Management of the mass casualty from the 2001 Jos crisis.

BACKGROUND: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. MATERIALS AND METHODS: A retrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care. RESULTS: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients. Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside. CONCLUSION: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.

The value of international prostate symptom scoring system in the management of BPH in Jos, Nigeria.

OBJECTIVE: To determine the value of international prostate symptom scoring (IPSS) system in management of patients with benign prostatic hyperplasia (BPH) in Jos, Nigeria. MATERIALS AND METHODS: This was a prospective study of 104 newly diagnosed patients with BPH from June 2006 to July 2007. Patients' symptoms were initially evaluated by administering a pretreatment IPSS/Quality of Life Score (QOLS). This categorized patients into mild, moderate, and severe symptom groups. The mild symptom group had watchful waiting as mode of management. The moderate symptom group received doxazosin, an alpha blocker, while the severe symptom group had prostatectomy. A post-treatment IPSS/QOLS was administered 3 months after. Mean changes in IPSS/QOLS was calculated and subjected to paired student's t- test for significance in changes. Spearman's correlation coefficient was used to test significance between correlations. RESULTS: Mean age of patients was 64.3 years. 3 patients (2.9%), 53 patients (51.0%), and 48 patients (46.1%) fell into the minor, moderate, and severe symptom categories, respectively. The QOLS correlated with IPSS. There was a mean change in symptom scores of +2.3 for the minor symptom category, -8.1 (P < 0.001) for IPSS and -1.7 (P < 0.001) for QOLS in the moderate symptom category, and -24.6 (P < 0.001) for IPSS and -4.0 (P < 0.05) for QOLS in the severe symptom category. CONCLUSION: The study has shown that IPSS is a valuable tool in management of patients with BPH.

Has the creation of a urology residency programme translated in to more surgical exposure for final year residents?

BACKGROUND: Surgical residency programmes are supposed to enhance resident operative experience. The impact of urology residency was assessed at our institution before and after establishing a structured urology training programme in 2006. MATERIALS/METHODS: Log books of final year Urological residents presented for the West African College of Surgeons (WACS) and National Postgraduate Medical College (NPMC) final part II exams from January 2007 to December 2011 at Jos University Teaching Hospital (JUTH) were reviewed. All residents had completed mandatory 3 years of urology training. The records of surgeries performed by residents were extracted. These surgeries were categorized as Endoscopic procedures, open kidney/ureter surgeries, open bladder surgeries, open prostate surgeries, open urethral and open testicular/penile sugeries. The records were compared with records of operated cases in the same category before the commencement of Urology residency training from January 2001 to December 2005. Results were presented as tables and charts. The Students unpaired t-test was used to assess significance. P value of < 0.05 was taken as significant. RESULTS: There was an overall increase in absolute number of operative cases performed by final year residents in the period after the commencement of the Urology residency programme (n = 596) compared to the period before the training began (n = 381) this however, was not statisically significant (p = 0.3). There was a decline in endoscopic surgeries done by residents after the training begun compared to the era before the training. CONCLUSION: Whereas creation of the urology training programme in JUTH has resulted in more operative cases done by trainee urologists, the exposure to endosopic surgeries has declined. This will not augur well for the training programme in the long run. Periodic rieiew of the data should be performed to maintain consistent, positive experiences for residency training.

The management of prostatic haematuria.

BACKGROUND: Prostatic haematuria is a common clinical problem. In this report, we have reviewed the incidence, precipitating/co morbid factors, treatment and outcome of haematuria in patients with benign prostatic hyperplasia and prostate cancer METHODS: A two year prospective review of 37 patients who presented with haematuria associated with benign prostatic hyperplasia and prostate cancer Each patient had full clinical assessment, including any associated precipitating or co morbid factors. All patients had urethral catheterization; and cystoscopy to exclude bladder tumours or bladder stones. Subsequent management depended on severity of bleeding; and consisted of one of the following: observation only, irrigation only, irrigation and blood transfusion and emergency prostatectomy. Upon stabilization, the definitive treatment in each patient was based on primary pathology. RESULTS: A total of 134 patients who had either benign prostatic hyperplasia or prostate cancer were treated. Thirty seven (27.6%) patients presented with haematuria. The incidences of haematuria in benign prostatic hyperplasia and prostate cancer were 26.7% and 29.2% respectively. Haematuria was precipitated in 17 (45.9%) patients; while nine (24.3%) patients had 12 associated co morbidities. Seventeen (45.9%) patients had blood transfusion. A total of 34 (91.8%) patients were managed conservatively. There were four (10.8%) deaths. CONCLUSION: Prostatic haematuria is a common urologic challenge. In most cases conservative management is the key In the absence of modern facilities, emergency open prostatectomy may be needed to control bleeding, in those in whom conservative approach has failed; or when specifically indicated based on the individual patient or as dictated by other local factors.

