The epidemiology of prostate cancer in Jamaica

PURPOSE: Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans. MATERIALS AND METHODS: The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population. RESULTS: The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80 percent of the cases were pathologically confirmed. Of the patients 30 percent presented with acute urinary retention, 16 percent presented with bone metastases, 15 percent had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42 percent. Prostate specific antigen was measured in only 7 percent of cases in 1989 but in 48 percent of cases by 1994. CONCLUSIONS: These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States(AU)

Penile trauma: the Kingston Public Hospital experience; 1995 - 1996 - abstract

Significant penile trauma is thought to be relatively uncommon. However, 19 such cases were managed by the Urology Service at the Kingston Public Hospital in Jamaica during a 12-month period 1995-1996. There were nine penile "fractures", 5 gunshot wounds, 4 ring injuries, and 2 amputations. All patients with ring injuries and the penile amputation had psychiatric histories. Principles of management were aimed at preserving the functions of the penis while producing a good cosmetic result. Early repair of the cavernosal sheath if indicated and/or the urethra produced the least morbidity. In amputations, careful spatulated mucosa-to-skin anastomosis was important. If the amputated section of the penis is available then a replant procedure should be attempted. Minimal cavernosal tears with small non-expanding haematomas were successfully treated convervatively. Unfortunately, most ring injuries came for treatment from 6 days to 2 weeks after having had their problem. These patients also did not return for follow-up, which was again unfortunate as late urethral strictering could be a complication in this group. (AU)

Modified plication reduction cystoplasty - abstract

Management of the large atonic dysfunctional bladder remains a medical challenge. Conservative measures such as voiding by the clock, parasympathomimetic drugs and Credo-assisted voiding are only occasionally helpful. Intermittent catheterization and post sphincter inactivation condom drainage in the male are associated with long-term morbidity. Electrical stimulation of the bladder is still experimental. Reduction cystoplasty by partial cystectomy has a high relapse rate. Modified reduction cystoplasty by invaginating the dome of the bladder to produce a predetermined capacity is a relatively simple surgical procedure with a high long-term success rate. In all 6 patients in this series, retention was cured and urinary hesitancy and flow rate markedly improved. Residual urine was significantly reduced to less than 15 per cent of bladder capacity. Cystometrographic studies showed a return to physiological function. Follow-up time extended to 3 years when bladder capacity and all voiding parameters stabilized (AU)

Unusual lower GU tract gunshot injuries - abstract

With over 100 gunshot injuries seen at the University Hospital of the West Indies and the Kingston Public Hospital annually and with lower GU injuries occurring in approximately eight per cent of cases, it is not surprising that unusual trauma pathology will occur in this region. Described are four cases seen over a six-month period where the courses of the bullets almost defy an anatomical explanation. In two, the entry site was in the buttock with entry into the bladder through the posterior wall without causing bowel injury. In another, the entry wound was also lodge in the lumen of the bulbous urethra. In the other case, the skin entry wound was in the lower anterior abdominal wall with exit through the posterior inferior wall of the urinary bladder just above the mid trigone, again somehow avoiding bowel to finally lodge in the buttock. It is impossible to explain any of the above pathology if it is assumed that the bullets travelled on a straight course. Seemingly, their trajectories were altered, allowing the path of least resistance to be taken, thereby pushing structures with mobile walls out of their way. It is theoretically possible that the high pressure area that precedes a high velocity bullet pushes mobile structures out of harm's way (AU)

Access to urethral stump in radical prostatectomy - abstract

Prostatic carcinoma is the commonest cancer in the male and is now being more frequently diagnosed at an earlier and potentially curable state. The operation of radical prostatectomy offers the best chance of a cure and is therefore being more often used in preference to radiotherapy. Vesicourethral anastomosis is probably the most technically difficult part of this procedure as the urethral stump may not be clearly visible nor accessible. When poorly performed, anastomosis may contribute to the increased morbidity associated with extravasation, incontinence and stricture formation, and may negate the success of a nerve sparing operation. Visibility of and access to the urethral sphincteric stump may be greatly increased by placing a Foley catheter in the urethra with its tip protruding into the pelvis through the stump. With 8 ml of water inflating the balloon which lies under the perineal membrane, traction upwards elevates this stricture along with the urethral stump into the pelvis. The technique has been successfully used in eight (8) patients over the past year with no untoward complications (AU)

The mid-forearm arteriovenous fistula as vascular access for haemodialysis

Successful chronic haemodialysis requires permanent vascular access. The Scribner procedure which utilizes an external arteriovenous shunt, the internal synthetic arteriovenous shunt and the direct arteriovenous fistula as described by Cimino and Brescia have all been used for haemodialysis. Of the three methods, the arteriovenous fistula is the most trouble-free and durable. However, as originally described and constructed in the distal forearm, the morbidity associated with this method is significant. The cubital fossa fistula has even more problems. The mid-forearm fistula was designed by the authors and has been used for chronic haemodialysis over the past eighteen years. This article compares the various methods of access used in the haemodialysis units of the University Hospital of the West Indies and the Kingston Regional Hospital. The mid-forearm fistula was found to have lowest initial failure rate and was associated with fewer complications than any of the other methods used for access. (AU)