Waiting Times in Prostate Cancer Diagnosis and Treatment: A Ten-Year Experience in A Nigerian Teaching Hospital.

INTRODUCTION: Prostate cancer is still the leading male cancer and the leading cause of cancer deaths in Nigeria, and other low- and middle-income countries (LMIC) in Sub-Saharan Africa. Early diagnosis is essential to ensuring prompt treatment and reducing morbidity and mortality. Reducing the waiting times for diagnosis and treatment is therefore important. AIMS AND OBJECTIVES: To study prostate cancer management waiting times, to serve as a baseline in improving the quality of cancer care in the Nigerian populace. PATIENTS AND METHODS: This was a ten-year retrospective study of waiting times of all histologically-confirmed prostate cancer patients seen at Alex-Ekwueme Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. Statistical analysis was done SPSS version 26. A P-value less than 0.05 was considered statistically significant. RESULTS: A total of 189 patients presented with prostate cancer; however, 73 patients with complete data were analysed. The mean age of the patients was 71.48±8.16 years. The median duration of symptoms before presentation was 6 months. The mean total prostate-specific antigen was 82.08±54.9ng/mL. The mean duration between the first visit to the definitive diagnosis was 6.53±11.68 months with a median of 1 month. The median duration from visit to treatment was 3 months with a mean of 9.71±13.4 months. There were no associations between occupation, highest educational level, financial constraints, and the different waiting times studied (P>0.05). CONCLUSION: The waiting times for prostate cancer management were unduly prolonged in this study; patient-related factors did not influence this wait. INTRODUCTION: Le cancer de la prostate est toujours le principal cancer chez les hommes et la principale cause de décès par cancer au Nigéria et dans d'autres pays à revenu faible et intermédiaire (PFR) en Afrique subsaharienne. Un diagnostic précoce est essentiel pour garantir un traitement rapide et réduire la morbidité et la mortalité. Il est donc important de réduire les délais d'attente pour le diagnostic et le traitement. OBJECTIFS: Étudier les délais d'attente dans la prise en charge du cancer de la prostate, afin de servir de référence pour améliorer la qualité des soins contre le cancer dans la population nigériane. PATIENTS ET MÉTHODES: Il s'agit d'une étude rétrospective de dix ans sur les délais d'attente de tous les patients atteints de cancer de la prostate confirmé histologiquement et traités à l'hôpital universitaire fédéral Alex-Ekwueme, à Abakaliki, dans l'État d'Ebonyi, au Nigéria. L'analyse statistique a été réalisée avec la version 26 du logiciel SPSS. Une valeur de P inférieure à 0,05 a été considérée comme statistiquement significative. RÉSULTATS: Un total de 189 patients ont présenté un cancer de la prostate ; cependant, seuls les 73 patients avec des données complètes ont été analysés. L'âge moyen des patients était de 71,48±8,16 ans. La durée médiane des symptômes avant la présentation était de 6 mois. La concentration moyenne d'antigène spécifique de la prostate (PSA) total était de 82,08±54,9 ng/mL. La durée moyenne entre la première visite et le diagnostic définitif était de 6,53±11,68 mois, avec une médiane de 1(1) mois. La durée médiane entre la visite et le traitement était de 3 mois, avec une moyenne de 9,71±13,4 mois. Aucune association n'a été observée entre l'occupation, le plus haut niveau d'éducation, les contraintes financières et les différents délais d'attente étudiés (P>0,05). CONCLUSION: Les délais d'attente pour la prise en charge du cancer de la prostate étaient anormalement prolongés dans cette étude ; les facteurs liés au patient n'ont pas influencé cette attente. MOTS-CLÉS: Cancer de la prostate, Délai d'attente, Délai, Diagnostic, Traitement.

Open prostatectomy for benign prostatic hyperplasia: A critical analysis of patient presentation and surgical outcomes in a contemporary series.