Outcome of urethroplasty for urethral stricture at Jos Universitry Teaching Hospital.

BACKGROUND: The treatment of urethral stricture disease has remained a challenge over the years. The outcome has also been varied, with recurrent stricture being a major concern. We determined the outcome of urethroplasty with particular reference to the complications. METHODOLOGY: This was a retrospective study over 10 years (1995 to 2005) done at the Jos University Teaching Hospital, a tertiary health institution in the middle belt region of Nigeria. RESULTS: There were a total of 32 patients whose ages ranged from 0.06 to 75 years (mean 25 yrs, SD 18.8 yrs,). Eleven patients had had one form of stricture treatment or the other. Stricture aetiology was traumatic in 21 (66%) and inflammatory in 6 (19%) patients. Of the 24 patients in whom the stricture length at operation was specified, six, 11 and seven were <2 cm, 2-4 cm and >4 cm respectively. The stricture was located in the anterior urethra in 18 (58.1%), posterior urethra in 2 (6.4%) and bulbomembranous in 11 (35.5%) of patients (unspecified in one). The bulbar urethra was the single most involved region, occurring in 12 (38.7%) patients. Resection and end to end anastomosis was done in 16 patients and replacement urethroplasty in 16 others (Quarteys in 12, Swinney in 3 and Orandi in 1). Complications observed were urinary tract infection in 12 (37.5%) patients, recurrent stricture 11 (34.4%) wound infection 10 (31.3%), oedema of genitalia 7 (21.9%), urethrocutaneous fistula 4 (12.5%), impotence 3 (9.4%), wound haematoma 2 (6.3%) and urinary incontinence in 1 (3.1%) patient(s). CONCLUSION: Urinary tract infection, recurrence of the stricture and wound infection remain our major challenges. We recommend that in order to improve outcome, surgeons should regularly audit their practice and make necessary adjustments. In addition, urethroplasty should preferably be carried out by those with the cognate experience, while not compromising the need to teach younger colleagues.

Comparative analysis of urethral catheterization versus suprapubic cystostomy in management of neurogenic bladder in spinal injured patients.

BACKGROUND: The objective of this study was, to prospectively and retro respectively evaluate urethral catheterization (UC) versus supra-pubic cystostomy (SPC) in prevention of urinary tract infection (UTI) in patients with spinal cord injury lesion. METHODS: A total of 125 patients with neurogenic bladder and a mean age of 30 years had UC (n=80) and SPC (n=40) at the Jos University Teaching Hospital (JUTH) between January 1984 and June 2005. RESULTS: Episodes of UTI were significantly more; UC 65% versus 14% forS PC (P< O 0 5). Urinary tract infection occurred relatively late in the course of admission, in patient who had SPC. Patients in SPC group were significantly satisfied with this management option; 57% versus 8% for UC. Similarly, mortality at 1 year post admission was significantly less; 9% versus 36% for UC and death due to UTI related septicaemia was 33% versus 18% respectively. CONCLUSION: It was concluded that SPC was a better management option since it was associated with a low morbidity, better quality of life and a longer life expectancy than UC.

The scope and utilisation of day case surgery in a developing country.

BACKGROUND: The practice of day case surgery is today an attractive and an appealing one with increase spread to many specialties and many regions of the world. However, there is a great variability in its use and application. OBJECTIVE: To determine the scope and degree of utilisation of day case surgery in a developing country. DESIGN: A prospective study. SETTING: Jos University Teaching Hospital, Jos, Nigeria between January and December 2004. SUBJECTS: One thousand and twenty four patients had elective surgical procedures carried out during the study period out of which, three hundred and twenty procedures were done as day cases. MAIN OUTCOME MEASURES: There is a changing trend with a great prospect for the practice of day case surgery in the developing world. CONCLUSION: There is the need to harness all resources and keep abreast with relevant technological drive to realise the full potentials of this practice in this part of the world.

Digital rectal examination for prostate cancer: attitude and experience of final year medical students.

