Pre-and Post-Prostatectomy Detrusor Wall Thickness and the Symptom Profile in Patients with Benign Prostatic Enlargement: A Prospective Review.

INTRODUCTION: The urinary bladder undergoes morphological and functional changes in patients with symptomatic benign prostatic enlargement (BPE). These detrusor changes reflect chronically increased intravesical pressure as a result of outlet obstruction. This study aims to determine the relationship between the Pre- and Post-op detrusor wall thickness (DWT), international prostate symptom score (IPSS), and duration of lower urinary tract symptoms (LUTS) in patients who had open simple prostatectomy (OSP). METHOD: This was a prospective study of a cohort of patients who had OSP for symptomatic BPE. The IPSS and symptom duration for each patient were noted. Each patient also had an abdominal ultrasound scan with a measurement of their DWT. Retropubic OSP was done for each patient. The detrusor wall thickness was also measured 12 weeks after the prostatectomy. RESULTS: Fifty-two patients completed the study; the mean age was 66.37 ± 8.09 years. The median pre-operative IPSS was 28 (IQR = 13.75), and the median duration of symptoms was 24 months (IQR = 37 months). The mean pre-operative DWT was 4.41 ± 1.38mm, while the mean post-operative DWT was 2.16 ± 0.98mm. The preoperative IPSS (p = 0.833) and duration of symptoms (p = 0.375) did not significantly correlate with the pre-operative DWT. There was a significant reduction in the mean DWT (p < 0.001) and IPSS (p < 0.001) following prostatectomy. CONCLUSION: DWT appears not to be significantly influenced by the severity or duration of LUTS. However, it reduced significantly following OSP with corresponding improvement in urinary symptoms.

INTRODUCTION: La vessie subit des changements morphologiques et fonctionnels chez les patients présentant une hyperplasie bénigne de la prostate (HBP) symptomatique. Ces modifications du détrusor reflètent une pression intravésicale chroniquement augmentée en raison de l'obstruction de la sortie. Cette étude vise à déterminer la relation entre l'épaisseur de la paroi du détrusor (EPD) avant et après l'opération, le score international des symptômes prostatiques (IPSS) et la durée des symptômes des voies urinaires inférieures (LUTS) chez les patients ayant subi une prostatectomie simple ouverte (OSP). MÉTHODE: Il s'agissait d'une étude prospective d'une cohorte de patients ayant subi une OSP pour une HBP symptomatique. L'IPSS et la durée des symptômes pour chaque patient ont été notés. Chaque patient a également subi une échographie abdominale avec mesure de leur EPD. Une OSP rétropubienne a été réalisée pour chaque patient. L'épaisseur de la paroi du détrusor a également été mesurée 12 semaines après la prostatectomie. RÉSULTATS: Cinquante-deux patients ont terminé l'étude ; l'âge moyen était de 66,37 ± 8,09 ans. L'IPSS médian préopératoire était de 28 (IQR = 13,75), et la durée médiane des symptômes était de 24 mois (IQR = 37 mois). L'EPD moyenne préopératoire était de 4,41 ± 1,38 mm, tandis que l'EPD moyenne postopératoire était de 2,16 ± 0,98 mm. L'IPSS préopératoire (p = 0,833) et la durée des symptômes (p = 0,375) n'ont pas significativement corrélé avec l'EPD préopératoire. Il y a eu une réduction significative de l'EPD moyenne (p < 0,001) et de l'IPSS (p < 0,001) après la prostatectomie. CONCLUSION: L'EPD ne semble pas être significativement influencée par la gravité ou la durée des LUTS. Cependant, elle a considérablement diminué après l'OSP avec une amélioration correspondante des symptômes urinaires. MOTS-CLÉS: Hyperplasie bénigne de la prostate, Épaisseur de la paroi du détrusor, Score international des symptômes prostatiques, Prostatectomie simple ouverte.

Effect of Perioperative Tranexamic Acid on Blood Loss following Open Simple Prostatectomy: A Prospective Review in Nigerian Men.

BACKGROUND: Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement. METHODOLOGY: This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented. RESULTS: Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups. CONCLUSION: The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve.

