Anterior bladder wall thickness, post-void urine residue, and bladder emptying efficiency as indicators of bladder dysfunction in Nigerian men with benign prostatic hyperplasia.

BACKGROUND: Benign Prostatic Hypertrophy [BPH] is associated with voiding dysfunctions. Urodynamic study is the gold standard for diagnosis of voiding dysfunctions but is invasive. Bladder wall thickness (BWT), post-void urine residue (PVR), and bladder emptying efficiency (BEE) are noninvasive predictors of voiding dysfunction. OBJECTIVE: To study the relationship among BWT, PVR, and BEE in BPH. SUBJECTS AND METHODS: A hospital-based cross-sectional prospective study of new BPH patients at Nnamdi Azikiwe University Teaching Hospital, Nnewi. The participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥200 mls), prostate volume (PV), and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with an abdominal probe frequency of 3.5 MHz. Then the BEE was calculated. The anterior BWT was divided into two groups: <5 mm and ≥5 mm. The data were analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann-Whitney test. A P- Value <0.05 was considered significant. RESULTS: Seventy seven men with a mean age of 66.66 ± 10.74 years were included in the study. Sixty one percent had symptoms lasting >12 months. The average anterior BWT, PBV, PVR, BEE, PV, and PSA were 4.55 ± 1.02 mm, 260.98 ± 57.44 mls, 58.36 ± 52.94 mls, 77.98 ± 17.37%, 66.31 ± 46.38 mls, and 8.04 ± 5.97 ng/ml, respectively. There was a significant positive correlation between BWT and duration of symptoms (P = 0.044) and a significant negative correlation between BWT and BEE (P = 0.005). An insignificant positive correlation was found between BWT and PVR (P = 0.255). Fifty four (70.1%) had BWT <5 mm and 29.9% had BWT ≥5 mm. The mean IPSS (P = 0.000), PV (P = 0.032) and PVR (P = 0.020) were significantly higher in the ≥5 mm group. The ≥5 mm group also had a significantly lower BEE (P = 0.002). CONCLUSION: Voiding dysfunction was more severe in patients with BWT of 5 mm or more. There was a positive, but insignificant, correlation between anterior BWT and PVR and a significant negative correlation between BWT and BEE.

Comparison of the efficacy of eutectic mixture of local anesthetics (EMLA) and dorsal penile nerve block (DPNB) in neonatal circumcision.

BACKGROUND: Neonates feel pain. There is a concern among practitioners that pain of injecting analgesics to neonates prior to circumcision could as well be the same as the pain of the procedure. This has made many reluctant to offer effective analgesia for circumcision. If eutectic mixture of local anesthetics (EMLA) provides analgesia comparable to dorsal penile nerve block (DPNB), it will obviate needle prick and encourage analgesia use in neonatal circumcision. AIM: To determine how the analgesic efficacy of EMLA compares with that of DPNB in neonatal plastibell circumcision. METHODS: A prospective study of 110 male neonates for plastibell circumcision randomized into two groups: A and B, of 55 each, received EMLA or DPNB as analgesia prior to circumcision, respectively. The pulse rates and SpO2 were recorded with pulse oximeter pre-procedural and at four stages of the procedure (adhesiolysis, dorsal slit, tying, and excision) for each neonate. Also the modification of neonatal infant pain scale (NIPS) was recorded during the procedure. RESULTS: There were differential changes in SpO2 (lower absolute mean values) and pulse rate (higher absolute mean values) for neonates who received EMLA when compared with DPNB before the procedure. These differences were significant with SpO2 at adhesiolysis (91.0% and 95.0%), dorsal slitting (90.9% and 94.7%), and excision stages (93.4% and 95.3), respectively (P < 0.05). They were also significant with the pulse rates at adhesiolysis (167.9 and 158.6), dorsal slitting (174.3 and 161.7), and tying stages (182.2 and 169.0), respectively (P values = 0.013, 0.015, and 0.044, respectively). This shows DPNB is better than EMLA. However, the difference was not significant at the tying stage with SpO2 and at excision stage with PR (P > 0.05). CONCLUSION: EMLA produces analgesic effect. However, it does not provide effective analgesia for plastibell circumcision in neonates. DPNB provides a better analgesia than EMLA for neonatal plastibell circumcision.

