Urologic daycase surgery: A five year experience

Background: Expectedly, daycase surgery (DCS) is today witnessing a boom in developing countries as a reasonable option in the face of global economic recession, although with limited scope.Aim: The aim of this study was to describe the urologic day surgery experience at the Lagos State University Teaching Hospital, Ikeja.Materials and Methods: All day-case urologic surgeries done between January 2006 and December 2010 were retrospectively studied. Data obtained were patients’ personal details, diagnoses, procedures performed, mode of anesthesia, and surgical complications as well as admission rate.Results: A total of 1070 operations were performed. The patients were aged 7 days to 92 years. Local anesthesia was employed in 42.2% while general anesthesia was used in 1.7% of patients, mostly pediatric cases. Caudal block anesthesia (55.8%) was administered for transrectal prostate biopsy and urethrocystoscopic procedures. The diagnostic and therapeutic urologic procedures in adults were mainly prostate biopsy (n = 344, 32.1%), urethrocystoscopy (n = 218, 20.4%), varicocelectomy (n = 143, 13.4%), and orchidectomy (n = 93, 8.7%). Mohan’s valvotomy was the most common pediatric operation (n = 19, 1.8%). Postoperative morbidities that warranted hospital admission were observed in 17 (1.6%) cases.Conclusion: Urologic day surgery is feasible with minimal morbidities. The provisions of a dedicated day-case unit or a mobile DCS service may further improve on the volume of cases that can be operated on a  day-case basis and has the potential of further reducing the waiting time for surgery.Key words: Daycase, surgery, urolog

Urethrocutaneous fistula complicating circumcision in children

Introduction: Urethrocutaneous fistula is an unusual but preventable complication following circumcision. We describe our experience with the management of this potentially challenging condition.Materials and Methods: We reviewed all patients who had surgical repair of post‑circumcision urethrocutaneous fistula from September 2008 to September 2011 in our institution.Results: Thirty‑one cases presenting at age 4 weeks to 12 years were managed. Twenty‑six (84%) had had circumcision in the neonatal period. Most circumcisions (81%) were carried out by nurses using the dissection method and without anesthesia. In 30 (97%) patients, the fistula was single. The fistula size ranged from 1.5 to 12 mm in the widest diameter. Modified Mathieu’s flap procedure was used in the repair of 18 (56%) fistulae and 9 (28%) fistulae were by simple closure. Recurrence of the fistula was seen in 8 (25%) patients with large fistulae > 5 mm in diameter. The recurrent fistulae were small and were repaired by simple closure.Conclusion: Urethrocutaneous fistula post‑circumcision is frequently seen in our practice and the surgical repair is challenging and associated with high recurrence rate in large fistulae. This preventable condition may be avoided by proper education and training of circumcisers.Key words: Circumcision, complication, repair, urethrocutaneous fistul

Surgical Management of Prepubertal Urethral Prolapse: A report of 3 cases.

Background: Urethral Prolapse is rare but a differential diagnosis of interlabial masses in prepubertal females. It usually presents with vaginal bleeding and may heighten the suspicion of sexual abuse.Methods: Our series of 3 cases all presented with vaginal bleeding and all had primary surgical excision of the prolapsed urethral mucosa.Results and Conclusion: Surgical management is definitive and should be considered as the first line treatment in our environment.Parents, caregivers and medical personnel in our environment should be able to identify and recognise it

Prevalence and characteristics of prostate cancer among participants of a communitybased screening in Nigeria using serum prostate specific antigen and digital rectal examination

Introduction: Prostate cancer (CaP) is the most commonly diagnosed cancer among Nigerian men but CaP screening is not a common practice. The true burden of the disease in Nigeria is not known. The study was aimed at studying the community burden of CaP in Lagos. Methods: During a community-based prostate cancer awareness program in 13 local government areas of Lagos, men aged >40 years had serum total PSA (tPSA) test and digital rectal examination (DRE). Those with abnormal DRE or tPSA >95th percentile of the cohort or both were selected for prostate biopsy (TRPB). Results: 4172 men were screened and complete data was available for 4110 (98.5%). The mean age was 60.8 years. DRE was abnormal in 410 men and was significantly correlated with the age of the patient and tPSA (p<0.001). The tPSA ranged from 0 to 438.3ng/ml with a median, mean and 95th percentile of 1.5, 2.5 and 10.0ng/ml respectively. 341 out of the 438(78%) men selected were subjected to TRBP. Forty-three men had histological diagnosis of CaP, giving an estimated prevalence rate of at least 1.046% or 1046 per 100,000 men of age ≥40. Only 11 (26%) had organ-confined disease while 17 (40%) had locally advanced disease and 15 (35%) men had metastatic disease. The  majority of the men, 32 (74%) were reported to have Gleason's score of ≥7. Conclusion: The prevalence rate of CaP among men aged ≥40 years in Lagos is higher than previously reported in hospital-based study. Majority have advanced and high-grade diseaseKey words: Prostate, cancer, prevalence, screening, Nigeri

Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial [ISRCTN77781689]

BACKGROUND: Randomized controlled trials comparing different vasectomy occlusion techniques are lacking. Thus, this multicenter randomized trial was conducted to compare the probability of the success of ligation and excision vasectomy with, versus without, fascial interposition (i.e. placing a layer of the vas sheath between two cut ends of the vas). METHODS: The trial was conducted between December 1999 and June 2002 with a single planned interim analysis. Men requesting vasectomies at eight outpatient clinics in seven countries in North America, Latin America, and Asia were included in the study. The men were randomized to receive vasectomy with versus without fascial interposition. All surgeons performed the vasectomies using the no-scalpel approach to the vas. Participants had a semen analysis two weeks after vasectomy and then every four weeks up to 34 weeks. The primary outcome measure was time to azoospermia. Additional outcome measures were time to severe oligozoospermia (<100 000 sperm/mL) and vasectomy failure based on semen analyses. RESULTS: We halted recruitment after the planned interim analysis, when 841 men had been enrolled. Fascial interposition decreased time to azoospermia (hazard ratio [HR], 1.35; P < 0.0001) and time to severe oligozoospermia (HR, 1.32; P < 0.0001) and reduced failures based on semen analysis by about half, from 12.7% (95% confidence interval [CI], 9.7 to 16.3) to 5.9% (95% CI, 3.8 to 8.6) (P < 0.0001). Older men benefited less from fascial interposition than younger men in terms of the speed of achieving azoospermia. However, the number of vasectomy failures was reduced to a similar degree in all age groups. Slightly more adverse events occurred in the fascial interposition group, but the difference was not significant. These failure rates may appear high to practitioners in countries such as the USA, but they are similar to results from other careful studies of ligation and excision techniques. CONCLUSION: Fascial interposition significantly improves vasectomy success when ligation and excision is the method of vas occlusion. A limitation of this study is that the correlation between postvasectomy sperm concentrations and risk of pregnancy is not well quantified

Penile Injuries In Lagos State University Teaching Hospital Ikeja: A 7-year Experience

Background: Injuries to the penis are not frequent events and usually not life threatening. However, they may be associated with significant  long term psychological and functional impairment. This study elucidates the clinical spectrum of penile injuries in the Lagos State University Teaching Hospital and how they were managed.Methods: This was a 7-year retzrospective study of all cases of penile injury managed in the Urology unit of a teaching hospital in South West Nigeria; between February 2006 and January 2012.Results: There were 50 cases of penile injury, with the age range between 4 weeks to 49 years and an average age of 12.1 years. Circumcision and sex-related causes accounted for 76% and 18% of the injuries respectively, while occupation and ritual-related causes accounted for 2% each. Urethro-cutaneous fistula (n=22, 44%), penile fracture (n=9, 18%) and penile amputation (n=5,10%) were the commonest injury types. All the cases were managed operatively.Coculusion: Circumcision was the leading cause of penile injury in this study. Mass education of all categories of circumcisers on safe circumcision practices would be desirable