CONTEXTE: L'hémorragie est une complication courante après une prostatectomie simple ouverte et les patients doivent parfois recevoir une transfusion sanguine. Il a été démontré que l'acide tranexamique réduit la perte de sang après une résection transurétrale de la prostate et une prostatectomie radicale ouverte. Cette étude a évalué l'effet de l'administration intraveineuse périopératoire d'acide tranexamique sur les pertes sanguines et les taux de transfusion sanguine chez des patients ayant subi une PSO pour hypertrophie bénigne de la prostate. MÉTHODOLOGIE: Il s'agissait d'une étude comparative de patients dont la prostate de 60 g et plus était documentée et qui devaient subir une PSO. L'hématocrite de base a été effectué un jour avant la chirurgie. Les patients ont été répartis aléatoirement dans le groupe acide tranexamique, qui a reçu de l'acide tranexamique periopératoire par voie intraveineuse, et dans le groupe sans TXA, qui a reçu un placebo. Tous les patients ont subi une prostatectomie rétropubienne simple ouverte. L'hématocrite postopératoire a été évalué, et la perte de sang calculée à l'aide de la formule de Gross modifiée. Le taux de transfusion a été documenté. RÉSULTATS: Cinquante-six patients ont participé à cette étude et ont été randomisés entre le groupe avec acide tranexamique et le groupe sans acide tranexamique. L'âge moyen des patients du groupe acide tranexamique était de 66,07 ±7,08 ans et était comparable à celui du groupe sans acide tranexamique qui était de 66,50 ± 8,80 ans (P =0,842). La perte sanguine totale médiane était plus faible dans le groupe avec acide tranexamique (502 ml, IQR 613) que dans le groupe sans acide tranexamique (801 ml, IQR 1069). La différence de la perte de sang médiane entre les deux groupes était de 299 ml (U 275, P 0,055). Le taux de transfusion sanguine était inférieur dans le groupe acide tranexamique (6 patients, 21%) par rapport au groupe sans acide tranexamique (11 patients, 39%), (P =0,146). Il n'y avait pas de différence dans les taux de complication entre les deux groupes. CONCLUSION: L'utilisation de l'acide tranexamique chez les patients subissant une prostatectomie simple ouverte a montré une tendance à la réduction de la perte de sang peropératoire et un besoin moindre de transfusion sanguine. Mots clés: Hypertrophie bénigne de la prostate, Prostatectomie simple ouverte, Hémorragie, Acide tranexamique.

Simple Prostatectomy for Giant Benign Prostatic Hyperplasia in Sub-Saharan Africa: Case Series and Literature Review.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a common cause of bladder outlet obstruction in men worldwide. African men are known to have larger mean prostate volumes than other races. Giant benign prostatic hyperplasia (GBPH) is defined as prostate size greater than 200 grams. Management of GBPH is associated with several challenges which have been under-reported from the African sub-region. OBJECTIVE: To highlight the peculiarities of clinical presentation, surgical management and outcome of GBPH. PATIENTS AND METHODS: Men with BPH and trans-rectal ultrasound estimated prostate volume > 200 grams who were scheduled for open simple prostatectomy between January and December 2016 in our hospital were prospectively studied. RESULTS: Four patients with GBPH had simple prostatectomy during the period under review. Their ages ranged from 68 to 78 years with a mean age of 73.7 years.Three patients (75.0%) had transvesical prostatectomy while one (25.0%) had retropubic prostatectomy. The enucleated prostate specimen were found to weigh 312.1g, 396.4g, 420.8g and 450.0g respectively with mean weight of 394.8 ±50.2g and mean operation time of 111.7 ±19.7 minutes. They all had blood transfusion post-operatively with mean transfusion of 3±1.5 pints of blood per patient with relatively longer hospital stay (mean 10 days). CONCLUSION: The surgical management of GBPH can be quite challenging. Recalcitrant gross haematuria, chronic urinary retention and renal impairment are possible modes of presentation. Open simple prostatectomy is the best option for treatment in our environment. It is associated with improved quality of life and minimal morbidity in expert hands.

