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.

Prevalence of erectile dysfunction and its correlates among men attending primary care clinics in three countries: Pakistan, Egypt, and Nigeria.

The prevalence and correlates of erectile dysfunction (ED) in developing countries are largely unknown. Our objectives were to determine the prevalence and associated factors of ED in three countries (Pakistan, Egypt, Nigeria) that represent very different cultures. Men 35-70y of age seeking primary medical care answered a structured questionnaire adapted to reflect local cultures. Degree of ED was categorized as 'none,' 'mild,' 'moderate,' or 'complete.' The age-adjusted prevalence rates of ED among men attending primary care clinics was 57.4% in Nigeria, 63.6% in Egypt, and 80.8% in Pakistan. Older age, diabetes, peptic ulcers, prostate disease, depression-related symptoms, and caffeine consumption were independently associated with increased prevalence of ED, whereas being moderately active to very active at work (hard physical labor) and during leisure time (strenuous exercise) was associated with half the prevalence of moderate-to-complete ED. Our multicultural study demonstrates that in every country studied, high proportions of men older than age 35 have some degree of ED (57-81%). Both severity and prevalence increase consistently with age. Factors associated with ED are similar, but their distribution differs across countries.

Sildenafil citrate (Viagra) for the treatment of erectile dysfunction in Nigerian men.

Fifty-eight Nigerian outpatients with documented erectile dysfunction (ED) received open-label sildenafil citrate (Viagra) for 8 weeks. The 50-mg starting dose could be adjusted to 100 or 25 mg based on response and tolerability. The International Index of Erectile Function (IIEF) Questionnaire, a global efficacy question, and intercourse data recorded in a patient event log were used to assess efficacy. Frequency of penetration and maintained erection were both significantly enhanced (P<0.0001); 95% of patients reported improved erections and 81% of all attempts at intercourse were successful. Orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction also improved significantly (P&<0.0001). The most frequent adverse events (all-cause) were headache (17%) and myalgia (3%); only one patient discontinued treatment because of headache, which was considered unrelated to sildenafil. Oral sildenafil significantly improved erectile function and was well tolerated in this trial of Nigerian men suffering from ED. Our results are consistent with reports from other countries.

The causes of male infertility in 504 consecutive Nigerian patients.

The causes of infertility in 504 men were studied prospectively. The major causes were varicocele (28.8%), infection (20.8%), bilateral testicular failure (15%), idiopathic oligospermia (6.6%), multifactorial (5.6%), cryptorchidism (4%), sexual problems (3.8%) and surgical injury (1.6%). Unilateral testicular torsion and sickle cell disease though of less frequent occurrence were of particular interest because their roles are only now beginning to be realized. Gonadotrophin deficiency was an insignificant cause of subfertility. In spite of the high incidence of infection and past history of urethritis Neisseria gonorrheae was surprisingly not isolated from any patient. Compared with Caucasian studies, the high incidence of infection, and the low incidence of gonadotrophin deficiency are major points of difference.

The use of intermittent chlorhexidine bladder irrigation in the prevention of post-prostatectomy infective complications.

The efficacy of peri-operative intermittent bladder irrigation with 0.05% chlorhexidine gluconate solution in the prevention of post-prostatectomy infective complications was assessed in men with pre-operative indwelling urinary catheters. Thirty-two consecutive patients undergoing transvesical prostatectomy were randomly allocated to the test group (chlorhexidine irrigation) and control group (saline irrigation). Pre-operatively, intermittent chlorhexidine bladder irrigation achieved sterile urine in only 3 of 13 patients, in the rest bacteriuria persisted. However, the irrigation was able to reduce significantly (P < 0.05) the incidence of intra-operative bacteraemia and severe wound infection. Furthermore, septicaemia was absent and post-operative urinary catheter requirements and hospital stay were shortened. Histology of bladder mucosal biopsies revealed that 0.05% chlorhexidine used on intermittent basis caused no injuries.

True hermaphroditism in older patients: problems of diagnosis and management.

Four new cases of true hermaphroditism in older patients are herein presented. The diagnosis was delayed in all 4 patients and not made in 3 until feminization had occurred. The clinical features, the sex of rearing, gonadal locations, sex chromosomes, treatment and fertility potentials of these patients are discussed. Problems encountered in the management of these older patients underscores the need to exclude at birth bisexuality in any patient with perineal hypospadias and crytorchidism.

Torsion of testis in Nigerians.

