One-stage urethroplasty for urethral strictures at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, south western Nigeria.

BACKGROUND: Urethral stricture, a common urologic condition, is probably the most common cause of urinary retention in tropical Africa and a frequent cause of lower urinary tract symptoms worldwide. This study aimed at presenting our experience with one-stage urethroplasty at the Ladoke Akintola University of Technology Teaching Hospital Osogbo, Nigeria. METHODS: All male patients who underwent one-stage urethroplasty between December 2005 and December 2011 were studied retrospectively. Details of their presentation and management were reviewed. RESULTS: A total of 50 patients aged 2-75 years (mean ± SD 44.2 ± 21.53 years) with a urethral stricture underwent one-stage urethroplasty. The modal age group was 61-75 years (26 %). In all, 27 (54 %) patients were >40 years. Strictures following previous urethritis were more common (29, 58 %) than those seen after trauma (21, 42 %). Strictures following trauma were more common in men ≤ 40 years (52.2 %), and 69 % of strictures in men >40 years were infective in origin. Altogether, 88 % of strictures were exclusively found in the anterior urethra. In all, 32 (64 %) patients had bacteriuria at presentation. Strictures ≥ 2 cm with extensive fibrosis were noted in 21 (42 %). Excision of scar tissue was done, followed by end-to-end anastomosis in 32 (64 %), penile pedicle flap in 16 (32 %), and buccal mucosal graft in 2 (4 %) of the patients. Wound infection was the most common complication. Overall, 76 % of patients achieved a urine flow rate of 15 ml/s and postvoid residual urine of ≤ 50 ml. CONCLUSIONS: One-stage urethroplasty offered satisfactory results in the study group. It is recommended for urethral reconstruction in men with urethral stricture.

Bilateral secondary testicular, epididymal and spermatic cords carcinoma of prostatic origin: a case report and review of the literature.

BACKGROUND: Prostatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide. Patients often present with locally advances stages, and common sites of metastasis are the spine, pelvis, chest, and long bones. Metastases to the testes and spermatic cords are reputed to be rare and may be indicative of a worse outcome, when they occur. We recently encountered a clinical case of bilateral testicular, epididymal and spermatic cords prostatic cancer metastases. CASE PRESENTATION: A 71-year-old Nigerian man, who presented at our hospital with 1-month-old complaints of inability to walk together with low back and bilateral thigh pains. This presentation had been preceded by a 5-month history of lower urinary tract symptoms. On examination, the prostate was hard and nodular as were the left testis and spermatic cord. On histological assessment of a needle biopsy, prostatic adenocarcinoma (Gleason score 5 + 5 = 10) was diagnosed. A subsequent therapeutic bilateral total orchidectomy specimen was found to contain metastatic prostatic carcinoma deposits, in the testes, epididymides, and spermatic cords. Although our patient is currently doing well postoperatively on zoledronic acid, ketoconazole, bicalutamide, and tamsulosin, he is being re-evaluated periodically for any feature of recurrence. CONCLUSION: Since it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy.

Pattern of abdominal wall herniae in females: a retrospective analysis.

BACKGROUND: Gender differences are expected to influence the pattern and outcome of management of abdominal wall hernias. Some of these are left to speculations with few published articles on hernias in females. OBJECTIVES: To describe the clinical pattern of abdominal wall hernias in females. METHOD: A 5 year retrospective review. RESULT: There were 181 female patients with 184 hernias representing 27.9% of the total number of hernia patients operated. Mean age was 41.66±24.46 years with a bimodal peak in the 1(st) and 7(th) decades. Inguinal hernia accounted for majority (50.5%) but incisional hernia predominated in the 30-49 age group, while only inguinal and umbilical hernias were seen in the first two decades (p=0.04). There was no side predilection in the cases of inguinal hernia. There were 12 (6.6%) emergency presentations, most of which occurred in the 6th decade and above and none below 30 years (p=0.02). Umbilical (4 cases) and femoral hernias (3cases) accounted for most of these cases. Incisional hernia was the commonest cause of recurrent hernias. CONCLUSION: Inguinal hernia is the commonest hernia type in females followed by incisional hernias which also accounteds for most recurrent cases. Age appears to be a risk factor for developing complications.

