Transperineal versus transrectal prostate biopsy: Our findings in a tertiary health institution

Context and Objective: Prostate cancer is a major public health issue. Its incidence is rising, especially in Nigeria. Prompt diagnosis is necessary by histology. Transperineal and transrectal approaches to prostate biopsy are well documented. Both methods are fraught with complications though, most times minor. Studies carried out to compare both methods were carried out mainly on Caucasians, generating conflicting results. This study aims to compare the complication rates and tissue yield of these two methods in Nigerian men.Materials and Methods: Seventy-five patients completed the study. Forty-five patients had transperineal prostate biopsy (TPbx), while 30 patients had transrectal prostate biopsy. Pain perception for all patients was determined by visual analog scale; whereas the complications were ascertained by a validated purpose designed questionnaire administered on the 7th and 30th day post operatively.Results: The risk of rectal bleeding was higher for transrectal prostate biopsy compared to transperineal (Odds ratio: 0.03; 95% confidence interval (CI): 0.001.0.450; P = 0.012). TPbx was more painful than transrectal (P < 0.0001; df: 75; t: 4.98; 95%CI of difference in mean: .2.98.[.1.28]). There was no statistical difference between transperineal and transrectal prostate biopsy in hemospermia, fever, prostatic abscess, urethral bleeding, acute retention and tissue yield.Conclusion: TPbx is more painful than transrectal prostate biopsy though with a significantly reduced risk of rectal bleeding. There appears to be no significant difference with respect to risk of fever, urethral bleeding,  hematospermia, prostatic abscess and acute retention. Both routes provided sufficient prostate tissue for histology.Key words: Comparative analysis, transperineal prostate biopsy,  transrectal prostate biops

Recall of Consent Information by Day Care Prostate Biopsy Patients: An Assessment of the Role of a Third‑party Check

Background: To evaluate the extent of recall of consent  information by daycare prostate biopsy patients in our low-literacy setting. And to evaluate the role of a 3rd party check on patient’s recall of consent information. Subjects and Methods: As part of our standard of care, a formal informed consent session for day care prostate biopsy takes place 3 days prior to the procedure. For this study, before leaving the outpatient clinic the same day, the patient acknowledged before a third‑party that his concerns were or were not satisfactorily addressed. The extent of recall of consent information was assessed on the morning of the procedure using a researcher‑administered questionnaire. Consecutive patients participated in this cross‑sectional study for day care prostate biopsy at a tertiary hospital in southeast Nigeria from February to November 2015 after obtaining due consent. Results: The recall of the risks associated with the planned procedure was poorer than the recall of the nature of the disease condition or the nature of the planned procedure. However, it was observed that aggregate recall was significantly poorer among patients who negatively attested to a satisfying consent session (OR 0.125; P < 0.0005). Conclusion: The use of a third‑party in determining patient satisfaction after a consent session may be a better indicator of patient comprehension and subsequent recall of consent information, especially in low‑literacy settings. Using a third‑party, in this manner, may assist in checking paternalism inherent in the patient‑doctor relationship

Serum total prostate-specific antigen values in men with symptomatic prostate enlargement in Nigeria: role in clinical decision-making

Ikenna I Nnabugwu,1,2 Fred O Ugwumba,1 Oghenekaro A Enivwenae,2 Emeka I Udeh,1 Chris O Otene,2 Chinwe A Nnabugwu3 1Urology Unit, Department of Surgery, College of Medicine, University of Nigeria, Nsukka, 2Urology Unit, Department of Surgery, 3Department of Medical Laboratory Services, Federal Medical Centre, Asaba, Nigeria Background: Prostatic enlargement is a common cause of bladder outlet obstruction in men in Nigeria. Malignant enlargements must be differentiated from benign enlargements for adequate treatment of each patient. High serum total prostate-specific antigen (tPSA) levels suggest malignancy, but some of the biopsies done due to a serum tPSA value >4 ng/mL would be negative for malignancy because of the low specificity of tPSA for prostate cancer. This study aims to compare the histologic findings of all prostate specimens obtained from core needle biopsy, open simple prostatectomy, and transurethral resection of the prostate with the respective serum tPSA values in an attempt to decipher the role of serum tPSA in the management of these patients.Methods: The case notes of patients attended to from April 2009 to March 2012 were analyzed. Essentially, the age of the patient, findings on digital rectal examination, abdominopelvic ultrasonography report on the prostate, serum tPSA, and histology reports from biopsy or prostatectomy specimens as indicated were extracted for analysis.Results: The relationship between age, findings on digital rectal examination, serum tPSA, abdominopelvic ultrasonography report, and histology are compared. A statistically significant relationship existed between a malignant histology and age 65 years and older, suspicious findings on digital rectal examination, suspicious ultrasonography findings, and serum tPSA >10 ng/mL, but not tPSA >4 ng/mL.Conclusion: In Nigerian patients with symptomatic prostate enlargement, serum tPSA should be seen as a continuum with increasing risk of prostate malignancy. Keywords: serum total prostate-specific antigen, symptomatic prostate enlargement, prostate histolog