Correlation between intravesical prostatic protrusion and international prostate symptom score among Nigerian men with benign prostatic hyperplasia.

BACKGROUND: Intravesical prostatic protrusion (IPP) is a noninvasive test that can predict bladder outlet obstruction in patients with benign prostatic hyperplasia (BPH). OBJECTIVE: The objective of this study was to determinethe correlation between IPP and International Prostate Symptom Score (IPSS) in patients with BPH. PATIENTS AND METHODS: A cross-sectional prospective study of new patients with symptomatic BPH who presented to the urology clinics of NAUTH, Nnewi. Ethical approval and informed consent were obtained. Participants had abdominal ultrasonography measurements of IPP from midline sagittal image of the prostate (at bladder volume ≥100 mL) using Prosound SSD3500 with abdominal probe frequency of 3.5 MHz. IPP was divided into three grades (grade I: 0-4.9mm, grade II: 5.0-9.9 mm, and grade III: ≥10.0 mm). Data were analyzed using SPSS version 20. The data were subjected to analysis of variance, and Pearson's correlation was used to assess correlation where necessary. P value < 0.05 was considered significant. RESULTS: In all, 101 men with a mean age of 67.09 ± 10.93 years were included in the study. The average IPSS, storage symptoms IPSS (IPSS-S), voiding symptoms IPSS (IPSS-V), Quality of Life (QoL) index, and IPP were 17.05 ± 7.62, 7.81 ± 5.17, 9.24 ± 3.16, 4.75 ± 1.59, and 13.50 ± 7.47 mm, respectively. There were significant differences between the mean IPSS (P = 0.000), mean IPSS-S (P = 0.000), and mean IPSS-V (P = 0.002) among the three grades of IPP. There were significant positive correlations between IPP and IPSS (P = 0.000), IPSS-S (P = 0.000), IPSS-V (P = 0.000), and IPSS QoL index (P = 0.000). CONCLUSION: There were significant positive correlations between IPP and IPSS, IPSS-S, IPSS-V, and IPSS QoL index.

Urethroplasty Practices among Reconstructive Urologists in Nigeria.

OBJECTIVES: To determine the national practice patterns in the management of male urethral stricture disease by the open urethroplasty technique. MATERIALS AND METHODS: A questionnaire-based national survey of Nigerian urologists was performed during the 19(th) Annual General Meeting and Scientific Conference of the National Association of Urological Surgeons of Nigeria, held at Ibadan, Southwest Nigeria in 2013. RESULTS: A total of 55 respondents (67.1%) completed the questionnaire. About 43.6% were between the ages of 40 and 49 years. Almost 41.8% had between 5 and 9 years of experience as a reconstructive urologist, and 50.9% performed 1-9 urethroplasties/year. A total of 80 responders reported trauma as the most common etiology for their strictures. About 63.7% preferred to treat strictures after 3-6 months of diagnosis and 67.3% of respondents preferred the combination of retrograde urethrography and voiding cystourethrography for the diagnosis of urethral stricture. Stenting of the urethra was done after urethroplasty using size 16 Fr of 18 Fr silastic catheter; however, the duration of stenting varied among urologists. About 41.8% followed up their patients for a year, and uroflowmetry was used by 36.6% of the responders to follow-up their patients. Stricture recurrence was the most common reported complication by 36.4% of the respondents. CONCLUSIONS: In Nigeria, most urethral stricture diseases are treated by open urethroplasties. Very few of these surgeries are performed annually by young urologists. There is no uniformity in the method of diagnosis, stenting, and follow-up after treatment.

Accuracy of Prader orchidometer in measuring testicular volume.