Groin exploration for the nonpalpable testes: a single center experience.

BACKGROUND: Management of non-palpable testes in Nigeria can be difficult due to late presentation and poor resources. Surgical exploration is often required for diagnosis and treatment. AIM: This study reviews the management outcome of clinically non-palpable testeis in a tertiary center in Nigeria. MATERIALS AND METHODS: Ten years retrospective review of all clinically non-palpable testes in children aged 2-15years managed at the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria. RESULTS: Thirty two children with 44 testicular units were managed. The right side was involved in 12 (37.5%); left in 8 (25.0%) and bilateral in 12 (37.5%) patients. Pre-operative ultrasound was done in 12 patients with localization in just 4 patients (33.3% success rate). At groin exploration, 34 (77.32%) testicular units were located in the inguinal canal. Eight patients with 10 The remaining 10 (22.7%) testicular units required additional mini-laparotomy for which six (13.6%) and 4 (9.1%) testicular units respectively were either in the retroperitoneum or not found. Of the testes in the groin, twenty two (64.7%) testicular units were normal while 12 (35.3%) were atrophic. Four of the retroperitoneal testes were normal while 2 were atrophic. Eight (22.5%) testicular units among the inguinal group had multi-staged orchidopexy; while 2 each of the retroperitoneal group had orchidectomy, one stage orchidopexy, two staged Fowler Stephens (F-S) procedure or lost to follow up after first stage of F-S procedure. Mean follow up period was 2 months. 2 testicular units each had retracted or vanished respectively during follow up. CONCLUSION: Groin exploration still offers a viable approach Surgical exploration is still useful in to the management of non-palpable testes in low resource environment despite the lack of laparoscopy.

A 5-year Review of Darning Technique of Inguinal Hernia Repair.

CONTEXT: The Darning technique of inguinal hernia repair is a tissue-based technique with documented low recurrence rate in some parts of the world. Though practiced in our setting, little is documented on its outcome. AIMS: The aim was to review the outcome of Darning technique of inguinal hernia repair in our setting. STUDY DESIGN: A descriptive retrospective study. PATIENTS AND METHODS: Clinical records of all patients who had inguinal hernia repair using the Darning technique between January 2007 and December 2011 in our institution were obtained. Details of sociodemographic data, intraoperative findings and postoperative complications were reviewed. STATISTICAL ANALYSIS USED: simple frequencies, proportions and cross-tabulations. RESULTS: A total of 132 patients whose ages ranged from 15 to 84 years (mean = 49.4 years) with a male: female ratio of 12:1 were studied. Majority of the hernias were right sided (68.9%), mostly indirect (81.8%). The procedures were for emergencies in 17 (12.9%) cases whereas the rest (87.1%) were done electively. Most procedures, 110 (83.3%) were performed under local anesthesia. Surgical site infection was the most common complication occurring in six patients (4.5%), while four patients (3%) had chronic groin pain. At a mean follow-up period of 15 months there were two recurrences (1.5%) both occurring in patients with bilateral hernias (P = 0.001). CONCLUSIONS: The Darning technique of inguinal hernia repair is a safe and effective method for inguinal hernia repair in our setting.

Herniorrhaphy: an unusual cause of ureteral injury in Nigeria.

KEY CLINICAL MESSAGE: Herniorrhaphy is a common surgery worldwide. Common complications include hemorrhage, infection, chronic pain, and recurrence. Ureteric injury from herniorrhaphy is unusual. We present a case of ureteric injury complicating an inguinal herniorrhaphy for a huge right inguino-scrotal hernia. Patient had primary uretero-neocystostomy but died from septicemia in the postoperative period.

Giant scrotal lymphedema of unclear etiology: a case report.

INTRODUCTION: Scrotal lymphedema is common in the tropics and subtropics. The giant variants can cause a lot of physical disability and psychological disturbances. CASE PRESENTATION: We present a 25-year-old Nigerian male with giant scrotal lymphedema with severe debilitating symptoms, immobility and emotional disturbance. He benefited from a modified Charles' procedure and reconstruction of the penile shaft using a split-thickness skin graft. CONCLUSION: Giant scrotal lymphedema related to poverty, ignorance and neglect, is amenable to surgery. Surgery provides a cosmetically acceptable and functionally satisfying outcome.