OBJECTIVE: Prostate cancer which tends to take an aggressive course in black populations can be detected by digital rectal examination (DRE). There are concerns however that medical students are not acquiring the necessary DRE skills. We therefore studied their experience and attitude towards DRE for prostate cancer to assist us make any necessary adjustments in training. METHODS: This was a self-administered questionnaire based study of final year medical students two months to graduation carried out at the Jos University Teaching Hospital, location for clinical studies of the Medical Faculty ofthe University of Jos. RESULTS: There were 100 students in the study, with a male: female ratio of 3.6:1. The ages ranged from 24 to 35 with a mean of 28 years. Fifty-one percent and 94% agreed they had been taught DRE in class and on the ward/clinic respectively. Almost half (45%) had never performed a DRE and 43% performed it only 1-2 times. Sixty-two percent of the students had never confidently palpated a prostate; while 30% had palpated it 1 2 times. Eighty-six percent and 7% respectively have never felt a clinically malignant prostate or felt it 1 2 times. There was no statistically significant difference in the number of DREs performed by sex or age (p> 0.05). On supervision 43% were never supervised to do DRE while 23% were supervised all the time. Ninety-five percent believed DRE is an essential requirement for a medical practitioner and 96% believed they should have the skills before graduating. Only 36%, however, believed their teachers have been supportive, teaching them DRE (p value = .033). Ninety percent agreed that DRE is useful for screening for prostate cancer. The major reason for not performing DRE more than half the time was the student not feeling competent (54%). CONCLUSION: Students have received adequate teaching on DRE, have the right attitude and perspective, have adequate knowledge on DRE findings suggestive of prostate cancer but have not translated this knowledge into practice. This is mainly due to the students not feeling competent. Teachers need to intensify practical supervision to enable medical students acquire the necessary experience during clinical training.

Paediatric blunt abdominal trauma: challenges of management in a developing country.

BACKGROUND: In developed countries, the availability of advanced imaging techniques has reduced the necessity for laparotomy following blunt abdominal trauma in children. Laparotomy rates still remain high in developing countries where these advanced imaging techniques are lacking. A simple management protocol to identify patients who require laparotomy could reduce the laparotomy rate in children with blunt abdominal trauma in these countries. PATIENTS/METHODS: This is a review of children aged 15 years or below managed in our institution over a 5 1/2-year period for blunt abdominal trauma. The children were divided into two groups. Group A consisted of children managed from January 1999 - December 2000. During this period, there was no protocol. Group B consisted of children managed from January 2001 - June 2004. During this period, a simple management protocol was introduced. The laparotomy rates in the two groups were analysed using a simple chi-square. RESULTS: A total of 48 children, representing 63 % of children with abdominal trauma during the study period, were examined (Group A 17; Group B 31). Their ages ranged from 1.5 years - 15 years (median 9 years). Thirty-four were boys, 14 were girls (M:F = 2.4:1). Road traffic accidents accounted for 38 (79.1 %) and falls from heights for 9 cases (18.75 %), and one boy with a hydronephrotic kidney fell off the staircase at home. The diagnosis was clinical, supported by abdominal ultrasound scan (USS) and plain abdominal film. Twenty-eight (58.3 %) children had laparotomy (15 in Group A; 13 in Group B). There was a statistically significant difference in the laparotomy rates between Group A and B (p < 0.01). Nineteen children were managed nonoperatively (2 in Group A; 17 in Group B); one child died before an operation could be performed. There were 59 abdominal organ injuries in 45 children. In 2 children, ultrasound could not diagnose any organ injury. There were 33 splenic injuries; 15 children had splenic conservation, 7 underwent a splenectomy, while 10 were managed nonoperatively. One child with splenic injury died before operation. Of 7 liver injuries, 4 required suturing of lacerations, 1 subcapsular haematoma was left undisturbed at laparotomy, while 2 were managed nonoperatively. There were 4 pancreatic injuries. Three were managed nonoperatively, while 1 associated with duodenal injury had a laparotomy. All 6 gastrointestinal injuries had laparotomy. There were 5 renal injuries: 3 had laparotomy with suturing, while 2 were managed nonoperatively. There were 4 bladder injuries: 2 had laparotomy with suprapubic catheter insertion, while 2 were managed nonoperatively. There were 7 retroperitoneal haematomas in association with other organ injuries. Associated injuries included head injury in 2, long bone fracture in 2, spinal injury and chest trauma in 1 each. There were 4 deaths, 1 before surgery could be performed. CONCLUSION: Blunt abdominal trauma in children resulted mainly from road traffic accidents. The use of a simple protocol supported by ultrasound scan could reduce the laparotomy rate in countries with limited facilities.

