Nigerian Journal of Urology

Single Stage Buccal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: Experience and Outcome From a Tertiary Hospital.

M Abdullahi — 2022-06-08

Background: Urethral stricture is one of the common urologic diseases constituting significant workload to urology practice worldwide. The prevalence is estimated to be 229–627 per 100,000 malesand its effects on the quality of life of those with the disease are enormous. Successful treatment of urethral stricture has been a challenge to urologists particularly long segment and complex strictures. This led to several procedures to evolve over past several decades. Substitution urethroplasty has become the gold standard procedure for the treatment of long segment anterior urethral strictures. Objective: To document the experience and outcome of use of single stage buccal graft urethroplasty for treatment of long segment anterior urethral stricture in a tertiary hospital. Patients and Method : It was a retrospective descriptive study of all patients who were treated for long segment anterior urethral stricture by single stage buccal graft substitution urethroplasty in our hospital from 2016 to 2021(5years). Medical records of patients were retrieved and their information about bio-data, presentation, risk factors for urethral stricture, investigations done. The type of buccal graft harvest and onlay and outcome including complications were extracted and entered into the already designed proforma. The generated data was entered into excel sheets and analyzed using special package for social sciences (SPSS) and results presented in tables and figures. Results: A total of 45 patients were treated for long segment anterior urethral stricture by single stage buccal graft substitution urethroplasty between 2016 and 2021(5years) of which the records of 42 patients were retrieved and data was collected and analyzed. All were males within the age range of 35 to 78 years and a mean age of 57.2years ±7.4SD. The risk factors for urethral stricture were past history of purulent urethritis (59.5%), prolong catheterization (21.5%), urethral trauma (9.5%), past urethral surgery (9.5%). The site of the urethral stricture was found as follows; Penile urethra (61.9%), Penobulbar (26.2%), Bulbar urethra (7.1%) and Panurethra (4.8%). Intra operative length of the stricture was found as follows: <5cm (21.4%), 5-10cm (23.8%), 10 -15cm (50%) and >15cm (4.8%). The buccal graft onnlay procedures used were dorsolateral onlay (73.8%), dorsal onlay (14.3%), ventral onlay (11.9%). Following urethroplasty catheter was removed as follows: <4weeks (42.9%), 4-6weeks (38.1%) and >6weeks (19%). Complications recorded were: Surgical site infection (21.4%), urethral diverticulum (4.8%), urethrocutaneous fistula (2.4%) and recurrence (4.8%). Majority of the patients (66.7%) had no complication. Conclusion: Single stage buccal graft substitution urethroplasty for long segment anterior urethral stricture has overall good success rate with minimal complications.

Comparison of Biochemical Efficacy of Bilateral Orchidectomy and Medical Castration (Goserelin) in Patients with Advanced Prostate Cancer at Lagos State University Teaching Hospital, Lagos.

MO Omorinde — 2022-06-08

Background: PCa is a leading cause of cancer –related deaths among men and it is the most commonly diagnosed cancer among Nigerian men. Most of the patients with PCa in Nigerian hospitals present with advanced disease and this requires ADT which can be in form of surgical or medical castration. This study was designed to determine which of the two options is more efficacious. Aim: The study compared the biochemical efficacy of medical castration (Goserelin) with bilateral orchidectomy in reducing serum testosterone and serum PSA in patients with advanced PCa. Design and setting of the study: A prospective, hospital based, non-randomized clinical study was conducted over one year period from November 2016 - October 2017. Each patient was followed up for six months. Patients who met the inclusion criteria were recruited consecutively into two groups; surgical and medical castration groups after obtaining written informed consent. Serum testosterone and PSA were measured before prostate biopsy was done using chemiluminescent immunoassay. Serum testosterone and PSA were repeated at 1, 3 and 6 months following commencement of treatment in the two groups. Data were analyzed using the Statistical Package for Social Sciences (SPSS IBM) version 20.0. Results: Fifty patients were studied, twenty-five patients in each group. The percentage drop in median serum testosterone at 1,3 and 6 months for the orchidectomy group was 85.40%, 91.30%, 91.90% respectively and the percentage drop in median serum testosterone for the medical castration(Goserelin) group at 1,3 and 6 months was 87.30%, 93.80%, 94.00% respectively. The percentage drop in median serum PSA at 1,3 and 6 months for orchidectomy treatment group was 69.40%, 97.50% and 99.20% respectively and for medical castration(Goserelin) group, the percentage drop in median serum PSA at 1,3 and 6 months was 68.40%,
96.80%, 98.20% respectively. Local complications associated with orchidectomy were scrotal hematoma (20%) and surgical site infection (28%). Injection site reaction (8%) was recorded in goserelin group. All patients in both groups had hot flushes, reduced libido and weak erection as systemic side-effects. Conclusion: Medical castration (Goserelin) and surgical castration(Orchidectomy) are both equally efficacious in the short term,in the treatment of advanced prostate cancer.

Prognostic Factors and Outcome of Treatment in Patients With Fournier's Gangrene in a Tertiary Institution in Nigeria.