Background: Open prostatectomy (OP) is still a valid treatment option for benign prostatic hyperplasia (BPH), but it needs to be constantly reevaluated in the context of minimally invasive treatments (MITs). Aim: Our purpose is to present contemporary data on patient presentation and surgical outcomes of OP with which other OP series and MITs can be compared. Methods: A retrospective study of all OP was carried out in our institution from January 2011 to December 2020. All patients had a thorough preoperative workup and optimization of comorbidities before surgery. Data were collected in a predesigned pro forma and analyzed. Results: The mean age of the 148 patients studied was 66.2 (±7.9) yrs. The mean duration of symptoms before surgery was 32.2 (±33.7) mos. The mean preoperative prostate volume was 118.0 (±67.1) cm3. There was a 54.4% comorbidity rate with diabetes mellitus (DM) topping the list (16.0%). An incidental prostate cancer rate of 6.1% was found. The overall complication rate was 45.3%. Perioperative hemorrhage requiring blood transfusion (BT) was the most common complication (26.1%). There was no significant difference in age, duration of surgery, and prostrate volume between subjects with and without BT (P > 0.05). Wound infection was significantly associated with diabetes (P = 0.043, OR = 3.507, 95% CI = 1.042-11.805). The reoperation rate was 1.4%, and mortality rate was 0.7%. The International Prostate Symptom Score (IPSS), quality-of-life (QOL) score, and post-void residual urine (PVR) volume were significantly improved (P < 0.001). Conclusion: OP was found to be a safe and effective procedure for the relief of bladder outlet obstruction (BOO) secondary to BPH. However, it was associated with high morbidity and low reoperation rate.

Correlation between bladder wall thickness and uroflowmetry in West African patients with benign prostatic enlargement.

Background: Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. Objective: The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. Materials and Methods: This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. Results: The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Conclusion: Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.

The modified suprapubic prostatectomy technique is associated with improved hemostasis and decline in blood transfusion rate after open suprapubic prostatectomy compared to the freyers technique.

Background: Open suprapubic prostatectomy is attended by significant perioperative haemorrhage and need for blood transfusion. Aim: To share our experience on how the adoption of a modified suprapubic prostatectomy technique has led to improved hemostasis and decline in the blood transfusion rate after open suprapubic prostatectomy in our center. Patients and Methods: This was a retrospective study comparing two open prostatectomy techniques. The patients in group 1 had Freyer's suprapubic prostatectomy while the patients in group 2 had a modified suprapubic prostatectomy technique. The groups were compared for the effectiveness of hemostasis using change in packed cell volume, clot retention, blood transfusion, and requirement of continuous bladder irrigation. Results: Both groups were similar concerning age, body mass index (BMI), total prostate-specific antigen (PSA), prostate volume, presence of comorbidities, duration of surgery, and duration of follow-up. The clot retention rate was 34% in group 1 versus 16.4% in group 2, P = 0.030. The clot retention requiring bladder syringe evacuation occurred in 32.1% of the patients in group 1 versus 14.8% in group 2, P = 0.048. The mean change in the packed cell volume (PCV) in group 1 was 8.0 ± 5.3 versus 6.9 ± 3.5 in group 2, P = 0.175. The blood transfusion rate in group 1 was 40.0% versus 13.3% in group 2, P = 0.040. The complication rate in group 1 was 67.2% versus 41.9% in group 2, P = 0.004. A general decline in blood transfusion was noted from January 2011 to December 2019. Conclusion: The modified suprapubic prostatectomy technique was associated with better hemostasis compared to the standard Freyer's prostatectomy technique. It should be a worthwhile addition to the numerous modifications of the original Freyer's suprapubic prostatectomy technique.

Urological emergencies in a Nigerian teaching hospital: Epidemiology and treatment.

BACKGROUND: Urological emergencies constitute a significant part of emergency presentations in various referral centers. Data on the prevalence of these emergencies in West African sub-region are sparse. OBJECTIVE: The study is aimed at determining the pattern of urological emergencies in our center and is geared towards bridging the gap in knowledge of the epidemiology of urological emergencies in this sub-region as a means of achieving efficient use of scarce resources. SUBJECTS AND METHODS: It was a retrospective study of all urological emergency cases that presented over six years in a Federal University Teaching Hospital in Nigeria. Data were collected from emergency register and theatre logs. Data analysis was done using SPSS version 25. RESULTS: A total of 267 patients presented with urological emergencies during the period of study with 258 (96.6%) men and 9 (3.4%) women. The mean age of the patients was 50.6 ± 20.8 years. Urinary retention was the most common urological emergency accounting for 159 (59.6%) cases followed by Fournier's gangrene 23 (8.6%) and testicular torsion 23 (8.6%). Bladder and ureteral injuries accounted for 5 (55.6%) of the urological emergency presentations in women while both injuries accounted for only 4 (1.6%) in men (P = 0.000). Urethral catheterization was the most commonly performed procedure 139 (52.1%), followed by percutaneous suprapubic cystostomy (SPC) 31 (11.6%). CONCLUSION: Urological emergencies have varying presentations in both sexes. Urinary retention, and acute scrotum were the most common urological emergencies in our facility. This knowledge can be used in emergency preparedness planning which involves personnel training and resource allocation.