BACKGROUND: Seminiferous tubules comprise 80-90% of testicular mass. Thus, the testicular volume is believed to be an index of spermatogenesis. Therefore, accurate testicular volume is one way to assess testicular function. OBJECTIVE: To determine the accuracy of Prader orchidometer for measuring the testicular volume by comparing the resultant measurement with the actual testicular volume in humans. MATERIALS AND METHODS: The testicular volumes of 121 testes from 62 patients with prostate cancer (mean age 72.74 ± 9.38 years) were measured using Prader orchidometer before therapeutic bilateral orchidectomy. The actual testicular volumes were then determined by water displacement of the testis. RESULTS: The mean testicular volume of the 121 testes was 10.60 ± 3.5 ml and 13.26 ± 5.2 ml for water displacement and Prader orchidometer measurements, respectively. A strong correlation was found between the actual testicular volume and volumes obtained by Prader orchidometer ( r = 0.926, P = 0.0001). The Prader orchidometer however, over-estimated the mean actual testicular volume by 2.66 ± 2.37 ml (25.10%). CONCLUSION: The result of this study has shown that measuring the testicular volume by Prader orchidometer overestimates the actual testicular volume.

Malignant renal tumours in adults in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

BACKGROUND: Malignant renal tumour is the third commonest urological tumour after prostate and bladder cancer. It is however the urological tumour with the highest mortality/incidence ratio. OBJECTIVE: To review the frequency, mode of presentation and histological pattern of patients with malignant renal tumours in Nnamdi Azikiwe University Teaching Hospital. METHOD: A 7 year retrospective review of all our renal tumour folders in theinstitution. RESULTS: 19 patients qualified for the study with a male/female ratio of 1:2.8 and a mean age of 52.6 +/- 15.8 years. The peak age was in the seventh decade. Most patient present late (78.9%). Renal cell cancer was the commonest tumour type with the commonest mode of presentation being abdominal mass and pain. CONCLUSION: Malignant renal tumours present very ate in our environment and patients hesitate in accepting available treatment option which is surgery. There is need for increased patient awareness and high index of suspicion by the clinician, particularly during imaging procedures, as this would significantly enhance the early detection of these patients.

Malignant renal tumours in adults in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

BACKGROUND: Malignant renal tumour is the third commonest urological tumour after prostate and bladder cancer. It is however the urological tumour with the highest mortality/incidence ratio. OBJECTIVE: To review the frequency, mode of presentation and histological pattern of patients with malignant renal tumours in Nnamdi Azikiwe University Teaching Hospital. METHOD: A 7 year retrospective review of all our renal tumour folders in the institution. RESULTS: 19 patients qualified for the study with a male/female ratio of 1:2.8 and a mean age of 52.6 +/- 15.8 years. The peak age was in the seventh decade. Most patient present late (78.9%).Renal cell cancer was the commonest tumour type with the commonest mode of presentation being abdominal mass and pain. CONCLUSION: Malignant renal tumours present very late in our environment and patients hesitate in accepting available treatment option which is surgery. There is need for increased patient awareness and high index of suspicion by the clinician, particularly during imaging procedures, as this would significantly enhance the early detection of these patients.

Post-orchiectomy anaemia in patients with advanced carcinoma of the prostate.

OBJECTIVE: To study postorchiectomy anaemia in black Nigerian patients who had bilateral orchiectomy for advanced carcinoma of the prostate. Anaemia has been observed in similar studies done on Caucasians and non-black patients in non-tropical environments MATERIALS AND METHODS: Consecutive patients with advanced carcinoma of the prostate who were managed by the authors over a four-year period, and who were treated with bilateral orchiectomy were prospectively studied. They also satisfied the set criteria for inclusion in the study. RESULT: Thirty-six patients were studied. The mean age was 71 years (SD = 7.6). Preoperative white blood cell count with blood film examination, and serum urea and creatinine were within normal limits and remained so for the duration of the study. The mean value of the haemoglobin concentration dropped significantly from 11.9 g/dl to 10.1 g/dl at six months (p < 0.005). The prostate specific antigen decreased from a mean preoperative value of 62.2 ng/ml (SD = 58.6) to a mean postoperative nadir of 2.9 ng/ml (SD = 1.3) after three months. CONCLUSION: In Nigerians, there is a statistically significant decrease in the heamoglobin concentration after bilateral orchiectomy. This should be closely monitored, and treated when indicated.

Axillary fibroadenoma mimicking lymphadenopathy.

