Prevalence of chronic kidney disease and risk factors in North-Central Nigeria: a population-based survey.

BACKGROUND: Chronic kidney disease (CKD) is a growing challenge in low- and middle-income countries, particularly in sub-Saharan Africa. There is insufficient population-based data on CKD in Nigeria that is required to estimate its true burden, and to design prevention and management strategies. The study aims to determine the prevalence of CKD and its risk factors in Nigeria. METHODS: We studied 8 urban communities in Kwara State, North-Central zone of Nigeria. Blood pressure, fasting blood sugar, urinalysis, weight, height, waist circumference and hip circumference were obtained. Albuminuria and kidney length were measured by ultrasound while estimated glomerular filtration rate (eGFR) was derived from serum creatinine, using chronic disease epidemiology collaboration (CKD-EPI) equation. Associations of risk factors with CKD were determined by multivariate logistic regression and expressed as adjusted odds ratio (aOR) with corresponding 95% confidence intervals. RESULTS: One thousand three hundred and fifty-three adults ≥18 years (44% males) with mean age of 44.3 ± 14.4 years, were screened. Mean kidney lengths were: right, 93.5 ± 7.0 cm and left, 93.4 ± 7.5 cm. The age-adjusted prevalence of hypertension was 24%; diabetes 4%; obesity 8.7%; albuminuria of > 30 mg/L 7%; and dipstick proteinuria 13%. The age-adjusted prevalence of CKD by estimated GFR < 60 ml/min/1.73m2 and/or Proteinuria was 12%. Diabetes (aOR 6.41, 95%CI = 3.50-11.73, P = 0.001), obesity (aOR 1.50, 95%CI = 1.10-2.05, P = 0.011), proteinuria (aOR 2.07, 95%CI = 1.05-4.08, P = 0.035); female sex (aOR 1.67, 95%CI = 1.47-1.89, P = 0.001); and age (aOR 1.89, 95%CI = 1.13-3.17, P = 0.015) were the identified predictors of CKD. CONCLUSIONS: CKD and its risk factors are prevalent among middle-aged urban populations in North-Central Nigeria. It is common among women, fueled by diabetes, ageing, obesity, and albuminuria. These data add to existing regional studies of burden of CKD that may serve as template for a national prevention framework for CKD in Nigeria. One of the limitations of the study is that the participants were voluntary community dwellers and as such not representative for the community. The sample may thus have been subjected to selection bias possibly resulting in overestimation of CKD risk factors.

Autologous buccal mucosa harvest under local anesthesia: Feasibility, safety, and acceptance for substitution urethroplasty.

OBJECTIVE: The objective of the study is to report our experience with buccal mucosa harvest under local anesthetic agent infiltration for urethroplasty. MATERIALS AND METHODS: All patients who had buccal mucosa graft harvest under local anesthesia (1% Xylocaine) for repair of their urethral stricture, from January 2007 to December 2016, were retrospectively studied from two public urologic service centers. The demographic data of the patient, length of graft harvested, complications recorded, among other things, were entered into a pro forma and the data were analyzed using IBM SPSS Statistics version 16. RESULTS: A total of 102 patients underwent urethroplasty with buccal mucosa harvested under local anesthesia; however, only 88 patients had complete data for analysis. The mean age was 55.03 years (±12.30). The mean harvested graft length was 5.41 cm (±2.62 cm). There was no need for conversion to general anesthesia. The majority of them (94.3%) reported that it was "easy" or "very easy" to maintain the mouth opened during the procedure. Over 91% do not have difficulty opening their mouth after the harvest. Only a patient had bothersome primary hemorrhage that required gauze packing. No significant oral cavity pain was experience in 69.3% of patients; among those with pain, the perineal pain was more. Over 90% of the patients will be willing to undergo the procedure again under local anesthetic infiltration again. CONCLUSION: Buccal mucosa harvest under local anesthesia infiltration is feasible, safe, and acceptable among our patients who had urethroplasty for urethral stricture disease.

A novel slit-integration method of graft urethroplasty in the prevention of ring recurrence: Short-term results of a pilot study.

Purpose: To describe and evaluate the efficacy of the slit-integration method in the prevention of ring recurrence after graft substitution urethroplasty. Materials and Methods: This was a pilot study of selected patients with urethral stricture disease who required urethroplasty from January 2016 to December 2018. Patients were recruited into the study after they granted informed consent about the procedure. Results: A total of eight patients were involved in this pilot study. The mean age (±standard deviation, SD) of the patients and the mean stricture length (±SD) were 44.25 (±11.07) years and 3.88 (±1.25) cm, respectively. The peno-bulbar region was the most frequently involved. The majority of the patients, 7 of 8 patients, underwent buccal mucosal graft repair with a mean graft length of 5.88 cm (range, 4-8 cm). There was leak during pericatheter urethrography in one patient. The mean (±SD) urethral calibers of the distal and proximal urethral anastomotic sites following urethroplasty were 26.00 (±1.85) and 25.25 (±1.83) at 1 week after removal of the urethral catheter stent and 27.75 (±0.71) and 27.75 (±0.71) at 12 months postoperatively, respectively. The mean maximum flow rate (±SD) at the 6- and 12-month follow-up was 20.25 (±1.83) and 21.88 (±1.73) mL/s, respectively. Conclusions: A slit-graft appropriately quilted into the corresponding urethrotomy incisions at the proximal and distal summit of the urethral stricture segments appears to mitigate the occurrence of ring contracture after urethroplasty. A randomized controlled trial of this technique with additional outcome assessment will be required to validate this observation.

