Direct vision internal urethrotomy in 459 urethral stricture patients at Mulago Hospital, Kampala

Four hundred and fifty nine patients seen with simple urethral strictures between 1990 and 1998 underwent direct vision  urethrotomy.. The procedure was successful in 441 patients and failed in only 18 patients. Postoperative complications included fever in 31 patients, urethral bleeding in 14 and epididymitis in 17 patients. The average  hospital stay for patients who did not develop  complications was 3 days. In  conclusion, direct vision internal urethrotomy can be used to treat simple urethral  strictures. It is an easy and short procedure and only associated with minor complications.Keywords: Direct vision, internal, urethrotomy, urethral and strictur

Prevalence and patterns of undescended testis among primary school pupils in Kampala, Uganda

A cross sectional study was undertaken with the main objective of determining the prevalence and patterns of undescended testis (UDT) among 437 primary  School pupils from randomly selected primary schools in one Division of  ampala in Uganda. The study variables included age, tribe, scrotal findings, side and location of the undescended testis plus associated groin and external genitalia abnormalities. UDT was found in 27 of the 437 children. The right side alone was involved in 17 (63%), the left alone in 5 (18.5%) and was bilateral in five cases (18.5%). Sixteen (59%) of UDT were palpable in the inguinal region while in 11 (41%) could not be palpated. Ultrasonography of the groin area located five of the 11 impalpable testes. This study showed that the prevalence of UDT in the study population was 5.5% and occurred more commonly on the right side and the superficial inguinal pouch was the commonest site.Key words: Prevalence, pattern. Undescended and testis

Nasogastric Tube Knotting: Two Case Reports from Kampala, Uganda

Background: Nasogastric tube (NGT) use is common in patients’ care right from basic health units to tertiary hospitals. NGT knotting is a very rare complications associated with its insertion. In this review, we present two cases of NGT knottingencountered in two cases. Case Reports: The two cases presented around the same time in two major hospitals in Kampala. One was a 60-year female (Case 1) and another, a 24-year old female (Case 2). Both cases had been admitted with clinical features of small bowel obstruction secondary to adhesions. At surgery, Case 1 had resection and primary anastomosis for a gangrenous loop of ileum. Case 2 was first managed conservatively failing of which she had a laparotomy. As part of their preoperative management, they had a NGTs inserted, while fully conscious. The NGTs functioned well pre-operative, intraoperative and postoperative. Postoperatively, they both had difficulty NGT removal. Case 1 was a case of “overhand” knotting, while case 2 was a complex, “4-loop”knot, of plastic NGT. Conclusion: A review of literature reveals that no such cases have been documented from the East African region, and offer lesson for surgeons and gynaecologists. Healthcare providers should be aware of this and complication and how to ‘troubleshoot” the problem

Comparison of Desarda versus modified Bassini inguinal hernia repair: A randomized controlled trial

Background: Although the tension free inguinal hernia repair with a mesh is the standard technique in many developed countries, its use has remained low in the developing world due to the initial cost of the mesh. The most commonly used method in Mulago hospital is modified Bassini. The main aim of this study was to compare the short-term out come of Desarda’s versus modified Bassini inguinal hernia repair.Methods: One hundred and eight patients each with a unilateral, primary, reducible inguinal hernia were recruited through the surgical out patients department. Patients were randomly assigned to either the Desarda’s or Modified Bassini inguinal hernia repair. Postoperative pain was assessed using a visual analogue scale 1 to 2 hours after the operation, on the 3rd post operative day (POD) and again on the 7th POD. The gait was assessed on the 7th POD for all the patients and again on the 14th POD for those patients who had not attained their normal gait or had any postoperative wound complications on the 7th POD.Results: Of the 108 patients recruited, 88 (81%) were male and 20(19%) female. 3 patients were lost to follow up and 1 had an emergency laparotomy. The mean POD for resumption of normal gait was 3.62 for both methods. There was no statistically significant difference between the days of resumption of normal gait between the two methods (p-value = 0.94). There were no major complications using either of the two methods. There was no statistically significant difference between the two methods as regards the postoperative pain patterns 2 hours postoperative, on 3rd POD and on the 7th POD.Conclusion: There is no difference in short-term outcome between Desarda and modified Bassini inguinal hernia repair as regards resumption of normal gait and patterns of pain

Histopathological findings in post-inflammatory urethral strictures treated at Mulago hospital, Kampala, Uganda