INTRODUCTION: L'hyperplasie bénigne de la prostate (HBP) est une cause fréquente d'obstruction de la vessie chez les hommes du monde entier. Les hommes africains sont connus pour avoir des volumes de prostate moyens plus importants que les autres races. L'hyperplasie bénigne géante de la prostate (GBPH) est définie comme une taille de la prostate supérieure à 200 grammes. La gestion du GBPH est associée à plusieurs défis qui ont été sous-déclarés dans la sous-région africaine. OBJECTIF: Mettre en évidence les particularités de la présentation clinique, de la prise en charge chirurgicale et du résultat de la GBPH. PATIENTS ET MÉTHODES: Les hommes atteints d'HBP et d'une échographie trans-rectale d'un volume prostatique estimé> 200 grammes qui devaient subir une prostatectomie simple ouverte entre janvier et décembre 2016 dans notre hôpital ont été étudiés de manière prospective. RÉSULTATS: Quatre patients atteints de GBPH ont eu une prostatectomie simple au cours de la période sous revue. Leur âge variait de 68 à 78 ans avec un âge moyen de 73,7 ans). Trois patients (75,0%) ont eu une prostatectomie transvésicale et un (25,0%) une prostatectomie rétropubienne. L'échantillon de prostate énucléé pesait respectivement 312,1 g, 396,4 g, 420,8 g et 450,0 g avec un poids moyen de 394,8 ± 50,2 g et une durée opératoire moyenne de 111,7 ±19,7 minutes. Ils ont tous eu une transfusion sanguine postopératoire avec une transfusion moyenne de 3 ± 1,5 pintes de sang par patient avec un séjour à l'hôpital relativement plus long (10 jours en moyenne). CONCLUSION: La prise en charge chirurgicale de la GBPH peut être assez difficile. Une hématurie macroscopique récalcitrante, une rétention urinaire chronique et une insuffisance rénale sont des modes de présentation possibles. La prostatectomie simple ouverte est la meilleure option de traitement dans notre environnement. Elle est associée à une meilleure qualité de vie et à une morbidité minimale entre des mains expertes. MOTS CLÉS: Hyperplasie bénigne géante de la prostate, prostatectomie simple, Afrique subsaharienne.

Are there differences in disease progression and mortality among male and female HIV patients on antiretroviral therapy? A meta-analysis of observational cohorts.

Studies examining the sex differences in morbidity and mortality among HIV/AIDS patients have yielded inconsistent results. We conducted a meta-analysis of sex differences in disease progression and mortality among HIV/AIDS patients. Medical literature databases from inception to August 2014 were searched for published observational studies assessing sex differences in immunologic and virologic response, disease progression and mortality among HIV-infected patients. Random effects meta-analyses of 115 eligible studies were conducted to obtain pooled estimates of outcomes and heterogeneity was explored in sub-group analyses. Pooled estimates showed an increased risk of progression to AIDS (relative risk [RR]=1.11,95% CI=1.02-1.21) and all-cause mortality (RR=1.23, 95% CI=1.17-1.29) among males compared to females. All-cause mortality differed by sex only in low and middle income countries. The risk of AIDS-related mortality (RR=1.03, 95% CI=0.82-1.30), immunologic failure (RR=1.19,95% CI: 0.97-1.47), virologic suppression (RR=0.98, 95% CI=0.84-1.14), virologic failure (RR=1.26, 95% CI=0.99-1.61) and the change in CD4 cell count (Weighted mean difference [WMD] = -5.15, 95% CI= -13.57 to 3.28) did not differ by sex. These findings were modified by disease severity, adherence and use of highly active antiretroviral therapy. We conclude that HIV-related disease progression and survival outcomes are poorer in males.

Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria.