An appraisal of a technical modification for prevention of bladder neck stenosis in retropubic prostatectomy: An initial report.

OBJECTIVE: To report the experience with our technical modification of the trigone-bladder neck complex management in the prevention of bladder neck stenosis (BNS) following open simple retropubic prostatectomy. MATERIALS AND METHODS: It was a retrospective review of data of patients that underwent open simple retropubic prostatectomy with technical modification of the trigone-bladder neck complex in two Nigerian tertiary hospitals, by a single surgeon, from January 2007 to December 2011. The data analysed included the demographic variables, the modes of presentation, need for blood transfusion, duration of catheterization and the duration of hospital stay. The primary end-point was the development or otherwise of BNS. RESULTS: Eighty-seven patients' data were available for analysis from a total of 91 patients. The mean age (±standard deviation [SD]) was 65.14 years (±10.55). Preoperative urinary retention was present in 58% of the patients. The maximal flow rate (Qmax) was 12.05 ml/s among the 20 patients that had preoperative uroflowmetry. The transfusion rate was 35%, but almost two-third of them had only one unit of blood transfused. The mean weight (±SD) of the enucleated adenoma was 82.64 g (±36.63). Bladder irrigation was required in 14% of the patients, majority of the patients had urethral catheter removed after 96 h and the mean hospital stay was 6.52 days. No patient developed BNS after a mean follow-up duration of 16.39 months. CONCLUSION: Bladder neck stenosis can be a distressing complication of prostatectomy. The result of our technical modification of managing the trigone-bladder-neck complex looks promising for prevention or delaying the onset of BNS. A long-term observation and a prospective randomised control trial to ascertain this initial experience is needed.

Vesicocolonic fistula: a sequela of missed blunt abdominal injury.

A case of vesicocolonic fistula secondary to a missed abdominal injury is described. The patient, a 25-year-old male Hausa, Nigerian, was involved in a road traffic accident and sustained head injury with a fractured left femur and a missed blunt abdominal injury. He was referred to us about six months following the injury, on account of failure to micturate, recurrent passage of frequent watery stool, and recurrent fever and weight loss. A suspected diagnosis of intestinovesical fistula was confirmed on micturating cystography. He had a single stage repair of the vesico-colonic fistula. The repair of urethrocutaneous fistula was scheduled for a later date, which he later had. He was discharged but continued with orthopaedic consultation and management.

Skills acquisition for trainee urologists: are the Federal Medical Centers in Nigeria suitable?

BACKGROUND: Surgical training involves acquisition of knowledge and skills. The district hospitals are known to play complementary role in surgical training in many parts of the world; it is time to evaluate for the possible role Federal Medical Centers (FMC) in Nigeria can play to complement the training of urologists. Against this background, we retrospectively reviewed the relative frequency of urologic procedures performed in one of the FMC as a case study. MATERIALS AND METHODS: Hospital data were retrospectively reviewed from January 2007 to June 2010 and records of urologic procedures were extracted for analysis. The total numbers of operations done within same period were also recorded. RESULT: Urological procedures formed 24.6% of the surgical operation in the hospital during the study period. Uncomplicated prepuce, bladder outflow obstruction, uro-oncology and congenital urological lesion topped the list and accounted for 31.3%, 22.7%, 11.9%, and 11.0% of the cases, respectively. The most frequently performed urological operation in the center was circumcision. Nephrectomy, ureteroneocystostomy, pyeloplasty, cystectomy, and urinary diversion were other procedures performed. CONCLUSION: The varieties and volume of urologic cases recorded in this centre is comparable with those documented in other established training institutions and thus, it is recommended that the trainees should find time to visit some of these centers and acquaint themselves with hands-on surgical exposure.

Knowledge of prostate cancer screening among native African urban population in Nigeria.

BACKGROUND: Cancer of the prostate a worldwide public health concern. It is the most commonly diagnosed cancer in men and ranked second as the cause of cancer-related deaths. OBJECTIVE: To evaluate the awareness and attitude of the populace to screening for cancer of the prostate. METHODS: It is a cross-sectional study involving 156 respondents. A structured questionnaire detailing the biodata, the knowledge of cancer of prostate, the practice of screening by prostate specific antigen (PSA) estimation and the readiness to undergo screening by the respondent was used to obtain the set-out objectives. RESULTS: A total of 156 respondents completed the questionnaire and forms the basis of further analysis. The mean age of the respondents is 44.15 (+/- 11.9) years. Majority of the respondents were civil servant (51.9%) followed closely by politicians. About 23.1% of them have no formal education while 53.8% have acquired tertiary education. The result shows that 78.8% have never heard any information on cancer of the prostate and only 5.8% have heard about PSA. None of the respondents have ever had PSA test done, even once. Eighty four per cent of the respondents are ready to pay for prostate cancer screening test by PSA assay. CONCLUSION: We conclude that there was remarkable lack of awareness of prostate cancer among the Nigerian native African urban populace. Prostate cancer screening and serum PSA test for screening is globally unknown among them.