Contemporary management of genitourinary injuries in a tertiary trauma centre in Nigeria

Background: The genitourinary system has been shown to be involved in 10% of patients presenting after trauma and is therefore a significant factor in trauma induced morbidity and mortality. It affects all age groups and both sexes. The aim of this study is to determine the aetiology, mechanism of injury and management of genitourinary injuries in a tertiary trauma centre.Methods: This is a prospective study carried out at the Jos University Teaching Hospital between 2012 and 2017. All patients who presented at the A and E with genitourinary trauma were recruited into the study. Initial assessment involved taking an AMPLE history and resuscitation, using the Advanced Trauma Life Support (ATLS) protocol of the American College of Surgeons. Physical examination and investigation were carried out to localize and determine extent of injury. Investigations carried out were complete blood count, blood grouping, serum electrolyte, urea and creatinine and radiography where applicable. Surgical intervention was carried out where indicated.Results: A total of 104 patients were involved in this study. The mean age was 32.14±15.5 years with a range of 3 to 75yrs. Median age was 28yrs. Eighty-nine (85.6%) were males while fifteen (14.4%) were females. The genitalia were the most affected in 34% (n=35) of the patients. Gunshot was the commonest mechanism of injury (37.5%, n=39). Operative and non-operative management were employed depending on mechanism and extent of injury.Conclusions: Gunshot was the commonest cause of genitourinary trauma. These injuries require specialized attention for proper assessment and management.

Use of transverse penile fasciocutaneous flap in management of long segment anterior urethral stricture at the Jos university teaching hospital, Jos Nigeria

Background: Urethral stricture may be defined as a narrowing of the lumen of the urethra due to scar tissue formation. It results from fibrosis and loss of compliance of the urethra leading to bladder outlet obstruction. Treatment of long segment urethral stricture is a huge challenge to the reconstructive Urologist. This study is to determine the aetiology of long segment urethral stricture, location of the stricture, use of distal transverse penile fasciocutaneous flap and the complications associated with the use of the flap.Methods: Twenty two patients with long segment anterior urethral stricture from 2014 to 2017 at the Jos University teaching hospital were included in the study. Patient assessment included complete history including past interventions for the urethral stricture disease, physical examination and radiological examination. Patient’s age, aetiology of stricture, stricture length, location of stricture, surgical management and complications were recorded.Results: Twenty two consecutive patients were involved in the study. The mean age was 48.8years with a range of 35 to 70 years. Post infection accounted for 64% of the strictures while catheter induced inflammatory stricture accounted for 36%. The mean length of the stricture was 9.4cm, with a range of 5cm to 15cm. Penile fasciocutaneous flap was used in all the repairs. Overall complication was 27.3%.Conclusions: Transverse penile fasciocutaneous flap is a well-vascularized pedicle and skin island. It is mobile and can be adapted to repair long segment anterior urethral strictures. Surgical complications include ring stenosis, penile skin necrosis and urethrocutaneous fistula

Correlation of Level of Serum 25-Hydroxy Vitamin D and Gleason Score as a Measure of Aggressiveness of Prostate Cancer in Black Africans

Background Cancer of the prostate (CaP) is the second most commonly diagnosed cancer worldwide and the sixth leading cause of death from cancer in males. . Black men of African descent have higher risk for developing prostate cancer and are most likely to present at a younger age with more advanced disease and a poorer disease prognosis. Objective To determine if there is a relationship between the level of serum 25 hydroxy vitamin D and aggressiveness of prostate cancer using the Gleason score in black Africans in Jos. Methods A cross sectional study conducted among fifty patients presenting at the urological surgical out-patient clinics of the Jos University Teaching Hospital who were evaluated to have a clinical diagnosis of prostate cancer and scheduled for prostate biopsy. Blood samples for serum 25-hydroxy vitamin D were assayed using the ELISA technique, prostate biopsy was done and only those histologically confirmed to be prostate cancer were analysed. Data was collected using a proforma with statistical analysis done using SPSS(R) version 23 and Spearman’s rank correlation test used with a p-value < 0.05 considered significant. Results Fifty patients with histologically proven prostate cancer was studied whose age ranged from 50-89 years with a predominant age group 70-79 years (70.0±7.9).The mean level of serum 25-hydroxy vitamin D was 37.90ng/ml±17.92. All patients in the study had adenocarcinoma as the histologic type with a mean Gleason score of 9.36±13.14. A Spearman’s rank order correlation was statistically significant (rs (50) = -0.423, p = 0.002). Conclusion A Spearman’s rank order correlation shows a moderate negative correlation between the serum 25- hydroxy vitamin D and Gleason score (rs (50) = -0.423, p = 0.002.Thus, serum 25-hydroxy vitamin D assay can be used to prognosticate in patients with cancer of the prostate

Value of the visual prostate symptom score in evaluation of symptomatic benign prostatic enlargement: prospective study in a Nigerian population

Background: To evaluate the correlation of Visual Prostate Symptom Score (VPSS) with International Prostate Symptom Score (IPSS) and Maximum Urinary Flow (Qmax). To investigate the effect of educational level on the ability to independently complete the VPSS versus the IPSS and time taken to do so.Methods: Bio data was taken from men with lower urinary tract symptoms (LUTS) due to Benign Prostatic Enlargement (BPE) who presented at the Urology clinic of Jos University Teaching Hospital. They were administered the IPSS questionnaire and VPSS pictogram, which they completed with or without physician assistance and the time taken to do so was noted. They subsequently had uroflowmetry done on same visit and the data was recorded in a structured proforma. Statistical analysis was done using SPSS(R) version 20. Correlation test was done for VPSS, IPSS and Qmax 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: Eighty-five men (aged 42 to 94 years) were enrolled in the study. The VPSS correlated significantly with the IPSS in terms of total score (r = +0.684, p<0.001) and QoL (r = +0.570, p<0.001), as well as with the Qmax (r = -0.222, p = 0.041). A greater proportion (21.2%) of men with limited education could complete the VPSS without physician assistance as compared to the IPSS (6.0%) and the average time taken to complete the VPSS (170.51 seconds) was significantly shorter than the time taken to complete the IPSS (406.42 seconds).Conclusions: The VPSS correlates significantly with the IPSS and Qmax. It can be completed without physician assistance by a greater proportion of men with limited education within a shorter time period