Torsion in a black population is presented. The clinical features are the same as the white counterpart, but the mean age is, however, much higher. There is no bias against any side of testis. Physicians are to blame for the poor salvage rate. Gangrenous testes should not be conserved and early diagnosis and treatment remain the only means of saving torted testis. Prophylactic fixation of contralateral testis is mandatory and must not be postponed. External manual detorsion is not a substitute for surgery and should not remove the sense of emergency. Relevant pathology, the mechanism of torsion and differential diagnosis are discussed.

Penile fasciocutaneous flap urethroplasty: recent experience and challenges in a sub-Saharan African teaching hospital.

OBJECTIVE: To evaluate penile fasciocutaneous flap urethroplasty for complex anterior urethral strictures in circumcised West African men. METHODS: Between January 2002 and December 2006, 26 patients with anterior urethral strictures underwent penile fasciocutaneous flap urethroplasty (PFU), using a modification of the technique described by Quartey (Quartey JKM. J Urol. 1985;134:474-475). Of these patients, 21 had dorsal onlay patches and 5 had tubularize patches. Average follow-up was 19 months. RESULTS: There was a 100% immediate success rate with the dorsal onlay group. No recurrence was seen in all patients available for follow-up at 30 months. The tubularized flap had an immediate success of 80% but at 30 months it was only 40%. Troublesome postvoid dribbling was completely eliminated and complications were minor and few, which included 1 case of distal superficial dorsal penile skin loss, 1 case of urethrocutaneous fistula, and 2 cases of postvoid dribbling all of which were managed conservatively. CONCLUSIONS: PFU when used as a dorsal onlay gives excellent results at least in the immediate and intermediate periods in black West African population. A multiracial study to compare the effect of skin color on the short- and long-term outcome of PFU is also suggested.

Testicular function after unilateral bacterial epididymo-orchitis.

In order to determine whether bacterial infection of the gonads may account for some male-related infertility, the fertility status of 45 young men who developed gonococcal urethritis and then epididymo-orchitis were studied prospectively. The fertility potential of the subjects was evaluated through history of paternity, repeated semen examinations, serum follicle-stimulating hormone determinations, and testicular biopsy. Before infection, 14 married men (100%) had proved their fertility through their children. Two years after infection, only 21% of these fathers and 40% of all subjects produced semen considered adequate for conception. The semen values in the rest were comparable to those of infertile/subfertile men. Although the lesion was clinically confined to one testis, testicular biopsy and follicle-stimulating hormone studies showed that testicular damage involved both testes. The study showed that bacterial gonadal infection may result in permanent azoospermia or oligospermia and this without question may result in male-related barrenness.

Prostate cancer in Nigerians: facts and nonfacts.

PURPOSE: We established the actual incidence of prostate cancer in Nigeria, the largest concentration of indigenous black patients in the world, to ascertain whether the global ranking for Nigeria as a low risk for prostate cancer is accurate. MATERIALS AND METHODS: We prospectively studied Nigerian men 45 years old or older with prostatic symptoms. Patients histologically positive for prostate cancer were analyzed for clinical features, tumor characteristics and survival. The hospital incidence, national prostate cancer risk, pool and death rate were calculated from the hospital admissions data and national population statistics. RESULTS: Mean age of patients with prostate cancer plus or minus standard deviation was 68.3 +/- 9.4 years. The hospital incidence was 127/100,000 cases. The national prostate cancer risk was 2% of patients, the pool was 110,000 and the death rate was 20,000 annually. The predominant clinical findings were those of advanced disease. Approximately 64% of the patients died within 2 years. CONCLUSIONS: Prostate cancer incidence and the magnitude of the risk in our population may have been grossly underestimated. The clinical prostate cancer rate in Nigerians may be as great as that noted in black men in the United States, which may suggest a common enhancing genetic predisposition.

Pulse pattern of luteinizing hormone (LH) in patients with varicocele: a preliminary report.

Serum concentrations of LH were measured every 20 minutes for 6 hours in 4 varicocele patients and 4 control subjects. In both groups, a pulsatile pattern of LH secretion was observed. Also in the two groups, LH pulse rate (2-5/6 hour) and amplitude (23.5-61%) were identical. These findings suggest that Gonadotrophin releasing hormone (Gn RH) and LH secretions have no role in the deranged sperm parameters often found in infertile men with varicocele.

Haematuria and sickle cell disease. A report of 12 cases and review of the literature.

