Gross haematuria among adult Nigerians: current trend.

AIMS AND OBJECTIVES: To determine if there is any change in the common causes of gross haematuria among adults Nigerians and to determine what proportion of these aetiologies is due to urological malignancies. PATIENTS AND METHODS: Consecutive adults with presenting with gross haematuria seen in our centre were studied prospectively between February 2006 and January 2007. All patients had detailed clinical and diagnostic evaluation including urine cytology, flexible/rigid urethrocystoscopy, ultrasonography and intravenous urography to determine the causes of their haematuria. Other special investigations including CT scan and tissue biopsies were only used in selected patients as indicated. RESULTS: The cause of haematuria was determined in 74 patients (93.7%) while haematuria was of undetermined origin in 5 patients (6.3%). Fifteen different specific diagnoses were made as the causes of haematuria in this study. The three commonest individual causes of haematuria were benign prostatic hyperplasia (30.4%), bladder carcinoma (12.6 %) and carcinoma of the prostate (10.1%). Urological malignancies were diagnosed in 29.1 % of the patients. The Urological malignancies detected were bladder cancers (12.6 %), prostate cancers (10.1%), renal Cell Carcinoma (5.1%) and urethral Carcinoma (1.3%). The incidence of the cancers increased with age; 82.6% of the patients with malignancies were aged 50years and above while only 17.4% were below 50 years of age (P= 0.045). Urological malignancies were also more common in men (73.9 %) than in women (26.1 %) (P < 0.05). CONCLUSION: We conclude that there is changing trend in the aetiologies of gross haematuria among adult Nigerian patients with urological malignancies being now more prevalent than previously reported in our environment.

Outcome of management of acute prolonged priapism in patients with homozygous sickle cell disease.

BACKGROUND: Priapism is a persistent, often painful, purposeless penile erection, which amy or may not be associated with sexual desire, excitement stimulation, or intercourse. OBJECTIVE: To present the outcome of management of acute prolonged priapism in patients with homozygous sickle cell disease. METHODS: Fifty-four patients seen over a 20-year period were studied. Of these, 35 were treated surgically with Ebbehoj's cavernosa-glandular shunt while 19 were treated conservatively. The information documented for each patient included age, haemoglobin genotype, duration of priapism before treatment , time of onset, previous history of priapism and possible aetiological factors. RESULTS: The age range 2.5-38 years with a mean of 20.56 + or - 9.33 years. The potency rate in those treated conservatively was 47.37% while it was 70.37% in those treated surgically. The potency rate in those treated conservatively was 47.37% while it was 70.37% in those treated surgically. The potency rate decreased with increasing duration of priapism before treatment. Those treated within three days had a significantly better outcome than those treated after three days. (chi(2)=4.2986, P=0.038). The potency rate also decreased with increasing age at onset but there was no statistically significant difference between the potency rate in the age groups. CONCLUSION: Surgical treatment of acute prolonged priapism may be associated with a higher potency rate compared to conservative treatment. There is an inverse relationship between the potency rate and duration of priapism before treatment and age at onset of Priapism. Acute prolonged priapism is a common cause of impotence in patients with homozygous sickle cell disease.

Genito-urinary system injuries in Lagos: pattern and general treatment outcome.

BACKGROUND: Genitourinary injuries (GUI) are relatively uncommon. Even though mortality from isolated injuries is rare, they are commonly associated with significant and life long morbidity. OBJECTIVE: This study is to assess the pattern of the injuries and the overall short term treatment outcome in our environment. METHODS: Fifty consecutive patients diagnosed with genitourinary injuries seen by the Urology Unit through the Accident and Emergency, emergency referrals (or consultations) from the ward or theatre between June 2004 to February 2006 were included in the study. Information collected included demographic data, pattern of presentation, aetiology of injury, type of injury the type of treatment and the immediate outcome. RESULTS: There was a total of 61 injuries in 50 patients. Road traffic accidents was the commonest cause of GUI (58%) followed by straddle injuries (18%) and iatrogenic causes (12%) and miscellaneous (12%). The male- female ratio was 6:1. The urethral was also the most commonly injured organ (60.6%), followed by the kidney (11.5%). The testes were the least injured organs (1.6%). The blunt renal injuries and extraperitoneal bladder injuries were managed by non operative means while most other injuries were managed by surgical intervention. Immediate treatment outcome was satisfactory in most patients. There was one mortality. CONCLUSION: Most cases of GUI are preventable. Improved safety on the roads,'proper training of surgeons and attention to clinical and surgical details will go a long way in preventing GUI. Early intervention significantly reduces the morbidity and mortality.

Genito-urinary system injuries in Lagos: pattern and general treatment outcome

BACKGROUND: Genitourinary injuries (GUI) are relatively uncommon. Even though mortality from isolated injuries is rare; they are commonly associated with significant and life long morbidity. OBJECTIVE: This study is to assess the pattern of the injuries and the overall short term treatment outcome in our environment. METHODS: Fifty consecutive patients diagnosed with genitourinary injuries seen by the Urology Unit through the Accident and Emergency; emergency referrals (or consultations) from the ward or theatre between June 2004 to February 2006 were included in the study. Information collected included demographic data; pattern of presentation; aetiology of injury; type of injury the type of treatment and the immediate outcome. RESULTS: There was a total of 61 injuries in 50 patients. Road traffic accidents was the commonest cause of GUI (58) followed by straddle injuries (18) and iatrogenic causes (12) and miscellaneous (12). The male- female ratio was 6:1. The urethral was also the most commonly injured organ (60.6); followed by the kidney (11.5). The testes were the least injured organs (1.6). The blunt renal injuries and extraperitoneal bladder injuries were managed by non operative means while most other injuries were managed by surgical intervention. Immediate treatment outcome was satisfactory in most patients. There was one mortality. CONCLUSION: Most cases of GUI are preventable. Improved safety on the roads;'proper training of surgeons and attention to clinical and surgical details will go a long way in preventing GUI. Early intervention significantly reduces the morbidity and mortality