Predictive Value of Transrectal Ultrasonic Doppler and Elastographic Features in Prostate Cancer Detection in Lagos University Teaching Hospital.

Introduction: This study aimed at determining the predictive value (PV) of transrectal ultrasonic Doppler and elastographic features in prostate cancer (PCa) detection among patients in Lagos University Teaching Hospital. Materials and Methods: This prospective study involved patients that underwent evaluation for PCa. Participants had digital rectal examination (DRE), prostate-specific antigen (PSA) assay, and transrectal ultrasound-guided prostate biopsy using colour Doppler (CD) and elastography. All cores were sent for histopathology. Data were analysed using Statistical Package for the Social Sciences Version 22.0. CD and elastography PV in PCa detection and their relationships to the Gleason score (GS) were analysed (P < 0.05). Results: Seventy men (aged between 45 and 87 years) were enrolled. Forty-three (61.4%) patients had PCa with a mean age of 69.37 ± 8.22years. The sensitivity, specificity, positive PV (PPV), negative PV (NPV) and accuracy of CD were 8.50%, 97.44%, 64.10%, 66.42% and 66.31%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of elastography were 84.21%, 94.59%, 88.89%, 92.11% and 91.07%, respectively. Conclusion: There is a significant association between decreased elasticity (elastography) and PCa detection but a weak association between increased vascularity (CD) and PCa detection. A positive correlation exists between extent of prostatic stiffness and GS.

Monopolar transurethral resection of the prostate using water as the irrigation fluid: Our initial experience.

BACKGROUND: Monopolar transurethral resection of the prostate (M-TURP) has been the gold standard of surgical intervention in patients with benign prostatic hyperplasia with the indication for surgery. This can be achieved using varieties of irrigation fluids. OBJECTIVES: To document our experience with M-TURP using water as irrigation fluid in 123 consecutive patients. MATERIALS AND METHODS: A retrospective study of all patients who had M-TURP with water as irrigation fluid was performed between January 2017 and July 2019. Information retrieved from theatre records and case notes includes patient's socio-demographic data, indications for surgery, intra-operative findings, the volume of resected chips and irrigation fluid used, post-operative complications and patient's satisfaction with the outcome of the procedure. These data were analysed using SPSS version 23. RESULTS: Data from 123 patients were analysed and presented. The age range was 44-96 years with a mean of 69 years. Prostate volume ranges from 13.9 to 276.00 mls with a mean of 95.69 mls while resected prostate volume ranges from 2.0 to 158.0 mls with a mean of 56.68 mls. Volume of the sterile water used as irrigation fluid ranged from 5.0 L to 174.0 L with a mean of 68.7 L. Mean reduction in International Prostate Symptoms Score, improvement in Q-max and reduction in post-void residual urine were 22.1, 16.9 and 141.6 mls, respectively. Transfusion rate was 6.5% while the duration of admission ranges from 1 to 6 days, with a mean of 2.5 days. The overall complication rate was 26.0%. Ninety-six percent were satisfied with the outcome. CONCLUSION: M-TURP using water as irrigation fluid is safe and is as good as using the more rather expensive glycine or normal saline in bipolar TURP.

Short-term Effect of Tamsulosin and Finasteride Monotherapy and their Combination on Nigerian Men with Benign Prostatic Hyperplasia.

OBJECTIVE: The objective of this study was to assess the efficacy of tamsulosin and finasteride monotherapies, and their combination in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This is a prospective single-blind randomized study of ninety men with BPH who were managed using drugs. The International Prostate Symptom Score (IPSS), peak urinary flow rate, and prostate volume were measured as parameters for assessment at the beginning, 3 months, and 6 months of the study. RESULTS: The mean age of patients was 61.65 with a range of 44-81 years. There was a progressive and sustained improvement in the IPSS score in all patient groups with mean decrease at 3 months of 7.24 (42.59%), 7.60 (41.85%), and 7.24 (40.61%) and at 6 months of 8.14 (47.88%), 10.33 (56.88%), and 11.1 (62.25%) in the tamsulosin, finasteride, and combination groups, respectively. There was an increase in peak urinary flow rate in all groups with mean increase at 3 months of 0.98, 0.05, and 3.55 (ml/s) and at 6 months of 4.11, 0.87, and 3.74 (ml/s) in the tamsulosin, finasteride, and combination groups, respectively. There was a reduction in the prostate volume in the finasteride and combination groups at 6 months of 6.8 and 6.32 cm3, respectively, while the tamsulosin group recorded an increase. CONCLUSION: At the end of 6 months, tamsulosin monotherapy and combination therapy appear to be equally effective in the treatment of lower urinary tract symptoms BPH while finasteride monotherapy appears to be the least effective. Bothersome, side effects were more in patients taking finasteride alone or as combination therapy.

Research experience of resident doctors who attended research methodology courses of the National Postgraduate Medical College of Nigeria.

