MANAGEMENT OF PROSTATE CANCER IN ACCRA, GHANA.

INTRODUCTION: Africans living with prostate cancer in Africa face problems of early diagnosis and appropriate treatment. AIM: To study the clinical incidence of prostate cancer, risk factors, TNM stage, their management and outcomes. METHODS: A prospective study of Prostate Cancer cases managed at Korle Bu Teaching Hospital and hospitals in Accra, diagnosed by history, abnormal PSA/DRE, physical examination and histologically confirmed by biopsy from 2004 to 2013 was carried out. The cases were TNM staged and managed by approved protocol. RESULTS: There were 669 cases with a mean age 70±0.045SE years, median Gleason Score of 7, organ confined Prostate Cancer(PC) in 415(62%), locally advanced in 167(25%) and metastatic Prostate Cancer in 87(13%) cases. The cases were followed for median of 10 months to ≥ 84 months. Organ confined cases were managed by: Radical Prostatectomy (RP) 92 (13.8%) with a mortality of 0.3%; brachytherapy 70 (10.5%) with a mortality of 0.1% and External Beam Radiotherapy (EBRT) 155 (23%) with a mortality 0.7%. In all, 98 men constituting (14.1%) cases with a mean age of 75+0.25SE years, life expectancy <10 years were treated by hormonal therapy with a mortality of 1.7%. Twenty cases who were for active surveillance (GS6), PSA <10ng/ml, life expectancy <10 years later all opted for EBRT. Locally advanced cases 25% all had neoadjuvant hormonal therapy then Brachytherapy in 3 (0.4%) mortality 0.15% and EBRT in 64 (9.5%), mortality 0.59%. Hormonal therapy was given in 100 (15%) locally advanced cases, mortality 5%. Metastatic prostate cancer cases (13%) were managed by hormonal therapy, mortality 6%. CONCLUSION: Improved facilities and dedicated skilled teams led to a significant rise in proportion of organ confined Prostate Cancer from 15.3% to 62% curable by Radical Prostatectomy, brachytherapy or EBRT with longer disease free survival.

Penile Strangulation by self-Placement of Metallic Nut.

We report a case of a 37-year-old male who presented with a 12-hour history of a strangulating 2cm wide by 0.8 cm thick metallic nut on the penile shaft at the peno-scrotal junction. Unlike instances where these metallic objects are placed to enhance sexual stimulation this nut was rather placed to prevent intercourse. A Bosch electric circular grinder was successfully used for removal but a thermal burn to the penile tissues was sustained in the process as the hardness of the nut required a high energy to cut and its thickness did not allow for effective cooling during the process of removal. This resulted in a circumferential denudation of penile skin, a urethro-cutaneous fistula at the peno-scrotal junction and a mid-bulbar urethral stricture. The penile wound was subsequently covered with a split skin graft with a delayed closure of the urethrocutaneous fistula and a buccal mucosa patch urethroplasty for the mid bulbar stricture. Despite the degree of thermal burns sustained the patient has maintained good erectile function with grade four rigidity. The tunica albuginea and the underlying corpora cavernosa have shown a significant degree of resilience to thermal burns compared to the corpora spongiosum where the thermal burns led to a urethrocutaneous fistula.

SURGICAL MANAGEMENT OF BPH IN GHANA: A NEED TO IMPROVE ACCESS TO TRANSURETHRAL RESECTION OF THE PROSTATE.

BACKGROUND: Open prostatectomy for benign prostate hyperplasia (BPH) is widely practiced in Ghana and Africa. Some of the reasons include lack of expertise and facilities for Transurethral Resection of the Prostate (TURP) and digital rectal examination assessment of prostates as greater than 50 grams. OBJECTIVES: To assess the prostate volumes of patients for surgical management of BPH by transrectal ultrasound (TRUS) and to determine, on the basis of prostatic volume, what percentage of those who had open prostatectomy could have been managed by TURP. DESIGN: Prospective cohort study. SETTING: The Korle Bu Teaching Hospital, Accra, Ghana. SUBJECTS: Patients for elective surgical management of BPH from March to September 2010 were studied. RESULTS: Fifty-eight. patients had surgical management of BPH. Forty-six of them (79.3%) had open prostatectomy whilst twelve (20.7%) had TURP with a mean age of 70.4 and 65.2 years respectively. The most common reason for the open prostatectomy was refractory retention of urine (76.0%) while that for TURP was lower urinary tract symptoms (58.3%). The mean prostate volume for the patients who had open prostatectomy was 64.2ml ± 28.7mls (range 23.0-121.0ml) while that of the TURP group was 40.1g ± 16.2mls (range 18.5-70.0mls). Of the open prostatectomy group, 67.4% of them had prostate volumes 75 mls or less. The blood transfusion and peri-operative complication rates for the open prostatectomy and TURP groups were 13% versus 8.3% and 8.7% versus 8.3% respectively. There was no mortality. CONCLUSION: Access to TURP in the surgical management of BPH in Ghana is low (20.7%). With improved facilities including routine use of TRUS for assessing prostate size and availability of expertise for TURP, 67.4% of patients offered open prostatectomy presently could benefit from TURP, using prostate volumes 75mls (75g) or less as indication for TURP.

Retrocaval ureter: two case reports.

Retrocaval ureter also referred to as pre-ureteral vena cava is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava. Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life from a resulting hydronephrosis. We present the first two cases to be reported in Ghana; a 36-year-old male and a 40-year-old female both with right flank pains and associated right hydronephrosis. Diagnoses were confirmed with retrograde ureteropyelogram and both had an open surgical repair of the anomaly.

