An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital

Background: Surgical site infections (SSI) are a potential cause of morbidity and increased cost of care after operations such as open prostatectomy.Objective: To audit the occurrence of SSI after open prostatectomy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, NigeriaMethods: A review of all patients who underwent open prostatectomy over a ten-year period (July 2005 to June 2015). Data analysis was done using the statistical package for social sciences version 21. Association between variables was determined using Chi-square or Fisher’s exact test as appropriate. A p-value < 0.05 was considered statistically significant.Results: A total of 247 open prostatectomy surgeries were reviewed, with the patients’ ages ranging from 43 – 91 years and a mean age of 67.0 ± 8.8 years. Elective procedures were 98.8% while the remaining 1.2% were emergency cases. There were 24 (9.8%) surgical site infections. The duration of admission of the patients with SSI ranged from 6 – 15 days with a mean of 9.5 ± 3.2 days, as against 4 – 9 days (mean of 5.0 ± 2.1days) for those without SSI. All the patients with SSI were successfully managed with no resultant mortality. Risk factors identified for SSI were emergency surgery (p=0.001), obesity (p<0.0001), diabetesmellitus (p=0.008), smoking (p<0.0001), pre-operative catheterization (p<0.0001), excessive haemorrhage (p<0.0001) and post-operative suprapubic bladder drainage (p<0.0001).Conclusion: SSI is a recognized complication of open prostatectomy. Identified risk factors for its occurrence from this audit are emergency operation, obesity, diabetes mellitus, smoking, pre-operative catheterization, excessive haemorrhage and post-operativesuprapubic bladder drainage. Age, approach to prostatectomy (retropubic vs transvesical), incision type (lower midline vs pfannenstiel), level of the surgeon, catheter type and modality of irrigation were however not significant risk factors for post-prostatectomy SSI in this study.Keywords: Surgical site infection, risk factors, open prostatectomy

Management of pelviureteric junction obstruction at a tertiary teaching hospital in southwestern Nigeria: A retrospective analysis of case records

Background: Pelviureteric junction obstruction (PUJO) is an important cause of upper urinary tract obstruction. It can cause marked impairment of renal function, especially in bilateral cases, if not diagnosed and treated promptly. Surgical intervention is currently the mainstay of treatment. We aimed to review the pattern of presentation and management outcomes of patients diagnosed with PUJO. Methods: We conducted a retrospective study of patients aged 2–60 years who presented with PUJO between January 2005 and December 2014. Demographic characteristics, clinical presentation, investigations, and treatment modalities were extracted from case notes. Data were analysed using SPSS version 20. Results: The age range of the 32 included PUJO patients was 2–60 years, with a median age of 30 years. Children constituted 31% of patients. There were 15 males and a male-to-female ratio of 0.88:1. Most PUJO was unilateral and left-sided (n = 19; 59%). Loin pain was the commonest symptom (n = 26; 81%), while 25% of patients had a urinary tract infection at presentation. All patients had normal renal function at the time of surgery, and Anderson–Hynes pyeloplasty was the most common technique employed (72% of cases). Postoperatively, the majority of patients (n = 31; 97%) had complete symptom resolution. Surgical site infection (n = 3; 9%) was the commonest postoperative complication, and the median hospital stay was 11 days. There was no mortality. Conclusions: Most patients with PUJO presented late. Most of our patients underwent Anderson–Hynes pyeloplasty with satisfactory outcomes. Keywords: pelviureteric junction obstruction; PUJO; loin pain; Anderson–Hynes pyeloplasty; Foley Y-V plasty; Nigeria