PURPOSE: To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography. MATERIALS AND METHODS: 60 adult subjects with suspected obstructive uropathy and 60 asymptomatic apparently healthy controls with normal renal ultrasound features were evaluated. B-mode sonography of the kidneys and spectral Doppler examination of the renal interlobar arteries of all the participants were performed. The mean resistive indices (mRI) of both interlobar arteries were obtained and compared to that of the controls. The mRI of bilaterally obstructed kidneys were also compared with the mRI of unilaterally obstructed kidneys. RESULTS: The mRI of the right and left kidneys of subjects were 0.72±0.04 and 0.69±0.06 while those of the controls were 0.64±0.04 and 0.63±0.03 respectively. The mRI for the grades of caliectasis increased from grade I (0.72±0.03) to grade II (0.73±0.03) and grade III (0.73±0.02) but fell within the most severe levels of obstruction (0.69±0.07). There was no statistically significant relationship between the grades of caliectasis and unilateral or bilateral obstruction for both kidneys. The results show a sensitivity and specificity of 86.7% and 90% respectively when mRI≥0.7 was used to determine presence of obstruction. CONCLUSION: Renal duplex sonography is highly sensitive and specific for diagnosis of obstructive uropathy. Increased resistive index of the obstructed kidney may be a useful diagnostic tool in situations where intravenous urography cannot be done or is contraindicated.

Overflow urinary incontinence due to bladder stones.

Overflow urinary incontinence is rare in women. We report a case of overflow incontinence due to bladder stones in a 40-year-old widow (para 2) who presented with a 5-month history of involuntary loss of urine aggravated by postural change, and associated with recurrent painful ineffectual urge to urinate. Her intravenous urogram revealed multiple bladder stones, for which she underwent cystolithotomy. However, following catheter removal on the fifth postoperative day, she developed urge incontinence due to urinary tract infection. She responded well to the choice of antibiotics dictated by the sensitivity result of her postoperative urinary culture, and she was discharged home on the ninth postoperative day. This case highlights the uncommon occurrence of bladder stones as a cause of urinary incontinence, as well as the potential value of intravenous urography in incontinence evaluation.

Effects of Ficus exasperata vahl. (moraceae) leaf aqueous extract on the renal function of streptozotocin-treated rats.

The present study was undertaken to evaluate the possible reno-protective effect of Ficus exasperata leaf aqueous extract (FEE) in a rat experimental paradigm of diabetes mellitus. Forty Wistar rats (weighing 200-230 g) were divided into four (A, B, C, and D) groups, each group consisting of 10 rats. Group A rats served as 'control' animals and received citrate buffer (pH 6.3) solution in quantities equivalent to intraperitoneally-administered volumes of streptozotocin (STZ) and FEE. Diabetes mellitus was induced in Groups B and C rats by intraperitoneal injections of STZ (75 mg/kg). Group C rats were additionally treated with FEE (100 mg/kg/day, p.o.) 4 weeks post STZ injections, for 4 consecutive weeks. Group D rats received FEE (100 mg/kg/day p.o.) only for 4 weeks. Post-euthanisation, kidney tissues were excised for histopathological evaluation and processed for light microscopy. Plasma malondialdehyde and tissue nitric oxide were determined. Serum creatinine, blood urea nitrogen, nitrite, and albumin concentrations were measured for the evaluation of renal function. The diabetic rats significantly lost more weight and their blood glucose levels were significantly elevated as compared to the 'control' group of animals. Renal dysfunction was evidenced by kidney hypertrophy, decreased renal blood flow, and increased serum creatinine and nitrite concentrations. Furthermore, vascular dysfunction, as evidenced by decreased carotid blood flow, was observed in the diabetic rats. FEE treatment positively ameliorated the alterations in the biochemical variables in the STZ + FEE-treated rats. In conclusion, our findings suggest that FEE treatment ameliorates STZ-induced nephrotoxicity.

Characteristics of clients accessing HIV counseling and testing services in a tertiary hospital in Sagamu, Southwestern Nigeria.

