Treatment of benign prostatic hyperplasia at Mater Hospital, Nairobi.

OBJECTIVE: To evaluate the use of medical therapy in the management of patients with mild, moderate and severe symptoms of benign prostatic hyperplasia. DESIGN: Prospective study. SETTING: Private urology clinic in Mater Hospital, Nairobi between 1995 and 2005. PATIENTS: Six hundred and eighty patients with benign prostatic hypertrophy aged 50-80 years. RESULTS: Two hundred and eighty (43.8%) patients benefited from the drug treatment alone and were released from the clinic follow up after five years. Two hundred and seventy (42.2%) cases could not complete the five years follow up on drugs alone due to symptoms recurrence or severity or unavailability of drugs. They were removed from the drugs alone treatment and put on other interventions. Ninety (15.9%) cases were operated on based on their decision and insistence or severity of their symptoms or no drugs response. CONCLUSIONS: This observational study confirms that medical treatment is beneficial in the management of benign prostatic hyperplasia (BPH) and is cheap and gives better first line option of treatment choice to many patients. It also gives hopes to the surgical risk patients. The quality of life (QOL) of patients and their family disturbance is also improved.

Urinary tract stone disease in Nairobi.

At the Kenyatta National Hospital (KNH) and other private hospitals in Nairobi urinary stone disease is not being correctly diagnosed. Over a 15 year period (1980-1995) only 56 patients have been confirmed to have urinary tract stones out of the expected number of 220 patients. The age range was 10-60 years. The peak age was 30-40 years. Pain and haematuria were the commonest presenting symptoms. Ultrasonography and plane abdominal radiology were the commonest methods of diagnosis. Open surgery and endoscopic stone removal were the commonest modes of management. Extracorporeal shortwave lithotripsy (ESWL) has recently been introduced into the Nairobi Hospital, but was not functional at the time of this study. Percutaneous nephrolithotomy (PCNL) is possible but has not been adequately used due to lack of correct equipment. Septicaemia and haemorrhage were the commonest complications of the open surgery.

Clinical presentation and management of renal cell carcinoma.

A study of clinical presentation and management of renal cell carcinoma (RCC) in 35 patients during the period 1983 to 1997 is presented. The peak age was 40-50 years. Haematuria, abdominal pain, fever of unknown origin and abdominal mass were the commonest presenting features. Computerised tomographic (CT) scanning, intravenous urography (IVU) and magnetic resonance imaging (MRI) were the important diagnostic tools. Early diagnosis and surgery are the most important approaches in management.

Surgical aspects of live donor kidney transplants in Kenya.

Review of twenty cases of live-donor kidney transplants in Kenya for a period of 5 years (1985-1989) and the follow up study results revealed that there were both high graft losses, high morbidity and mortality due to various complications pertaining to surgery and immunosuppression. The most serious complications were intercurrent infections, acute or chronic rejection, pulmonary embolism, steroid induced diabetes, pneumonia, and myocardial infarction. At the end of the first year follow up, there were only twelve graft patients alive. Magnetic Resonance Imaging (MRI) was not available for assessing the anatomical and functional behaviour of the transplanted kidneys. This would have assisted in early diagnosis of the degree and onset of rejection for appropriate treatment before the death of the allografts. It would also assist in differentiating perfusional problems from rejection.