Urethral obstruction from dislodged bladder diverticulum stones: a case report.

BACKGROUND: Secondary urethral stone although rare, commonly arises from the kidneys, bladder or are seen in patients with urethral stricture. These stones are either found in the posterior or anterior urethra and do result in acute urinary retention. We report urethral obstruction from dislodged bladder diverticulum stones. This to our knowledge is the first report from Nigeria and in English literature. CASE PRESENTATION: A 69 year old, male, Nigerian with clinical and radiological features of acute urinary retention, benign prostate enlargement and bladder diverticulum. He had a transurethral resection of the prostate (TURP) and was lost to follow up. He re-presented with retained urethral catheter of 4 months duration. The catheter was removed but attempt at re-passing the catheter failed and a suprapubic cystostomy was performed. Clinical examination and plain radiograph of the penis confirmed anterior and posterior urethral stones. He had meatotomy and antegrade manual stone extraction with no urethra injury. CONCLUSIONS: Urethral obstruction can result from inadequate treatment of patient with benign prostate enlargement and bladder diverticulum stones. Surgeons in resource limited environment should be conversant with transurethral resection of the prostate and cystolithotripsy or open prostatectomy and diverticulectomy.

Cosmetic Appeal, HRQoL, and Effectiveness of Simple and Pseudotesticular Techniques of Orchidectomy in Prostate Cancer.

INTRODUCTION: Orchidectomy is the most cost-effective means of hormonal therapy for locally advanced or metastatic prostate cancer (LAMP). However, cost-effectiveness should not detract from health-related quality of life (HRQoL) considerations. Bilateral simple orchidectomy (BSO) has been linked to negative psychometric deficits from an empty scrotum. This study compared the HRQoL, therapeutic efficacy, and cosmetic appeal of BSO with endogenous pseudotesticular techniques of bilateral subcapsular orchidectomy (BSCO) and bilateral-epididymal-sparing orchidectomy (BESO). Research Design. Nigerian patients with LAMP were randomised into three surgical arms: BSO, BSCO, and BESO. Expanded Prostate Cancer Index Composite-26 HRQoL and sociodemographic questionnaires were administered before and three months after orchidectomy. Serum testosterone and PSA were measured at 0, 1, 2, and 3 hours; 7 days; and 3 months postoperatively. Pseudotesticular volumes and cosmetic appeal were assessed at 3 months. RESULT: Sixty-three patients were recruited (24 BSO, 21 BSCO, 18 BESO), 73% of whom were low-income earners. There was no significant difference in the procedure cost nor the PSA or testosterone nadirs achieved over the three-month follow-up period (11.3, 12.6, 15.2 ng/ml (p=0.667) and 0.44, 0.64, 0.79 nmol/l (p=0.603) respectively). Those with pseudotesticles (BSCO, BESO) felt less emasculated (p=0.010). BSCO produced the least sexual bother, highest sexual function, and largest pseudotesticular volumes. The cosmetic appeal scores were similar between groups (77.9 ± 22.8, 81 ± 13.9, and 81.9 ± 22.5, respectively, p=0.858). CONCLUSION: Endogenous pseudotesticular techniques, when compared with BSO, reduce the negative psychological impact experienced by patients without increasing costs. BSCO produced the best pseudotesticular volumes and postoperative sexual function. This study is registered with the ClinicalTrials.gov of the National Institute of Health U.S. National Library of Medicine as TEPSO study, NCT03744494: Comparison of the Therapeutic Efficacy and Patient Satisfaction of Three Techniques of Bilateral Orchidectomy in Prostate Cancer Patients of a Nigerian Sub-population. Registration completed on 16th of November, 2018 (registered retrospectively) NCT03744494.

Urethral steinstrasse: Day case care.

Urethral steinstrasse is rare. Only a few cases of spontaneous or postinterventional urethral steinstrasse have been reported in pediatric and adult patients. We report a case of a 52-year-old Nigerian man with a secondary urethral steinstrasse, and the treatment options possible, as day case procedures, under caudal anesthesia.

Epidemiology of complications of male circumcision in Ibadan, Nigeria.