Ectopic breast tissues are subject to the similar physiological and pathological alterations seen in breast tissues situated in their normal anatomical positions. We report a 34-year old multiparous woman who presented with a right axillary lump of about 1 year duration, for which clinical impression of axillary lymphadenopathy was made and lumpectomy carried out. Histology of excised lump revealed fibroadenoma. We discussed possible pathogeneses and consequences of this lesion.

Can physique and gluteal size predict penile length in adult Nigerian men?

BACKGROUND: In Nigeria, especially among the Igbo tribe, there is a well-held belief that a man's penile size can be predicted from his physique and the size of his buttocks, with people of small physique and flat buttocks likely to have long penile lengths. STUDY DESIGN: A prospective study to test the scientific veracity of this traditional and apparently mythical belief. Stretched penile length was measured in 115 men between the ages of 30-65 years and its correlation with the body-mass index and the circumference of the hip as measured around the most prominent points on their buttocks, was statistically determined. RESULT: The mean age of the subjects was 42.30 years (SD = 9.67), with a median of 40 years and a range of 30-65 years. The mean penile length was 13.37 cm with a median of 13 cm and a range of 7.5-19.5 cm. The mean circumference of the body around the buttocks was 96.46 cm (SD = 10.91), median 98 cm, and range 73-122 cm. The body-mass index ranged 17.34-44.44, with the mean at 26.87 (SD = 5.86), and the median 25.53. Linear regression statistics showed no statistically significant correlation between stretched penile length and body-mass index, thus physique. There was a significant direct correlation between penile length and gluteal size. CONCLUSION: The supposed relationship between penile length and gluteal size may have a scientific basis, but contrary to belief, large buttocks is more predictive of longer penile length than small buttocks. Penile length has no relationship to physique.

Genitourinary tuberculosis in Nigeria; a review of thirty-one cases.

OBJECTIVE: To report and discuss the characteristics of genitourinary tuberculosis as observed in a sub-Saharan African setting, where reports suggest its rarity despite reported high incidence and prevalence of pulmonary tuberculosis. PATIENTS AND METHOD: Thirty one consecutive patients with discharge diagnoses of genitourinary tuberculosis seen in a small community-based hospital over a five-year period were retrospectively studied. RESULT: There were 28 males and three females, with a mean age of 37.6 (SD 11.5) years. Forty- three sites were involved in seven organs: epididymis 25 (58.1%), kidney 7 (16.3%), testis 4 (9.3%), bladder 3 (7.0%), ureter 2 (4.7%), prostate 1 (2.3%), and cord of the testis 1 (2.3%). The commonest presenting features were scrotal/testicular mass with or without pain/tenderness (80.6%), fever/headache (51.6%), and dysuria (22.6%). Other common features were back, loin, or abdominal pain/tenderness. hydrocoele, scrotal abscess, and haematuria. 26.9% had evidence of concurrent or previous pulmonary tuberculosis, and 9.1% were positive on HIV 1 & 11 screening. CONCLUSION: With the prevailing conditions in sub-Saharan Africa and most of the developing world and the slightly different characteristics of the disease in our environment, diagnosis of genito-urinary tuberculosis may be difficult. It is advised that patients with unexplained symptoms in the urinary tract should be investigated for tuberculosis.

Cyclical haematuria sequel to uterine myomectomy: a case report.

A thirty-year old married nulliparous lady had a difficult myomectomy done by a general practitioner one year prior to presentation. Two months after the operation, she had her menstruation, but with a concurrent total, painless haematuria. This combination continued for nine months before her family physician referred her to the urological clinic. Full urological work-up revealed an iatrogenic vesico-uterine fistula, but the features were not consistent with those of the classical vesico-uterine fistula syndrome. Transabdominal fistulectomy not only controlled the haematuria but also helped the patient to achieve a viable pregnancy.

Combined intrauterine and extrauterine gestation with a general surgical presentation.

A case is presented of a combined intrauterine and extrauterine gestation. The diagnosis of the ectopic pregnancy was made intraoperatively with a pre-operative diagnosis of a simple intestinal obstruction, while the intrauterine pregnancy was diagnosed after a spontaneous abortion. A family history of twinning associated with a surgical evidence of chronic inflammatory disease is thought to be the cause.