Tubularized Incised Plate in Previously Operated (redo) Hypospadias

Hypospadiology, despite its decades of existence is still recognized as an evolving and expanding specialty. Three associated anomalies are classically found in hypospadias namely, an ectopic position of the urethral meatus anywhere from the ventral surface of penis to the perineum, a ventral curvature of the penis (chordee), and a defect of the ventral prepuce often referred to as dorsal hood. The only constant feature that defines hypospadias is the abnormal position of the meatus on the ventral surface of the penis. Options for urethroplasty in children with hypospadias can be classified as tubularization of the urethral plate, skin flaps and grafts. Throughout the history of surgery for this condition flaps have been most commonly used, but in the past 10 years incision and tubularization of the urethral plate (tubularized incised-plate, TIP) has rapidly gained popularity for correcting distal, proximal and re-operative hypospadias. TIP potentially simplifies both decision-making and surgical technique, and has a low complication rate with better cosmetic results.We report our experience of using the tubularized incised plate (Snodgrass) for redo hypospadias repair in patients who have had one or more failed attempts at repair irrespective of the type of repair they had before

Xanthogranulomatous Pyelonephritis: A Retrospective Review of 21 Cases

Xanthogranulomatous Pyelonephritis is a relatively uncommon disorder of unknown etiology, a rare form of chronic pyelonephritis that is usually characterized by extensive destruction of the involved kidney. The renal parenchyma is replaced by lipid-laden macrophages referred to as xanthoma cells. It is increasingly being recognized as an important cause of renal morbidity worldwide. Patients who had nephrectomy had favorable outcome

A five-year review of nephrectomies at the Lagos State University Teaching Hospital (Lasuth) Ikeja Lagos

Background: Nephrectomies are performed for various reasons ranging from benign to malignant renal diseases. The surgical approach for a nephrectomy also varies with location. In Nigeria and many other developing countries, the major technique of performing a nephrectomy is an open approach.Objective: The objective of the study was to evaluate the cases of nephrectomies performed over a 5-year period at the Lagos State University Teaching Hospital, Ikeja and compare the findings with those from other institutions in our region.Materials and Methods: This was a retrospective study. The clinical records of consecutive patients who had nephrectomies done over a 5-year period between January 2009 and December 2014 were reviewed. The data extracted from their record included age, sex, indication for  nephrectomy, laterality (whether right or left), surgical approach, duration of surgery, the incidence of blood transfusion, histological findings and treatment outcome.Results: The records of a total of 40 patients were available. There were 16 males (40%) and 24 females (60%) with a M:F ratio of 1:1.5. The mean age was 44.75 ± 17.16 years (range: 3-70 years). The indication in the majority of the patients was renal malignancy (n = 30, 75%) while the remaining 10 (25%) were benign cases ranging from non-functioning hydronephrotic kidneys from pelviureteric junction obstruction to staghorn calculi. A total of 25 cases (62.5%) were on the right, while 15 (37.5%) were on the left. The imaging study done for diagnosis was majorly an abdominopelvic CT scan in 32 patients (80%). Twenty-one patients (52.5%) had a flank approach, while 19 patients (47.5%) had an anterior approach for their surgery. The mean duration of surgery was 140 ± 53.2 minutes (range 60-270 minutes). 27 patients (67.5%) were transfused perioperatively. The majority (n = 14, 46.7%) of the patients with renal malignancy had a histological diagnosis of the papillary variant of renal cell carcinoma. 32 patients (80%) were followed up for at least 3 years, while the rest were lost to follow up. The quantity of blood transfused correlated with the duration of the surgery.There was no perioperative mortality.Conclusion: Renal malignancies are the most common indication for nephrectomy in our centre. Though associated with a high transfusion rate, open nephrectomy (even when performed for a malignant condition) remains a safe procedure with a good outcome. Keywords: Nephrectomy, Renal malignancies, Blood transfusio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Outcome of Mainz II pouch urinary diversion after radical cystectomy in patients with muscle-invasive bladder cancer: our experience

Introduction: Mainz II pouch urinary diversion in patients with muscle‑invasive bladder cancer is one of the options of continent urinary diversion following radical cystectomy (RC). We aim to report our experience and the outcome of our patients who had this procedure.Patients and Methods: Patients who had RC and Mainz II pouch urinary diversion for muscle‑invasive bladder cancer in our institution from 2007 to 2016 were evaluated. Variables analyzed included age, gender, stage of the disease, pathological grade and tumor types, complications, and survival status.Results: There were 11 patients who had Mainz II pouch urinary diversion after RC for bladder cancer over a 10‑year period. Four (36%) were male and 7 (64%) were female. The mean age of the patients was 58.6 (range, 52–65) years. The diseases were pT2, pT3, and pT4 in 2 (18%), 7 (64%), and 2 (18%) patients, respectively. Four (36%) had pelvic nodal metastasis. Nine (82%) had a histological diagnosis of transitional cell carcinoma, and two (18%) were squamous cell carcinoma (SCC). Ten (91%) patients had high‑grade disease, whereas only 1 (9%) patient had low‑grade disease. Short‑term morbidities were electrolytes derangement, hypokalemia, and acidosis in 2 (18%) patients and pyelonephritis in 2 (18%) patient. The two patients with invasive SCC had recurrence and death within 12 months of surgery. At present, four of the patients are alive, and seven are dead. Survival till date ranged from 8 to 120 months (mean survival time was 48 months). All patients achieved day and night time continence, and there was no significant long‑term morbidity from the method of urinary diversion.Conclusion: Mainz II pouch urinary diversion is safe and acceptable to most of our patients with good long‑term results.Keywords: Bladder cancer, Lagos, Mainz II pouch urinary diversion, Nigeria, outcom