EA Obiesie — 2022-06-08

ABSTRACT

Objective: Fournier's gangrene is an extreme life threatening Urological condition. The objective of this study
was to identify the prognostic factors and outcome of treatment in patients with Fournier's gangrene in a tertiary institution in South East Nigeria. Methodology: This was a prospective study of 21 (twenty one) male patients diagnosed with Fournier's gangrene in our hospital, from June 2012 to June 2019. History and comprehensive physical examination as well as resuscitatory measures were commenced at the emergency units and continued through the wards. Laboratory investigations were conducted. Patients were assessed using Fournier's gangrene severity index scoring system FGSI. Extent of tissue involvement was assessed during debridement within 24 hours of presentation. Definitive treatment measures were commenced, and patients followed up till discharge. Performance status at discharge was assessed. Data generated were analysed using SPSS version 23 (IBM STATISTICS) Results: The mean age of the patients was 56years ± 13.3 (range of 22 to 78years). The peak age incidence was in the 60th decade. The commonest systemic predisposing factor was diabetes mellitus (23.8%) as a single independent etiologic factor, and 71.4% in combination with other systemic predisposing factors. Two patients (9.5%) were obese, diabetic, and presented with anal abscess. No systemic predisposing factor was identified in 4 patients (19.1%). Four patients (19.1%) had bladder outlet obstruction secondary to urethral stricture disease, and has had attempts at urethral catheterization. Four patients (19.1%) had ischio- rectal abscess, while two patients (9.5%) had scrotal injuries from trauma. Fever, malodorous scrotal swelling, anaemia and shock were the common clinical features. Scrotal gangrene was seen in 10 patients (47.6%), scroto-perineal gangrene in 6 patients (28.5%), scroto-abdominal gangrene in 4 patients (19.1%), while only one patient (4.8%) had scroto-penile gangrene. The mean FGSI score at presentation was 7.0 ± 4.0. The mean hospital stay was 52 days ± 45 (range 3 - 210 days). Following debridement, the testes were exposed in 12 patients. Mean performance status at discharge was 1.4. Three mortalities were recorded, and all had diabetic ketoacidosis with mean FGSI score of 10 at presentation. Conclusion: Complicated diabetes mellitus and poor FGSI scores are major predictors of mortality in patients with Fournier's gangrene. Proper and aggressive management protocol gives good outcome.

Efficacy of Urine Cytology in the Diagnosis of Bladder Cancer in Aminu Kano Teaching Hospital: Comparism of Cytology and Histological Findings.

S Auwal — 2022-06-08

Background: Bladder cancer is a common urologic malignancy worldwide and second most common
genitourinary malignancy after prostate cancer. Diagnosis of bladder cancer in developing countries is challenging. Despite the varying results in detection rate of bladder cancer by using the urine cytology, the method can be used in developing countries such as Nigeria, where there are limited diagnostic facilities. Objective: The general objective of the study was to determine the efficacy of urine cytology in the diagnosis of bladder cancer, in Aminu Kano Teaching Hospital. The specific objectives were; to determine the sensitivity, specificity and accuracy of urine cytology in the diagnosis of bladder cancer in Aminu Kano Teaching Hospital. Methodology: It was a prospective descriptive study of 52 patients who consecutively presented with suspected bladder cancer and were recruited via the Urology outpatient unit and casualty unit of Aminu Kano teaching hospital over a period of one year. On presentation patients with emergencies were resuscitated and evaluated clinically to establish the diagnosis of bladder cancer. Patient who had met the inclusion criteria and consented to the study had urinalysis and urine microscopy culture and sensitivity, abdominopelvic ultrasound scan, electrolyte urea and creatinine and full blood count. All the patients subsequently had fresh voided or catheter urine sample taken immediately for cytological analysis. Cystoscopy was done in the urology theatre under local anaesthesia in most patients with exception of few who had general anaesthesia. The cystoscopic findings were noted and multiple biopsies were taken and sent for histological analysis. Results: Of the Fifty two patients reviewed, the mean age was 55.6± 16.3 with male to female ratio of M: F 4.2:1. The overall Sensitivity, Specificity and Accuracy of Urine cytology were 60.4%, 100% and 63.5% respectively. The False negative rate was 39%. Urine cytology was found to be effective in detecting bladder cancer, p<0.05). Conclusion: Based on the findings from this study, Urine cytology is an effective method for evaluation of patients presenting with features suggestive of bladder cancer. Routine use of urine cytology as the initial test for evaluating patient with suspected bladder cancer is recommended.

Urinary Microbiome

TG Adedeji — 2022-06-08

The use of high-throughput sequencing technologies has played a major role in debunking the myth of human
urine sterility. With new technologies-16S rRNA amplicon sequencing, metagenomic sequencing- several genera, phyla and species of bacteria resident in the human urinary tract have been discovered and their role in health and disease have been reported. The focus of this review includes classification of microorganisms resident within the urinary tract, techniques used to sample, identify and classify these organisms, and the impact of resident microorganisms on normal and abnormal urinary tract function.

Premature Ejaculation: Response to Increasing the Frequency of Ejaculation. Report of a Case.

LI Okeke — 2022-06-08

Background: Premature ejaculation (PE) is currently the most common form of sexual dysfunction in men. A
good clinical history remains the best diagnostic method. Increasing the frequency of sexual intercourse between couples who experience PE has not been previously known to increased their self-reported Intravaginal ejaculation latency time. Case presentation: A case is reported of a couple who had been diagnosed with acquired premature ejaculation of 3 years duration with self-reported intravaginal ejaculatory latency time of 2 to 3 minutes. While participating in a study on the effect of increasing frequency of ejaculation on the serum prostate specific antigen level which required their having sexual intercourse 2 to 3 times a week, their self-reported intravaginal ejaculation latency time increased to 30 minutes. Conclusions: Increasing the frequency of sexual intercourse may be an additional armamentarium in the treatment of couples who have acquired premature ejaculation.