Correlation between prostate volume measured by ultrasound and symptoms severity score in patients with benign prostatic hypertrophy in Southeastern Nigeria.

Background: Benign prostatic hypertrophy (BPH) is a common urological condition in men older than 50 years. It is important in the aetiologies of life-threatening obstructive uropathies. Ultrasound measurement of prostate volume is non-invasive, easily available, and a cost-effective method, useful in assessing bladder outlet obstruction (BOO). The International Prostate Symptoms Score (IPSS) on the other hand objectively assesses symptoms severity in BOO patients. Aim: This study was aimed at determining the correlation between ultrasound-measured prostate volume and IPSS in men with BPH. Patients and Methods: Following ethical approval from the Nnamdi Azikiwe University Teaching Hospital Ethical Committee, 100 patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled into the study. They had no other identifiable cause of BOO except BPH after clinical evaluation. The IPSS, Quality of life score (QOL), and prostate volumes were measured. Correlation between prostate volume, IPSS, and QOL were done using SPSS version 20. P value <0.05 was considered significant. Results: The mean age of patients was 69.3 ± 10.6 years with a range of 48-100 years. The mean prostate volume, IPSS, and QOL were 96.0 ± 70.5 cm3, 15.63 ± 8.6, and 4.8 ± 1.3, respectively. The highest recorded IPSS was 35 and the lowest was 4, whereas the smallest and largest recorded prostate volumes were 19 cm3 and 350 cm3, respectively. Nocturia was the major IPSS subscore. There was a weak positive correlation between prostate volume and IPSS in men with BPH (r = +0.109; P = 0.28) and between prostate volume and QOL (r = +0.072; P = 0.45). There was also a weak positive correlation between patients with only severe symptoms and corresponding prostate volumes (r = +0.122; P = 0.125). The correlation between patients with severe symptoms and their corresponding QOL was strong (r = +0.537; P = 0.135, respectively). These findings were, however, not statistically significant. Conclusion: There is a weak positive correlation between prostate volume measured by ultrasound and symptoms severity scores in patients with BPH, although not statistically significant. This may be as a result of the small sample size. A larger sample size may be able to achieve statistical significance.

Correlation between international prostate symptom score and uroflowmetry in patients with benign prostatic hyperplasia.

OBJECTIVE: To determine the correlation between severity of symptoms using the International Prostate Symptom Score (IPSS) and uroflowmetry in patients with lower urinary tract symptoms-benign prostatic hyperplasia (LUTS-BPH). PATIENTS AND METHODS: We prospectively collected data from 51 consecutive men, who presented with LUTS-BPH at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2012 through December, 2014. Symptom severity was assessed using the self-administered IPSS questionnaire. We also performed uroflowmetry using the Urodyn 1000 (Dantec, serial no. 5534). RESULTS: The mean age of the patients was 67.2 ± 9.7 years (range 40-89 years). The most common presenting IPSS-LUTS was nocturia (100%) followed by urinary frequency (98%), straining (92.0%), weak stream (84.3%), urgency (41.2%), incomplete voiding (39.2%), and intermittency (35.3%) Most of the patients had moderate symptoms (58.8%) on IPSS with a mean value of 13.5 ± 3.0. The mean Qmax was 15.6 ± 18.7 mL/s and the mean voided volume was 193.0 ± 79.2 mL. About one-third of the patients (39.2%) had an unobstructed flow pattern based on Qmax. Correlation analysis showed a weak correlation between IPSS and voiding time (r = 0.220, P > 0.05), flow time (r = 0.128, P > 0.05), and time to maximum flow (r = 0.246, P > 0.05). These correlations were not significant (P > 0.05). IPSS showed a negative correlation with maximum flow rate (r = 0.368; P < 0.0075), average flow rate (-0.203, P > 0.05), and voided volume (r = -0.164, P > 0.05). This negative correlation was significant for maximum flow rate. CONCLUSION: Correlation between IPSS and Qmax was negative but statistically significant. This implies that an inverse relationship exists between IPSS and Qmax, and remains the only important parameter in uroflowmetry. There was no statistically significant correlation between IPSS and the other variables of uroflowmetry.

Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria.

BACKGROUND: Penile injuries are uncommon. The more severe injuries are often difficult to manage. OBJECTIVES: We report our experience with penile injuries from different causes and treatment options available. PATIENTS AND METHODS: We analyzed retrospectively 23 cases of penile injuries presenting to the Urology Unit of a tertiary hospital in the Southeastern part of Nigeria from January 2007 to December 2012. RESULTS: The management for each patient varied depending on the nature and extent of the injury. The mean age of the patients was 28.9 ± 14.4 years (range 3 weeks to 43 years). The mean duration before presentation was 22.7 ± 17.8 h (range 1-168 h). The causes of penile injuries were categorized as follows: Postcircumcision 3 (13.0%), genital mutilation (self-inflicted injury/attacks by assailants) 6 (26.1%), accident 4 (17.4%), penile fracture 8 (34.8%), and gunshot injury 2 (8.6%). Isolated blunt injuries to the corporal tissues as occurs in penile fractures was managed successfully with early exploration and closure of the tunical tear, while injuries to the penile skin was managed with dressing and secondary closure. Severe penile injuries resulting in partial or total phallic loss presented the most challenge to treatment. CONCLUSION: Traumatic penile injuries are not common. Severe penile injuries could be challenging because of the nature of the injuries, delayed presentation and unavailability of modern technological tools and experience required for the treatment of such severe injuries. Expertise in the use of flaps for a neophallus are still been developed, and penile prosthetic devices are not readily available in our setting.