The Management of Upper Urinary Tract Obstruction in Resource-Poor Settings

Objective: The management of upper urinary tract obstruction in the absence of modern facilities presents a major challenge to Urologic practice in developing countries. The aim of this study was to describe the etiology; presentation and treatment of upper urinary tract obstruction at the Jos University Teaching Hospital; Nigeria. Patients and Methods : This is a prospective analysis of 37 consecutive patients (18 males; 19 females) with a mean age of 35.5 years (range 3-55) who were managed for upper urinary tract obstruction at our department between January 2001 and December 2005. Two of them presented with a second pathology; so that we treated 39 pathologies in total. Flank pain was the most common clinical feature; being present in 35 patients (94.6). Other clinical features were gross hematuria in 12 (32.4); an enlarged kidney in 5 (13.5); renal impairment in 4 (10.8) and hypertension in 3 (8.1) patients. Diagnostic work-up consisted of plain radiography; abdominal ultrasound scan; intravenous urography and retrograde pyelography. Renal pelvic stones were the leading cause of obstruction (13 patients; 35.1); while congenital pelvi-ureteric junction (PUJ) obstruction was found in 7 (18.9) and ureteric stricture and vesical schistosomiasis in 4 (10.8) and 3 (8.1) patients; respectively. Two patients had bilateral obstruction from two different causes.Results: Twenty-nine open surgical procedures were carried out. They consisted of pyelolithotomy (n=12); pyeloplasty (n=6); ureteroureterostomy (n=4); ureteroneocystostomy (n=3); nephrectomy (n=2) and ureterolithotomy (n=2). Eight patients were treated non-surgically. Two patients are awaiting definitive surgical treatment. A total of 4 (13.8) complications following 29 operative procedures were encountered: two cases of migration of double-J ureteric stents ; one case of prolonged urine leakage and another case of wound infection. Conclusion : Upper urinary tract obstruction is not uncommon in our environment. In the absence of modern facilities; open surgery remains our main option of treatment; and it is relatively safe

Posterior urethral valves in childhood : experience in a center with scarce facilities

Objective: Posterior urethral valves (PUV) are the most common congenital causes of lower urinary tract obstruction in male children; but few cases have been reported from Nigeria. In this study we describe our 7-year experience of management of PUV in children in order to increase the awareness of this condition in our environment. Patients and Methods : This is a report of 41 consecutive children with PUV who were managed at the Jos University Teaching Hospitals (JUTH); Jos; Nigeria; from June 2000 to April 2006. Their age at presentation ranged from 2 days to 15 years (mean: 2.5 years). The relevant clinical; laboratory and radiological data were entered into a database and analyzed.Results: Twenty-eight patients presented with a condition highly suspicious of PUV; while 7 patients presented with other urological conditions. Six patients presented with non-urological symptoms which caused a delay in diagnosis and institution of treatment. Voiding cystourethrography was diagnostic in all cases. In the majority of patients (n=31); management consisted of transurethral balloon avulsion of the valves yielding a satisfactory outcome in over 80. Conclusion : Although this study was restricted to one hospital; there appears to be a high incidence of PUV in children in North Central Nigeria. An increased awareness of varied clinical features; a high index of suspicion and simple conservative treatment by balloon avulsion of PUV would improve the outcome.of the patients. Urethral stricture was the main complication (which responded to serial dilatation) and occurred in 3 patients. The postoperative mortality rate was 2.6

The acute scrotum: aetiology, management and early outcome-preliminary report.