Haematuria in a patient with S-haemoglobin poses a serious challenge of diagnosis and treatment. The first problem is to determine whether the haematuria is incidental or whether it is truly related to the S-haemoglobin. The second is to stop further blood loss. Twelve cases of haematuria induced by sickle cell disease, diagnosed through positive urographic findings of papillary necrosis and successfully treated without any loss of kidney are presented. The pathophysiology of sickle cell-induced haematuria, its incidence rate, its diagnostic criteria and available modalities of treatment are also reviewed in order to improve the diagnosis and treatment of this lesion in our subregion. It is suggested that the diagnosis of sickle cell induced haematuria should be based on identifiable features and not merely by exclusion of other lesions.

Oligo/azoospermia in Nigeria.

Oligo/azoospermia contributes significantly to infertility in male Nigerians, being responsible for most of the problem. By definition, it would appear that the criteria for the diagnosis of this problem in Nigerians should be sperm density below 10 million/ml, total sperm ejaculate below 25 million, motility below 40%, and normal forms below 40% in agreement with more recent findings in other parts of the world. This reinforces the already generally accepted that the WHO may need to review its criteria for diagnosing oligo/azoospermia. Preventable causes of oligo/azoospermia in Nigeria include poorly treated infections such as venereal diseases, delayed treatment of torsion of the testis and of undescended testis, and repair of inguinal hernia by inexperienced native doctor [3, 4]. In addition, better approaches to the diagnosis of causes of infertility, such as a careful search for and rational treatment of varicocele, may improve the chances of infertile couples. Hormonal disorders are important factors to consider in oligo/azoospermic Nigerians, as with their counterparts elsewhere. Wide-spread availability of hormonal assays will therefore be a great help in separating the untreatable (primary testicular disease) from the treatable (hypothalamic/pituitary) diseases and planning rational treatment. With improvement of clinical care, many more patients with sickle-cell disease are reaching reproductive age. Oligo/azoospermia is quite common in patients with sickle-cell disease, and sickle-cell disease will eventually contribute more proportionately to the etiology of oligo/azoospermia in Nigerians. Extensive investigations have been conducted on the nature, etiology, and diagnosis of oligo/azoospermia [2-11, 25, 30-56].(ABSTRACT TRUNCATED AT 250 WORDS)

Androgen concentration in blacks with benign and malignant prostatic disease.

We measured the concentrations of testosterone and its metabolites in serum and prostate glands of Nigerians, a low risk population for prostatic tumours, by means of radioimmunoassay after solvent and chromatographic extractions. Our results show that the values of serum testosterone in normal, elderly Nigerian men (447.0 +/- 112 ng./dl.) and those with benign prostatic hypertrophy (BPH) (430 +/- 112 ng./dl.) were similar (p greater than 0.05) and compare with values reported for Caucasians. In the Nigerian patients with advanced prostatic cancer, the serum testosterone concentrations (314 +/- 202 ng./dl.) were significantly lower (p less than 0.001) than those of Nigerians with normal prostate and BPH. This again is similar to reports in Caucasians with metastatic prostatic cancer. The serum concentrations of testosterone metabolites in our patients were the same in normal BPH and cancer subjects. The ratios of testosterone to its metabolites were similar in our normal and BPH subjects but lower in cancer patients. Also the testosterone concentrations in BPH glands of Nigerians (0.5 +/- 0.03 SEM ng./gm.) compared favourably with those reported from the western world. The testosterone concentrations in malignant prostate gland (7.9 +/- .06 SEM ng./gm.) were significantly higher than those in hypertrophic glands. This again agrees with the pattern in Caucasians. The DHT concentrations (4.9 +/- 0.3 SEM ng./gm.) were considerably higher in BPH than in cancerous glands (1.7 +/- 0.2 SEM ng./gm.). This pattern has been documented elsewhere. Because the concentrations and pattern of distribution of androgens in serum and prostate gland of our patients are comparable to published Caucasian and black American values, any difference in incidence rates of BPH and carcinoma of the prostate between whites, Afro-Americans and indigenous Africans may not be related to androgens.

Semen features of 596 truly infertile men.

Semen examinations were performed on 596 truly infertile men. The results obtained were compared with those of supposedly infertile men. Our findings indicate that the mean sperm count, mean total sperm per ejaculate, mean percentage motility and morphology of truly infertile males were far lower than past reports suggest. The type of male population studied was identified as the possible source of discrepancy. The data obtained further suggest that the realistic cutoff point between fertile and infertile semen should be a sperm concentration of 10 million/ml, a total sperm per ejaculate of 25 million, percentage motile and well-formed sperms of 40 and 60, respectively.

Haematuria in Nigerians: a prospective study.

