Prevalence and Distribution of Postvoid Residual Urine Volume in a Hospital-Based Sample of Men with Symptomatic Benign Prostatic Hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a known cause of bladder outlet obstruction (BOO) in aging men. Patients present with lower urinary tract symptoms (LUTS), elevated postvoid residual urine (PVR), and reduced peak flow rate of urine. Although urodynamic study is the gold standard for diagnosing and quantifying BOO, it is invasive and as such urologists in their routine practice frequently rely on less invasive methods like PVR estimation to objectively assess BOO. AIM: To study the prevalence and distribution of PVR in a hospital-based population of men with symptomatic BPH. MATERIALS AND METHODS: Patients aged 40 years and above were enrolled for the study. History was taken from each of the 170 participants recruited, and physical examination was done including digital rectal examination. Every one of them completed the International Prostate Symptom Score (IPSS) questionnaire and also had ultrasonography assessment of PVR. Relevant laboratory investigations (PSA, renal function test, full blood count, urinalysis, and urine culture) and uroflowmetry to determine the peak flow rate of urine (Qmax) were done. RESULTS: A total of 170 subjects who met the inclusion criteria were enrolled for this study. The mean age of the subjects was 63.70 ± 9.92 years with a range of 42-88 years. The subjects had a mean PSA of 2.68 ± 0.91 ng/ml and a mean prostate volume of 70.8 ± 39.5 ml. The prevalence of significant PVR was 57.06%. The distribution of PVR was skewed with values ranging from 4.0 ml to 382.9 ml, a median value of 60.5 ml (interquartile range, IQR, =25.0-100.76), and a mean value of 77.70 ± 69.30 ml. An IPSS range of 8 to 23 with a mean value of 13.64 ± 4.14 and a median value of 13 (interquartile range = 10.0-16.0) was observed. The Qmax range was from 5 ml/s to 50 ml/s with a mean value of 20.25 ± 9.70 ml/s, and a median value of 18.0 ml/s (interquartile range = 14.0-24.0). CONCLUSION: This study showed that the prevalence of significant PVR volume among men with symptomatic BPH in our environment is high. There was also a high variation in the distribution of PVR among the subjects. Therefore, it is essential to create more public awareness especially among men in their fourth decade of life and above to visit a urologist whenever they have BPH symptoms so as to avoid impairment in quality of life and renal function associated with neglected significant PVR.

Recall of consent information by day care prostate biopsy patients: An assessment of the role of a third-party check.

BACKGROUND: To evaluate the extent of recall of consent information by daycare prostate biopsy patients in our low-literacy setting. And to evaluate the role of a 3rd party check on patient's recall of consent information. SUBJECTS AND METHODS: As part of our standard of care, a formal informed consent session for day care prostate biopsy takes place 3 days prior to the procedure. For this study, before leaving the outpatient clinic the same day, the patient acknowledged before a third-party that his concerns were or were not satisfactorily addressed. The extent of recall of consent information was assessed on the morning of the procedure using a researcher-administered questionnaire. Consecutive patients participated in this cross-sectional study for day care prostate biopsy at a tertiary hospital in southeast Nigeria from February to November 2015 after obtaining due consent. RESULTS: The recall of the risks associated with the planned procedure was poorer than the recall of the nature of the disease condition or the nature of the planned procedure. However, it was observed that aggregate recall was significantly poorer among patients who negatively attested to a satisfying consent session (OR 0.125; P < 0.0005). CONCLUSION: The use of a third-party in determining patient satisfaction after a consent session may be a better indicator of patient comprehension and subsequent recall of consent information, especially in low-literacy settings. Using a third-party, in this manner, may assist in checking paternalism inherent in the patient-doctor relationship.

Learning transurethral resection of the prostate: A comparison of the weight of resected specimen to the weight of enucleated specimen in open prostatectomy.

BACKGROUND: Minimally invasive procedures in the surgical management of benign prostate enlargement (BPE) are of limited use in the resource-poor settings due to nonavailability of the requisite facilities and skills. It has been observed that teaching uroendoscopy inclusive of transurethral resection of the prostate (TURP) can be challenging in the resource-poor settings where the traditional master-apprentice (Halstedian) approach has remained the prevalent training technique. PATIENTS AND METHODS: We aimed in this retrospective study to assess completeness of resection in TURP by comparing the proportion of prostate tissue resected to the proportion enucleated in open retropubic prostatectomy (ORP). We included all BPE patients on urethral catheter managed in the first 18 months after Halstedian training in TURP. The analysis was done using SPSS® 20 and VassarStats® online software. RESULTS: Twenty patients' files for TURP and twenty-eight patients' files for ORP met the inclusion criteria. Patients in the 2 treatment arms were similar in age (P = 0.22), body mass index (P = 0.45), proportion of prostate tissue extirpated (P = 0.38), and International Prostate Symptom Score 12-month postprocedure (P = 0.06). However, larger prostates were treated with ORP (P < 0.0005). The correlation of the weight of resected specimen to preoperative prostate volume (PV) (r = 0.78; P < 0.001) was similar to that of enucleated specimen to preoperative PV (r = 0.89; P < 0.001). Similarly, the proportion of extirpated specimen correlated positively with the preoperative PVs for both TURP (r = 0.23; P = 0.33) and ORP (r = 0.292; P = 0.13), with no evidence of any difference between the 2 correlation values (P = 0.84). CONCLUSION: With appropriate patient selection, especially as a newly trained Surgeon, resections in TURP are as complete as enucleations in ORP.

Transperineal versus transrectal prostate biopsy: our findings in a tertiary health institution.

CONTEXT AND OBJECTIVE: Prostate cancer is a major public health issue. Its incidence is rising, especially in Nigeria. Prompt diagnosis is necessary by histology. Transperineal and transrectal approaches to prostate biopsy are well-documented. Both methods are fraught with complications though, most times minor. Studies carried out to compare both methods were carried out mainly on Caucasians, generating conflicting results. This study aims to compare the complication rates and tissue yield of these two methods in Nigerian men. MATERIALS AND METHODS: Seventy-five patients completed the study. Forty-five patients had transperineal prostate biopsy (TPbx), while 30 patients had transrectal prostate biopsy. Pain perception for all patients was determined by visual analog scale; whereas the complications were ascertained by a validated purpose designed questionnaire administered on the 7 th and 30 th day post operatively. RESULTS: The risk of rectal bleeding was higher for transrectal prostate biopsy compared to transperineal (Odds ratio: 0.03; 95% confidence interval (CI): 0.001-0.450; P = 0.012). TPbx was more painful than transrectal (P < 0.0001; df: 75; t: 4.98; 95%CI of difference in mean: -2.98-[-1.28]). There was no statistical difference between transperineal and transrectal prostate biopsy in hemospermia, fever, prostatic abscess, urethral bleeding, acute retention and tissue yield. CONCLUSION: TPbx is more painful than transrectal prostate biopsy though with a significantly reduced risk of rectal bleeding. There appears to be no significant difference with respect to risk of fever, urethral bleeding, hematospermia, prostatic abscess and acute retention. Both routes provided sufficient prostate tissue for histology.

Fournier's gangrene -- analysis of management and outcome in south-eastern Nigeria.

BACKGROUND: Fournier's gangrene is a necrotising fasciitis of the genitalia and perineum, with associated polymicrobial infection and risk of organ failure or death. The purpose of this study was to determine the presentation, systemic and local predisposing factors, management challenges and outcome in south-eastern Nigeria. PATIENTS AND METHODS: We studied 28 out of 34 consecutive male patients with complete case notes seen in two centres (the University of Nigeria Teaching Hospital and St Mary's Hospital) between January 1995 and December 2008. Operating theatre registers and urology ward admission registers were used to identify patients. RESULTS: The mean patient age was 48.3 years (range 28 - 66 years), with a peak age incidence of 50 - 59 years. The majority of patients were farmers, manual labourers and artisans. The site of gangrene was scrotal in 22 patients (78.6%), penoscrotal in 3 (10.7%), abdominoscrotal in 2 (7.1%) and scroto-perianal in 1 (3.6%). The mean interval between onset of symptoms and presentation was 7.2 days (range 3 - 14 days). Systemic predisposing factors identified were diabetes mellitus in 6 patients (21.4%), filariasis in 2 (7.2%), congestive cardiac failure in 1 (3.6%) and HIV infection in 1 (3.6%). In 18 patients (64.3%) no systemic factor was identified. Local predisposing factors identified were chronic scrotal skin itching in 16 patients (57.1%), scrotal thorn injury in 2 (7.1%) and urethral catheterisation in 2 (7.1%). Scrotal carbuncle and scrotal surgery each accounted for 2 patients (7.1%), and zipper injury and ischiorectal abscess occurred in 1 patient each (3.6%). No local predisposing factor was identified in 1 patient (3.6%). The common clinical features were fever, scrotal swelling/pain, and later a malodorous painless wound. Treatment involved fluid administration, correction of electrolyte imbalance, antibiotics, debridement and daily wound inspection/dressing with hydrogen peroxide soaks and sodium hypochlorite. The mean duration of hospital stay was 37.1.days (range 21 - 84 days). One patient died (3.6%). CONCLUSION: Fournier's gangrene is a challenging surgical problem, with significant morbidity. Diabetes mellitus is a significant systemic risk factor. In the majority of our cases, no systemic predisposing factor was identified. Local risk factors, especially chronic scrotal itching, were contributory. With proper management, mortality is low.

