A comparison of loupe-assisted and non-loupe-assisted subinguinal varicocelectomy.

Introduction: Varicocele is a treatable aetiology of male infertility. Magnification with surgical loupe has been associated with improved outcome and reduced morbidity than the conventional technique without magnification. Objective: To compare the outcomes of two techniques of subinguinal varicocelectomy, with a surgical loupe and without. Patients and Methods: This was a prospective randomised hospital-based study. Forty-six patients were randomised to two arms - Group A: loupe-assisted subinguinal varicocelectomy (LASV) and Group B: open subinguinal varicocelectomy without Loupe (OSV). They all had their semen and hormonal parameters compared preoperatively and at 3 and 6 months postoperatively. Post-operative complications were also assessed. P < 0.05 was considered statistically significant. Results: The mean age was 38.28 ± 4.55 years with a range of 27-46 years. The mean age in Group A was 37.35 ± 4.68 and 39.22 ± 4.33 years in Group B. There was an improvement in motility, sperm count and concentration in both the groups at 3 and 6 months (P < 0.05). However, there was no difference in these parameters on comparison of the two groups at 3 and 6 months (P > 0.05). Follicle-stimulating hormone decline was significant in the OSV group at 3 and 6 months, P = 0.010 and 0.021, respectively. There was no difference in other hormonal parameters both at 3 and 6 months (P > 0.05). The pregnancy rate in each arm of study was 4.3%. All complications occurred in Group B. Conclusion: Both techniques resulted in improvement in seminal fluid parameters. All complications occurred in the arm that had subinguinal varicocelectomy without loupe. Loupe-assisted subinguinal varicocelectomy is safe and effective.

Quality and appropriateness of uro-surgical referrals at a Nigerian teaching hospital.

Introduction: An effective referral system is crucial for a high-quality health system that provides safe medical care. Aim and Objectives: This study aimed at evaluating the appropriateness and adequacies of information in the referral letters of patients. Materials and Methods: A prospective study of referral letters of all new patients in the urology clinic. Information retrieved was socio-demographic characteristics, source of referral and presence or absence of important information in their letters. We compared the information provided to the new history taken to determine the appropriateness and adequacy using different domains of medical history. Referrals were adjudged appropriate if the diagnosis is urologic, while any referral lacking relevant information is adjudged inadequate. The results were displayed using the simple proportions in tables and charts. Results: A total of 1188 referrals were reviewed. There were 997 (83.9%) males and 191 (16.1%) females. Referrals from private hospitals were the most common in 627 (52.8%) cases. Of all new referrals, 1165 (98.1%) were adjudged to be appropriate, while 23 (1.9%) were inappropriately referred. Referrals from teaching hospitals had higher proportions of good-quality referrals than those from primary healthcare and private centres. The most common deficiencies were the lack of documentation of relevant examination findings (37.8%) and provisional diagnosis (21.4%). The majority, 956 (80.5%), of letters were narrative in nature, whereas 232 (19.5%) were structured. Structured letters were found to be more informative. Conclusion: A significant percentage of referral letters lacked completeness in many key areas. We recommend the use of structured forms or template letters to improve the quality of referrals.

Urinary Catheter Documentation in a Nigerian Teaching Hospital: Are We Recording Enough?

Background: Urinary catheters are an important armamentarium of urologic practice. Several indications for their use exist. A good knowledge of the details surrounding every urinary catheter inserted is necessary for the proper management of the patients. Inadequate documentation can lead to complications such as urinary tract infection or even forgotten catheters. Objectives: This study aimed at auditing the practice of documentation of urinary catheter parameters in our hospital as a means to improving the standard of care and aligning with international best practices with respect to the use of urinary catheters in our hospital. Materials and Methods: This study was a 3-month audit on the quality of documentation on the parameters of each urinary catheter use in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. The parameters included the indication for catheterisation, route of catheterisation, staff who catheterised, size of catheter, type of catheter, volume of water used for inflating catheter balloon, volume of urine drained, if aseptic technique was followed during catheterisation, informed consent and complications encountered. Data were summarised as frequencies and means. Statistical significance was pegged at P < 0.05. Results: Seventy-four patients were men, whereas two were women. The mean age of the patients was 67.29 ± 15.17 years. Overall, sex (76 [100%]), age (76 [100%]) and route of catheterisation (68 [89.5%]) were the three most commonly documented information. The documentation on complications and volume of fluid instilled to inflate the catheter balloon were the least-documented parameters (6 [7.9%] and 11 [14.5%], respectively). The following parameters were better documented in the SPC arm: The staff who passed the catheter p = 0.000), the type of catheter passed (p = 0.004), asepsis (p = 0.001) and acquisition of informed consent (p = 0.043). Conclusions: Documentation following urinary catheter use was noted to be poor in this study. Documentation of catheter parameters was noted to be higher in patients who had SPC than those who had urethral catheterisation.