BACKGROUND: The number of infants managed for neonatal circumcision injuries in our unit has been on the increase over the past 16 years. In our search for the sources and reasons for these injuries, we were unable to identify any previous studies of circumcision injuries from our environment. We therefore decided to carry out this study in order to shed some light on this growing problem. METHODS: The patients were made up of 370 consecutive consented children attending our infant welfare clinic for immunization over a period of 3 months. Information on their demographic data, their age at circumcision, where, why and who circumcised them was obtained from their mothers. They were clinically examined for the presence and type of complications of circumcision. RESULTS: Our circumcision rate was 87%. Neonatal circumcision had been performed in 270 (83.9%) of the children. Two hundred and fifty nine (80.7%) were performed in hospitals. The operation was done by nurses in 180 (55.9%), doctors in 113 (35.1%) and by the traditional circumcisionist in 29 (9%) of the children. Complications of circumcision occurred in 65 [20.2%] of the children. Of those who sustained these complications, 35 (53.8%) had redundant foreskin, 16 (24.6%) sustained excessive loss of foreskin, 11 (16.9%) had skin bridges, 2 (3.1%) sustained amputation of the glans penis and 1 (1.5%) had a buried penis. One of the two children who had amputation of the glans also had severe hemorrhage and was transfused. Even though the complications tended to be more likely with nurses than with doctors or traditional circumcisionists, this did not reach statistical significance (p = 0.051). CONCLUSION: We have a very high rate of complications of circumcision of 20.2%. We suggest that training workshops should be organized to adequately retrain all practitioners of circumcision on the safe methods available.

Urethral duplication with a perineal opening in a four-year-old boy.

Urethral duplication (UD) is a rare congenital anomaly. In UD, there is in addition to a normally positioned urethra an accessory urethra arising from the bladder, bladder neck or the proximal urethra and terminating anywhere between the base of the penis along the ventral surface and the glans penis. The embryologic development of UD remains to be clearly elucidated and the etiology of the condition is unknown. We present our experience with a 4 year old boy who presented with urethral duplication.

Familial torsion of the testis.

We report a family of a man and two of his three male children who all had torsion of the left testis, all at the age of 15 years and all occurring during sleep. Their management and the possible modes of inheritance are discussed.

Erectile Dysfunction Among Men Attending Surgical Outpatients Department in a Tertiary Hospital in South-Western Nigeria.

BACKGROUND: Erectile dysfunction is becoming a public health issue with high incidences reported in community studies. OBJECTIVE: To evaluate the characteristics and outcome of treatment in men with erectile dysfunction in a tertiary center in Ibadan southwestern Nigeria. METHODS: Data of men with erectile dysfunction was retrieved between July 2004 and June 2014 and analyzed using SPSS version 16 statistical software. RESULTS: Eighty-nine men with erectile dysfunction were managed which constituted 2% of all urological cases seen during the study period. Their median and mean ages were 39 years and 39.6 ± 1.2SD (range 19-76 years). The peak age incidence at 30-44 years was 41.6% and reduced with increasing age after 65 years to 4.5%. The etiologies were psychogenic in 55%, organic in 27%, idiopathic in 17% and 1% was familial. 67.5%, 31.5% and 3.4% were married, single and separated respectively. Seventy percent neither smoked cigarette nor drank alcohol, 21.3% drank alcohol and 9% took both alcohol and smoked cigarette. Seventy seven and half percent of men presented within 5 years of their symptom. The treatments offered were PDE type 5 inhibitors alone or in combination with psychotherapy or modification of medications. The outcome of these treatments ranged from 89% to 91% success rate. CONCLUSION: The number of men with erectile dysfunction managed in the tertiary hospital is very low though the outcome of treatment is within acceptable range. Increase public enlightenment may encourage increase hospital patronage and access to the available treatments for erectile dysfunction.

Congenital complex penile curvature.

Congenital complex penile curvature is a rare deformity that arises from asymmetry of the corpora cavernosa. The deformity is generally not severe enough to interfere with sexual intercourse but can be a source of great concern to the patient and may cause him to avoid sexual contact altogether. We report a case of congenital complex penile curvature in a 21-year-old man who was satisfactorily corrected using the modified Nesbit procedure.

Prevalence of Linea nigra in patients with benign prostatic hyperplasia and prostate carcinoma.

BACKGROUND: Linea nigra (LN) is linear hyperpigmentation occurring from the umbilicus to the pubic symphysis. Although commonly associated with pregnancy (when it is known as linea gravidarum), it has been found in normal male and female individuals, particularly in the younger age group where estrogen or lack of sensitivity of androgen receptors has been suggested as a possible factor. From a previous study the incidence of LN varied in different genders, age groups, and certain clinical status such as pregnancy and, in men, benign prostate hyperplasia (BPH)/prostate carcinoma (PC). OBJECTIVE: The need to get a clinical feature that can aid diagnosis of PC, the commonest male neoplasm in Nigeria, at an affordable cost prompted us to look at the incidence of LN in three male populations (i.e., one with BPH, one with PC, and a control population unaffected by these two conditions). Gynecomastia and female hair distribution, two features considered hormone related were looked for additionally in the study population. The study was carried out in a teaching hospital in Ibadan, southwestern Nigeria. RESULTS: LN was found in 48% of PC, 26% of BPH, and 8% of controls. Female pubic hair was found in 48% of PC, 26% of BPH, and 12% of controls. Gynecomastia was found in 36% of PC, 12% of BPH, and 0% of controls. Differences between patients with BPH, PC, and controls regarding incidence of LN and female pubic hair were deemed explicable by chance (P = 0.17, Fisher exact test). Differences between PC and BPH patients with respect to gynecomastia were deemed inexplicable by chance (P = 0.008, Fisher exact test). CONCLUSION: LN alone cannot be used to differentiate PC and BPH. Further studies will be needed to characterize the role of LN in these conditions in men before and after treatment.