Outcome of Mainz II Pouch Urinary Diversion after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer: Our Experience

Introduction: Mainz II pouch urinary diversion in patients with muscle-invasive bladder cancer is one of the options of continent urinary diversion following radical cystectomy (RC). We aim to report our experience and the outcome of our patients who had this procedure. Patients and Methods: Patients who had RC and Mainz II pouch urinary diversion for muscle-invasive bladder cancer in our institution from 2007 to 2016 were evaluated. Variables analyzed included age, gender, stage of the disease, pathological grade and tumor types, complications, and survival status. Results: There were 11 patients who had Mainz II pouch urinary diversion after RC for bladder cancer over a 10-year period. Four (36%) were male and 7 (64%) were female. The mean age of the patients was 58.6 (range, 52–65) years. The diseases were pT2, pT3, and pT4 in 2 (18%), 7 (64%), and 2 (18%) patients, respectively. Four (36%) had pelvic nodal metastasis. Nine (82%) had a histological diagnosis of transitional cell carcinoma, and two (18%) were squamous cell carcinoma (SCC). Ten (91%) patients had high-grade disease, whereas only 1 (9%) patient had low-grade disease. Short-term morbidities were electrolytes derangement, hypokalemia, and acidosis in 2 (18%) patients and pyelonephritis in 2 (18%) patient. The two patients with invasive SCC had recurrence and death within 12 months of surgery. At present, four of the patients are alive, and seven are dead. Survival till date ranged from 8 to 120 months (mean survival time was 48 months). All patients achieved day and night time continence, and there was no significant long-term morbidity from the method of urinary diversion. Conclusion: Mainz II pouch urinary diversion is safe and acceptable to most of our patients with good long-term results

Waiting Times for Prostate Cancer Diagnosis in a Nigerian Population

Background. Prostate biopsy remains an important surgical procedure in the diagnostic pathway for prostate cancer, but access to prostate biopsy service is poorly studied in the Nigerian population. While there has been a well-documented delay in patient presentation with prostate cancer in Nigeria, little is however known about how long patients wait to have a histological diagnosis of prostate cancer and start treatment after presenting at Nigerian hospitals. Method. This was a descriptive retrospective study to document the specific duration of the various timelines in getting a diagnosis of prostate cancer at the Lagos State University Teaching Hospital, Ikeja, Nigeria. Results. There were 270 patients. The mean age was 69.50±8.03 years (range 45-90). The mean PSA at presentation was 563.2±1879.2 ng/ml (range 2.05-15400), and the median PSA was 49.3 ng/ml. The median waiting times were (i) 10 days from referral to presentation; (ii) 30 days from presentation to biopsy; (iii) 24 days from biopsy to review of histology; (iv) 1 day from histology review to discussion/planning of treatment. The median overall waiting time from referral to treatment was 103 days. The mean time from presentation to biopsy was significantly shorter for patients with PSA of ≥50 ng/ml compared to those with PSA<50 ng/ml. p=0.048. Overall, the median time from biopsy to histology was significantly shorter for patients whose specimens were processed in private laboratories (17 days) compared to those whose specimens were processed at the teaching hospital laboratory (30 days), p≤0.001. Conclusion. There is a significant delay within the health care system in getting a prostate cancer diagnosis in the Nigerian population studied. The major points of the identified delay were the waiting time from patient presentation to having a biopsy done and the histology report waiting time

The Fire Service for the Removal of a Metallic Penile Constricting Device: A Ready Help When All Else Fail

The placement of a constricting device around the penis is a urologic emergency. Though injuries from constricting penile devices are generally rare, they may be associated with serious complications. There is no standard modality for the removal of penile constricting devices and the management of the patient can therefore prove to be a formidable challenge to the urologist. Timely intervention is always important in preventing complications especially penile gangrene. Depending on the type of device used along with the duration and severity of penile constriction caused, significant resourcefulness may be required in the treatment of the patient. Achieving a timely and successful outcome may require a multidisciplinary approach involving equipment only available with the fire service or other agencies. We report the case of a 30-year-old man with a background psychiatric illness who had his penile constricting device removed under conscious sedation in the emergency room with the aid of a power driven arc saw from the fire service with a successful outcome