Urological Surgeries in a West African Teaching Hospital.

Introduction: Urological surgeries are a significant part of surgical services. The need for these services varies regionally and globally. Knowledge of the local need is important for prioritisation of resources. Objectives: To describe the urological procedures done in our hospital for effective utilisation of the already scarce resource in this region. Patients and Methods: This was a retrospective one-year study of the urosurgical cases done in a Nigerian Teaching Hospital. The main theatre register was used to collate data. Data collected included age, sex, operation done and anaesthesia employed. Results: One hundred and twenty-two male and three female patients were included with a male-to-female ratio of 41:1. The mean age of the patients was 56.6 ± 19.89 years. Elective cases accounted for 102 (81.6%) of surgeries. Regional anaesthesia was the most common form of anaesthesia accounting for 105 (84%) followed by local anaesthesia in 16 (12.8%). Day cases accounted for 77 (61.6%) of procedures. More than 80% of the study population was 50 years and older. Overall, the three most common performed surgeries were digital-guided prostate biopsy 47 (37.6%), suprapubic cystostomy 16 (12.8%) and open prostatectomy 9 (7.2%). In male patients, the three most common procedures were prostate biopsy 47 (38.5%), suprapubic cystostomy 16 (13.1 %), open prostatectomy 9 (7.4%) whereas nephrectomy, pyeloplasty and stent removal each accounted for 33.3% each of procedures in female patients. Endourological procedures accounted for 5 (4%) of cases. Conclusion: Open surgeries accounted for the majority of these cases done with prostate-related procedures being the most common procedures. Few endourological procedures were performed.

The Burden of Urologic Diseases in a Tertiary Hospital in South-eastern Nigeria: A Three-Year Review.

Background: Urological diseases are an integral part of the surgical burden of diseases. There are national, regional, and global variations. Characterisation of the burden of disease in this specialty is important for the registry and in allocation of the already scarce resource in this sub-region. Objective: This study was aimed at characterising the burden of urological diseases in our teaching hospital as a means towards addressing the gap between resources and urological needs. Materials and Methods: It was a retrospective study of new patients seen over 3 years from January 2019 to December 2021 at the urology clinics of Alex-Ekwueme Federal University Teaching Hospital Abakaliki. Data collected included sex, age, and diagnosis. Data analysis was done using SPSS version 26. Results: A total of 2893 patients were available for analysis, of which 2777 (96%) were male patients whereas 116 (4%) were female patients with a male-to-female ratio of 23.9:1. The mean age of the patients was 58.11 ± 16.76 years. The common presentations were benign prostatic enlargement (BPE) 1515 (52.4%), cancer of the prostate (CAP) 349 (12.1%), urethral stricture disease 268 (9.3%), and urinary tract infection (UTI) 192 (6.6%). In men, the three most common diagnoses were prostate-related diseases 1864 (67.1%), urethral stricture disease 268 (9.70%), and UTI 170 (6.1%), whereas, in women, urolithiasis, urinary tract infection, and hydronephrosis accounted for 50 (43.1%), 22 (19%), and 20 (17.2%), respectively. Conclusion: BPE, CAP, and urethral stricture disease were the most common presentations in men whereas urolithiasis, UTI, and hydronephrosis were common in women. This knowledge can be used to channel hospital resources appropriately.

Prostate Cancer and Challenges in Management in a Semi-urban Centre: A 10-year Experience.

Introduction: Prostate cancer (CaP) is the second most common cancer in men and the fifth most common cancer worldwide. The incidence in Nigeria is rising. Numerous challenges exist that prevent the successful management of these patients in this subregion. Aims and Objectives: This study aimed to report on the modes of presentation and difficulties encountered in managing patients with CaP in our environment with a view to finding solutions to these challenges. Materials and Methods: This was a retrospective study of all CaP patients who were managed in Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria over a 10-year period from 2012 to 2021. Data were collated using a pro forma. Numerical data were summarized as means, median, and standard deviation, whereas categorical data were summarized as frequencies. Statistical significance was pegged at P < 0.05. Results: Seventy-three patients were analysed. The mean age of the patients was 71.48 ± 8.15 years. The three most common presenting complaints were lower urinary tract symptoms (LUTSs) 23 (31.5%), acute urinary retention 9 (12.3%), and LUTS with low back pain 9 (12.3%). The median duration of symptoms was 6.5 months. No difference was noted among educational level, occupation, and stage of CaP, (P=0.222 and P=0.548), respectively. The median total prostate-specific antigen was 85.0 ng/mL. Sixty-seven patients (91.8%) had an abdominopelvic ultrasound scan. Fifty patients (68.5%) had stage 4 disease. Thirty-eight (52.1%) had financial constraints. Forty-nine (67.1%) patients were lost to follow-up. Bilateral orchidectomy was offered to 28 (38.4%) patients. Conclusion: Financial constraint was a huge barrier in the management of CaP patients in this study. Late presentation was common in this study.