INTRODUCTION: Client-initiated HIV testing and counseling has helped millions of people learn their HIV status. Nevertheless, global coverage of HIV testing and counseling programs remains low. This study describes the characteristics of clients who accessed HIV counseling and testing (HCT) services in Olabisi Onabanjo University Teaching Hospital, (OOUTH) Sagamu. MATERIALS AND METHODS: A retrospective study of the clients accessing HCT services in OOUTH. Data was collected from clients using a client intake form. Pre-test counseling, HIV screening and post-test counseling were carried out. Informed consent and confidentiality were ensured. Data obtained were analyzed using SPSS 10.0. RESULTS: A total of 2607 clients accessed our HCT services between May 1 st 2008 and April 30 th 2010. The clients were between the ages of 1 year and 90 years. The mean age was 33.3 ± 15.26. The median age was found to be 32.0 years, with the modal age being 30.0 years. 73.7% (1828) were non-reactive (negative result), 25.9% (643) were reactive (positive result), while 0.3% (8) were indeterminate. Among the reactive results, 9.3% (242) were males while 15.1% (394) were females. CONCLUSION: A fair uptake of HCT services was noted. More females accessed services than males. More positive results were seen among females than males (P<0.05). RECOMMENDATIONS: Upscale of HCT services to involve Sexually transmitted infections clinics and free-standing, client-initiated testing centers is necessary. Continuous AIDS education and risk reduction should be promoted.

Examination malpractice in our medical schools: prevalence and import on tomorrow's doctors.

UNLABELLED: AIMS AND OBJECTIVES. The objective of this paper is to estimate the prevalence of examination malpractice among medical students; its import on medical education and future doctors. MATERIALS AND METHODS: Structured questionnaires were administered to consenting medical students of participating four medical colleges in Nigeria. Data was collated and analysed using SPSS version 11. RESULTS: Three hundred and eighty two students responded. There were 210 males and 172 females (M: F-1.2:1); age range 19-45 years, mean 24.86 ± SD. Majority 304(79.6%) were in the 5th and final years. At secondary and tertiary levels, 67(18.1%) and 79(22.2%) were respectively involved in cheating. Mode of cheating included seeking examination materials, 10(2.6%); copying answers between examination rooms, 18(4.8%); copying assignments, 290(77.7%) and copying laboratory results 206(56.6%). Clinical examinations not performed were described as "normal" by 206(56.6%). Motivation for cheating included previous failures and escape punishment in 6(3.3%) and 31(10.4%) respectively. While 46(12.8%) tried to induce lecturers to change grades, 97(25.8%) would not inform the authority if they suspected that examination leaked. CONCLUSION: Examination malpractice in High schools and Tertiary institutions also includes the medical students. Educating pupils from the elementary schools on effects of cheating, inclusion of this practice in the medical curriculum as part of Medical Ethics and Institutional culture of Integrity among doctors are recommended. Stiffer punishment for offenders would reduce the practice among the students.

HISTOMORPHOLOGICAL PATTERN OF UROLOGIC MALIGNANCIES IN ILE-IFE, SOUTH-WESTERN NIGERIA.

INTRODUCTION: The last decade witnessed a remarkable rise in the prevalence of several malignant diseases in Nigeria. Whether Urologic malignancies (UM) have followed the same trend remains to be studied. The pattern of UM diagnosed in a Nigerian tertiary hospital is hereby presented. Our aim was to determine the pattern and prevalence of histologically diagnosed UM in Obafemi Awolowo University Teaching Hospitals Complex. Ile-Ife, Nigeria. MATERIALS AND METHODS: A 10-year retrospective review of all patients diagnosed with UM was carried out between January 2005 and December 2014. Data was obtained from the patients' case files and the Ife-Ijesha Cancer registry. Information obtained included demographic characteristics, site of origin and histology. Data was analysed with Statistical package for Social sciences (SPSS) Version 20. RESULTS: A total of 4675 malignancies were histologically confirmed during the study period. UM accounted for 420 (8.9%) of total malignancies. Prostate cancer was the commonest UM with 315 (75%) cases. Others include renal tumours 62(14.8%), bladder tumours 29 (6.9%), testicular tumours 13(3.1%) and scrotal tumour 1(0.2%). UM were commoner in males (348, 88.8%) than females (47, 11.2%) and accounted for 13.8% and 2.18% of all tumours in males and females respectively. CONCLUSION: This study revealed a rising prevalence of UM most especially Prostate and Renal Cancers among other malignancies in Ile-Ife.

Digital rectal examination for prostate and rectal tumour: knowledge and experience of final year medical students.

