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

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

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

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways