The effect of unusual presentation on delayed diagnosis of prostate cancer: a case series.

BACKGROUND: Early diagnosis of prostate cancer is key to achieving a cure and its proper management leads to a good prognosis. In Ghana a large percentage of patients present with advanced disease and unusual presentations in these patients result in greater delay in the diagnosis thus worsening the outcomes. CASE PRESENTATION: We present three African males with advanced prostate cancer who had delayed diagnosis. The first patient, a 64 year old male presented with ascites of 2 years duration with weight loss and no lower urinary tract symptoms, the second, a 69 year old man with end stage renal failure of 6 months duration and was receiving dialysis, the third case, an 87 year old man was managed for pulmonary tuberculosis after he presented with chronic cough and lower urinary tract symptoms. All patients eventually had a prostate specific antigen done which were elevated. Further investigations including prostate biopsies, abdominopelvic CT scans for case 1, abdominopelvic ultrasound, prostate biopsies and blood urea and electrolytes for case 2, prostate biopsies, chest and lumbosacral showed a diagnosis of metastatic prostate carcinoma, and all patients were managed with androgen deprivation. The second patient received additional radiotherapy. CONCLUSION: A lack of knowledge of prostate cancer symptoms including unusual symptoms, can result in delayed diagnosis especially in regions of the world where a large number of patients present with advanced disease.

Comparing the effectiveness and lubricity of a novel Shea lubricant to 2% lidocaine gel for digital rectal examination: a randomized non-inferiority trial.

This study compared the level of lubricity and pain reduction of a novel shea lubricant to 2% lidocaine gel during digital rectal examination (DRE). Our research group performed a 9-week single-blind non-inferiority trial at the Ho Teaching Hospital involving 153 patients. The primary outcome measure was the mean pain difference during the procedure using a Visual Analogue Scale. 75 and 78 patients were randomized to the shea lubricant and 2% lidocaine gel groups respectively. The analysis considered the per-protocol population. The mean pain difference at endpoint was Δ - 0.01. The 95% lower confidence interval was a -0.595 difference in means, above the non-inferiority (NI) limit of - 0.720, thus establishing non-inferiority (Δ - 0.01, 95% CI - 0.59 to 0.57, NI - 0.72). With secondary outcome measures, perianal pruritus (p = 0.728), discomfort (p = 0.446), bowel urgency (p = 0.077) and urinary urgency (p = 0.841) were similar during the procedure. Shea lubricant had better lubricity and ease of use (p = 0.002). While the novel shea lubricant achieved similar level of pain reduction as obtained with 2% lidocaine gel, it had better ease of performance and lubricity.

A 6-year retrospective clinical review of iatrogenic ureteric injuries repaired in a resource-deprived setting.

BACKGROUND: Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost. OBJECTIVE: The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting. PATIENTS AND METHODS: This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015-2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients' demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0. RESULTS: Twelve patients aged between 24-54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention. CONCLUSION: Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.

Bilateral Female Inguinal Hernia Repair in Margaret Marquart Catholic Hospital and Review of Literature.

Background: Bilateral inguinal hernias are relatively rare in females compared to men. The management outcome of bilateral nylon darn, a method predominantly used in sub-Saharan Africa for same time repairs in complicated or elective hernia surgeries is largely unknown. Aims and Objectives: Our aim is to report a rare case of same time bilateral inguinal hernia obstruction and review the outcome of bilateral nylon darn posterior wall repairs after herniotomy. Design of the Study: This was a retrospective analysis of bilaterally operated inguinal hernia female patients data that was retrieved for the past 6-year period. Settings: All complete records of female patients who had same time bilateral inguinal hernia repairs at the Margaret Marquart Catholic Hospital (district hospital), for the period January 2015 to December 2020 were included in the study. Materials and Methods: Patient biodata, clinical notes on diagnosis, surgical management, postoperative care, and complications were extracted from hospital records and analysed. Results: A total of 14 patients aged between 40 and 87 years which represented 1.85% of the total hernia repairs were female with same time bilateral inguinal hernia repairs. Seven (50%) patients presented at the emergency with hernias detected over a year. Surgical site infection and pains after surgery were the predominant complications and occurred more common after emergency repairs. Conclusion: Emergency bilateral inguinal hernia repairs were three times associated with surgical site infection compared to elective repairs.

Solitary kidney functional damage due to caesarean ureteric injury monitored for 2 years after acute management: A case report.