BACKGROUND: It is most pertinent that medical students are taught the necessary skills for digital rectal examination (DRE) before they become doctors. OBJECTIVE: The study is to assess the knowledge and experience of final year medical students regarding DRE for prostate and rectal tumours. METHODS: Well-structured questionnaire were administered to each of the final year medical students of Ladoke Akintola University of Technology a week to their final examinations. RESULTS: Response was received from 127 (60%) of the students, 124 (97.6%) agreed that they have been taught DRE. Most of the students, 102 (80.3%), have done one to five DRE, three (2.4%) and have never performed DRE while none of the students have done more than ten DRE. Only in 49 (38.6%) of cases were the findings of the students on DRE always confirmed by a doctor. Nine students (7.1%) have never felt a clinical BPH and none had felt it more than five times. Sixty-six (52.0%) have never felt a malignant prostate and none of the students have felt it up to three times. Most of the students, 106 (83.5%), have never felt a rectal tumour on DRE Only five (3.9%) felt very confident of their ability to give an opinion based on their findings on DRE while 105 (82.7%) felt reasonably confident CONCLUSIONS: The students have been taught DRE and a good number of them have performed it. Few of the DRE done by the students were cross-checked by a doctor. Most of the students have problems differentiating BPH from cancer of the prostate and many of them were not very confident of their findings on DRE.

Preliminary experience with laparoscopic surgery in Ile-Ife, Nigeria.

This study presents a pioneer experience with laparoscopic operations in a General Surgical unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Consecutive patients who had laparoscopic operations from April through December 2008 were prospectively studied. Following clinical diagnosis, initial diagnostic laparoscopy was undertaken in all patients, followed by therapeutic open or laparoscopic procedures. All procedures were done under general anaesthesia. Duration of operation and outcome including complications were recorded. In all, there were 12 patients (8 males, 4 females), aged 15 to 50 years. Eight patients had clinical diagnoses of acute appendicitis, one each had undetermined right lower abdominal pain suspected ectopic gestation, adhesive intestinal obstruction and metastatic liver disease. The first 4 patients with inflammed appendix confirmed at laparoscopy had open appendicectomy. Of the next cohort of 5 patients, laparoscopic appendicectomy was completed in four but converted to open procedure in one. Normal findings were noted in the lady with suspected ectopic gestation. Laparoscopic adhesiolysis was done for adhesive intestinal obstruction while a laparoscopic liver biopsy was done for the patient with metastatic liver disease. Operative time ranged from 55-105 minutes with marked reduction in operation time as confidence and experience grew. No intraoperative complication was observed but one patient had superficial port site infection postoperatively. We conclude that with good patient selection and some improvisation, laparoscopic general surgical operations are feasible with acceptable outcome even in a poor resource setting.

Prune belly syndrome in an adult Nigerian: case report.

Prune Belly Syndrome is a rare congenital anomaly characterized by deficient anterior abdominal wall musculature, bilateral cryptorchidism, bilateral megaureters and often unilateral or bilateral vesico-ureteric junction obstruction. The report of prune belly syndrome in the adult is scanty. We report a case of prune belly syndrome in a 24 year old Nigerian who presented with 3 year history of recurrent right loin pain. Examination showed wrinkled abdominal skin, bilateral undescended testes and an hypoplastic rectus abdominis, below the umbilicus. Further evaluation revealed enlarged bladder, bilateral megaureters and right intra-abdominal testis. A diagnosis of Prune Belly Syndrome was made. The challenges in the diagnosis and management of this rare condition are highlighted in this presentation.

Relations of the neck of groin hernias to pubic tubercle.

OBJECTIVE: The traditional anatomical and surgical teaching is that any hernia with the neck above and medial to the pubic tubercle are inguinal. Present day surgical authors and teachers mostly adhere to this teaching but observe a difference in this relationship in clinical demonstrations. This confuses most medical students and surgical residents. This all-important clinical teaching should hence be revisited. Hence this study was to ascertain and validate clinically the true relationship of pubic tubercle and the neck of groins hernia. DESIGN: Aprospective observational study. SETTING: Surgical Outpatient Clinic of Wesley Guild Hospital, Ilesa Unit of the Obafemi Awolowo University Teaching Hospital Complex, Nigeria. SUBJECTS AND MEASUREMENTS: Consecutive patients seen in the clinic with uncomplicated groin hernias were studied from January 1993 to December 2004. Examinations were done to ascertain the relationship of the groin hernias to the pubic tubercle. RESULTS: 96.8% of inguinal hernias have their necks above and lateral to pubic tubercle while all femoral hernia had their necks below and lateral to the pubic tubercle. CONCLUSION: Location above or below the pubic tubercle should be used as the sole difference between femoral and inguinal hernias in clinical demonstrations. More observations and inguinal dissections will be necessary for further clarification.