An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital

Background: Surgical site infections (SSI) are a potential cause of morbidity and increased cost of care after operations such as open prostatectomy. Objective: To audit the occurrence of SSI after open prostatectomy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria Methods: A review of all patients who underwent open prostatectomy over a ten-year period (July 2005 to June 2015). Data analysis was done using the statistical package for social sciences version 21. Association between variables was determined using Chi-square or Fisher\u2019s exact test as appropriate. A p-value < 0.05 was considered statistically significant. Results: A total of 247 open prostatectomy surgeries were reviewed, with the patients\u2019 ages ranging from 43 \u2013 91 years and a mean age of 67.0 \ub1 8.8 years. Elective procedures were 98.8% while the remaining 1.2% were emergency cases. There were 24 (9.8%) surgical site infections. The duration of admission of the patients with SSI ranged from 6 \u2013 15 days with a mean of 9.5 \ub1 3.2 days, as against 4 \u2013 9 days (mean of 5.0 \ub1 2.1days) for those without SSI. All the patients with SSI were successfully managed with no resultant mortality. Risk factors identified for SSI were emergency surgery (p=0.001), obesity (p<0.0001), diabetes mellitus (p=0.008), smoking (p<0.0001), pre-operative catheterization (p<0.0001), excessive haemorrhage (p<0.0001) and post-operative suprapubic bladder drainage (p<0.0001). Conclusion: SSI is a recognized complication of open prostatectomy. Identified risk factors for its occurrence from this audit are emergency operation, obesity, diabetes mellitus, smoking, pre-operative catheterization, excessive haemorrhage and post-operative suprapubic bladder drainage. Age, approach to prostatectomy (retropubic vs transvesical), incision type (lower midlinevs pfannenstiel), level of the surgeon, catheter type and modality of irrigation were however not significant risk factors for post-prostatectomy SSI in this study. DOI: https://dx.doi.org/10.4314/ahs.v19i2.30 Cite as: Salako AA, Badmus TA, Onyia CU, David RA, Adejare IE, Lawal AO, Onyeze CI, Ndegbu CU. An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital. Afri Health Sci.2019;19(2): 2068-2072. https://dx.doi.org/10.4314/ahs.v19i2.3

Effect of Melatonin on Carbon Tetrachloride-Induced Kidney Injury in Wistar Rats

Exposure to carbon tetrachloride (CCl4) induces acute and chronic renal injuries as well as oxidative stress in rats. The aim of this study was to evaluate the effect of exogenous melatonin (MEL) treatment on CCl4-induced oxidative stress and nephrotoxicity in rats using histopathological and biochemical parameters. Serum creatinine, blood urea nitrogen (BUN), nitrite and albumin concentrations were measured for the evaluation of renal function. Antioxidant status in the kidney tissue was estimated by determining the activities of superoxide dismustase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and glutathione-S-transferase (GST) as well as thiobarbituric acid reactive substances (TBARS) and reduced glutathione (GSH) levels. For histopathological evaluation, kidney of all rats were excised and processed for light microscopy. CCl4 caused elevated level of TBARS and marked depletion of renal endogenous antioxidant enzymes. Furthermore, severe deterioration of renal function was observed in CCl4-treated rats as assessed by increased serum creatinine, BUN levels and decreased creatinine and urea clearance as compared with the control rats. MEL treatment positively ameliorated the alterations in these biochemical variables in the CCl4 + MEL-treated rats. MEL markedly reduced elevated TBARS and nitrite, significantly attenuated renal dysfunction, increased the levels of antioxidant enzymes. Kidney sections of CCl4-treated group showed, changes in microanatomy. In contrast, these deleterious histopathological alterations resulting from CCl4 nephrotoxin were absent after MEL treatment in CCl4 + MEL group of rats. In conclusion, our results demonstrated that MEL through its antioxidant activity effectively ameliorated CCl4induced nephrotoxicity

Posterior urethral valves in children: Pattern of presentation and outcome of initial treatment in Ile-Ife, Nigeria

Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within thefirst 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors

Complications of Transverse Distal Penile Island Flap: Urethroplasty of Complex Anterior Urethral Stricture

PURPOSE: To report the complications of transverse distal penile island flap urethroplasty for urethral reconstruction in adult patients with long/ multiple segments anterior urethral stricture. MATERIALS AND METHODS: This prospective study was carried out on 55 patients with complex anterior urethral stricture to study complications of transverse distal penile island flap urethroplasty in two teaching hospitals between June 2002 and December 2008. Pre-, intra- and postoperativeinformation were collected on a pro forma to generate data, which was analyzed. RESULTS: The patients’ mean age was 43.83 years (range, 19 to 73 years). The leading etiology of the stricture was urethral inflammation (76.4%) with the commonest complication being infection: wound infection in 9.1%, urosepsis in 3.6%, and epididymo-orchitis in 1.8% of the subjects. CONCLUSION: Transverse distal penile island flap urethroplasty has a remarkable outcome in treatment of a long/multiple segment urethral stricture with few manageable complications

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways