MANAGEMENT OF PROSTATE CANCER IN ACCRA, GHANA.

INTRODUCTION: Africans living with prostate cancer in Africa face problems of early diagnosis and appropriate treatment. AIM: To study the clinical incidence of prostate cancer, risk factors, TNM stage, their management and outcomes. METHODS: A prospective study of Prostate Cancer cases managed at Korle Bu Teaching Hospital and hospitals in Accra, diagnosed by history, abnormal PSA/DRE, physical examination and histologically confirmed by biopsy from 2004 to 2013 was carried out. The cases were TNM staged and managed by approved protocol. RESULTS: There were 669 cases with a mean age 70±0.045SE years, median Gleason Score of 7, organ confined Prostate Cancer(PC) in 415(62%), locally advanced in 167(25%) and metastatic Prostate Cancer in 87(13%) cases. The cases were followed for median of 10 months to ≥ 84 months. Organ confined cases were managed by: Radical Prostatectomy (RP) 92 (13.8%) with a mortality of 0.3%; brachytherapy 70 (10.5%) with a mortality of 0.1% and External Beam Radiotherapy (EBRT) 155 (23%) with a mortality 0.7%. In all, 98 men constituting (14.1%) cases with a mean age of 75+0.25SE years, life expectancy <10 years were treated by hormonal therapy with a mortality of 1.7%. Twenty cases who were for active surveillance (GS6), PSA <10ng/ml, life expectancy <10 years later all opted for EBRT. Locally advanced cases 25% all had neoadjuvant hormonal therapy then Brachytherapy in 3 (0.4%) mortality 0.15% and EBRT in 64 (9.5%), mortality 0.59%. Hormonal therapy was given in 100 (15%) locally advanced cases, mortality 5%. Metastatic prostate cancer cases (13%) were managed by hormonal therapy, mortality 6%. CONCLUSION: Improved facilities and dedicated skilled teams led to a significant rise in proportion of organ confined Prostate Cancer from 15.3% to 62% curable by Radical Prostatectomy, brachytherapy or EBRT with longer disease free survival.

Penile Strangulation by self-Placement of Metallic Nut.

We report a case of a 37-year-old male who presented with a 12-hour history of a strangulating 2cm wide by 0.8 cm thick metallic nut on the penile shaft at the peno-scrotal junction. Unlike instances where these metallic objects are placed to enhance sexual stimulation this nut was rather placed to prevent intercourse. A Bosch electric circular grinder was successfully used for removal but a thermal burn to the penile tissues was sustained in the process as the hardness of the nut required a high energy to cut and its thickness did not allow for effective cooling during the process of removal. This resulted in a circumferential denudation of penile skin, a urethro-cutaneous fistula at the peno-scrotal junction and a mid-bulbar urethral stricture. The penile wound was subsequently covered with a split skin graft with a delayed closure of the urethrocutaneous fistula and a buccal mucosa patch urethroplasty for the mid bulbar stricture. Despite the degree of thermal burns sustained the patient has maintained good erectile function with grade four rigidity. The tunica albuginea and the underlying corpora cavernosa have shown a significant degree of resilience to thermal burns compared to the corpora spongiosum where the thermal burns led to a urethrocutaneous fistula.

SURGICAL MANAGEMENT OF BPH IN GHANA: A NEED TO IMPROVE ACCESS TO TRANSURETHRAL RESECTION OF THE PROSTATE.

BACKGROUND: Open prostatectomy for benign prostate hyperplasia (BPH) is widely practiced in Ghana and Africa. Some of the reasons include lack of expertise and facilities for Transurethral Resection of the Prostate (TURP) and digital rectal examination assessment of prostates as greater than 50 grams. OBJECTIVES: To assess the prostate volumes of patients for surgical management of BPH by transrectal ultrasound (TRUS) and to determine, on the basis of prostatic volume, what percentage of those who had open prostatectomy could have been managed by TURP. DESIGN: Prospective cohort study. SETTING: The Korle Bu Teaching Hospital, Accra, Ghana. SUBJECTS: Patients for elective surgical management of BPH from March to September 2010 were studied. RESULTS: Fifty-eight. patients had surgical management of BPH. Forty-six of them (79.3%) had open prostatectomy whilst twelve (20.7%) had TURP with a mean age of 70.4 and 65.2 years respectively. The most common reason for the open prostatectomy was refractory retention of urine (76.0%) while that for TURP was lower urinary tract symptoms (58.3%). The mean prostate volume for the patients who had open prostatectomy was 64.2ml ± 28.7mls (range 23.0-121.0ml) while that of the TURP group was 40.1g ± 16.2mls (range 18.5-70.0mls). Of the open prostatectomy group, 67.4% of them had prostate volumes 75 mls or less. The blood transfusion and peri-operative complication rates for the open prostatectomy and TURP groups were 13% versus 8.3% and 8.7% versus 8.3% respectively. There was no mortality. CONCLUSION: Access to TURP in the surgical management of BPH in Ghana is low (20.7%). With improved facilities including routine use of TRUS for assessing prostate size and availability of expertise for TURP, 67.4% of patients offered open prostatectomy presently could benefit from TURP, using prostate volumes 75mls (75g) or less as indication for TURP.

Retrocaval ureter: two case reports.

Retrocaval ureter also referred to as pre-ureteral vena cava is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava. Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life from a resulting hydronephrosis. We present the first two cases to be reported in Ghana; a 36-year-old male and a 40-year-old female both with right flank pains and associated right hydronephrosis. Diagnoses were confirmed with retrograde ureteropyelogram and both had an open surgical repair of the anomaly.