Penile fracture at LAUTECH Teaching Hospital, Osogbo.

BACKGROUND/OBJECTIVE: We have seen three cases of penile fracture presenting in diverse ways in our teaching hospital. We want to highlight the difficulties of management when patients present late. PATIENTS AND METHODS: Three case reports of young men whose ages range between 22-32 years and who presented at 1 year 6 months, four weeks, and 3 hours respectively, following penile fracture. RESULTS: The patient that presented within 3 hours had immediate exploration and primary repair with good results while the one that presented after four weeks is still being followed up. The patient that presented very late has been lost to follow up after he was told that he would require surgery. CONCLUSION: Early surgical intervention in penile trauma still gives the best result and is hereby advocated. Decision to operate or not should also be based on the empirical finding of size of tear if there is no associated urethra injury.

Adult nephrectomy: our experience at Ile-Ife.

OBJECTIVES: To determine indications for adult nephrectomy in our community and the outcome of the procedure in our Institution. MATERIALS AND METHOD: Records of adult patients scheduled for nephrectomy at Obafemi Awolowo University Teaching Hospital from January 1993 to December 2004 were reviewed. Information extracted and analysed included age of patient, sex, presentation, investigations, indication, type and outcome of nephrectomy, histopathology result and duration of follow up. RESULTS: During the period, thirty adult patients mean age 42.73 yrs (range 16-80 yrs, M:F = 2:1) were scheduled for nephrectomy. Indications included suspicion of malignancy in 19 (63.3%) patients, protracted loin pain in non-functioning kidney in 2 (6.7%), uncontrollable bleeding in a patient with bilateral polycystic kidney (3.3%), pyonephrosis with septicaemia in a patient (3.3%), kidney injury (grade 5) in 2(6.7%) and kidney donation for transplantation in 3(10%). Ultrasound and intravenous urography were useful in the patients' evaluation. Twenty-seven (90%) patients were operated upon, but only 25 (83.3%) had nephrectomy. Sixteen (53.3%) had radical nephrectomy, 5 (16.7%) had simple nephrectomy, 3 (10%) had nephro-ureterectomy, and one (3.3%) had partial nephrectomy. Major surgical complications included wound sepsis (18.5%) and primary haemorrhage (7.4%). The overall morbidity and mortality rates were 7.4% and 3.7% respectively. Postuninephrectomy, patients' renal function remained stable after an average of 34.05 months follow-up. CONCLUSION: Renal tumours constitute the main indication for adult nephrectomy in our community. Kidney injury, kidney donation, and pyonephrosis are relatively uncommon indications. Open nephrectomy, which remains our local practice, is safe and unilateral nephrectomy is compatible with normal life.

SCROTAL SQUAMOUS CELL CARCINOMA AND ASSOCIATED BLINDNESS: A CASE REPORT AND LITERATURE REVIEW.

BACKGROUND: Carcinoma of the scrotum is a rare disease which has been linked with occupational exposure to certain industrial carcinogens. Scanty reports of scrotal carcinoma exist in literature but in very few places worldwide. To our knowledge, there has been one documented report of scrotal carcinoma in our country and this is the first report of scrotal carcinoma in over 45years existence of our tertiary Health institution. We present the clinical evaluation, investigations and surgical intervention of a blind elderly welder with squamous cell carcinoma of the scrotum at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. CASE PRESENTATION AND MANAGEMENT: A 65 year-old blind welder presented to us with a painless fungating scrotal mass of two years' duration. He had prior incision and drainage of the swelling in a primary health centre but this failed to heal, with copious purulent discharge. The mass measured 20cm x 15cm x 8cm and was inseparable from the right testis and cord structures, with infiltration of the root of the penis. The inguinal lymph nodes were not enlarged. CT scan confirmed localized scrotal tumour and biopsy confirmed squamous cell carcinoma.He subsequently had wide local excision of the scrotal tumour (with at least 2cm free margins), right total orchidectomy and advancement flap closure of scrotal defect. Histopathological reports corroborated the earlier findings and confirmed tumour free margins. He has remained well 18 months after surgery. CONCLUSION: Squamous cell carcinoma of the scrotum, though rare, is the commonest malignancy affecting the scrotum worldwide. Surgery still remains the mainstay of treatment and early intervention improves the chances of a favourable outcome.