Caesarean section with associated ureteric injuries that damage kidney function is uncommon. Such injury in women with a solitary kidney has far-reaching effects if the diagnosis is delayed. The case report describes the successful acute management with stenting of ureteric damage after caesarean section in a woman with a solitary kidney. A 29-year-old woman presented with anuria, hypertension (174/101 mmHg) and flank pain 3 days after caesarean section. Physical examination was significant for peri-orbital oedema, left flank tenderness, pallor and delirium. A diagnosis of acute kidney injury was confirmed by elevated blood urea and creatinine levels. An ultrasound scan revealed a solitary hydronephrotic left kidney. She had successful acute management at a resource-deprived facility, with normal renal function at a 2-year follow-up. Proteinuria lasted for about three months after surgery. Recovery of solitary kidney function with acute kidney injury due to caesarean section ureteric injury may be associated with prolonged proteinuria without evidence of further functional deterioration.

HIV patient with prolonged infection after hemicolectomy and repair of complicated hernia. Mini-review of a rare successful surgical outcome.

INTRODUCTION AND IMPORTANCE: Surgical site infection (SSI) is an inevitable occurrence in bowel perforation with faecal soiled hernia wound(s) especially in retroviral patients. Unfortunately, the increased antibiotics and wound care demands do not prevent delayed healing, increased risk of hernia recurrence, or multiple surgeries to control the infection. The standard open or endo-laparoscopic Mesh repairs are either deferred or avoided with alternative tissue-based hernia repairs after bowel surgery. The reported success of open tissue-based repairs remains mixed. Nylon monofilament that have been used in infected wounds was chosen for the patient in anticipation of wound infection. CASE PRESENTATION: A 48-year-old man presented with a 7-days complicated hernia at the emergency unit, Margaret Marquart Catholic Hospital. Clinical examination revealed signs of shock, intestinal obstruction, and peritonism, laboratory investigation was remarkable of anaemia, septicaemia, deranged renal function, and positive retroviral test. He had concurrent right hemicolectomy and nylon darn after optimisation. The outcome we evaluated after surgery included postoperative pain, scrotal collection, anastomotic breakdown, postoperative analgesic use, wounds infection, prolonged hospital stays, recurrence, and the need for a second surgery. Though he developed prolonged deep SSI, he has intact hernia repair after 6-years. CLINICAL DISCUSSION: The postoperative critical clinical events presented in this case were unexpected but might have been precipitated by his retroviral status. Thus, a weight loss of over 13 kg within 2 weeks was highly unusual. Furthermore, the positive retroviral status couple with the perforated caecum and soiled peritoneum was the cause of the surgical site infection. CONCLUSION: Nylon darning in a retro-positive patient developing prolonged SSI appeared beneficial. It should be considered in patients with anticipated long period wound infection.

Debilitating complications of unsuspected urethral stone: Case report and literature review.

Primary anterior urethral calculi account for <0.3% of urinary stones with over 90% resulting from luminal anomalies. These stones are often diagnosed early and treated without clinical problems. Fournier's gangrene (FG), a lethal complication, was diagnosed and managed following a decade-long complaint of voiding lower urinary tract symptoms (LUTS) and clinical workout revelation of giant anterior urethral calculus in a normal lumen. Though multiple interventions resulted in a satisfactory outcome, these feared complications are rare. Hence reporting will significantly shape clinical practice. The perception of LUTS needs re-evaluation to enable early diagnosis of urethral stone and avoid debilitating complications.

Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults.

PURPOSE: Inguinal hernia is a common male surgical disease. Intervention carries a wide range of complications such as scrotal haematoma and seroma which may require surgical re-intervention or predispose patients to developing infections, pains or feeling of mass. This could lead to long hospital stay. Scrotal tamponade by bandaging or wearing of tight pants and elevation are practiced to reduce bleeding and haematoma formation. These methods require prolong use. Closed suction drains are scarcely used in resource-deprived communities due to high cost and non-availability. AIM: This study was to determine the effectiveness of a closed non-suction drain in preventing scrotal collection requiring further surgical intervention and the predisposition to developing surgical site infection following nylon darn repair of inguinoscrotal hernia. METHODS: Forty (40) participants were recruited for a preliminary study and assigned into control and interventional groups (CG, IG) for purposes of inserting flexible feeding tube (FFT) wound drain after nylon darn (ND) repair. Daily measurement of drained scrotal collection was carried out in the IG till the day drainage was zero. Residual volumes in IG and wound collection in the CG who were not candidates for re-intervention were determined at 14th and 28th post-operative days using ultrasound scan. Data were analyzed using SPSS version 25. RESULTS: Three (3) patients (15.8%) in the CG required re-intervention. Surgical site infection rates for the CG and IG were, respectively, 2/19 versus 0/21 (ρ = 0.134).There was a numerical significant difference in the mean volumes of scrotal collections between the control (0.95 ± 0.42 ml) and the intervention group (0.44 ± 0.33 ml) [p value of 0.041] but with no clinical impact. CONCLUSION: Simple inexpensive flexible feeding tube placement significantly reduced scrotal collection which forms a base for larger sample size in subsequent studies. This could reduce the feared risk of re-intervention, wound infection and long hospital stay post-operative.

