Prostate cancer metastasis to the mandible: case report

Prostate cancer is recognised to be the commonest type of malignancy in the male in many parts of the world. Prostate cancer has a propensity to metastasize to bone, however metastasis to the jaw is uncommon and indeed among metastatic tumours of the jaws which are a rarity, only about 9% originate from a prostatic primary. We report a case of histologically proven metastatic prostate cancer to the right mandible which necessitated a hemi-mandibulectomy in order to improve the patient’s quality of life

Surgical management of BPH in Ghana: A need to improve access to transurethral resection of the prostate

Background: Open prostatectomy for benign prostate hyperplasia (BPH) is widely practiced in Ghana and Africa. Some of the reasons include lack of expertise and facilities for Transurethral Resection of the Prostate (TURP) and digital rectal examination assessment of prostates as greater than 50 grams.Objectives: To assess the prostate volumes of patients for surgical management of BPH by transrectal ultrasound (TRUS) and to determine, on the basis of prostatic volume, what percentage of those who had open prostatectomy could have been managed by TURP.Design: Prospective cohort study.Setting: The Korle Bu Teaching Hospital, Accra, Ghana.Subjects: Patients for elective surgical management of BPH from March to September 2010 were studied.Results: Fifty-eight patients had surgical management of BPH. Forty-six of them (79.3%) had open prostatectomy whilst twelve (20.7%) had TURP with a mean age of 70.4 and 65.2 years respectively. The most common reason for the open prostatectomy was refractory retention of urine (76.0%) while that for TURP was lower urinary tract symptoms (58.3%). The mean prostate volume for the patients who had open prostatectomy was 64.2ml ±28.7mls (range 23.0-121.0ml) while that of the TURP group was 40.1g±16.2mls (range18.5-70.0mls). Of the open prostatectomy group, 67.4% of them had prostate volumes 75mls or less. The blood transfusion and peri-operative complication rates for the open prostatectomy and TURP groups were 13% versus 8.3% and 8.7% versus 8.3% respectively. There was no mortality.Conclusion: Access to TURP in the surgical management of BPH in Ghana is low (20.7%). With improved facilities including routine use of TRUS for assessing prostate size and availability of expertise for TURP, 67.4% of patients offered open prostatectomy presently could benefit from TURP, using prostate volumes 75mls (75g) or less as indication for TURP

Retrocaval uterer: Two case reports

Retrocaval ureter also referred to as pre-ureteral vena cava is a rare congenital anomaly with the ureter pass-ing posterior to the inferior vena cava. Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life from a resulting hydronephrosis. We present the first two cases to be reported in Ghana; a 36-year-old male and a 40-year-old female both with right flank pains and associated right hydronephrosis. Diagnoses were confirmed with retrograde ureteropyelogram and both had an open surgical repair of the anomaly

Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa

<p>Abstract</p> <p>Background</p> <p>African American men have the highest prostate cancer morbidity and mortality rates than any other racial or ethnic group in the US. Although the overall incidence of and mortality from prostate cancer has been declining in White men since 1991, the decline in African American men lags behind White men. Of particular concern is the growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry in the Caribbean Islands, United Kingdom and West Africa. This higher incidence of prostate cancer observed in populations of African descent may be attributed to the fact that these populations share ancestral genetic factors. To better understand the burden of prostate cancer among men of West African Ancestry, we conducted a review of the literature on prostate cancer incidence, prevalence, and mortality in the countries connected by the Transatlantic Slave Trade.</p> <p>Results</p> <p>Several published studies indicate high prostate cancer burden in Nigeria and Ghana. There was no published literature for the countries Benin, Gambia and Senegal that met our review criteria. Prostate cancer morbidity and/or mortality data from the Caribbean Islands and the United Kingdom also provided comparable or worse prostate cancer burden to that of US Blacks.</p> <p>Conclusion</p> <p>The growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry follows the path of the Transatlantic Slave Trade. To better understand and address the global prostate cancer disparities seen in Black men of West African ancestry, future studies should explore the genetic and environmental risk factors for prostate cancer among this group.</p

The Efficacy of Intracorpus Spongiosum Anesthesia in Internal Urethrotomy for Anterior Urethral Strictures

