Is extended biopsy protocol justified in all patients with suspected prostate cancer?

Objective: To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance.Materials and Methods: We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson’s Chi square test with level of significance set at <0.05.Results: The overall cancer detection by the extended technique was 61 (48.8%) cases while the sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04).Conclusion: Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE

Intravesical Migration of a Failed and Forgotten Intrauterine Contraceptive Device after 20 years of Insertion - A case report

Intrauterine contraceptive device (IUCD) is a commonly utilized reversible contraceptive technique especially in the developing world. Though effective, it is not immune to complications. Migration of the device is a rare but serious complication which may be symptomatic or asymptomatic. We report a case of a 45yr old woman who had IUCD inserted 20 years earlier and had forgotten about it since she subsequently had three full term pregnancies leading to successful vaginal deliveries. The forgotten IUCD was discovered incidentally during evaluation of the woman for haematuria as it had migrated to the wall of the bladder. The case is reported to increase index of suspicion as detailed clinical history is important in evaluating cases of haematuria.Keywords: IUCD, intravesical migration, haematuria, LUT

Original Articles Efficacy and Safety of Doxazosin (CARDURATM) in the Management of Benign Prostatic Hyperplasia

ObjectiveTo assess the efficacy and safety of the selective á -blocker doxazosin in black men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia.Patients and MethodsAn open-label study involving consecutive patients with benign prostatic hyperplasia. They were asked to complete the International Prostate Symptom Score (IPSS), with its eighth question (bother score) and perform basic uroflowmetry. The study involved the use of doxazosin for the treatment of symptomatic benign prostatic hyperplasia in three phases. Phase 1 of washout period/enrolment, a two weekly interval titration phase and a maintenance phase for four weeks. The symptom score (IPSS), bother score and uroflowmetry were used to evaluate the severity of the condition and the efficacy of the drug.ResultsTwenty-four patients were enrolled into the study, only 18(75%) completed the eight-week study. The ages of the patients ranged between 46 years and 82 years with a mean of 66 years. (SD, 10.0). Fourteen patients were stabilized on 4mg doxazosin while the remaining 4 patients had 2mg. There was significant improvement of the symptoms, with a remarkable sharp decline after two weeks of medication in IPSS by 8 points from baseline. The improvement was sustained over the following six weeks period. The bother score (quality of life index) was similarly observed to decline from a mean of 4.7 at baseline to 1.3 at the end of the study. The clinical trial showed a significant increase in the urine flow rate with an improvement of 4mls/second from baseline and a 24.1% increase in voided volume. There was no adverse event recorded in all the patients to warrant discontinuation of the study.ConclusionDoxazosin is an effective and well tolerated drug in the treatment of symptomatic BPH in Nigerians.Key Words: BPH, LUTS, Quality of life, IPSS, a1-blocker, Doxazosin

Surgically Correctable Morbidity from Male Circumcision: Indications for Specialist Surgical Care in Lagos

Aim/Objective: To determine the pattern of morbidity and outcome among patients referred to the Pediatric Surgery Unit of the Lagos University Teaching Hospital (LUTH) following circumcision. Materials and Methods: Retrospective descriptive study of all patients with complications of circumcision who were managed in LUTH between 2008 and 2010. Results: There were 36 patients. The age range was between 2 days and9 years (median-3 months). Fifteen cases (42.9%) were due to urethro.cutaneous fistula while there were six cases (16.7%) of postcircumcision bleeding. There were four cases (11.1%) each of partial penile amputation and buried penis. There were also cases of meatal stenosis, penile implantation cyst and glanulo.preputial skin bridge. With respect to the treatment offered, eleven (30.6%) patients had urethroplasty for the urethro.cutaneous fistulae while seven (19.4%) patients had penile refashioning for the buried penis and penile amputation. Appropriate surgical treatments were performed for the other complications.Conclusion: Urethrocutaneous fistula and penile amputation are the commonest complications of circumcision for which referral is made to LUTH. Treatment outcome was satisfactory. Health education and legislation to ensure procedure is performed by qualified medical and paramedical staff may reduce the morbidity.Keywords: Circumcision morbidity, indications, specialistcar

Clinico-pathological Correlation of Digital Rectal Examination Findings Amongst Nigerian Men with Prostatic Diseases: A Prospective Study of 236 Cases

Aims and Objective: This study aims at correlating different digital rectal examination (DRE) abnormalities with histopathological results in patients with prostatic diseases. Materials and Methods: A prospective study of 236 patients who underwent prostate needle biopsy (PNB). Inclusion criteria were presence of abnormal DRE findings or elevated prostate specific antigen above 4 ng/ml or both. They all had 10.core extended transrectal biopsy and specimens were sentfor histopathological examination. Correlations were made between DRE findings and histopathology results. Two separate multivariate logistic regression models were created; the first evaluated the relationship of predictors (DRE findings) to the likelihood of detecting cancer and the second explored predictors of high.grade cancer on PNB.Results: Two hundred and thirty.six patients were enrolled with a mean age of 66.9 years and range of 43.90 years. Histopathology results were malignant in 102 (43.2%) and benign in 134 (56.8%). Ninety.one (38.6%) and 145 (61.4%) had normal DRE and abnormal DRE findings with cancer detection rates of 23.1% and 55.8% respectively. Nodular prostate is the most common abnormality in 63.4% patients with abnormal DRE. Each sign of DRE had different predictive value with enhanced positive predictive value when combinations of abnormalities are present. Abnormal DRE is an independent predictor of high.grade tumor. Mean Gleason scores were 4.7and 7.1 in patients with normal and abnormal DRE respectively.Conclusion: DRE is a useful and important tool in assessing patients with suspected prostate diseases who need prostate biopsy. An abnormal DRE correlated well with prostate cancer and independently predicted high.grade disease in these men. Keywords: Clinico-pathological correlation, digital rectal examination findings, prostate cancer, prostate needle biops

Clinical and Proctosigmoidoscopic findings in Patients with Anorectal Sepsis in a Private Health Facility in Lagos, Nigeria

Background: Anorectal sepsis is a distressing condition which is sometimes inadequately treated.Objectives: To determine the clinical and prostosigmoidoscopic findings in patients with anorectal sepsis seen by the authors over a 5 year period as well as identifying the commonly performed procedures.Method: A review of all the records of patients seen by the authors over a 5 year period was carried out. The demographic pattern was determined including the age, sex, mode of presentation, and associated co-morbidities. The detailed perianal and protosigmoidoscopic findings were also notedResults: 45 males and 10 females were seen during the study period. The mean age incidence was 43.4 years. The commonest mode of presentation was perianal discharge and pain in over 85% of the patients seen. The low anal fistula was the commonest pathology on proctosigmoidoscopy while abscesses and external haemorrhoids were the other commonly occurring lesions found. Fistulotomy was the most commonly perfomed procedure while diabetes was the most common comorbidity.Conclusion: Anorectal sepsis most commonly affects males in the fifth decade of life. Thorough evaluation and adequate operative treatment appear to result in satisfactory early outcome.KeyWords: Anorectal sepsis, fistula in ano, proctosigmoidoscop

Impact of prostate size on cancer detection values of two different prostate biopsy strategies amongst Nigerian men

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