Spontaneous scrotal faecal fistula in a Nigerian adult: review of literature and proposal for management protocol

We report a 28-year-old Nigerian who presented with four days history of spontaneous scrotal ulceration and faecal discharge. This symptom was preceded by features of intestinal obstruction which got relieved after the faecal discharge from the scrotum. He was resuscitated and had segmental resection and anastomosis of the ileum, debridement of the scrotal skin for secondary closure and delayed repair of the hernia

Bilateral Supernumerary Kidneys: Incidental Finding in a Three-Month-Old Infant

Supernumerary kidney (SNK) is a rare congenital anomaly with fewer than 100 cases reported in the English literature. The majority of these were unilateral and only five bilateral cases have been reported. We report an infant with six kidneys, incidentally diagnosed at ultrasonographic imaging after presenting with an anterior lower chest wall abscess. Confirmation of the diagnosis was confirmed by excretory urography. To our knowledge, this is the highest number of SNK reported.Key Words:  Supernumerary kidneys, bilateral, anomaly, infan

Knowledge of Prostate Cancer Screening Among Native African Urban Population in Nigeria.

Background: Prostate cancer is the must commonlydiagnosed cancer in men worldwide and ranked second as the cause of death in cancer-related diseases. Objective: To evaluate the awareness and attitude of the populace to screening for cancer of the prostate. Methods: It is a cross-sectional study involving 156 respondents. A structured questionnaire detailing the biodata, the knowledge of cancer of prostate, the practice of screening by prostate specific antigen (PSA) estimation and the readiness to undergo screening by the respondent was used to obtain the set-out objectives. Results: A total of 156 respondents completed the questionnaire and forms the basis of further analysis. The mean age of the respondents is 44.15 (±11.9) years. Majority of the respondents were civil servant (51.9%) followed closely by politicians. About 23.1% of them have no formal education while 53.8% have acquired tertiary education. The result shows that 78.8% have never heard any information on cancer of the prostate and only 5.8% had heard about PSA. None of the respondents have ever had PSA test, even once. Eighty four per cent of the respondents are ready to pay for prostate cancer screening test by PSA assay. Conclusion: We conclude that there is remarkable lack of awareness of prostate cancer among the Nigerian native African urban populace. Prostate cancer screening and serum PSA test for screening is globally unknown among them.Keywords: Knowledge, prostate cancer, serum PSA, screenin

Use and ease of self-administered International Prostate Symptoms Score (IPSS) and Visual Prostate Symptoms Score (VPSS) questionnaires for the assessment of lower urinary tract symptoms in Nigerian men

Objectives: To evaluate the use of the Visual Prostate Symptoms Score (VPSS) and International Prostate Symptoms Score (IPSS) questionnaires for the assessment of lower urinary tract symptoms (LUTS) in Nigerian men, with special emphasis on the ease of administration and the time needed to complete the questionnaires. Patients and methods: This cross-sectional survey of men with LUTS was carried out at a tertiary-care hospital in Nigeria between July and December, 2014. The symptoms were assessed using the IPSS and VPSS questionnaires. A structured questionnaire was created to collect data on socio-demographics, literacy, visual impairment and the time needed to complete the IPSS and VPSS questionnaires. The data were collated, and Pearson's chi-square test was performed using a contingency table. Spearman's rank correlation test was done for IPSS and VPSS, while the paired t-test was used for the average time spent in completing both questionnaires. A p-value <0.05 was considered as significant. Results: Ninety patients aged between 56 and 80 years were enrolled in the study. Thirty-one (34.4%) were literate in English, while 59 (65.6%) were illiterate. The literate patients with at least secondary education completed the IPSS questionnaire without assistance. The VPSS questionnaire was completed without assistance by 43 (72.9%) illiterate patients, while all the patients with visual impairment needed assistance to complete it. There was a statistically significant correlation between the IPSS and VPSS. Completion of the VPSS questionnaire required half of the time needed to complete the IPSS questionnaire. Conclusion: To complete the IPSS questionnaire, Nigerian men require a literacy status of at least secondary education. VPSS correlated significantly with IPSS. Both questionnaires can be used to assess LUTS in uneducated patients and those with a low educational level, but visual impairment may preclude their use. It takes less time to complete the VPSS compared to the IPSS questionnaire

Hypoglycaemia from misuse of oral hypoglycaemic agent in patients with lower urinary tract symptoms in Ilorin, Nigeria

