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

The Effect of Varied Doses of Nicotine on Some Morphometric Parameters of the Testis in Albino Wistar Rats

Background: This study is aimed at determining the effect of nicotine on male fertility by evaluating some morphometric parameters of male Wistar rat such as testicular weight, seminiferous tubule diameter, height of epithelium, sertoli-germ cell ratio and Johnsen’s score  in order to assess the spermatogic  index. Methods: 20 adult male rats were randomly divided into four groups, the test groups were administered with 0.2mg/100g, 0.4/100g and 0.6/100g body weight of nicotine base daily for 30 days using a polythene catheter orally , while the control were administered with 2mls 0.9%physiological saline. Histological slides of the testis were made and data obtained from the slides. Results: nicotine caused a significant reduction (P < 0.05) and (P< 0.01) in the mean values of the morphometric parameters of the test group compared with control. The Johnsen’s Score results were 5.4 ± 0.51*, 5.2 ± 0.37* for groups 2 and 3 respectively. For seminiferous tubule diameter the significant values were 208.0±4.22**, 184.5±11.31**in groups 2 and 3, whilst the height of epithelium showed a significant reduction of 153.9± 13.58*, 101.6 ± 1.35**, 76.6 ± 6.65** for groups 1, 2 and 3 respectively. Sertoli-germ cell ratio showed a significant reduction in groups 2 and 3 with values of 3.6 ± 0.77 ** , 1.5 ±  0.16**for groups 2, and 3 respectively, testicular weight showed significant reduction of 1.2±0.05**,1.1±0.05** for group 2 and 3.The results stated are only those that showed a significant reduction at 95% confidence level when compared with the control. Conclusion:  It was concluded that nicotine exerted an adverse effects on the spermatogenic index with concomitant reduction in reproductive potentials of the male rat. Nicotine and nicotine- based products should therefore be taken with caution in cases of infertility in man and animal. Key words: Morphometric parameters ,Johnsen’s Score,Spermatogenic index , fertilit

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

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