Benign urological manifestations of vesical schistosomiasis infestation in Abuja: case series

Urinary schistosomiasis is the most frequently encountered bilhaziasis infestation in Africa with wide range of clinical manifestation. We present three cases of urinary schistosomiasis with different manifestations. The aim is to emphasize the importance of high index of suspicion in the absence of the classical features of urinary schistosomiasis.Case One: He presented with left sided lower abdominal pain, recurrent hematuria and storage lower urinary tract symptoms. Urologic scan showed a hyperechoic mass measuring 10.2mm at the left ureterovesical junction and casting an acoustic shadow posteriorly. Intraoperative findings were that of a stenosed left distal ureter about 5mm from the ureteric orifice. We performed a left stented refluxing ureteroneocystostomy with excision of the stenosed ureter. Histologic section was suggestive of ureteric schistosomiasis.Case Two: She presented with predominantly storage lower urinary tract symptoms and lower abdominal pain. Urologic scan showed thick walled urinary bladder with a central mass. Cystoscopy revealed a small capacity bladder with a polypoid mass arising from the dome of the bladder which was excised endoscoically and sent for histological analysis. The histology report was suggestive of schistosomiasis.Case Three: She presented with storage lower urinary tract symptoms and painful terminal hematuria. Abdominal sonography and CT showed gross bilateral hydroureteronephrosis down to the vesicoureteric junction. Cystoscopy showed small capacity bladder (<60ml) with sandy patches at the trigone. She had augmentation cystoplasty and ureteric re-implantation.Conclusion: A strategy for public enlightment, screening and early detection of schistosoma infestation of the urinary tract will provide a better assessment of this endemic parasitic infection with rising global public health concern.Keywords: Bladder, Cystoscopy, Histology, Schistosoma haematobium, Schistosomiasis, Terminal Hematuri

Atherosclerosis of cavernosal arteries as a cause of erectile dysfunction in an adult: our findings on triplex doppler sonography

A sixty year old man presented to our health facility with a year history of severe erectile dysfunction (International Index of Erectile Function Score of 5 (IIEF-5)). He was also a known hypertensive and currently being managed for hypertensive heart disease by the Cardiologist. Colour Doppler interrogation of the Cavernosal Arteries showed multiple areas of narrowing in both arteries, giving beaded appearance. The peak systolic velocities of the arteries were less than 25cm/s, and there was persistent diastolic flow in the entire spectral recordings, prompting the diagnosis of arteriogenic erectile dysfunction (ED) secondary to atherosclerosis of the cavernosal arteries. He had medical treatment with PGE5-I, and intracavernosal injection of prostaglandin E1 (Caverjet), but all to no avail. He was counselled for penile implant and he is favourably disposed to that but largely being limited by funds

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Self-inserted foreign body in the urinary bladder following sounding: case report and review of the literature

Foreign bodies (FBs) in the urethra and bladder are a relatively uncommon event. A great variety of FBs have been described most of which were self-inflicted due to autoerotic stimulation, psychiatric disturbances, senility, substance abuse and as a result of iatrogenic causes. We present a case of a married lady with self- inserted eye brow pencil in her urinary bladder due to autoerotic stimulation. Diagnosis was confirmed by imaging studies and urethrocystoscopy and the FB was successfully removed by open cystostomy.Keywords: Stimulation, Autoerotism, Urethrocystoscopy, Cystostomy, Penci

Atherosclerosis of cavernosal arteries as a cause of erectile dysfunction in an adult: our findings on triplex doppler sonography

A sixty year old man presented to our health facility with a year history of severe erectile dysfunction (International Index of Erectile Function Score of 5 (IIEF-5)). He was also a known hypertensive and currently being managed for hypertensive heart disease by the Cardiologist. Colour Doppler interrogation of the Cavernosal Arteries showed multiple areas of narrowing in both arteries, giving beaded appearance. The peak systolic velocities of the arteries were less than 25cm/s, and there was persistent diastolic flow in the entire spectral recordings, prompting the diagnosis of arteriogenic erectile dysfunction (ED) secondary to atherosclerosis of the cavernosal arteries. He had medical treatment with PGE5-I, and intracavernosal injection of prostaglandin E1 (Caverjet), but all to no avail. He was counselled for penile implant and he is favourably disposed to that but largely being limited by funds.</jats:p