Relationship between Hormonal Profile and Therapeutic Testicular Biopsy/ TESE Findings in Azoospermic Men

Background: Ten to twenty per cent of infertile men are azoospermic. Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone, control development and maturation of the gonad as well as spermatozoa production. Understanding these hormonal interactions have significant clinical consequences in the evaluation and treatment of azoospermic men.Objective: To determine the pattern of hormonal derangement in azoospermic men, the histology of testicular tissue obtained at therapeutic testicular biopsy/ testicular sperm extraction (TESE) and the relationship between hormonal profile and histology of testicular tissue.Methodology: This study was conducted on patients with infertility from 2015 to 2019 in a fertility centre in Jos, Nigeria. Clinical evaluation included history, physical examination and seminal fluid analyses. Azoospermic men had hormonal profiles (FSH, LH, Prolactin and Testosterone) assay and subsequently counselled for therapeutic testicular biopsy/ testicular sperm extraction for artificial reproductive technology. Hormonal assay levels and histologic findings were analysed, using SPSS version 23.Results: Twenty-nine (n=29) men with azoospermia were analysed in this study. The mean age was 36.97±8.28 years with a range of 24-56years. Eight patients (n=8, 27.59%) had normal spermatogenesis while twenty-one patients (n=21, 72.41%) had various forms of abnormality, the commonest being spermatogenic arrest 31%. All patients with normal spermatogenesis (27.59%) and spermatogenic arrest at spermatocyte level(24.14%) had normal FSH and LH levels. FSH showed a strong correlation with testicular function, LH showed strong correlation while Prolactin showed negligible correlation.Conclusion: Hormonal profile of azoospermic men can provide an insight into the possibility of testicular sperm retrieval. Normal hormonal levels do not indicate adequate testicular sperm (spermatogenic arrest at spermatocyte level) at therapeutic testicular biopsy/TESE. Elevated hormonal levels, however, indicate various forms of impaired spermatogenesis, these men should be advised to have donor sperm backup for ICSI. Keywords: Infertility, Azoospermia, Hormonal profile, FSH, LH, Therapeutic testicular biopsy, TES

Contemporary management of genitourinary injuries in a tertiary trauma centre in Nigeria

Background: The genitourinary system has been shown to be involved in 10% of patients presenting after trauma and is therefore a significant factor in trauma induced morbidity and mortality. It affects all age groups and both sexes. The aim of this study is to determine the aetiology, mechanism of injury and management of genitourinary injuries in a tertiary trauma centre.Methods: This is a prospective study carried out at the Jos University Teaching Hospital between 2012 and 2017. All patients who presented at the A and E with genitourinary trauma were recruited into the study. Initial assessment involved taking an AMPLE history and resuscitation, using the Advanced Trauma Life Support (ATLS) protocol of the American College of Surgeons. Physical examination and investigation were carried out to localize and determine extent of injury. Investigations carried out were complete blood count, blood grouping, serum electrolyte, urea and creatinine and radiography where applicable. Surgical intervention was carried out where indicated.Results: A total of 104 patients were involved in this study. The mean age was 32.14±15.5 years with a range of 3 to 75yrs. Median age was 28yrs. Eighty-nine (85.6%) were males while fifteen (14.4%) were females. The genitalia were the most affected in 34% (n=35) of the patients. Gunshot was the commonest mechanism of injury (37.5%, n=39). Operative and non-operative management were employed depending on mechanism and extent of injury.Conclusions: Gunshot was the commonest cause of genitourinary trauma. These injuries require specialized attention for proper assessment and management.

Use of transverse penile fasciocutaneous flap in management of long segment anterior urethral stricture at the Jos university teaching hospital, Jos Nigeria

Background: Urethral stricture may be defined as a narrowing of the lumen of the urethra due to scar tissue formation. It results from fibrosis and loss of compliance of the urethra leading to bladder outlet obstruction. Treatment of long segment urethral stricture is a huge challenge to the reconstructive Urologist. This study is to determine the aetiology of long segment urethral stricture, location of the stricture, use of distal transverse penile fasciocutaneous flap and the complications associated with the use of the flap.Methods: Twenty two patients with long segment anterior urethral stricture from 2014 to 2017 at the Jos University teaching hospital were included in the study. Patient assessment included complete history including past interventions for the urethral stricture disease, physical examination and radiological examination. Patient’s age, aetiology of stricture, stricture length, location of stricture, surgical management and complications were recorded.Results: Twenty two consecutive patients were involved in the study. The mean age was 48.8years with a range of 35 to 70 years. Post infection accounted for 64% of the strictures while catheter induced inflammatory stricture accounted for 36%. The mean length of the stricture was 9.4cm, with a range of 5cm to 15cm. Penile fasciocutaneous flap was used in all the repairs. Overall complication was 27.3%.Conclusions: Transverse penile fasciocutaneous flap is a well-vascularized pedicle and skin island. It is mobile and can be adapted to repair long segment anterior urethral strictures. Surgical complications include ring stenosis, penile skin necrosis and urethrocutaneous fistula