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)

Extracorporeal shock wave lithotripsy without anaesthesia: a preliminary report of initial experience in Jamaica

Extracorporeal shock wave lithtripsy (ESWL) is the method of choice of treating most renal and ureteric stones. The electrohydraulic generated shock wave litholriptors, however, tend to produce pain at the shock wave entry site on the skin, and these treatments are usually administered under general anaesthsea. With the acquisition of an electrohydraulic ESWI machine (Econolith - 2000) by the UWI in August 1995, this method of treating stones is now available in Jamaica. Between September and November 1995 data was prospectively collected on all patients treated by ESWL. There were 20 patients in all undergoing 22 treatment sessions with 2 repeats. There were 11 females and 9 males with ages ranging from 24 to 73 years. A total of 20 renal stones and 2 ureteric were treated. Thirteen patients received Tenoxicam 40 mg IM 20 minutes before the procedure as the only form of analgesia. Of the thirteen patients, only one patient described the procedures as severely painful. Four patients described it as moderately painful and the remaining eight patients described the procedure as producing only mild pain or discomfort. There were no complications apart from bruising of the skin at the shock wave entry site of eight patients. There was fluoroscopic evidence of fragmentation of all stones during treatment. Patients receiving Tenoxicam 40 mg IM we able to be discharge a from hospital immediately after the treatment. In conclusion, from our preliminary experience thus far, electrohydraulic ESWL can be safely and humanely administered with good effect using 40 mg of Tenoxicam administered intra muscularly, thus obviating the need for general or regional anaesthesia with its attendant morbidity and mortality (AU)

Metastatic carcinoma of the penis

Metastic carcinoma of the penis is uncommon. The primary tumour is most commonly reported to be in the genitourinary or gastrointestinal tract. A case of metastatic carcinoma of the penis, secondary to a primary carcinoma of the prostate gland, is described (AU)

Metastatic carcinoma of the penis

Metastic carcinoma of the penis is uncommon. The primary tumour is most commonly reported to be in the genitourinary or gastrointestinal tract. A case of metastatic carcinoma of the penis, secondary to a primary carcinoma of the prostate gland, is described

Prostate cancer and PSA - a practitioner's perspective

Cancer of the prostate is the commonest malignant tumour in the male. Although it exhibits a wide range of biological activity, in its late stages considerable morbidity may occur with eventual death. Early diagnosis before the turmour has spread beyond the capsule allows cure by radical prostatectomy or ablative radiotherapy. Prostate specific antigen (PSA) is a sensitive biochemical marker which although not specific for prostate cancer is elevated in 90 per cent of cases with this disease. Specificity in the diagnosis of prostate cancer has been increased by using the principles of PSA density, PSA velocity, and differential PSA normal values. If digital rectal examination )DRE) is combined with PSA testing the detection rate of early prostate cancer is greatly increased. When either the PSA is elevated or the DRE is suspicious the diagnosis should be confirmed by transrectal ultrasonography (TRUS) and biopsy (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)

Vascular access in diabetics with renal failure - abstract

Good vascular access is essential for successful haemodialysis. The methods currently used to provide reliable long-term access are: 1) The creation of a peripheral arterio-venous fistula; 2) Formation of an internal arterio-venous shunt, using polyfluorotetra ethylene (PFTE); 3) Placement of a double-channel catheter into the vena cava percutaneously or by open surgery; 4) Creation of an externally-placed arterio-venous shunt. Access problems are more common and more serious in diabetics. These may be categorised as technical, early and late complications. The vascular changes in diabetics, which result in atherosclerosis of medium-sized vessels, lead to a high technical failure rate, and increase early complications in the A-V fistula, the internal A-V shunt and the external A-V shunt. The compromised defence mechanism in the diabetic leads to a higher rate of infection with the double-channel catheter, the external A-V shunt and also the internal A-V shunt. The mid-forearm A-V fistula, as used in the haemodialysis units at the University Hospital over the past three years, reduced the high incidence of technical problems associated with the wrist fistula in the diabetic. The risk of infection and thrombosis is also reduced as no synthetic shunting material is used (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)

Penile prostheses in the management of impotence in sickle cell disease

Priapism lasting more than 24h in adults with homozygous sickle cell disease usually results in impotence. The dense fibrosis of the corpora cavernosa which destroys the normal vascular erectile system of the penis also complicates insertion of penile prostheses. Our experience in 5 patients is reviewed. Sharp dissection and dilatation were necessary to form a tunnel for the prosthesis, which was more easily excavated anteriorly and posteriorly through a dorsal incision than for the length of the corpora through a traditional perineal-scrotal incision. Damage to the tunica was common and subsequent migration of the prosthesis necessitated an additional 11 procedures under general anaesthesia. Despite these technical difficulties, the procedure allowed satisfactory intercourse. The average interval between onset of impotence and implantation was 4 years. Early implantation before the dense fibrosis develops might give more satisfactory results.(AU)

An epidemiological survey of bladder cancer in Jamaica - abstract

A retrospective analysis of 121 patients with bladder carcinoma seen at the University Hospital of the West Indies between 1979 and 1987 was done. The group was divided histologically into transitional cell (108, 89 per cent) and squamous cell (13, 11 percent). Transitional cell tumours were significantly commoner in males: squamous cell carcinoma was relatively more common in females. These findings could be related to the prevalence of lower urinary tract obstructive uropathy in the aging male and the higher incidence of chronic urinary tract infection in females. The age distribution was similar to most other malignancies peaking in the 7th decade although some transitional cell tumours were found in younger patients. A diet high in fats may be significant in the aetiology of both groups of tumours although this may be more important in the aetiology of the squamous cell type. Sixteen percent of the transitional cell group worked with or came into regular contact with petroleum products, fertilizers or paints. The incidence of both types of bladder tumours were significantly higher in city dwellers (AU)

