males.

Selenium concentration in the sera and seminal plasma of 60 infertile males (40 oligospermia and 20 azoospermia) and 40 males with proven evidence of fertility (normospermia; control group) were estimated using atomic absorption spectrophotometry. Results were correlated with spermatogram and hormonal levels in order to determine their relationship and significance in male infertility. The mean serum concentrations of selenium was found to be significantly increased in oligospermic compared to azoospermic subjects and controls (p < 0.01), whereas the seminal plasma level was significantly higher in azoospermic compared to oligospermic subjects and controls (p < 0.001). Thus, the ratio of serum selenium to seminal plasma selenium was 1: 1 in controls, 4: 1 in oligospermia, and 1: 2 in azoospermic subject.A significant inverse correlation was observed between serum selenium level and sperm count (p < 0.01). Similarly, seminal plasma selenium correlated with spermatozoa motility, viability, and morphology. Serum selenium level shows positive correlation with the serum testosterone level (p < 0.01). In conclusion, there appears to be a physiological balance in the distribution of selenium in serum and seminal plasma compartment of control males. A disturbance in this balance has a significant influence on spermatogenesis. Selenium appears to have a positive influence on Leydig cells, thus influencing the secretion of testosterone.

Management of ectopia vesica in Ibadan: an 8-year review.

CONTEXT: The management of children with ectopia vesica is intricate and complex. Repair of the bladder soon after delivery is desirable, particularly in our environment as the social stigma associated with such an anomaly can lead to child abandonment or infanticide. OBJECTIVE: To report our experience in the management of children with ectopia vesica at the University College Hospital (UCH), Ibadan, over an 8-year period. STUDY DESIGN, SETTING AND SUBJECTS: All children who presented at the UCH, Ibadan between January 1995 and December 2002 with ectopia vesica had the bladder closed primarily. The children that presented between 1995 and 1998 had the symphysial diastasis approximated with no. 1 nylon suture, while those that presented subsequently had the muscle and fascial layer closed with a darning suture of no. 1 nylon. RESULT: A total of 13 children presented with ectopia vesica during the period of the study. The bladder was closed in all cases. Abdominal wound dehiscence occurred less frequently in patients who had darning suture approximation of the muscle and fascial layer, compared with those who had simple symphysial approximation with nylon suture. CONCLUSION: The result of immediate bladder closure in children with ectopia vesica can be satisfactory in this environment. There is a need for continuing experience in the management of these children to improve outcome.

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.

Sildenafil citrate (Viagra) for the treatment of erectile dysfunction in Nigerian men.

Fifty-eight Nigerian outpatients with documented erectile dysfunction (ED) received open-label sildenafil citrate (Viagra) for 8 weeks. The 50-mg starting dose could be adjusted to 100 or 25 mg based on response and tolerability. The International Index of Erectile Function (IIEF) Questionnaire, a global efficacy question, and intercourse data recorded in a patient event log were used to assess efficacy. Frequency of penetration and maintained erection were both significantly enhanced (P<0.0001); 95% of patients reported improved erections and 81% of all attempts at intercourse were successful. Orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction also improved significantly (P&<0.0001). The most frequent adverse events (all-cause) were headache (17%) and myalgia (3%); only one patient discontinued treatment because of headache, which was considered unrelated to sildenafil. Oral sildenafil significantly improved erectile function and was well tolerated in this trial of Nigerian men suffering from ED. Our results are consistent with reports from other countries.

Further characterization of storage-related alterations in immunoreactivity of archival tissue sections and its implications for collaborative multicenter immunohistochemical studies.

Storage of unstained paraffin slides may lead to the deterioration of specimens and failure to detect cellular proteins immunohistochemically. Although the implication of age-induced alterations on multicenter immunohistochemical studies would be considerable, they have not been investigated previously. The current study was undertaken to examine the effect of this factor further and to explore new ways of overcoming the resultant shortcomings. The authors now report on the immunodetection of a host of antigens in similarly preserved unstained serial paraffin slides obtained from three centers using a panel of eight antibodies. Staining of recently prepared sections from the authors' centers resulted in similar strong patterns in seven of eight antibodies, with one antibody demonstrating variable immunoreactivity. However, storage of unstained paraffin sections at room temperature resulted in a variable but progressive decrease in expression of several tissue antigens. Although the loss in antigenicity was proportional to the length of storage, the effect was reversible if super antibody concentrations were used. The authors conclude that recently prepared paraffin sections from centers with similar fixation protocols have similar immunoreactivity and are suitable for use in comparative multicenter studies. However, in view of the delays that may attend tissue transportation during these projects, the authors suggest that test systems should be checked for age-induced antigen degradation by incubating sections with higher antibody concentrations.

Increased incidence of prostate cancer in Nigerians.

An increased incidence of prostate cancer among African-American men (now the second most common cause of cancer death) has been attributed mainly to the introduction of screening techniques, which have enabled earlier diagnosis of patients. This study reviewed male cancer patients recorded in a Nigerian cancer registry to assess the current trends in prostate cancer in Nigeria. For comparison, data were broken into two groups: 1980-1988 and 1989-1996. Only the top 10 cancers occurring in both periods were considered initially in this report. For emphasis, an analysis of adult male cancers was done per decade since 1960. Results show that prostate cancer has become the number one cancer in Nigerian men and constitutes 11% of all male cancers. The median age of patients was 67.5 years (variance 5.6), and the mean age was 71.4 years (variance 14.3). These results indicate that despite the absence of screening programs in Nigeria, the number of prostate cancer cases has increased. The known risk factors probably contribute to a varying degree among Nigerians, who are generally of average build or in the low-normal range for body mass index. Moreover, the role of genetics cannot be underplayed. Given its biological characteristics, more cases of prostate cancer probably would be recorded among this population if screening were undertaken.

Seminoma arising in cryptorchid testes in Nigerian males.

Histological slides of seventy four patients with testicular malignancy found in the records of the cancer registry, University College Hospital, Ibadan over a thirty-five year period (1960-1994) were reviewed. Three (4%) cases occurred in undescended testes. Overall, eighteen (24.3%) patients were found to have seminomas. All the tumours seen in undescended testes (100%) were seminomas while about seventeen percent of seminomas were seen in undescended testes. There was a statistically significant difference between the mean ages of those with seminomas (37.6 years) and those with non-seminomatous testicular cancers (30.3 years); t = 1.69; p < 0.05. The numbers seen corroborate the fact that testicular cancers are not very common in this environment. The incidence of undescended testes is not established in this environment either. However, it seems that 100% of tumours arising in undescended testes are seminomas. It is recommended that abdominal testes seen after puberty should be removed and older patients presenting with abdominal masses should have a differential diagnosis of testicular cancer entertained.

Localised amyloidosis of the urinary bladder: a case report and review of treatment.

Since the first case of primary amyloidosis of the bladder was reported by Solomin in 1871, only about 50 other case reports have appeared in the English literature to our knowledge. Due to rarity of this condition, no unit has treated enough patients to formulate a standard protocol of management which in most cases is empiric. The clinical importance of this condition is to differentiate it from a neoplasm of the bladders.

Orbital metastases of prostatic carcinoma in a tropical African population.

We have reviewed the cases of orbital metastases from carcinoma of the prostate gland seen in the University College Hospital, Ibadan over an 11 year period, 1990-2000. During the period, seven cases of orbital metastases that presumably arose from carcinoma of the prostate were seen. Four of the patients died of progression of the primary disease over a variable period ranging between 2 weeks and 30 months of diagnosis and treatment, two were lost to follow up and one is alive 46 months after initial diagnosis of orbital metastases from carcinoma of the prostate and treatment.