Effects of electronic massager on patients with advanced cancer of the prostate

Background: The electronic massager has in recent times become sopopularized that it is used in the treatment of almost every ailment. Itsprescriptions range from treatment of obesity through acute painful conditions to the treatment of complications of cancer conditions. There are many claims and counter claims from the manufacturers of such massagers and it is becoming increasingly difficult to control its usage by people, both the sick and the healthy; even when its use is not obviously indicated. Some of our prostate cancer patients also were not left out in the craze for massagers.Objective: The objective of this study is to determine the effects of theelectronic massager on patients with advanced prostate cancer.Materials and Methods: This is a retrospective study done in our unit to find out any effects of using the electronic massager on advanced prostate cancer patients. The folders of patients diagnosed as cancer of the prostate over a period of five years were traced from the Records Department of the University of Nigeria Teaching Hospital, Ituku / Ozalla. Those who had histological diagnosis / clinical late stages i.e. stages III & IV were selected. The effects of electronic massager on those who had used it were studied vis-à-vis their counterparts who did not use it.Results: There were twenty-seven advanced (Stages III &IV) prostate cancer patients seen over a period of five years. Five of the patients used the electronic massagers and all five died within one year of getting readmitted in the hospital; four of them within three months, while the last one died about the seventh month. Those who did not use electronic massagers survived beyond one year from the time of readmission.Conclusions: The use of the electronic massager increases morbidity and mortality rates in prostate cancer patients.Keywords: Advanced prostate cancer, effects, massage

Peri-operative Blood Transfusion in open Suprapubic Transvesical Prostatectomy: Relationship with Prostate Volume and Serum total Prostate Specific Aantigen (TPSA)

INTRODUCTION: Open simple prostatectomy is the most effective and the most durable method of controlling symptoms associated with benign prostatic hyperplasia, especially in sub- Saharan Africa, where TURP set and expertise are unavailable in most health institutions. The risk of perioperative heterologous blood transfusion in open transvesical prostatectomy varies widely from one centre to another, and this risk is documented to improve over time in any given centre.AIM: To determine the perioperative blood transfusion rate in our centre and to determine its relationship with the prostate volume estimated with transabdominal ultrasonography and serum total PSA.METHOD: A Retrospective study of patients surgically managed for BPH in 25months (from March 2009 to March 2011). RESULTS: A total of 36 patients were included. Eighty-six percent of these patients had indwelling urinary catheter introduced earlier due to acute or chronic urinary retention, while 19.6% had macroscopic haematuria at presentation. The mean prostate volume was 90.4cm3 (36-164), with 67% of cases having volumes greater than 70cm3. Ninety-one percent of the patients had serum tPSA greater than 4ng/ml (1.5-85.3ng/ml, mean was 22.8ng/mL). The perioperative transfusion rate was 8.3% and it is not affected by the prostate volume (X2Yates = 0.884), or serum total PSA (X2Yates = 0.417). There was no perioperative mortality.CONCLUSION: Open suprapubic transvesical prostatectomy is still a safe procedure; with a perioperative blood transfusion rate of 8.3% in our centre. This risk appears to be unrelated to preoperative prostate volume and serum tPSA.KEY WORDS: Transvesical prostatectomy, Benign prostatic hyperplasia, Prostate volume, Perioperative blood transfusion

Predicting Gleason score using the initial serum total prostate-specific antigen in Black men with symptomatic prostate adenocarcinoma in Nigeria

