Urological emergencies in a Nigerian teaching hospital: Epidemiology and treatment.

BACKGROUND: Urological emergencies constitute a significant part of emergency presentations in various referral centers. Data on the prevalence of these emergencies in West African sub-region are sparse. OBJECTIVE: The study is aimed at determining the pattern of urological emergencies in our center and is geared towards bridging the gap in knowledge of the epidemiology of urological emergencies in this sub-region as a means of achieving efficient use of scarce resources. SUBJECTS AND METHODS: It was a retrospective study of all urological emergency cases that presented over six years in a Federal University Teaching Hospital in Nigeria. Data were collected from emergency register and theatre logs. Data analysis was done using SPSS version 25. RESULTS: A total of 267 patients presented with urological emergencies during the period of study with 258 (96.6%) men and 9 (3.4%) women. The mean age of the patients was 50.6 ± 20.8 years. Urinary retention was the most common urological emergency accounting for 159 (59.6%) cases followed by Fournier's gangrene 23 (8.6%) and testicular torsion 23 (8.6%). Bladder and ureteral injuries accounted for 5 (55.6%) of the urological emergency presentations in women while both injuries accounted for only 4 (1.6%) in men (P = 0.000). Urethral catheterization was the most commonly performed procedure 139 (52.1%), followed by percutaneous suprapubic cystostomy (SPC) 31 (11.6%). CONCLUSION: Urological emergencies have varying presentations in both sexes. Urinary retention, and acute scrotum were the most common urological emergencies in our facility. This knowledge can be used in emergency preparedness planning which involves personnel training and resource allocation.

Ureterolithiasis: Management in an environment with limited facilities.

BACKGROUND: In the past 2-3 decades, there has been a dramatic development in the techniques of stone removal. This study highlights the management of symptomatic ureteral stones in an environment without such facilities. MATERIALS AND METHODS: Sixty-nine patients, comprising 53 (76.8%) males and 16 (23.2%) females, diagnosed of symptomatic ureteric calculi within the study period in two tertiary health institutions were included in the study. Thorough history taking and physical examinations were performed. Extensive laboratory investigations using blood and urine specimens were carried out. Imaging studies, ultrasonography, intravenous urography, and computerized tomographic scan were used to locate the position and size of the calculi. RESULTS: Forty-six (66.7%) patients presented with excruciating flank ureteric colic radiating to the groin in 16 (23.2%) patients and hematuria in 62 (89.9%) patients. Bilateral ureteric calculi occurred in 3 (4.3%) patients. Eleven (15%) stones passed spontaneously. 33 (47.8%) patients had uneventful open surgery. The stones were mixed in nature. CONCLUSION: Management of ureteric stones in our environment is affected by delay in presentation, low level of awareness of urinary stone disease, lack of modern endourological equipment, and paucity of urological surgeons. Finally, medical treatment should be explored for stones below 10 mm in size.

FOREIGN BODIES IN THE URINARY BLADDER - CASE SERIES.

Foreign bodies get into the bladder by self insertion, migration or as a component of iatrogenic and penetrating injuries. Diagnosis and treatment pose great challenges to the urologist especially if they are radiolucent. A common pattern of presentation is with lower urinary tract symptoms. High index of suspicion is required in patient with lower urinary symptoms. We hereby report 5 cases of foreign bodies in the urinary bladder, 2 (40%) self inflicted, 2(40%) iatrogenic and 1(20%) due to migration of the object; as well as their successful management. CONCLUSION: Foreign bodies in the urinary bladder still remain a great challenge to the urologist; removal of the foreign body without injury to the urinary bladder or the urethra gives good outcome.

One-stage urethroplasty for strictures: Nigerian experience.

PURPOSE: To analyze the effects on voiding and complications of one-stage urethroplasty for urethral stricture. METHODS: All patients who underwent one-stage urethroplasty for stricture in two health institutions in Enugu, Nigeria, between January 1989 and December 1998, were included. The age of the patient, duration of symptoms and the cause of the stricture were noted. Retrograde urethrogram and, when necessary, micturating cystourethogram was done. Urethroplasty was either by substitution using pedicled penile skin flap or by end-to-end anastomosis. Patients were followed up monthly for 1 year during which the patient's ability to urinate satisfactorily was assessed and any complications were noted. One hundred and forty-four (144) men, aged between 11 and 76 years (mean 36.3 +/- 11.2 years), were studied. These included 121 cases who had rapidly recurring strictures after internal urethrotomy or dilatation and 23 cases of complete stricture. Etiology of the stricture included external trauma (43.8%), postinflammatory (36.1%) and iatrogenic (post-catheterization; 20.1%). Ninety-one (63.2%) strictures were in the anterior urethra, 47 (32.6%) in the posterior urethra and six (4.2%) bulbomembranous. The mean length of the strictures was 3.1 +/- 1.4 cm. RESULTS: Anastomotic urethroplasty was performed in 98 (68.1%) patients and substitution in 46 (31.9%). Hospital stay was between 12 and 14 days, except in those who developed complications. Normal voiding was achieved in 124 (86.1%) patients. Urethral fistula was encountered in five (3.5%) patients and recurrent stricture in 15 (10.4%). There was no mortality. CONCLUSIONS: One-stage urethroplasty affords an excellent cost-effective means of reconstruction of the urethra in patients with stricture of various etiologies. In our environment in particular, it avoids the fulminating infection often encountered after the first stage of a two-staged operation.

Renal cell carcinoma in Enugu, Nigeria.

Over a period of ten years (July 1988 to June 1998) all the patients seen at two health institutions in Enugu metropolis, with histologically diagnosed renal cell carcinoma, were studied to elucidate the pattern of presentation, management and response to treatment. Seventy four (74) such patients were seen during the study period. Fifty two (70.3%) were males while 22 (29.7%) were females. The ages of the patients ranged between 17 years and 72 years with a mean of 44 years. The commonest features at presentation were weight loss (100%) raised ESR (94.6%), haematuria (86.5%), anaemia (66.2%) and upper quadrant mass (64.9%). No bilateral case was encountered. Thirty two patients (43.2%) presented with the clinical triad of haematuria, loin pain and renal mass. Seven patients (9.5%) were HIV positive. Fifty nine patients (79.7%) presented with stages 3 and 4 disease and the outcome was poor. Those that presented with stages 1 and 2 tumour had good prognosis. Early diagnosis of the tumour is important in order to give the patients a high chance of survival.