One hundred and ninety Nigerians who presented with haematuria at an out-patient department were fully investigated and treated. There were 135 males and 55 females of mean age 37.8 years. Fifty-eight per cent of them presented over 3 months after onset of symptoms. Haematuria was severe in 27%, painless in 50%, intermittent in 26%. Infection accounted for 22.6%, neoplasms 17.4%, schistosomiasis, 14.2%, trauma 13.7%, benign prostatic hyperplasia 7.9%, calculous disease 7.9% and haemoglobinopathy 2.6%. There was no case of haematuria due to Hb type AS. Aetiology was unknown in 1.6%. Urethrocystoscopy and intravenous urography were the most rewarding investigations. All patients with carcinoma of the bladder presented very late and none survived more than 1 year after diagnosis. Eighty-six per cent of the cases were of non-schistosomal origin and the need for early and thorough investigation of haematuria is stressed.

Zinc and cadmium concentrations in indigenous blacks with normal, hypertrophic, and malignant prostate.

In order to determine the role of cadmium and zinc in the very low incidence (10/100,000) of cancer of the prostate, in African blacks which contrasts with the very high incidence (100/100,000) in American blacks, the authors measured the serum and prostatic concentrations of these trace metals in healthy Nigerian men and those with benign prostatic hypertrophy (BPH) and prostatic cancer using atomic absorption spectrophotometric study. The mean plasma zinc concentration of healthy men was 14.9 mumol/l +/- 0.5 SEM, whereas those with BPH and malignant glands were 16.5 mumol/l +/- 0.6 SEM and 11 mumol/l +/- 0.7 SEM, respectively. The mean serum cadmium concentrations were 15.2 mumol/l +/- 0.6 SEM, 15.5 mumol/l +/- 0.7 SEM, and 24.2 +/- 0.9 SEM for normal, BPH, and cancer subjects, respectively. The mean prostatic tissue zinc concentration in normal gland was 12.1 mumol/g +/- 0.8 SEM, BPH 17.9 mumol/g +/- 0.6 SEM, and cancer gland 2.9 mumol/g +/- 0.4 SEM. The mean prostatic tissue cadmium concentration for normal BPH and malignant glands were 3.8 mumol/g +/- 0.6 SEM, 14.6 mumol/g +/- 0.37 SEM. The serum and prostatic tissue values of these trace metals in our controls, BPH, and cancer subjects compare with those from populations with higher prostatic cancer rates. This suggests that these metals do not primarily play any significant role in the reported low incidence rate of prostatic cancer in our community. Furthermore, in control subjects and those with BPH, cadmium/zinc ratio, whether evaluated for serum or prostatic tissue was one or less. In patients with cancer, however, this ratio was always greater than one. The possible clinical use of this ratio to diagnose cancer of the prostate gland and to follow-up such patients needs to be further evaluated through more studies.

Prevalence and characteristics of cryptorchidism in a Nigerian district.

OBJECTIVE: To determine the prevalence and characteristics of cryptorchidism among primary schoolboys in a Nigerian district. SUBJECTS AND METHODS: The district selected had 35 primary schools with 23,342 pupils, consisting of 11,275 girls and 11,967 boys. Using a cluster-sampling technique, five primary schools were visited; 1096 boys (aged 5-13 years) participated in the study, giving a sampling ratio of 1:11. The boys underwent a clinical examination of the groin, scrotum and abdomen. RESULTS: Cryptorchidism was found in nine subjects, giving a prevalence rate of 0.82%. All the undescended testes were unilateral, of which five were right-sided. Eight of the testes were intracanalicular and one was at the external ring. There were no cases of orchidopexy. CONCLUSION: The prevalence of cryptorchidism among primary schoolboys in this district of Nigeria was high, at eight per 1000. Delayed diagnosis and treatment remains a problem because of the prevailing socio-economic factors. However, the incidence of cryptorchidism was similar to that reported in other parts of the world.

One-stage urethroplasty for complicated urethral strictures using axial penile skin island flap.

Surgical repair of urethral strictures complicated by multiple scrotal/perineal urethrocutaneous fistulae (watering-can perineum) can be very problematic. The perineal/scrotal skin is either not available or is riddled with infection, fibrosis or granulomata and therefore unsuitable as a graft source. The presence of infection makes free grafts from other sites unlikely to survive. Furthermore, extensive fibrosis may prevent excision and re-anastomosis as well as internal urethrotomy. The absence of preputial skin in circumcised patients compounds these problems. We have used a one-stage, transverse vascularized cutaneous penile flap to repair 20 cases of these complicated strictures. The graft took in 100% and no absolute repair failure was registered. In spite of obvious pre-operative infection, the result of repair was judged excellent in 17 patients (85%) and very fair in 3 (15%).