Managing the sequelae of urology medical tourism: A single center experience.

BACKGROUND: Medical tourism is a fast-growing business worldwide with almost every country involved as either a provider and/or consumer. The degree of participation may vary depending on the status of health-care system in that country. This study aims to present our experience in the management of patients who sought urologic care abroad or returned from medical tourism with urologic complications. METHODS: The method of study was based on the documentation of interaction with patients, patients' relations and their agents in a questionnaire between January 2010 and December 2015. The data obtained included, their demographics, indications/motivations for seeking treatment abroad, procedures performed and complications. We also documented the secondary procedures that were performed and complications managed in our center. The data were entered into Microsoft Excel and analysed using descriptive statistics, tables and figures. RESULTS: A total of 113 have either indicated intention of going to seek for urological care abroad or had already had urologic procedures abroad but were attending our clinic for follow up or for management of complications. Only about 12% of these patients were found to have genuine indications for seeking care abroad. Most of the indications were not justifiably based on the current capabilities of our health facility but more due to a lack of trust in the system or at worst pretentious. CONCLUSION: Patients seek for treatment abroad for variable reasons but and most could not be justified based on available local options. India and some Middle-East countries were the favoured destinations, and the quality of care and relative lower cost are the major attractions. The rising trend in medical tourism is fuelled by the poor state of our health-care system, perceived dearth of expertise and a general apathy and lack of trust.

Variable presentation of retrocaval ureter: Report of four cases and review of literature.

Retrocaval ureter is a rare anomaly in which the ureter passes behind the inferior vena cava due to abnormal embryogenesis. Very few cases have been reported from Africa. Although the anomaly is congenital, patients become symptomatic in the third or fourth decade of life. We reviewed the records of four patients with the diagnosis of retrocaval ureter and managed in our centre between January 2010 and December 2016. Three patients presented with recurrent colicky right flank pain while one was asymptomatic. Two patients each had Type I and Type II retrocaval ureters, respectively. Surgical repairs were achieved in the three symptomatic cases and recovery was uneventful. Retrocaval ureter, though congenital, manifests in young adults and it may be symptomatic. Pre-operative diagnosis may be difficult when the lesion is high and mimics pelviureteric junction obstruction. Thus, a high index of suspicion is required for pre-operative diagnosis. Under-reporting and asymptomatic cases may account for the low incidence.

Spectrum of urological emergencies and surgical interventions in a single tertiary health center.

Objectives: Emergency urologic conditions are relatively common, albeit rarely life threatening, there is often a need for prompt and expedient management in order to avert severe or permanent morbidities. This study aimed to evaluate the spectrum of Urologic emergencies and interventions offered in a tertiary hospital in Nigeria. Patients and methods: We retrospectively reviewed the records of patients who were managed in our institution for emergency urologic conditions over a period of 6 years (2011-2017). The data extracted included; the demographic information, diagnosis and the treatment offered. The data obtained were analyzed using SPSS version 20. Data were displayed using mean +/- standard deviation and percentages. Results: The records of a total of 681 patients were retrieved and they span across almost all ages with age range or 2-90 years. Urinary retention was the commonest emergency seen, accounting for 51.7% of the patients. Testicular torsion was the next most common (10%), others are bilateral ureteric obstruction and priapism with 5.4% and 5.3% respectively. Suprapubic cystostomy (SPC) was the commonest operative procedure performed (37.6%). The age range for patients with urinary retention was 3-90 years, though the peak incidence was in the 7th decade (37.3%). Patients with testicular torsion were young adults between the ages of 11 and 44 years. Conclusion: Urinary retention was the commonest urologic emergency followed by testicular torsion. Though urethral catheterization was successful in most patients urinary retention, making it the commonest procedure. SPC was the commonest emergency operative procedure performed. Other emergencies occurred sporadically.

Ureteric Injuries Following Obstetrics and Gynaecologic Surgeries: A Single-Center Experience.