Anatomic study of the pterion in Nigerian dry human skulls.

BACKGROUND: The pterion is a point of sutural confluence seen in the norma lateralis of the skull. The site is an important landmark in surgical approaches to the anterior and middle cranial fossa. OBJECTIVE: This study was designed to determine the frequency of pterion types and anatomic positions of the pterion in dry human skulls of Nigerians in the South Eastern Zone. MATERIALS AND METHODS: Specific measurements were taken on both sides of 56 Nigerian human skulls of unknown sex, obtained from the Department of Anatomy, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Nigeria. RESULTS: All the four types of the pterion were present, i.e. sphenoparietal, frontotemporal, stellate, and epipteric. The study showed that the sphenoparietal type was 75% on the right side, 76% on the left side, the frontotemporal type was 19.6% on both sides, the stellate type was 1.8% on the right side and absent on the left side. The epipteric type was 3.6% on both sides. The distances from the centre of pterion to the frontozygomatic suture were 2.74 ± 0.07 cm on the right side and 2.74 ± 0.06 cm on the left side. The pterion was 4.02 ± 0.05 and 4.01 ± 0.03 cm above the midpoint of the zygomatic arch on the right and left sides, respectively. CONCLUSION: These findings are important for the surgeon as the pterion junction is a common extracranial landmark in neurosurgical and surgical approaches.

Patterns of superficial venous arrangement in the cubital fossa of adult Nigerians.

BACKGROUND: The cubital fossa is a common site for the removal of venous blood for analysis, transfusion, and intravenous therapy. The superficial venous return from the upper limb follows two or three major superficial veins, which are extremely variable; these include the cephalic, basilic, median cubital, and antebrachial veins and their tributaries. OBJECTIVE: This anthroposcopic study was to determine the patterns of superficial venous arrangement in the cubital fossa of adult Nigerians. MATERIALS AND METHODS: One hundred and thirty-five subjects (100 males and 35 females), aged between 20 and 27 years, were studied. The judgment sampling technique was employed. A tourniquet was firmly tied at the midarm level and the conspicuous superficial veins were diagrammatized and photographed with a camera. RESULTS: Ten types of venous pattern arranged in six groups were noted. The most common pattern observed was the median antebrachial vein, dividing into median cephalic and median basilic veins, which join the cephalic and the basilic veins, respectively, with a variation. The result showed bilateral difference between the incidence of each type in males and females with the male values being statistically higher (P < 0.05). CONCLUSION: Appreciation of these venous patterns is useful to the medical and paramedical workers, especially in conditions that require venepuncture.

Complication rates of open transvesical prostatectomy according to the Clavien-Dindo classification system.

BACKGROUND: Traditional open prostatectomies either transvesical or retropubic remains the reference standard for managing benign prostatic enlargement in some centers, especially in developing countries. The comparison of complication rates between the various types of open prostatectomies is usually a source of significant debate among urologists, most times with conflicting results. The Clavien-Dindo classification system is an excellent attempt at standardization of reporting complications associated with surgeries. MATERIALS AND METHODS: We reviewed retrospectively the records of patients who had open transvesical prostatectomy (TVP) in three specialist urology centers in Anambra state, Southeast Nigeria, over a period of 5 years (January 2004-December 2009), with the aim of documenting medical and surgical complications arising from open TVP. These complications were then categorized according to the Clavien-Dindo system. RESULTS: A total of 362 patients had open TVP over the period under review. Of this number, 145 had documented evidence of complications. The mean age of the patients was 66.3 years (SD 9.4 years; range 49-96 years). The mean follow-up period was 27.8 months (SD 12.6 months; range 6-33 months). The overall complication rate for open TVP in this study was 40.1% (145/362). Complication rates for grades i, id, ii, iiia, and iiib were 0.8%, 0.6%, 35.1%, 0.6%, and 3.0%, respectively. Most complications of open TVP occur in the early postoperative period. CONCLUSION: Open TVP still remains a valid surgical option in contemporary environment where advanced techniques for transurethral resection of the prostate and laparoscopic prostatectomy are unavailable. Most complications occur in the early postoperative period, with bleeding requiring several units of blood transfusion accounting for the commonest complication. This should be explained to patients during the preoperative counselling.