Impact of the COVID-19 pandemic on surgical practice, training, and research in Nigeria.

INTRODUCTION: the rising rate of SARS-CoV-2 infections has caused perceptible strain on the global health system. Indeed, this disease is also a litmus test for the resilience of the structures in the African health system including surgery. Therefore, this study aimed to determine the impact of the COVID-19 pandemic on surgical practice, training and research in Nigeria. METHODS: it was a cross-sectional study conducted over three weeks in Nigeria among doctors in 12 surgery-related specialties. Consenting participants filled a pre-tested online form consisting of 35 questions in 5 sections which assessed demographics, infection control measures, clinical practice, academic training, research program, and future trends. Data were analyzed using Statistical Package for Social Sciences Version 20. RESULTS: a total of 384 respondents completed the form. Their mean age was 38.3 years. Lockdown measures were imposed in the state of practice of 89.0% of respondents. Most participants reported a decrease in patient volume in outpatient clinics (95.5%) and elective operations (95.8%) compared to reports for emergency operations (50.2%). They also noted a decrease in academic training [Bedside teaching (92.1%), seminar presentation (91.1%) and journal presentation (91.8%)] and research (80.5%). Except in bedside teaching, those who had other virtual academic programmes were thrice the number of those who used in-person mode for the events. CONCLUSION: COVID-19 pandemic has caused a significant change in pattern and a decrease in the volume of patients seen by surgeons in their practice as well as a decrease in the frequency of academic programs and research activities in Nigeria.

Delay of Surgery Start Time: Experience in a Nigerian Teaching Hospital.

BACKGROUND: Operating room delay has multiple negative effects on the patients, surgical team, and the hospital system. Maximum utilization of the operating room requires on-time knife on the skin and efficient turnover. Knowledge of the reasons for the delay will form a basis toward proffering solutions. PATIENTS AND METHODS: This was a prospective study of all consecutive elective cases done over a 15-month period from January 2016 to March 2017. Using our departmental protocol that "knife on skin" for the first elective case should be 8.00am, the delay was defined as a surgery starting later than 8.00am for the first cases while the interval between the cases of >30 min for the knife on the skin was used for subsequent cases. Reasons for delay in all cases of delay were documented. The prevalence and causes of the delays were analyzed. P < 0.05 was considered statistically significant. RESULTS: Of 1178 surgeries performed during the period of study, 1170 (99.3%) of cases were delayed. The mean delay time was 151 min for all cases. First on the list had a longer delay time than others; 198.9 min versus 108.5 min (P = 0.000). Delay in the first cases accounted for 47.5% of all delayed cases. Overall, patient-related factor was the most common cause of delay (31.3%) followed in descending order by surgeon-related factor (28.5%) and hospital-related factor (26.2%). Patient-related factors accounted for 43.2% of first-case delays. CONCLUSION: Delays encountered in this study were multifactorial and are preventable. Efforts should be directed at these different causes of delay in the theater to mitigate these delays and improve productivity.

Management of a giant prostatic enlargement: Case report and review of the literature.

Giant prostatic enlargement often referred to as giant prostatic hyperplasia (GPH) is a rare condition described as a massive prostatic enlargement >500 g. Up until now, the total number of GPH reported worldwide in medical literature is < 30. To the best of our knowledge, only one case of a giant prostate has been reported in Nigeria. We report a case of a giant prostatic enlargement treated by open simple retropubic prostatectomy in a 73-year-old man who was suffering from lower urinary tract symptoms and persistent visible (gross) haematuria necessitating repeated blood transfusions. Transrectal ultrasound (TRUS) scan revealed a markedly enlarged prostate measuring 565 ml with a suspicious nodule and prostate-specific antigen level of 48.5 ng/ml. He had a 20-core TRUS-guided prostatic biopsy which showed benign prostatic hyperplasia. We performed a retropubic open simple prostatectomy for complete enucleation of the adenoma. Specimen weighed 512.5 g with dimensions of 17 cm × 16 cm and a volume of 528 ml. Histological examination showed prostatic fibromuscular hyperplasia with a focus of adenocarcinoma. The patient had an uneventful post-operative recovery and was discharged within a week post-surgery. Urethral catheter was removed after 2 weeks with satisfactory outcome.