Objective: To critically evaluate the effectiveness of glans and intracorpus spongiosum anesthesia in performing internal urethrotomy for anterior urethral strictures. Patients and Methods: In this prospective study, 43 patients with anterior urethral strictures underwent visual internal urethrotomy under intracorpus spongiosum anesthesia. A small amount of eutectic mixture of local anesthetic (EMLA, Astra Zeneca) was applied to the glans penis as a topical anesthetic. Fifteen minutes later, 3 ml of 2% plain lidocaine was injected into the glans and routine internal urethrotomy was performed. The effectiveness of the anesthesia was evaluated by asking the patient to indicate his level of pain using the visual analogue scale. Results: Internal urethrotomy was successfully completed in 39 patients (91%), 4 cases were unsuccessful, two on account of bleeding and the other two because the strictures were found to be impassable. No procedure was abandoned on account of severe pain. The pain scores reported by patients ranged between 0 and 4, with an average of 1.6. Conclusion: Criteria indicating sufficient pain therapy (using the numerical visual analogue scale) are pain levels of 3 or less. In the study 98% of patients met this criterion providing evidence of the efficacy of this method. In areas where anesthetic services are limited, this technique provides a cheap, safe and effective alternative. Key words: urethral stricture, internal urethrotomy, anesthesia, glans, EMLA L\'efficacité de l\'anesthésie intracorps spongieux dans l\'urétrotomie interne pour les sténoses de l\'urèthre antérieur Objectif: Évaluer l\'efficacité de l'anesthésie locale du gland et du corps spongieux dans la réalisation de l'urétrotomie interne pour sténoses de l\'urèthre antérieur. Patients et Méthodes: Dans cette étude, 43 patients avec sténoses de l\'urèthre antérieur ont subi une urétrotomie interne endoscopique sous anesthésie intra corps spongieux. Une petite quantité de mélange d\'anesthésique local (EMLA, Astra Zeneca) a été appliqué au gland du pénis comme un anesthésique local. 15 minutes plus tard 3 ml de lidocaïne à 2% ordinaires ont été injectés dans le gland et l\'urétrotomie interne habituelle a été réalisée. L\'efficacité de l\'anesthésie a été évaluée en demandant que le malade indique son niveau de douleur en utilisant l\'échelle visuelle. Résultats: L\'urétrotomie interne a été complétée avec succès chez 39 patients (91%), 4 cas étaient impossibles, deux à cause d'un saignement et deux parce que les sténoses étaient infranchissables. Aucune procédure n\'a été abandonnée à cause d'une douleur sévère. Les scores de la douleur rapportés par les malades étaient entre 0 et 4, avec une moyenne de 1,6. Conclusion: Les critères qui indiquent qu'un traitement de la douleur est suffisant (en utilisant l\'échelle visuelle numérique) est un niveau de la douleur de 3 ou moins. Dans cette étude, 98% de malades ont obéit à ce critère ce qui met en évidence l\'efficacité de cette méthode. Dans les régions où les services anesthésiques sont limités cette technique est une alternative bon marché, sûre et efficace. African Journal of Urology Vol.11(2) 2005: 111-11

Penile Strangulation by Self‐Placement of Metallic Nut: Corporal Cavernosa Tissue Showed Resilience to Thermal Burns Sustained at Removal

We report a case of a 37-year-old male who presented with a 12-hour history of a strangulating 2cm wide by 0.8 cm thick metallic nut on the penile shaft at the peno- scrotal junction. Unlike instances where these metallic objects are placed to enhance sexual stimulation this nut was rather placed to prevent intercourse. A Bosch electric circular grinder was successfully used for removal but a thermal burn to the penile tissues was sustained in the process as the hardness of the nut required a high energy to cut and its thickness did not allow for effective cooling during the process of removal. This resulted in a circumferential denudation of penile skin, a urethro-cutaneous fistula at the penoscrotal junction and a mid-bulbar urethral stricture. The penile wound was subsequently covered with a split skin graft with a delayed closure of the urethrocutaneous fistula and a buccal mucosa patch urethroplasty for the mid bulbar stricture. Despite the degree of thermal burns sustained the patient has maintained good erectile function with grade four rigidity. The tunica albuginea and the underlying corpora cavernosa have shown a significant degree of resilience to thermal burns compared to the corpora spongiosum where the thermal burns led to a urethrocutaneous fistula.Keywords: Penile Strangulation, Metallic Nut , Thermal Burns , Corpora Cavernosa , Urethrocutaneous Fistula