BACKGROUND: Most patients with acute scrotal pain may require urgent exploration. We determined the aetiological factors, treatment and early complications in such patients. METHODS: This was a prospective study of consecutive patients presenting with the acute scrotum at Jos University Teaching Hospital, Nigeria from January 2001 to December 2002. RESULTS: Twenty-nine patients were studied with a mean age of 29.4 years (range 12 days to 80 years). Seventeen (58.6%) were 11 to 30 years old. The clinical diagnostic accuracy for testicular torsion was 75% because out of the 24 patients initially thought to have testicular torsion, 18 (62.1%), four (14.8%) and two (6.9%) had testicular torsion, epididymoorchitis and torsion of appendix testis respectively at exploration. The diagnosis in other patients was intrascrotral abscess in two (6.9%), Fournier's gangrene in one (3.4%) and haematocoele in one (3.4%). Only four (13.9%) patients presented within the first 24 hours of illness (all explored within 6 hours) and 14 (48.3%) in one to five days. Thirteen (44.6%) patients had orchidopexy while seven (24.2%) had orchidectomy as a result of testicular torsion (five) and intrascrotal abscesses (two). Testicular exploration only, with antibiotics was the treatment for patients eventually found to have epididymoorchitis, with good response. Testicular salvage rate was 72% in patients with testicular torsion. Postoperative complications observed in three patients were wound infection (two) and wound dehiscence (two). CONCLUSION: We conclude that testicular torsion is the most common cause of acute scrotum in our environment. Majority of our patients with acute scrotum present to hospital late. Health education of the public and attending physicians is required in order to reduce delay in presentation, improve diagnostic skills, testicular salvage rate and prognosis.

Acquired rectal fistula in human immunodeficiency virus-positive children: a causal or casual relationship?

Acquired rectal fistula in human immunodeficiency virus (HIV)-positive children is a new and worrisome entity. The aim of this paper is to highlight the relationship between HIV infection and acquired rectal fistula (RF) in children in order to create awareness among clinicians who attend to children. Over a 1-year period, 11 girls aged 4 weeks-11 months (median 5 months) with acquired RF were managed at our institution. Ten were HIV-positive by enzyme-linked immunosorbent assay and confirmed by Western blot test. One child defaulted before the test. All the mothers and three fathers of the 10 children were seropositive for HIV. Bronchopneumonia, otitis media, oral thrush, diarrhoea, and lymphadenopathy were common associations. Treatment was essentially conservative because the result of surgical intervention was disappointing. Two of the infants and one of the fathers are now dead from full-blown acquired immunodeficiency syndrome. Acquired RF seems to be a sign of HIV infection in children. It will be necessary to screen any child presenting with acquired RF for HIV infection.

Testicular torsion on the Jos Plateau.

In order to determine the pattern and the factors that influenced outcome, we retrospectively studied fifty-seven patients with torsion of the testis admitted to the Jos University Teaching hospital between August 1993 and July 2001. The age ranged from 2 to 55 years with a mean of 22.7 years. Majority (79%) of the patients were in the second and third decades of life. The main suspected precipitating factors in this study were cold weather and scrotal trauma: in 28% of the cases no cause could be ascertained. Eight (14%) patients presented within 4 hours and 35 (61%) presented after 24 hours of the onset of symptoms. Both sides were equally affected. Testicular pain, retraction and scrotal swelling were the most common presenting complaints. The highest incidence 65%) occurred between November and February when the weather on the Jos plateau is coldest. At surgery, 34 (60%) patients were found to have associated congenital anomalies; in 22 (39%) patients, the testis was non-viable. There was no mortality in this series and the complications were superficial wound infection (14%), testicular atrophy (7%) and sub-fertility (16%). High index of suspicion in a patient with acute scrotum, prompt and effective surgery will improve testicular salvage.

Acalculous cholecystitis in Nigerian children.

Sixteen children with acalculous cholecystitis (AC) were treated over a 9-year period (13 male and 3 female). Their ages ranged from 8 to 18 years (median 11). Eight (50%) presented with complications (perforation 4, gangrene 2, empyema 2); 13 (80%) presented with acute AC with a duration of symptoms of 2 weeks or less while 3 (20%) presented with chronic AC with symptoms present for more than 3 months. The diagnosis was made by ultrasound except in the patients with complications, who were diagnosed at laparotomy. Salmonella typhi was cultured in the bile and blood in 2 cases and the Widal titre was significantly elevated in 4 others. One child had chronic blockage of the cystic duct by a lymph node; in 9 there was no identifiable cause. Open cholecystectomy was successfully performed in 15 cases, while 1 child was managed non-operatively. The need for early diagnosis of cholecystitis in children is obvious if the potentially life-threatening complications of perforation and gangrene are to be avoided.

Surgical experience with management of vascular injuries.