Ikenna I Nnabugwu, Emeka I Udeh, Fredrick O Ugwumba, Francis O Ozoemena Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria Background: Men of Black African descent are known to have the highest incidence of prostate cancer. The disease is also more aggressive in this group possibly due to biologically more aggressive tumor or late presentation. Currently, serum prostate-specific antigen (PSA) assay plays a significant role in making the diagnosis of prostate cancer. However, the obtained value of serum PSA may not directly relate with the Gleason score (GS), a measure of tumor aggression in prostate cancer. This study explores the relationship between serum total PSA at presentation (iPSA) and GS.Patients and methods: The iPSA of patients with histologically confirmed prostate cancer was compared with the obtained GS of the prostate biopsy specimens. The age of the patients at presentation and the prostate volumes were also analyzed with respect to the iPSA and GS. The data were analyzed retrospectively using IBM SPSS Version 20. Pearson correlation was used for numeric variables, whereas Fisher’s exact test was used for categorical variables. Significance was set at P≤0.05.Results: There were 205 patients from January 2010 to November 2013 who satisfied the inclusion criteria. iPSA as well as age at presentation and prostate volume were not found to significantly correlate with the primary Gleason grade, the secondary Gleason grade, or the GS. However, the presence of distant metastasis was identified to significantly correlate positively with GS.Conclusion: GS may not be confidently predicted by the iPSA. Higher iPSA does not correlate with higher GS and vice versa. Keywords: PSA, patient age, prostate volume, prostate adenocarcinoma, Gleason scor

Learning Transurethral Resection of the Prostate: A Comparison of the Weight of Resected Specimen to the Weight of Enucleated Specimen in Open Prostatectomy

Background: Minimally invasive procedures in the surgical management of benign prostate enlargement (BPE) are of limited use in the resource‑poor settings due to nonavailability of the requisite facilities and skills. It has been observed that teaching uroendoscopy inclusive of transurethral resection of the prostate (TURP) can be challenging in the resource‑poor settings where the traditional master‑apprentice (Halstedian) approach has remained the prevalent training technique. Patients and Methods: We aimed in this retrospective study to assess completeness of resection in TURP by comparing the proportion of prostate tissue resected to the proportion enucleated in open retropubic prostatectomy (ORP). We included all BPE patients on urethral catheter managed in the first 18 months after Halstedian training in TURP. The analysis was done using SPSS® 20 and VassarStats® online software. Results: Twenty patients’ files for TURP and twenty‑eight patients’ files for ORP met the inclusion criteria. Patients in the 2 treatment arms were similar in age (P = 0.22), body mass index (P = 0.45), proportion of prostate tissue extirpated (P = 0.38), and International Prostate Symptom Score 12‑month postprocedure (P = 0.06). However, larger prostates were treated with ORP (P < 0.0005). The correlation of the weight of resected specimen to preoperative prostate volume (PV) (r = 0.78; P < 0.001) was similar to that of enucleated specimen to preoperative PV (r = 0.89; P < 0.001). Similarly, the proportion of extirpated specimen correlated positively with the preoperative PVs for both TURP (r = 0.23; P = 0.33) and ORP (r = 0.292; P = 0.13), with no evidence of any difference between the 2 correlation values (P = 0.84). Conclusion: With appropriate patient selection, especially as a newly trained Surgeon, resections in TURP are as complete as enucleations in ORP.Keywords: Correlation, enucleated weight, Halstedian approach, learning trans‑urethral resection of the prostate, resected weight, retropubic prostatectom

Reducing the burden of regular indwelling urinary catheter changes in the catheter clinics: the opinion of patients and relatives on the practice of self-catheterization

Ikenna I Nnabugwu, Emeka I Udeh, Oghenekaro A Enivwenae, Fred O Ugwumba, Oyiogu F Ozoemena Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria Background: Clean intermittent self-catheterization is accepted worldwide as a standard of care for patients with long-standing need for urinary bladder decompression. Evidence of its routine practice in our low-resource setting is lacking, leading to increasing number of patients with a long-standing indwelling urinary catheter.Objective: To seek the opinion of patients already using indwelling catheters regarding the practice of self-catheterization.Patients and methods: Over a 4-month period, the opinion of every patient and patient’s relative that attended the regular urinary catheter clinic was sought using an intern-administered questionnaire. The data was analyzed using SPSS version 20.Results: A total of 108 patients completed the questionnaire. Age range was 16–100 years with a mean of 62.2±15.5 years. Only 30.5% of the patients had formal education beyond the primary level. The median cost for change of the indwelling catheter was 1,325 naira (8.28 US) with a range of 500–4,000 naira (3.13–$25 USD). Analysis showed that: 70.8% of patients aged under 60 years/60.6% of those with formal education beyond primary level/61.9% of those wearing catheters for <3 months would give consent for training in self-catheterization. Higher cost of catheter change did not influence the decision to consider self-catheterization. Of the 59 patient relatives who completed the questionnaire, 63% of those younger than 50 years old and 69.2% of those with tertiary education would be willing to undertake training to administer self-catheterization.Conclusion: A select group of patients and accompanying relatives in our low-resource setting are willing to learn and practice self-catheterization. Keywords: self-catheterization, patients’ opinion, indwelling cathete