Peri-operative blood transfusion in open suprapubic transvesical prostatectomy: relationship with prostate volume and serum total prostate specific aantigen (TPSA).

INTRODUCTION: Open simple prostatectomy is the most effective and the most durable method of controlling symptoms associated with benign prostatic hyperplasia, especially in sub- Saharan Africa, where TURP set and expertise are unavailable in most health institutions. The risk of perioperative heterologous blood transfusion in open transvesical prostatectomy varies widely from one centre to another, and this risk is documented to improve over time in any given centre. AIM: To determine the perioperative blood transfusion rate in our centre and to determine its relationship with the prostate volume estimated with transabdominal ultrasonography and serum total PSA. METHOD: A retrospective study of patients surgically managed for BPH in 25 months (from March 2009 to March 2011). RESULTS: A total of 36 patients were included. Eighty-six percent of these patients had indwelling urinary catheter introduced earlier due to acute or chronic urinary retention, while 19.6% had macroscopic haematuria at presentation. The mean prostate volume was 90.4 cm3 (36-164), with 67% of cases having volumes greater than 70cm3. Ninety-one percent of the patients had serum tPSA greater than 4ng/ml (1.5-85.3 ng/ml, mean was 22.8ng/mL). The perioperative transfusion rate was 8.3% and it is not affected by the prostate volume (chi2(Yates) = 0.884), or serum total PSA (chi2(Yates) = 0.417). There was no perioperative mortality. CONCLUSION: Open suprapubic transvesical prostatectomy is still a safe procedure; with a perioperative blood transfusion rate of 8.3% in our centre. This risk appears to be unrelated to preoperative prostate volume and serum tPSA.

Effects of Electronic Massager on Patients with Advanced Cancer of the Prostate

Background:The electronic massager has in recent times become so popularized that it is used in the treatment of almost every ailment. Its prescriptions range from treatment of obesity through acute painful conditions to the treatment of complications of cancer conditions. There are many claims and counter claims from the manufacturers of such massagers and it is becoming increasingly difficult to control its usage by people; both the sick and the healthy; even when its use is not obviously indicated. Some of our prostate cancer patients also were not left out in the craze for massagers.Objective: The objective of this study is to determine the effects of the electronic massager on patients with advanced prostate cancer. Materials and Methods: This is a retrospective study done in our unit to find out any effects of using the electronic massager on advanced prostate cancer patients. The folders of patients diagnosed as cancer of the prostate over a period of five years were traced from the Records Department of the University of Nigeria Teaching Hospital; Ituku / Ozalla. Those who had histological diagnosis / clinical late stages i.e. stages III et IV were selected. The effects of electronic massager on those who had used it were studied vis-a-vis their counterparts who did not use it. Results: There were twenty-seven advanced (Stages III etIV) prostate cancer patients seen over a period of five years. Five of the patients used the electronic massagers and all five died within one year of getting readmitted in the hospital; four of them within three months; while the last one died about the seventh month. Those who did not use electronic massagers survived beyond one year from the time of readmission. Conclusions: The use of the electronic massager increases morbidity and mortality rates in prostate cancer patients