Penile prostheses in the management of impotence in sickle cell disease - abstract

Impotence following major attacks of priapism is common among patients with sickle-cell disease. Until recently, the severe corporal cavernosal fibrosis found in these patients has precluded successful surgical treatment. Seven patients with this condition were treated by implanting penile prosthese between 1977 and 1985. Three patients had multiple operations due to mal-positioning or migration of the prosthesis into surrounding structures. In one case, migration of the prosthesis was through the site of the previous spongiosum-cavernosal shunt. The initial failure rate feel with increasing surgical experience. All patients are now able to have satisfactory sexual intercourse (AU)

Open prostatectomy versus endoscopic resection of the prostate a retrospective comparison - abstract

All patients who were subjected to prostatectomy at the University Hospital, Mona, from June 1972 to December 1984 were reviewed. Radical prostatectomy for carcinoma of the prostate was not included. A total of 713 patients were subjected to prostatectomy of whom 235 had either transvesical or retropubic prostatectomy and 478 patients had endoscopic resection of the prostate gland. One hundred and two patients (14 percent) developed complications, 47 (10 percent) after endoscopic resection and 55 (23 percent) after open prostatectomies. Haemmorrhage requiring blood transfusion of 2 or more units of blood occurred with 1 percent of endoscopic resections and 10.6 percent of open prostatectomies. Transient urgency incontinence occurred in 6.3 percent of endoscopic resections and 1.3 percent of open prostatectomies: the latter took a longer time to resolve. One point seven per cent of open prostatectomies had total incontinence which settled within one year. Regrowth of the prostate gland, as shown by the recurrence of irritative or obstructive symptoms and a palpably enlarged prostate on rectal examination, occurred in 10 percent of all patients (9 percent of endoscopic resection and 12 percent of open prostatectomy). One per cent of endoscopic resections and 2.4 percent of open prostatectomies developed fever, probably secondary to prostatic bed infection. There were 2 intraoperative deaths from myocardial infarction among the endoscopic resections. Endoscopic resection is as effective as open prostatectomy for the management of prostatomegaly and has fewer complications (AU)

The anaesthesia penile tumescence test - abstract

A simple method of differentiating organic from psychogenic impotence is important if appropriate therapy is to be offered. Prostatic massage under light anaesthesia was consistently found to produce penile tumescence in ten controls. Tumescence usually started within one minute of the onset of prostatic massage, and progressed to a stage adequate for penetration within three minutes. The penile erection was maintained at least until the patient reached the recovery room. Eleven patients being investigated for impotence were subjected to the procedure in conjunction with hormonal and blood flow studies. All patients had nocturnal penile tumescence (NPT) stamp tests and two of those who failed this and the anaesthesia penile tumescence (APT) test, had nocturnal penile tumescence (NPT) strain gauge tests in the U.S.A. Seven patients had good APT results, two fair and two poor. The four patients who had fair and poor results also failed the NPT stamp tests and the NPT strain gauge test where this was done. APT testing therefore correlates well with the accepted standard NPT test, requires no special expensive equipment and allows polaroid documentation of rigidity instead of increase in circumference as in the NPT test. Polaroid documentation also allows patients to realise their potential and facilitates treatment of psychogenic impotence (AU)

Transverse ureterotomy for calculous disease - abstract

Transverse ureterotomy is compared to the traditional longitudinal ureterotomy for the management of calculous disease. Ninety-five patients had their ureteric stones removed by transverse ureterotomy. Parameters noted were urinary leak time, drain removal time, wound infection, length of hospital stay, need for further surgical procedures to eliminate the urinary leak and ureteric stricturing. These parameters were also compared in fifty patients who had previously had the traditional longitudinal ureterotomy performed. Urinary leak time was less than 24 hours in the transverse group compared to a range from 24 hours to 10 days in the longitudinal group. Time of drain removal was two days in the transverse group of 4 days or more in the longitudinal group. Wound infection occurred in 15 percent of the longitudinal and 5 percent of the transverse group. Hospital stay averaged less than 7 days for the transverse and 9 days for the longitudinal group. Five per cent of the longitudinal group needed a further surgical procedure. The longitudinal group had 3 cases developing ureteric stricture. Transverse ureterotomy is more muscle-splitting than longitudinal ureterotomy which is muscle-cuting. The decreased complication rate and morbidity associated with the transverse ureterotomy also results in a shorter hosital stay and subsequent savings (AU)

Bizarre (atypical) leiomyoma of the prostrate gland

A case of bizarre leimyoma of the prostate gland occurring in a 64-year-old Jamaican negro man is reported. This appears to be only the fourth example of this type of lesion to be reported. The relevant literature is reviewed and the prognosis is discussed (AU)

Renal transplantation in Jamaica

In a ten-year period beginning in 1970, twenty-five cadaver renal transplants were performed in Jamaica. Kidneys were transplanted with only short ischaemia times, and early function was a feature in most cases. Patient and graft survival were comparable with results obtained in larger centres even though tissue typing was not used to match donors and recipients. This experience shows that transplantation is an effective and suitable form of therapy for chronic renal failure in developing countries. Increasing awareness by the medical profession of the benefits of renal transplantation may increase the supply of donor kidneys and enable more patients with end-stage renal failure to receive treatment (AU)