Prevalence and factors associated to incidental prostate carcinoma among patients undergoing turp for benign prostatic enlargement.

Background: Prostate carcinoma carries higher morbidity and mortality when diagnosed late. Prostate cancer screening is paramount, however, there are no specific clinical signs for early-stage prostate cancer. As an independent variable, prostate-specific antigen is an established predictor of cancer. Incidental prostate cancer is detected by histological examination of resected biopsy tissue that had been previously diagnosed as benign. In the current PSA-use era the prevalence of incidental prostate cancer ranges from 1.4 to 13%. The prevalence in Tanzania as published by Gunda et al was 21.71%. This is alarmingly high. However, in his study, patients with high prostate-specific antigens were included. Objective: To determine the prevalence of incidental prostate carcinoma among patients undergoing transurethral resection of the prostate for benign prostate enlargement with prostate-specific antigen less than 5.5 ng/ml. Methods: A retrospective hospital-based cross-sectional study was conducted to establish the prevalence of incidental prostate cancer among men who underwent transurethral resection of the prostate with a considered normal range of prostate-specific antigen from 2010 to 2019 in Dar es Salaam, Tanzania. A minimum of 195 participants were reviewed, and factors associated with incidental prostate carcinoma were evaluated by binary regression analysis. Results: A total of 195 men were included in the study. The prevalence of incidental prostate cancer among men with prostate-specific antigen levels of less than 5.5ng/mL was 7.2%. More than half of the patients had high-grade cancer, and three quarters had T1b histological subtype making up the clinically significant category. For every one year increase in age from 76 years, v the risk of incidental prostate cancer increased by 1.6, and for every unit increase in prostate specific antigen, incidental prostate cancer increased by 2.2. Conclusion: The Incidental prostate cancer detection rate of 7.2% in our settings is within the Internationals range. Factors associated, were prostate-specific antigen levels and Age. 3.6% of all patient had high grade cancer with potential chance of progressing to an advance stage of prostate cance

Postoperative subcutaneous emphysema following percutaneous nephrolithotomy: A rare complication

Percutaneous Nephrolithotomy (PCNL) is a common urological procedure performed for complicated upper urinary tract stones. The advantages of PCNL include lower morbidity and mortality rates and quicker recovery compared to traditional open surgery. A number of complications have been reported which can be life threatening. Here we present a case of 71 years old lady, who developed subcutaneous emphysema following PCNL

Perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital in Tanzania

Background: Surgical Site Infections are a major cause of morbidity and mortality among operated patients. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medication for a single patient. Few studies have shown qualitatively factors influencing this and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania. Objective: To describe the perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital. Methods: A qualitative study involving in-depth interviews with surgeons was conducted in English by the primary investigator. The interviews were audio-recorded and transcribed verbatim. Systematic text condensation by Malterud was used for data analysis. Findings: Fourteen surgeons and obstetrics and gynaecologists participated. Their perceptions were summarized into three main categories: Inadequate data to support practice; one who sees the patient decides the antibiotic prophylaxis; prolonged antibiotic use for fear of unknown. The participants perceived that choice of antibiotic should be based on local hospital data for bacterial resistance pattern, however the hospital guidelines and data for surgical site infection rates are unknown. Fear of getting infection and anticipating complications led to prolonged antibiotics use. Conclusion: The study provides an understanding of surgical antibiotic prophylaxis use and its implementation challenges. This was partly expressed by unavailability of local data and guidelines to enhance practice. To improve this, there is a need of guidelines that incorporates local resistance surveillance data and enhanced antibiotic stewardship programmes. A strong consideration should be placed into ways to combat the fears of surgeons for complications, as these significantly affect the current practise with use of surgical antibiotic prophylaxis

Prevalence of Incidental Prostate Carcinoma among Patients Undergoing Turp for Benign Prostatic Enlargement

Background Incidental prostate cancer is detected by histological examination of resected biopsy tissue that has been previously diagnosed as benign. It has the potential for progressing to become a disease necessitating active treatment. There is paucity of data on detection of incidental prostate cancer in Tanzania. A study done in northern Tanzania among the urban public sector revealed an alarming detection rate of 21.71%. We aimed to establish the prevalence of incidental prostate cancer among men surgically treated for benign prostate enlargement with considered normal range of prostate specific antigen. Methods This was a retrospective hospital-based cross-sectional study conducted to establish the prevalence of incidental prostate cancer among men who underwent transurethral resection of prostate with considered normal range of prostate-specific antigen from 2010 to 2019 at Aga Khan Hospital Dar es salaam, Tanzania. To find the prevalence of incidental prostate cancer with 95% confidence level, 5% tolerable error, minimum of 195 participants’ data was reviewed, and factors associated with incidental prostate carcinoma were evaluated by binary regression analysis. Results Total of 195 men were included in the study. The prevalence of incidental prostate cancer among men with prostate-specific antigen levels of less than 5.5ng/mL was 7.2% (95% CI, 4.0 to 11.8%). More than half of the patients had high-grade cancer and three quarters had T1b histological subtype making up the clinically significant category. For every 1-year increase in age from age of 65 years, risk of incidental prostate cancer increased by 1.6 (95% CI, 1.054 to 23.38; P Conclusion The Incidental prostate cancer detection rate of 7.2% in our settings is within the range found internationally