Acute testicular torsion: A critical analysis of presentation, management and outcome in southeast Nigeria.

OBJECTIVES: The aim of this study is to evaluate the pattern of presentation, anatomic anomalies, and treatment outcomes in patients presenting with acute testicular torsion in a tertiary health institution in southeast Nigeria. METHODS: This was a prospective study of all consecutive patients with acute testicular torsion seen from January 2011 to November 2019 at our institution. Their demographic and clinical data were analyzed. RESULTS: Thirty-one acute testicular torsion cases were seen during the study period. Mean age was 22.6 (±7.3) years. Two peaks of incidence were observed. These were in the 14-19-year and 20-25-year age groups. The left testis was more commonly affected than the right; 15 cases (48.4%) versus 13 cases (41.9%). Past history of intermittent torsion was seen in 48.4% of cases. Abdominal pain was the commonest associated symptom followed by vomiting; 20 (64.5%) and 11 (35.5%). Seven cases (22.6%) of acute torsion occurred during sleep. Delay in presentation and delay in surgical intervention were observed. Only 22.6% of patients presented within 6 h of onset of symptoms and only 32.3% were operated on within 6 h of presentation. Transverse lie of the testes was the most common intraoperative finding (36%). Testicular salvage rate was 87.1%. CONCLUSIONS: Acute testicular torsion is a disease of young adults in southeast Nigeria. It is commoner on the left side with transverse lie being the most common predisposing factor. A new peak incidence in the 20-25-year age group is demonstrated. Late presentation is common but did not impact testicular loss in this study.

Cancellation of elective surgical cases in a nigerian teaching hospital: Frequency and reasons.

BACKGROUND: Dwindling economic resources and reduced manpower in the health sector require efficient use of the available resources. Day of surgery cancellation has far reaching consequences on the patients and the theatre staff involved. Full use of the theatre space should be pursued by every theatre user. OBJECTIVE: The study aimed to report on the rates and causes of day of surgery cancellation of elective surgical cases in our hospital as a means towards proffering solutions. MATERIALS AND METHODS: It was a retrospective study of all elective cases that were booked over a 15-month period from January 2016 to March 2017. Cancellation was said to have occurred when the planned surgery did not take place on the proposed day of surgery. Cancellations were categorized into patient-related, surgeon-related, hospital-related and anesthetist-related. Reasons for the cancellations were documented. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 22. Variables were compared using Chi-square tests. A value of P < 0.05 was considered statistically significant. RESULTS: During the 15-month period, a total of 1296 elective surgeries were booked. Of this, 118 (9.1%) cases were cancelled. Patient-related factor was the most common reason (47.5%) followed by surgeon-related factor (28%). Lack of funds was the most common patient related-reason for cancellation. Majority of the cancelled cases were general surgical cases (36.4%) followed by orthopedics (25.4%) and urology (11%). Seventy percent of the cancelled cases were first and second on the elective list. CONCLUSION: The cancellation rate in this study is high. The reasons for these cancellations are preventable. To ensure effective use of the theatre, efforts should be made to tackle these reasons.

Intermittent testicular torsion.