Diagnosis of prostate cancer with needle biopsy: should all cases be biopsied before treatment?

BACKGROUND: The triad of digital rectal examination (DRE), serum prostate specific antigen, and transrectal ultrasound-guided prostate biopsy is used in the detection of prostate cancer (PCa). It is recommended that all cases of PCa should be diagnosed with needle biopsy before treatment. The exclusion criteria for those that may not be suitable have not yet been defined. MATERIALS AND METHODS: We reviewed all the patients diagnosed with PCa at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast, Nigeria, from January 2007 to December 2010. Relevant biodata and method of diagnosis of PCa before treatment were reviewed. RESULTS: A total of 133 patients had bilateral orchidectomy over the period. 120 (90.2%) had their diagnosis confirmed by needle biopsy before bilateral orchidectomy (category 1), while 13 (9.8%) had bilateral orchidectomy before diagnosis was confirmed. The method of diagnosis for category 1 patients was with lower urinary tract symptoms (LUTS), abnormal DRE findings, elevated prostate-specific antigen (PSA), and transrectal needle biopsy. For category 11 patients, diagnosis of PCa was suspected based on LUTS, abnormal DRE findings, and elevated PSA. Of this number, 11 (84.6%) had, in addition, sudden onset paraplegia at presentation, while 2 (15.4%) had severe uncontrolled hematuria at presentation. All the patients in both categories had needle biopsy confirmation of their disease. The sensitivity of PSA was 99.2%. CONCLUSION: Needle biopsy of the prostate is the preferred method for the diagnosis of PCa in most cases before treatment is undertaken. There are valid reasons why all PCas will not be diagnosed in this fashion. Elevated PSA when combined with an abnormal DRE finding increases the predictive value for cancer. In areas where pathologists are lacking, abnormal DRE and elevated PSA results can be a guide to proceed to treatment especially, where there is severe compromise of patients' quality of life due to symptoms of advanced PCa while awaiting confirmation.

Malignant renal tumours in adults in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

BACKGROUND: Malignant renal tumour is the third commonest urological tumour after prostate and bladder cancer. It is however the urological tumour with the highest mortality/incidence ratio. OBJECTIVE: To review the frequency, mode of presentation and histological pattern of patients with malignant renal tumours in Nnamdi Azikiwe University Teaching Hospital. METHOD: A 7 year retrospective review of all our renal tumour folders in theinstitution. RESULTS: 19 patients qualified for the study with a male/female ratio of 1:2.8 and a mean age of 52.6 +/- 15.8 years. The peak age was in the seventh decade. Most patient present late (78.9%). Renal cell cancer was the commonest tumour type with the commonest mode of presentation being abdominal mass and pain. CONCLUSION: Malignant renal tumours present very ate in our environment and patients hesitate in accepting available treatment option which is surgery. There is need for increased patient awareness and high index of suspicion by the clinician, particularly during imaging procedures, as this would significantly enhance the early detection of these patients.

Malignant renal tumours in adults in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

BACKGROUND: Malignant renal tumour is the third commonest urological tumour after prostate and bladder cancer. It is however the urological tumour with the highest mortality/incidence ratio. OBJECTIVE: To review the frequency, mode of presentation and histological pattern of patients with malignant renal tumours in Nnamdi Azikiwe University Teaching Hospital. METHOD: A 7 year retrospective review of all our renal tumour folders in the institution. RESULTS: 19 patients qualified for the study with a male/female ratio of 1:2.8 and a mean age of 52.6 +/- 15.8 years. The peak age was in the seventh decade. Most patient present late (78.9%).Renal cell cancer was the commonest tumour type with the commonest mode of presentation being abdominal mass and pain. CONCLUSION: Malignant renal tumours present very late in our environment and patients hesitate in accepting available treatment option which is surgery. There is need for increased patient awareness and high index of suspicion by the clinician, particularly during imaging procedures, as this would significantly enhance the early detection of these patients.

Success of nephron-sparing surgery in the treatment of localized renal cell carcinoma.

Advancement in imaging techniques has now made it possible for small renal tumors to be detected incidentally. This has led to the use of minimally invasive techniques for treatment of these cases. A 33-year-old woman was diagnosed to have a small renal mass after routine abdominal ultrasonography for epigastric discomfort. Computed tomography scan was used to characterize the mass, and an elective partial nephrectomy was successfully carried out. The procedure is safe, less morbid, and has good oncological outcome.

Schistosomal stricture of the ureter-diagnostic dilemma.

Chronic schistosomiasis of the urinary tract can present with symptoms unrelated to the disease. A 33-year-old man from Edo State Nigeria presented with recurrent left flank pain. Laboratory investigations did not reveal any cause. Radiological investigation revealed a stricture of the left ureter and hydronephrosis of the left kidney. Management included surgical excision and antischistosomiasis chemotherapy. Histopathological examination of specimen of the ureter obtained after surgical exploration revealed Schistosoma heamatobium ova in the wall of the ureter.