UNLABELLED: To highlight the problems that are associated with the causes, diagnosis and management of vascular injuries. MATERIALS AND METHODS: A retrospective study of 52 cases of vascular injuries managed at the Jos University Teaching Hospital (JUTH) during a ten year period. RESULTS: The sex ratio M:F was 6:1 and the mean age at presentation was 23 years. The most common causes of vascular injuries were road traffic accidents in 44 per cent, iatrogenic 27 per cent and industrial in 13 per cent. These resulted in 50 cases (96 percent) of penetrating vascular injuries and 2 (4 percent) of blunt injury to vessels. Fifty-four percent of patients presented in shock. Active bleeding was recorded in 81 percent, pulse deficit in 65 percent and frank gangrene in 16 per cent. Aneurysms of various types occurred in 14 percent. Associated injuries were fractures in 60 percent, soft tissue injuries in 56 per cent and peripheral nerve injuries in 10 per cent. Overall, 52 arteries and 51 veins were injured, resulting in 15 lacerations, 74 complete transactions and 2 vascular blunt injuries with intimal tears and intraluminal thrombosis. Direct lateral suture of vessels was employed in 13 vessels, anastomosis in 12 vessels, graft interposition in 4 cases, ligation in 49 cases and aneurysmectomy in 3 cases. Three primary amputations were performed versus 7 secondary amputations. Hospital mortality was 16 percent and was mainly due to hypovolaemic shock, acute renal failure and sepsis.

Safety of daycare hernia repair in Jos, Nigeria.

OBJECTIVE: To evaluate the safety of day surgery for inguinal hernia. DESIGN: A randomised prospective study of patients presenting for elective inguinal hernia repair. SETTING: Jos University Teaching, Jos, Nigeria. SUBJECTS: One hundred and twenty one patients who completed a six-week follow up period. INTERVENTIONS: Sixty one patients had elective hernia repair as daycares while 60 patients were treated as inpatients. Forty six herniotomies and seventy five herniorrhaphies were performed under local or general anaesthesia. MAIN OUTCOME MEASURES: Early post-operative complications, including wound complications were evaluated. RESULTS: Early post-operative complications occurred in two of the 61 daycares and 15 of 60 inpatients (p=0.002). There were twelve and ten wound complications in daycares and inpatients respectively (p=0.668). There was no mortality. CONCLUSION: Outpatient elective inguinal hernia repair in carefully selected patients is relatively safe in our environment.

Patient acceptance of outpatient treatment for inguinal hernia in Jos, Nigeria.

BACKGROUND: Patient acceptability constitutes an important component of outpatient treatment for hernias. It is essential that patients are properly selected so that only those who need admission are admitted and cared for with the limited available resources. It is also equally important that those who qualify for outpatient care are adequately informed that there is no added risk attributable to outpatient treatment and that they are free to accept or reject such treatment. OBJECTIVE: To determine the acceptability of day care treatment for inguinal hernia in our environment. DESIGN: Prospective cross sectional study. SETTING: Jos University Teaching Hospital. SUBJECTS: 121 selected patients were randomized to undergo elective inguinal hernia repair either as outpatients (61) or inpatients (60). MAIN OUTCOME MEASURES: Six weeks after operation, an assessment of patients' opinion was made as to their preferred method. RESULTS: 52 of 61 day cases and 24 of 60 inpatients preferred outpatient treatment, while two daycare patients and 36 inpatients preferred hospital admission (p < 0.001). Altogether, acceptability rate for outpatient treatment was 68.6%. CONCLUSION: in carefully selected and adequately informed patients, outpatient elective inguinal hernia repair is readily acceptable.

alpha-receptor blockade for benign prostatic hyperplasia: uses and problems in a developing country.

OBJECTIVE: To evaluate the use and problems of alpha-receptor blockade with prazosin among patients in Nigeria with benign prostatic hyperplasia (BPH) who face a prolonged wait for a prostatectomy. PATIENTS AND METHODS: The study comprised 31 patients (mean age 64.4 years, range 55-89) facing a prolonged wait for prostatectomy: in group 1, 14 patients presented in acute urinary retention and had an indwelling urethral catheter; in group 2, six patients had indwelling catheters but removal was deemed necessary to control urinary tract infection: in group 3, 11 patients had troublesome symptoms from BPH but no retention. Some of the patients were also hypertensive. After receiving I mg of prazosin twice daily, the catheters were removed at various intervals and the effect on symptom scores and residual urine volume determined after one week and 2 months. RESULTS: Prazosin allowed the catheters to be removed, improved the symptoms of prostatism and/or controlled high blood pressure in seven, five and nine patients in each group, respectively. CONCLUSION: The use of this alpha blocker for BPH in the absence of facilities to measure urinary flow rate, intravesical pressure and serum prostate specific antigen can be justified for short periods. However, a large default rate among these patients raises additional questions about long-term safety and underlines the importance of selecting patients carefully.