OBJECTIVE: The aim of this study is to highlight the clinical characteristics of patients with intermittent testicular torsion and draw attention to this underreported condition. METHODS: Clinical and demographic data of all patients treated for intermittent testicular torsion from January 2007 to June 2015 were prospectively collected in a pro forma and analyzed. A diagnosis of intermittent torsion was made on the basis of recurrent scrotal pain, presence of abnormal testicular lie in otherwise normal testes, absence of urinary symptoms, and negative urine cultures. This diagnosis was confirmed by resolution of symptoms following bilateral orchidopexy. All patients had bilateral orchidopexy at the next operative day and were followed up for 12 months. RESULTS: Forty-five patients with a mean age of 20.9 years (±4.02) were seen within the study period. The left testis was more often involved than the right: 53.3% versus 37.8%. The condition was bilateral in 4 patients (8.9%). A total of 84 testes were evaluated. Horizontal lie was the most common anomaly causing intermittent testicular torsion 49%, followed by the clapper-bell deformity 27.5%. Patients experienced a mean of 2.8 (±1.74) acute pain episodes before testicular fixation. Bilateral orchidopexy resulted in resolution of symptoms and preservation of testicular volume. CONCLUSION: Horizontal lie of the testis is the most common cause of intermittent testicular torsion. The condition is more common on the left than the right testis and is predominantly unilateral. Intermittent testicular pain in the presence of abnormal testicular lie should warrant a diagnosis of intermittent testicular torsion. Early bilateral orchidopexy is efficacious.

Short segment bulbar urethral strictures: Review of 48 cases managed in a resource-poor setting.

OBJECTIVE: To share our experience on the presentation and management of short segment bulbar urethral strictures (BUSs) in a resource-poor center. METHODS: Short segment bulbar urethral strictures (BUSs) managed from January 2009 to December 2014 were analyzed. Patients'age, stricture aetiology, mode of presentation, stricture characteristics, time to surgery, associated morbidity, operative procedure, and post-operative outcome were reviewed. All patients had bulbar anastomotic urethroplasty (BAU). RESULTS: Total 42 bulbar anastomotic urethroplasties (BAUs) were done. The mean age of the patients in years was 37.46 (± 13.80). Fall astride injuries accounted for most strictures, 39(89.3%) of cases. The mean stricture lenght was 1.04 cm ± 0.49 and was longer in patients who had prior instrumentation,1.45 cm (± 0.37) versus 0.70 cm (± 0.26), P = 0.000. Associated lower urinary tract comorbidities were noted in 38 (79.2%) patients. Mean time to surgery was 10.20 (± 4.96) months. Patients operated on after 6 months of presentation had more associated comorbidities, 24/26 patients (92.3%), compared to those operated on within 6 months; 8/16 cases (50%), P = 0.003. However, this did not impact negatively on the outcome of surgery (P = 0.275). Patients with complete strictures tended to accept surgery earlier than those with incomplete strictures, 29 patients (60.4%) versus 19 patients (39.6%), P = 0.208,with no difference in outcome between the two groups, P = 0.581.The overall success rate was 92.9%. CONCLUSIONS: Fall astride injuries are the commonest cause of short segment BUSs. Prior urethral instrumentation is associated with recurrence and longer stricture lenght. Suprapubic catheter-related associated comorbidity increases with the duration of catheterization but does not impact negatively on the surgical outcome. BAU has low morbidity and high success rate of 92.7%. It should be the first line treatment for short segment BUS in low-resource countries.

Isolated Fournier's gangrene of the penis.

To share experience on the presentation and management of 4 cases of isolated penile Fournier's gangrene. Clinical and demographic data of four patients with isolated penile Fournier's gangrene seen over an 8-year period (January 2006-December 2013) were reviewed. All patients had intravenous fluid resuscitation, emergency surgical debridement, and broad-spectrum intravenous antibiotics. Fournier's gangrene of the penis was, respectively, due to long segment anterior urethral stricture, penile edema from poorly controlled congestive cardiac failure, penile abrasion from oral sex and idiopathic. The mean age of the patients was 34.3 ± 5.6 years. One patient with urethral stricture had urinary tract infection. The patients presented with a prodromal period of genital pain and fever followed by genital swelling, gangrene, and ulceration. The most common wound swab isolates were Staphylococcus aureus and Escherichia coli. Only the skin and dartos fascia were affected with sparing of the corporal cylinders. Mean hospital stay was 17.3 ± 3.0 days and mean Fournier's gangrene severity index (FGSI) was 4.0 ± 0.8. Wound closure was achieved by split skin grafting in 2 patients, delayed primary closure in the third and healing by secondary intention in the fourth patient. Subjectively assessed erectile function was preserved in all four patients. Isolated Fournier's gangrene of the penis is very rare. It is associated with low FGSI and sparing of the three corporal cylinders. It may rarely follow oral sexual practice.