Perception and Attitude of Medical Students towards Cadaveric Dissection in Anatomical Science Education.

BACKGROUND: Cadaveric dissection is essential and effective teaching method of anatomy in medical schools. In cadaveric dissection, the learner plays the central role of the teaching process and to view structures in their natural location. Cadaveric dissection is however perceived as tedious and time consuming by most students which influence their perception and attitude towards the teaching method. This study was therefore designed to evaluate UHAS medical students' perception and attitude toward dissection in the teaching and learning of human anatomy. METHOD: This was a cross-sectional and descriptive study. A Likert-style questionnaire, comprising 26 items was sent to study population via online using google form. Ethical issues were duly dealt with approval and consent. RESULT: Majority of the students (84.5%) perceived dissection more interesting, and the better way to really learn and understand the human body. About 87% of students also indicated that it assists in retention of what they learnt in theory. Majority of the students (74.5%) felt dissection should not be replaced by other forms of learning. CONCLUSION: There is a strong positive perception and attitude towards the use of cadaveric dissection as a teaching and learning method of anatomy. Cadaveric dissection brings about the skills, courageous and the ability to confidently work on the human body without any fear for future practice. It is therefore, recommended that more time should be allocated to cadaveric dissection.

Amyand's hernia- outcome of nylon darn repairs after complicated appendix surgeries in a district hospital: case series.

INTRODUCTION: Complicated appendix is a least expected sac content of inguinal hernias that always require appendix surgery and hernia repair. The current recommendations for posterior wall repairs however, continue to attract conflicting views as to which modality gives the best outcome in infected surgical wounds. New posterior wall repair methods with properties to withstand surgical site infections, minimise hernia recurrence, affordable and easy skill to acquire with a potential to be widely adopted are continuosly sort. AIM: To determine the surgical outcomes of complicated Amyand Hernias repaired using the open tissue base Nylon Darn posterior wall re-enforcement method. METHOD: A retrospective review of medical records of patients who had surgery for emergency inguinal hernia with intra-operative confirmation of complicated appendix in the hernia sac from January 2015 to December 2020 at the Margaret Marquart Catholic Hospital, Kpando were included. Data on age, sex, clinical presentation, surgical procedure, intra-operative findings, post operative complications were captured and presented as descriptive statistics. RESULTS: Twelve out of 286(4.6%) repairs were complicated Amyand Hernias in patients aged 6weeks to 76-years{median age 54.5-years}. Most of them were adults, long-standing hernias. All diagnosis were made on-table. Surgical site infections was the most frequent complication in types III and IV AHs which resolved with antibiotic treatment. CONCLUSION: The incidence of complicated AHs is higher and should be anticipated in surgeries for long-standing complicated inguinal hernias. Even though complications were significantly associated with longer hospital stay, no second procedure or mortality was recorded.

Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report.

BACKGROUND: Disorders of sex development are anomalies in which the development of urogenital ridge is undifferentiated for the male and female child. Imaging plays a vital role in investigating the gross anatomy and associated anomalies. Ultrasonography, such as genitography and magnetic resonance, is the primary modality for demonstrating internal gonads and genitalia. Early multidisciplinary approach in the management of ambiguous genitalia including early surgical intervention is the predominant practice, with few current considerations on deferral of genital reconstruction until adolescent age. CASE PRESENTATION: We report the rare case of a 24-year-old adult female from a majority ethnic group of the Volta region, Ghana who was diagnosed and raised as male, now requiring surgical restoration to the female gender. The surgical team decided to assign external genitalia to correspond with the already intact internal organs, thus constructing the vulva. Consent was given by the client and her family members for management and surgical intervention. The surgery was scheduled and duly performed with a successful outcome. Understanding and consent was sought from the patient for the purpose of using her images for teaching, scientific publication, and demonstrations. CONCLUSION: The advantages of deferring surgical reconstruction with psychological counseling after early assessment need to be considered to prevent inappropriate gender assignment.

Penile skin bridge multiple liathiasis, a diagnosis made in a complication of circumcision in a 24 year old young adult: Case report.

Penile skin bridge stones are rare complications which has never been reported in literature hence information about management is non-existent. This case reports a 24-year-old man presenting with recurrent inflammatory symptoms in his sizeable penile skin bridge. Clinical examination revealed multiple calculi which was confirmed after surgical division of the SB. Phimosis and stone migration are the pathological basis underlying all reported cases of non-urethral calculi in uncircumcised elderly phallus. Extra-luminal urolithiasis in a young circumcised man, we believe have different predisposing factors and prognosis. Treatment involved stone removal and debridement of the skin bridge which yielded successful outcome.