Prostate cancer metastasis to the mandible: case report.

Prostate cancer is recognised to be the commonest type of malignancy in the male in many parts of the world. Prostate cancer has a propensity to metastasize to bone, however metastasis to the jaw is uncommon and indeed among metastatic tumours of the jaws which are a rarity, only about 9% originate from a prostatic primary. We report a case of histologically proven metastatic prostate cancer to the right mandible which necessitated a hemi-mandibulectomy in order to improve the patient's quality of life.

A review of genitourinary cancers at the Korle-Bu teaching hospital Accra, Ghana.

OBJECTIVE: To determine the frequency and pattern of genitourinary malignancies seen at the Korle-Bu Teaching Hospital, Accra, Ghana MATERIALS AND METHODS: A retrospective review of genitourinary malignancies seen at the Korle-Bu Teaching Hospital from 1980 to 1990 was undertaken. Data was obtained from the operating theatre register, histopathology reports, and patient case notes. Information retrieved included age and sex of patients, organ involved and laterality where appropriate and tumour type. RESULTS: 548 genitourinary malignancies were seen, of which 479 (87.4%) were in males and 69 (12.6%) in females. Adults comprised 93.4% and children 6.6%. The organ-specific distribution was as follows-prostate 349 (63.7%), bladder 117 (21.3%), kidney 57 (10.4%), testis 13 (2.4%), penis 10 (1.8%) and one each of the ureter and urethra. The kidney tumours comprised nephroblatoma (56.1%), adenocarcinoma (35.1%) with the rest being of urothelial origin. Of the bladder tumours, 50.4 % and 44.8 % were transitional cell and squamous cell carcinoma respectively. Virtually all the prostatic cancers (99%) were adenocarcinomas. Of the testicular tumours 8(61.5%) were of germ cell and 5 (38.5%) non-germ cell origin. The penile cancers were all squamous. The ureteric and urethral tumours were due to transitional cell and squamous cell carcinomas respectively. CONCLUSION: Prostatic carcinoma was the predominant genitourinary tumour, accounting for nearly two-thirds of cases, followed by the bladder and the kidney. Other tumours were relatively uncommon. Transitional cell carcinoma of the bladder was seen a little more commonly than the squamous type.

Upper urinary tract stones in Accra, Ghana.

Fifty-one patients with newly diagnosed upper urinary tract stones were seen at the Korle Bu Teaching Hospital, Accra over an 8 years period from September 1985 to August 1993. Their mean age was 40.1 years (range 20-61 years). The sex ratio was 36 males to 15 males. During the same period 3, 217, 135 patients (both adults and children) attended the hospital's clinics. Thus putting the incidence of upper urinary tract stone at 2 per 100,000. On presentation 37 patients had solitary stones, 11 had multiple stone and 3 had partial or complete staghorn calculi. A total of 71 stones were seen; 30 were renal and 35 ureteric. The etiology of the stone disease was established in only 10 cases (20%). Urinary stasis was a predisposing factors in 5 patients, urinary infection in 3 others and hyperuricaemia and uricosuria in another 2. Stones from 29 patients that were removed at surgery or passed spontaneously were analysed chemically. Of these 25 (86%) consisted of calcium oxalate and/or calcium phosphate, 3 (10%) consisted of magnesium ammonium phosphate and 1(4%) contained only uric acid.

Varicocelectomy: what benefits to the infertile Ghanaian male?

Fifty Ghanaian males of infertile marriages found on clinical examination to have varicoceles underwent varicocelectomy. Their mean age was 34.2 years (range 24 to 47 years). The varicocele was left-sided in 36 patients (72 per cent); bilateral in 13 (26 per cent) and right-sided in 1 (2 per cent). The mean of 3 preoperative semen analysis showed 9 patients (18 per cent) had azoospermia while 26 (52 per cent) had counts of 5 million/ml or less. The rest had counts between 6 and 20 million/ml. Normal sperm motolity (50 per cent or more motile sperms) and morphology (50 per cent or more with normal morphology) were seen in 36 per cent and 22 per cent of cases respectively. Following varicocelectomy 26 (52 per cent) obtained an overall improvement in semen quality. Of these 15 (30 per cent) had mean sperm counts above 20 million/ml. None of the patients with azoospermia obtained any benefit. A conception rate of 18 per cent (9/50) was obtained

Priapism: experience with the caverno glandular shunt.

Twenty cases of Priapism were managed surgically over a 3-year period with the A1-Ghorab modification of the caverno-glandular shunt. The procedure was simple and short. Except for post-operative bleeding in 2 patients, no major complications were encountered. Post-operative potency rate of 39 per cent was achieved. Late presentation and repeated previous episodes may have contributed to this low potency rate.

Internal optical urethrotomy: a report of fifty-one cases treated under local anaesthesia.

Over the 15-month period beginning from October 1985, internal optical urethrotomy was successfully performed under local anaesthesia on 51 patients with urethral stricture. The procedure was well tolerated and 48 patients were discharged home on the day of operation. A urethral catheter (18 or 20F Foley) was left indwelling for one week post-operatively. Subsequently patency was assessed by check catheterisation using size 18F Nelaton Catheter, weekly for 6 weeks, and then at 3 monthly intervals. Thirty-nine patients have been followed up regularly for 3 to 15 months. Six patients restrictured (failed check catheterisation). The remaining 33 (84.6%) have retained urethral patency with no additional treatment.