Daycase urology at Ibadan, Nigeria: a ten year review.

INTRODUCTION: The objective of the study was to report the extent of urological surgeries performed as day cases in a major tertiary hospital in Ibadan and document the outcome. METHODS: We retrospectively reviewed the data of all urologic patients treated at the day-case theatre between January 2000 and December 2009. The parameters evaluated were: age, diagnosis, type of surgery/procedure, anaesthesia administered and the rank of the surgeon. Day case endoscopic procedures as well as prostate biopsies were excluded from the study. RESULTS: In total, 1292 patients were managed, 290 (22.4%) were children aged between 5 days and 15 years while 1002 (77.6%) adults aged between 17 years and 91 years. The majority of the procedures were carried out by the senior registrars (1169 cases, 90.5%) and consultants were involved in 123 cases (9.5%). General anaesthesia was primarily used in children (158 children vs. 4 adults), while local anaesthesia was used only in adults. 131 (45.2%) children had no anaesthesia for circumcision. The most common procedures performed in adults were varicocelectomy (426 cases, 42.5%), orchidectomy (332 cases, 33.1%), testicular biopsy (120 cases, 12.0%). While in children male circumcision (231 cases, 79.7%) was the main procedure performed. CONCLUSION: The day-case theatre is still suitable for day case urologic procedure in our setting. The common procedures are varicocelectomy, orchidectomy, and open testicular biopsy in the adults. While in children, male circumcision is commonly carried out.

Epidermal inclusion cyst as a rare complication of neonatal male circumcision: a case report.

INTRODUCTION: Ibadan, Nigeria, has a very high rate of complications of male circumcision. In a previous survey, redundant or excessive loss of foreskin, skin bridges and injury to the glans penis were the major types of complications identified. Epidermal inclusion cyst complicating neonatal male circumcision appears to be extremely rare, and an extensive search of all databases revealed no reports in the recent literature. CASE PRESENTATION: In 1992, a 10-year-old boy was seen at the urology outpatients clinic presenting with a globular swelling in the penile skin located at the ventral surface proximal to the coronal sulcus. The histology of the excised mass revealed an epidermal inclusion cyst. Since then, he has remained healthy. CONCLUSIONS: Epidermal inclusion cyst complicating male neonatal circumcision is extremely rare. The diagnosis is easy and a simple total excision is curative.

Thread embedded into penile tissue over time as an unusual hair thread tourniquet injury to the penis: a case report.

INTRODUCTION: Hair thread tourniquet syndrome has been recognized since the 1960s. Since then, sporadic reports have appeared in the literature describing different degrees of strangulation and/or amputation of the penis caused by a hair thread being inadvertently tied around the penis. CASE PRESENTATION: A 9-year-old boy presented with a 3-year history of hair thread tourniquet injury to his penis. Instead of the usual strangulation or amputation, the tourniquet had become embedded into the penile tissue, manifesting with exuberant granulation tissue and a tight urethral stricture. At surgery, the intact tourniquet was still in place, embedded in dense fibrous tissue and associated with a dense urethral fibrosis which measured about 2 cm long. The tourniquet was divided and removed, the fibrotic urethra excised and a distal penile pedicled skin flap used to perform a single-stage substitution urethroplasty. The patient has been voiding well for 28 months. CONCLUSION: This case is unusual and is the first report of its kind. It is also the first report of a hair thread tourniquet as the cause of pediatric penile injury in Nigeria.

Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

OBJECTIVE: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. METHODS: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999-November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4-6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P < or = 0.05 was considered significant. RESULTS: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5-7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of > or =20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) CONCLUSION: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy.

Dermoid cyst of the urinary bladder as a differential diagnosis of bladder calculus: a case report.

Dermoid cysts are extremely rare in the urinary bladder and can pose a diagnostic dilemma to both the Urologist and the Histopathologist. Only a few cases were found documented and cited in PubMed. We present a case of dermoid cyst in the urinary bladder presenting as a bladder stone with a brief review of the literature.