Background: Ureteric injuries are not uncommon in obstetric and gynaecologic surgeries. Some specific procedures predispose to these injuries. Recognition is often delayed. This study aims to present a single-center experience on the presentation, risk factors, and management of ureteric injuries. Methodology: We retrospectively reviewed case files of patients primarily presenting or referred to our urology division with ureteric injuries following obstetrics or gynaecologic surgeries from June 2005 to May 2015. Data extracted included the time of presentation or recognition, the specific offending surgery, the laterality, and site involved, the repair performed, and outcome. Results: Twenty-three patients had injuries (with a total of 25 ureters involved owing to 2 bilateral injuries). Caesarian-section is the commonest offending surgery in 13 (56.5%). The reasons for early recognition were sudden anuria in two and urinary leakage in the operating field in four patients constituting 26.0%, while 17 (74.0%) were recognized in the post-operative period. Urinary fistulae were the commonest presentation in 13 (76.5%) patients recognized postoperatively. Transection and ligation are the commonest mechanisms of injury. The distal third was the site involved in all patients, while ureteroneocystostomy alone was the most predominant repair in 18 (72.0%). Ureteroneocystostomy with Psoas hitch and Boari flap reconstruction was offered in six (24.0%) suggesting greater than5cm ureteral loss. Conclusions: Ureteric injuries often occur following obstetrics and gynaecologic surgeries. Caesarian-section is the commonest predisposing surgery in our center. Prompt recognition and repair is recommended.

Acute urinary tract infection in patients with underlying benign prostatic hyperplasia and prostate cancer.

INTRODUCTION: the occurrence of urinary tract infection in patients with obstructing prostate causes reduction in their health-related quality of life and overall well-being. The objective of this study was to determine the prevalence, risk factors and antimicrobial sensitivity pattern of pathogens causing urinary tract infection in patients with benign prostatic hyperplasia and prostate cancer. METHODS: all patients who presented to our urology division with bladder outlet obstruction secondary to benign prostatic hyperplasia or prostate cancer between January 2016 and January 2019 were included. Information on age, co-morbid conditions, presence of an indwelling catheter, bacteriologic analysis, imaging findings and histological diagnosis were obtained and analyzed using SPSS version 20. RESULTS: de-novo urinary tract infection occurred in 35.6% of patients while recurrent infection occurred in 5.9% of them. The most commonly isolated organisms were gram-negative bacteria with Escherichia coli, Klebsiella spp, Citrobacter spp and Aerobacter spp accounting for 62.2%, 27.0%, 8.1% and 2.7% respectively. Nitrofurantoin (64.3%), Ceftriaxone (46.3%) and Genticin (42.9%) were the three most sensitive antimicrobials to the organisms isolated. Only the presence of an indwelling catheter in the bladder was an independent predictor of urinary tract infection in the study population. CONCLUSION: about one-third of patients with benign prostatic hyperplasia and prostate cancer develop urinary tract infection. The predominant bacterial cause was Escherichia coli, which had a high degree of sensitivity to Nitrofurantoin. The presence of an indwelling catheter was the only independent predictor of this infection. Appropriate measures should be re-enforced to prevent the occurrence of catheter-associated infections.

Assessment of Health-care Research and Its Challenges among Medical Doctors in Nigeria.

INTRODUCTION: Health-care research in Nigeria has been growing over the years but is constrained by many difficulties. This study aimed to identify the challenges encountered in health-care research and suggest policies to address these problems. MATERIALS AND METHODS: It was a cross-sectional study of medical doctors who have been involved in health-related researches. All participants filled a self-administered online questionnaire comprising 31 questions in five sections. The responses were analyzed using the Google forms and the Statistical Package for the Social Sciences software version 23. RESULTS: The mean age of the study participants was 41.0 ± 8.4 years. Three-quarters of the respondents (75.5%) worked in teaching hospitals. Nearly all (96.6%) carried out their studies using personal funds and only one in 10 had been involved in high-budget projects (≥₦1,000,000). The generation of quality researches was impeded by the restriction of literature review to free online journals (93.2%), incomplete health records (88.0%), limited access to research kits (65.7%), limited use of advanced statistical analysis (29.8%), and challenges with obtaining ethical approval (21.2%). Despite the average online visibility of these researches (52.2%), only 28.5% stated that it has been locally adopted to influence medical practice in their center. CONCLUSION: There is a wide disparity in research capacity among hospital tiers. It is important to leverage on and expand existing partnerships to provide institutional access to premium literature, offer robust, and assessable financial support for the conduct of high-quality researches and provide a framework to bridge the gap in the use of these works to influence practice change in Nigeria.