Hypoglycaemia can be defined biochemically as level of blood glucose below 2.8 mmol/L (50mg/dL) in otherwise healthy adult. It is often characterized by variety of symptoms including confusion, loss of consciousness, seizures and rarely death may occur. The most common cause of hypoglycaemia is medications used to treat diabetes. Although, only some few recent studies found a significant association between factors in the metabolic syndrome and presence of benign prostatic hypertrophy (BPH); there has been no documented beneficial effect of the use of oral hypoglycaemic agent in the treatment of lower urinary tract symptoms (LUTS) from BPH either in diabetes or non-diabetes individuals.The incidence of diabetes mellitus is high about the same decades of life when the prevalence of LUTS/BPH is also at its peak. This coincidence may influence the pattern of presentations of such patients with LUTS associated with BPH especially in the rural African settings where patients tend to share their medications or prescription because of similarity in perception of their symptomatology.Case series of five patients with lower urinary tract symptoms, who had abused oral hypoglycaemic agents and presenting in various stages of altered consciousness and frank hypoglycaemic coma, were presented to illustrate this occasional occurrence and suggestion on how to militate this trend.In conclusion, misuse of oral hypoglycaemic agents (OHA) to treat LUTS with subsequent presentation in hypoglycaemic coma should be of concern to the health care provider especially the urologist. It is of no benefit and constitutes drug abuse that should be discouraged.Keywords: drug abuse, hypoglycaemia, lower urinary tract symptom

“Close-loop” urethral obstruction: Clinico-radiological features and management consideration in a resource-constraint environment

Objective: To document our observation of “close-loop” obstruction among patients with dual urethral obstruction from BPH and urethral stricture disease. Materials and Methods: The hospital records of all patients that presented to our centres with evidences of urethral stricture co-existing with BPH were retrospectively reviewed from January 2007 to December 2011. Among other things, the salient features in the contrast radiograph of those with “close-loop” obstruction and their treatment were documented and analysed. Results: Forty three patients were managed for radiological evidence of urethral stricture and elevated bladder base (dual obstruction). Thirty (69.7%) of these patients had open prostatectomy with easy dilatation of the urethral stricture. Twelve (27.9%) of the patients had urethroplasty for urethral stricture diseases; of these twelve, five patients presented with persistent LUTS (“close loop” obstruction). These five (11.6%) patients were aged between 50 to 80 years; they all had suprapubic cystostomy. In addition to delineating the anatomy of the urethral stricture and elevated bladder base, other salient features on the contrast radiographies included dilated prostatic urethral, visualization of the seminal vesicles and closed bladder neck on voiding cystogram. The initial treatment was urethroplasty but two each had combination therapy (with alpha adrenergic blocker and 5-alpha reductase inhibitor) and open prostatectomy respectively as further treatment while the last patient had perineal urethrostomy as first-stage redo-urethroplasty. Conclusion: “Close-loop” urethral obstruction appears to be an entity that needs further evaluation

Prolonged use of indwelling urinary catheter following acute urinary retention in a tertiary care centre in sub-Saharan Africa: Causes, costs and concerns

Objectives: To evaluate the causes, estimate out-of-pocket payments and assess concerns associated with prolonged use of urinary catheters following acute urinary retention secondary to benign prostate enlargement (BPE) and urethral stricture disease (USD) in men attending the urology out-patient clinic of a tertiary referral centre in North-central Nigeria. Patients and methods: This was a cross-sectional survey of men attending urology clinic and who are using indwelling urinary catheter for >3 months following acute urinary retention due to BPE or USD. The study was conducted over a six-month period (1st March 2012 to 31st August 2012) at a tertiary hospital in North-central Nigeria using interviewer administered questionnaires. Results: Of seventy-six men, 36/76 (47.4%) had BPE and 40/76 (52.6%) had USD. Median age, median duration of catheter use and median out-of-pocket payment per catheter change was 65 years (range 20–90 years), 12 months (range 3–120 months) and US$9.31 (range$3.63–18.75) respectively. There was no significant difference in the duration of catheter use and out-of-pocket payments between men with BPE and USD; however, men with USD were significantly younger than those with BPE. One-fifth and half of the men with BPE and USD, respectively attributed inability to pay for surgery as the reason for prolonged use of catheters. The second common reason was long waiting list for surgery. Men with BPE had their sexual relationships disrupted significantly more than those with USD and unexpectedly, we found that men using catheters for less than 6 months describe themselves as unhappy significantly more than those using the catheters for longer periods (p = 0.033). Conclusions: Inability to pay for definitive surgery and long waiting lists are the leading causes of prolonged use of indwelling urinary catheters in men with BPE and USD in our sub-Saharan setting. Prolonged catheter use adversely affected quality of life disrupting sexual relationships especially of men with BPE. Recommendations made to reduce out-of-pocket payments and shorten waiting times may help to improve access to urologic surgical care for these men