Identifying the training needs of traditional birth attendants.

With the aid of pre-tested, structured, interview questionnaires, 51 traditional birth attendants (TBAs), identified by their certificate of traditional midwifery, were assessed for their knowledge about the care given in pregnancy, labour, and the postnatal period, beliefs and delivery practices including child care, and their attitude towards orthodox midwifery. A total of 22 (43.1%) so identified were found to be practicing traditional midwifery as a full-time job, while 29 (56.9%) were practising on a part-time basis, doing other jobs such as farming and trading. Twenty-two (51.2%) of the male TBAs practised traditional midwifery as a full-time job, while the remaining 21 (48.8%) practised traditional midwifery part-time, along with farming occupation. All the female TBAs practised traditional midwifery part-time with their main occupation such as trading. There was no significant difference between the mean age of male compared with female respondents (59.3+/-15.1 vs. 54.6+/-15.9 years; P = 0.43). Harmful traditional practices, practices that may need verification and areas where training is needed are highlighted. The importance of registration and active supervision of their practices were discussed. The skills that need to be stressed include identification of danger signs in pregnancy and prompt referral of maternal complications. The essence of registration for monitoring of their activities cannot be overemphasized. Findings also revealed that appropriate training could expand their roles in primary health care programmes.

Severe gastrointestinal haemorrhage due to primary intestinal Kaposi's sarcoma - a case report.

Kaposi's sarcoma (KS) was previously a relatively rare disease. With the advent of HIV/AIDS pandemic however, AIDS-related KS has been on the increase and so has interest in the disease. Ninety per cent of patients with KS present with skin lesions. While the gastrointestinal tract is a fairly common site of metastatic KS, primary gastrointestinal KS is uncommon. The presentation of gastrointestinal KS with severe gastrointestinal bleeding is rarer still. In this report, we present a 56yr old HIV-negative patient who presented with severe gastrointestinal bleeding without any skin lesions. Multiple haemorrhagic polypoidal lesions were found on the walls of the jejunum and ileum as well as the liver at exploratory laparotomy and these were found to be KS on histopathologic examination. We also discuss the diagnostic and therapeutic challenges we had with this rare cause of severe GI bleeding.

Giant renal oncocytoma masquerading as infiltrating renal cell carcinoma: case report and literature review.

Renal oncocytomas (RO) are tumours containing a population of cells with highly differentiated eosinophilic granular cytoplasm, extremely rich in mitochondria. It is estimated they account for about 3 to 7% of all solid renocortical tumours that were previously regarded as renal cell carcinoma. Based on their clinical behaviour and distinct pathologic features they are now regarded as benign renal tumours, often less than 5cm in diameter. We present a case of giant renal oncocytoma in a patient with synchronous bladder tumour, with pre-operative clinical, urographic and ultrasound features of locally advanced renal cell carcinoma (RCC). Findings at surgery included huge right renal tumour with infiltration to the duodenum; hepatic colic flexure; gall bladder; liver capsule and the greater omentum with small indurations at the base of the bladder. There was no tumour extension to the renal vein, no peritoneal seedling, no nodal metastasis and no ascites. Radical nephrectomy was carried out with good prognosis and without recurrence 52months post nephrectomy. This presentation, besides highlighting the possible giant nature of RO, also illustrates the malignant potential of RO to infiltrate contiguous structures and mimics infiltrating RCC. In view of the difficulties at establishing pre-operative diagnosis in this disease and because nephron-sparing surgery is curative, especially for the well-circumscribed tumours, RO should be considered in the management of patients with features of infiltrating RCC. A review of literature is also presented.