Monopolar transurethral resection of the prostate using water as the irrigation fluid: Our initial experience.

BACKGROUND: Monopolar transurethral resection of the prostate (M-TURP) has been the gold standard of surgical intervention in patients with benign prostatic hyperplasia with the indication for surgery. This can be achieved using varieties of irrigation fluids. OBJECTIVES: To document our experience with M-TURP using water as irrigation fluid in 123 consecutive patients. MATERIALS AND METHODS: A retrospective study of all patients who had M-TURP with water as irrigation fluid was performed between January 2017 and July 2019. Information retrieved from theatre records and case notes includes patient's socio-demographic data, indications for surgery, intra-operative findings, the volume of resected chips and irrigation fluid used, post-operative complications and patient's satisfaction with the outcome of the procedure. These data were analysed using SPSS version 23. RESULTS: Data from 123 patients were analysed and presented. The age range was 44-96 years with a mean of 69 years. Prostate volume ranges from 13.9 to 276.00 mls with a mean of 95.69 mls while resected prostate volume ranges from 2.0 to 158.0 mls with a mean of 56.68 mls. Volume of the sterile water used as irrigation fluid ranged from 5.0 L to 174.0 L with a mean of 68.7 L. Mean reduction in International Prostate Symptoms Score, improvement in Q-max and reduction in post-void residual urine were 22.1, 16.9 and 141.6 mls, respectively. Transfusion rate was 6.5% while the duration of admission ranges from 1 to 6 days, with a mean of 2.5 days. The overall complication rate was 26.0%. Ninety-six percent were satisfied with the outcome. CONCLUSION: M-TURP using water as irrigation fluid is safe and is as good as using the more rather expensive glycine or normal saline in bipolar TURP.

Research experience of resident doctors who attended research methodology courses of the National Postgraduate Medical College of Nigeria.

INTRODUCTION: For over three decades, the National Postgraduate Medical College of Nigeria (NPMCN) has been vested with the responsibility of overseeing postgraduate medical training. The main objective of this study was to assess the residents' perception of research as well as challenges faced in pursing seamless research during their training. MATERIALS AND METHODS: This study was a cross-sectional descriptive survey in 2013. Self-administered questionnaires were distributed to the participants of the annual research methodology workshop in all the 15 faculties of the NPMCN. The questionnaires assessed the residents' previous exposure to research, their publication history and their trainers' input to their own research. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software. RESULTS: Four hundred and one resident doctors, out of a total of 415 who attended the course, completed the questionnaires during the study period (96.6% response rate). There were 269 (67.0%) males and 132 (33.0%) females, giving a male-to-female ratio of 2:1. About three-quarters of them admitted that their exposure to research during training was grossly inadequate. Twenty-five percent of them were involved in a previous research before residency training, and a further 70% of respondents were involved in their trainers' research work. Ninety-four percent in our study identified a lack of dedicated time to be spared for research as a major obstacle to research. CONCLUSION: Contribution and exposure to research among postgraduate trainees in Nigeria are low. Lack of dedicated time for research was viewed as the major obstacle to research by most residents.

The role of transrectal ultrasound-guided fine-needle aspiration biopsy in the diagnosis of prostate cancer: Sextant versus extended protocol.

AIM AND OBJECTIVES: The aim of this study is to compare the prostate cancer detection rates of sextant and extended transrectal ultrasound (TRUS)-guided fine-needle aspiration biopsy (FNAB) protocols. MATERIALS AND METHODS: This was a prospective study of 96 patients investigated for prostate cancer. An extended 10-aspiration TRUS-guided FNAB using a 22G Echotip Chiba needle was performed. Inclusion criteria included the presence of one or more of the following: Abnormal digital rectal examination (DRE) findings, persistently elevated prostate specific antigen, and abnormal prostatic imaging. A set of traditional sextant aspirations were carried out as well as four laterally guided aspirations taken from the middle base of the peripheral zone on either side. The cancer detection rates of sextant and extended (combination of sextant and lateral) FNAB protocols were determined and compared. The value of P < 0.05 was considered statistically significant. RESULTS: The overall cancer detection rate was 24%. Benign cases were reported in 71.8% of patients and 4.2% reported as suspicious. Of the 23 patients' aspirations positive for malignancy, 16 (69.6%) were detectable by the sextant protocol while the lateral protocol detected 21 (91.3%). Two cancers were detected by the sextant protocol only (where the lateral technique was negative for malignancy), 7 cancers were detected by the lateral protocol only while 14 cancers were positive in both the sextant and lateral protocols. The extended protocol showed a statistically significant 30.4% increase in cancer detection over the traditional sextant (P = 0.007). CONCLUSION: The extended protocol rather than the sextant protocol should be offered to patients who require FNAB of the prostate as the optimum FNAB protocol.

Combined Laparoscopic and Cystoscopic Retrieval of Forgotten Translocated Intrauterine Contraceptive Device.

The most commonly used long-term reversible female contraception is intrauterine contraceptive device (IUCD). Its use is however associated with documented complications. Uterine perforation, though rare, is arguably the most surgically important of all these complications. We report a case of a 48-year-old para 4+0 (4 alive) woman who had IUCD insertion 17 years earlier and had forgotten she had the device having had two children thereafter. The IUCD was subsequently translocated through the dome of the bladder into the peritoneal cavity with calculus formation around the tail and thread of the IUCD in the urinary bladder causing recurrent urinary tract infection. This "Collar Stud" effect made either cystoscopic or laparoscopic retrieval alone unsuccessful necessitating a combined approach. This case report highlights the need for a combined laparoscopic and cystoscopic approach in the retrieval of the unusual presentation of translocated IUCD.