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.

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.

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.

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.