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.

Traditional medicines and alternative practice in the management of prostate diseases in southern Ghana.

OBJECTIVE: This study was aimed at identifying Ghanaian traditional medicines used for the management of prostate diseases and their constituents. Reviews of studies conducted on them are also presented. METHODOLOGY: This was a prospective study. Traditional Medicine samples from consecutive patients with either lower urinary symptoms (LUTS) presenting at the Urology Unit of the Korle Bu Teaching Hospital (KBTH) in Accra from January 2015 to June 2016 and had a prior treatment with traditional medicines, had the samples retrieved. Additionally, all the 58 licensed pharmaceutical shops in Okaishie, a whole sale and retail depot for medicines in the main business district of Accra, were visited and traditional medicines for the management of prostate diseases acquired. The products constituent as labeled were documented and entered once on a proforma. This study was part of a study on the management of benign prostate hyperplasia at the KBTH approved by the Medical Directorate.The findings were analyzed and presented using descriptive statistics and presented as a table. RESULTS: Eleven products were identified with the main indigenous medicinal plant identified being the root extract of Croton membranaceus. This was the constituent in four products (Uro 500®, UR-Quick mixture®, Prostacure® and prostat®60). Although studies on the basic pharmacology and animal studies have confirmed its effect on the prostate, only one clinical study was identified. CONCLUSION: Croton membranaceus was the indigenous traditional medicine identified for relieving LUTS due to prostate disease. There is the need for empirical evidence on its efficacy in treating Prostate cancer. FUNDING: Not declared.

Determinants of peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia.

BACKGROUND: The objective of this study was to determine the factors responsible for peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia and thus offer a guide for blood product management for the procedure. METHODS: This was a prospective study of 200 consecutive patients who underwent open prostatectomy for BPH from January 2010 to September 2013 at the Korle Bu Teaching Hospital, Accra. The data analyzed included the pre-operative blood haemoglobin level (Hb), presence of co-morbidities, the case type, indication for the surgery, ASA score, anaesthetic method used, systolic blood pressure, status of the operating surgeon, duration of surgery and the operative prostate weight. The transfusion of blood peri-operatively was also documented. RESULTS: The mean age of the patients was 69.1 years. Elective cases formed 83.5 % with refractory retention of urine being the commonest indication for surgery (68.0 %). The mean pre-operative Hb was 12.1 g/dl. Consultants performed 56.0 % of the prostatectomies. Transvesical approach was used in 90.0 % of the cases. The mean operative time was 101.3mins (range 35.0-240.0) with a mean operative prostate weight of 110.8 g (range 15-550 g). Most of the patients (82.0 %) had spinal anaesthesia. The blood transfusion rate was 23.5 %. The transfusion rate was significantly higher in patients with anaemia (p = .000), emergency cases (p = .000), the use of general anaesthesia (p = .002), a resident as the operating surgeons (p = .034), prostate weight >100 g (p = .000) and duration of surgery (p = .011). In a multivariable logistic regression analysis however only the pre-operative Hb (p = .000. OR 0.95, 95 % CI [0.035-0.257]) and the duration of surgery (p = .025, OR 1.021, 95 % CI [1.003-1.039]) could predict blood transfusion in open prostatectomy for BPH in this series. CONCLUSIONS: A 'group and save' policy should be the preferred blood ordering procedure for patients with Hb ≥ 13.0 g/dl scheduled for an elective open prostatectomy for BPH under spinal anaesthesia. A long operative time however may increase the need for blood transfusion.

Nephrectomy in adults: Experience at the Korle Bu Teaching Hospital, Accra, Ghana.

The objective of this study was to analyze nephrectomies performed in adults over a 12-year period at the Korle Bu Teaching Hospital, Accra and to compare our findings with reports from other institutions. In this retrospective study, medical records of 97 consecutive adult patients who underwent nephrectomy from January 2000 to December 2011 were reviewed. The parameters extracted included the patients' age, gender, indication for nephrectomy and the side of nephrectomy. Also considered were the histology of the nephrectomy specimen and the peri-operative mortality. The data were analyzed using the Statistical Package for Social Sciences for Windows (Version 19.0). Of the 97 nephrectomies performed, 62 were performed for suspected malignant renal tumors and 35 were performed for clinically benign renal conditions. Malignancy was confirmed in 85.5% (53/62) of the suspected cases. The mean age of this group was 52.2 ± 15.5 years and the male to female ratio was 1:0.9. Thirty-two tumors (60.4%) were in the right kidney and 21 (39.6%) tumors were in the left kidney; the mean tumor size was 16.8 ± 4.0 cm. The predominant presenting complaints included flank pain (67.9%), flank mass (50.9%) and hematuria (24.5%). In one case (1.9%), the renal mass was found incidentally. Among patients who had benign disease, non-functioning kidney due to renal cystic disease was the most common lesion (11/44; 25.0%). A peri-operative mortality rate of 3.1% was recorded. Our study suggests that malignant renal tumors constitute the main indication for nephrectomy in our institution. Non-functioning kidney due to renal cystic disease was the most common benign renal indication for nephrectomy.