The predominant risk factor for recurrence of urethral stricture after surgical  treatment is the extent of scarring and other related pathological findings in the affected segment of the urethra. In this study, 107 patients with post inflammatory urethral strictures aged between 23-79 years seen between 1996 and 1998 underwent a two-staged urethroplasty. During the first stage, incisional biopsies were taken from four areas namely the stricture itself, the segments proximal and distal to the stricture and the peri-urethral tissues surrounding the stricture. All the  four biopsies for each patient were subjected to histological examination. The  main histological finding was non-specific chronic inflammation and fibrosis. In the stricture part there was moderate diffuse chronic inflammation. In proximal segment, severe chronic inflammation with  ulceration of stratified squamous pithelium and urinary pockets werc the predominant  histological findings. It1 the distal segment, mild chronic inflammati( )11 dominated. Lastly, in the periurethral tissues there was fibrosis interspersed with chronic mild inflammation

The sonographic pattern of diseases presenting with scrotal pain at Mulago hospital, Kampala, Uganda

Background: Scrotal pain is a common presentation in the male patient. There is a wide overlap of symptoms and signs making differentiation at clinical diagnosis difficult. Ultrasound has been documented to improve the accuracy of diagnosis of scrotal diseases. This study was aimed at determining the sonographically detectable diseases in patients with scrotal pain, describe their sonographic appearances and to relate the diseases to the sociodemographic and clinical characteristics of the patients presenting at Mulago hospital.Patients and Methods: This was a Cross sectional descriptive study done at Mulago Hospital, between May 2003 and March 2004. Consecutive patients with scrotal pain referred for ultrasound evaluation and consented were scanned using an ATL HDI 1500 machine model 2000 with a 5-12 MHz linear probe.Results: Of the seventy-three patients, 19 had acute epididymitis, 19 chronic nonspecific epididymitis, 12 testicular torsion, and 7 tuberculous epididymo-orchitis diagnosed at ultrasound. The entire epididymis was more often involved and there was no significant difference in pattern of involvement in acute and tuberculous epididymitis except that the frequency of calcifications was significantly higher in tuberculous  epididymo-orchitis lesions than in those of either acute epididymitis  (p=0.0017) or chronic epididymitis (p=0.0017).Testicular torsion was more  common in adolescents and young adults. Acute epididymitis was seen in all age-groups and was associated with anomalies of the genitourinary tract at the extremes of age and sexual activity in young adults. Clinical assessment had low accuracy in diagnosis of cause of scrotal pain.Conclusion: Scrotal ultrasound gave added information in the diagnosis of patients with scrotal pain. This expedites proper patient management and reduces morbidity. Infections and testicular torsion are the commonest cause of scrotal pain at Mulago hospital. Tuberculous epididymo-orchitis is still a problem at Mulago Hospital

Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma

Background: The fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers’ burden can lead to a reduction in caregivers’ involvement. There is a relationship between caregivers’ involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers’ burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda. Methods: A cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers. Results: The findings indicate that affiliated stigma serves as a full mediator between the caregiver’s roles and involvement (β=15.97, p<0.001). Being female increased the caregivers’ burden of caregiving (β= -0.23, p<0.001). Conclusion: The findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden

Risky sexual behaviours among Ugandan university students: a pilot study exploring the role of adverse childhood experiences, substance use history, and family environment

Background: University students are known to have risky sexual behaviours (RSBs). The severity of the RSB is influenced by many factors, including the family environment, exposure to adverse childhood events (ACEs), and the use of addictive substances. However, there is limited information about the influence of ACEs and the family environment of these students in low-and medium-income countries (LMICs). Therefore, a pilot study was conducted among university students from a LMIC, Uganda. Methods: The present study comprised a cross-sectional online survey among Ugandan students at a public university (N = 316; 75% male; 52.2% aged between 18–22 years). The survey included questions relating to socio-demographic information, family environmental information, the Sexual Risk Survey (SRS), and the Adverse Childhood Experiences-International Questionnaire (ACE-IQ). Results: Over half (53.8%) reported having had sexual intercourse. Males reported over two times higher mean total SRS score compared to females (χ2 = 4.06, p = 0.044). Approximately one-sixth of the sample had drunk alcohol or used illicit psychoactive substances in the past six months (16.1%). Among four regression analysis models, sociodemographic variables predicted the highest variance (13%), followed by family environment variables (10%), and both psychoactive substance use history (past six months) and ACEs individually explained approximately 5% variance in total SRS score, with the final model predicting 33% of the variance in RSB. Conclusions: The present study demonstrated a gender disparity with males involved in more RSB than females, as has been reported in most previous RSB studies. Family environment, sociodemographic factors, substance use, and ACEs all appear to contribute to RSB among university students. These findings will benefit other researchers exploring factors associated with RSB among university students and will help develop interventions to reduce RSB to protect students from unwanted pregnancies, sexually transmitted diseases, and HIV/AIDS