INTRODUCTION: For over three decades, the National Postgraduate Medical College of Nigeria (NPMCN) has been vested with the responsibility of overseeing postgraduate medical training. The main objective of this study was to assess the residents' perception of research as well as challenges faced in pursing seamless research during their training. MATERIALS AND METHODS: This study was a cross-sectional descriptive survey in 2013. Self-administered questionnaires were distributed to the participants of the annual research methodology workshop in all the 15 faculties of the NPMCN. The questionnaires assessed the residents' previous exposure to research, their publication history and their trainers' input to their own research. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software. RESULTS: Four hundred and one resident doctors, out of a total of 415 who attended the course, completed the questionnaires during the study period (96.6% response rate). There were 269 (67.0%) males and 132 (33.0%) females, giving a male-to-female ratio of 2:1. About three-quarters of them admitted that their exposure to research during training was grossly inadequate. Twenty-five percent of them were involved in a previous research before residency training, and a further 70% of respondents were involved in their trainers' research work. Ninety-four percent in our study identified a lack of dedicated time to be spared for research as a major obstacle to research. CONCLUSION: Contribution and exposure to research among postgraduate trainees in Nigeria are low. Lack of dedicated time for research was viewed as the major obstacle to research by most residents.

The role of transrectal ultrasound-guided fine-needle aspiration biopsy in the diagnosis of prostate cancer: Sextant versus extended protocol.

AIM AND OBJECTIVES: The aim of this study is to compare the prostate cancer detection rates of sextant and extended transrectal ultrasound (TRUS)-guided fine-needle aspiration biopsy (FNAB) protocols. MATERIALS AND METHODS: This was a prospective study of 96 patients investigated for prostate cancer. An extended 10-aspiration TRUS-guided FNAB using a 22G Echotip Chiba needle was performed. Inclusion criteria included the presence of one or more of the following: Abnormal digital rectal examination (DRE) findings, persistently elevated prostate specific antigen, and abnormal prostatic imaging. A set of traditional sextant aspirations were carried out as well as four laterally guided aspirations taken from the middle base of the peripheral zone on either side. The cancer detection rates of sextant and extended (combination of sextant and lateral) FNAB protocols were determined and compared. The value of P < 0.05 was considered statistically significant. RESULTS: The overall cancer detection rate was 24%. Benign cases were reported in 71.8% of patients and 4.2% reported as suspicious. Of the 23 patients' aspirations positive for malignancy, 16 (69.6%) were detectable by the sextant protocol while the lateral protocol detected 21 (91.3%). Two cancers were detected by the sextant protocol only (where the lateral technique was negative for malignancy), 7 cancers were detected by the lateral protocol only while 14 cancers were positive in both the sextant and lateral protocols. The extended protocol showed a statistically significant 30.4% increase in cancer detection over the traditional sextant (P = 0.007). CONCLUSION: The extended protocol rather than the sextant protocol should be offered to patients who require FNAB of the prostate as the optimum FNAB protocol.

Clinico-pathological Correlation of Digital Rectal Examination Findings Amongst Nigerian Men with Prostatic Diseases: A Prospective Study of 236 Cases.

AIMS AND OBJECTIVE: This study aims at correlating different digital rectal examination (DRE) abnormalities with histopathological results in patients with prostatic diseases. MATERIALS AND METHODS: A prospective study of 236 patients who underwent prostate needle biopsy (PNB). Inclusion criteria were presence of abnormal DRE findings or elevated prostate specific antigen above 4 ng/ml or both. They all had 10-core extended transrectal biopsy and specimens were sent for histopathological examination. Correlations were made between DRE findings and histopathology results. Two separate multivariate logistic regression models were created; the first evaluated the relationship of predictors (DRE findings) to the likelihood of detecting cancer and the second explored predictors of high-grade cancer on PNB. RESULTS: Two hundred and thirty-six patients were enrolled with a mean age of 66.9 years and range of 43-90 years. Histopathology results were malignant in 102 (43.2%) and benign in 134 (56.8%). Ninety-one (38.6%) and 145 (61.4%) had normal DRE and abnormal DRE findings with cancer detection rates of 23.1% and 55.8% respectively. Nodular prostate is the most common abnormality in 63.4% patients with abnormal DRE. Each sign of DRE had different predictive value with enhanced positive predictive value when combinations of abnormalities are present. Abnormal DRE is an independent predictor of high-grade tumor. Mean Gleason scores were 4.7 and 7.1 in patients with normal and abnormal DRE respectively. CONCLUSION: DRE is a useful and important tool in assessing patients with suspected prostate diseases who need prostate biopsy. An abnormal DRE correlated well with prostate cancer and independently predicted high-grade disease in these men.

Surgically correctable morbidity from male circumcision: indications for specialist surgical care in lagos.

AIM/OBJECTIVE: To determine the pattern of morbidity and outcome among patients referred to the Pediatric Surgery Unit of the Lagos University Teaching Hospital (LUTH) following circumcision. MATERIALS AND METHODS: Retrospective descriptive study of all patients with complications of circumcision who were managed in LUTH between 2008 and 2010. RESULTS: There were 36 patients. The age range was between 2 days and 9 years (median-3 months). Fifteen cases (42.9%) were due to urethro-cutaneous fistula while there were six cases (16.7%) of postcircumcision bleeding. There were four cases (11.1%) each of partial penile amputation and buried penis. There were also cases of meatal stenosis, penile implantation cyst and glanulo-preputial skin bridge. With respect to the treatment offered, eleven (30.6%) patients had urethroplasty for the urethro-cutaneous fistulae while seven (19.4%) patients had penile refashioning for the buried penis and penile amputation. Appropriate surgical treatments were performed for the other complications. CONCLUSION: Urethrocutaneous fistula and penile amputation are the commonest complications of circumcision for which referral is made to LUTH. Treatment outcome was satisfactory. Health education and legislation to ensure procedure is performed by qualified medical and paramedical staff may reduce the morbidity.