Transperineal versus transrectal prostate biopsy: Our findings in a tertiary health institution

Context and Objective: Prostate cancer is a major public health issue. Its incidence is rising, especially in Nigeria. Prompt diagnosis is necessary by histology. Transperineal and transrectal approaches to prostate biopsy are well documented. Both methods are fraught with complications though, most times minor. Studies carried out to compare both methods were carried out mainly on Caucasians, generating conflicting results. This study aims to compare the complication rates and tissue yield of these two methods in Nigerian men.Materials and Methods: Seventy-five patients completed the study. Forty-five patients had transperineal prostate biopsy (TPbx), while 30 patients had transrectal prostate biopsy. Pain perception for all patients was determined by visual analog scale; whereas the complications were ascertained by a validated purpose designed questionnaire administered on the 7th and 30th day post operatively.Results: The risk of rectal bleeding was higher for transrectal prostate biopsy compared to transperineal (Odds ratio: 0.03; 95% confidence interval (CI): 0.001.0.450; P = 0.012). TPbx was more painful than transrectal (P < 0.0001; df: 75; t: 4.98; 95%CI of difference in mean: .2.98.[.1.28]). There was no statistical difference between transperineal and transrectal prostate biopsy in hemospermia, fever, prostatic abscess, urethral bleeding, acute retention and tissue yield.Conclusion: TPbx is more painful than transrectal prostate biopsy though with a significantly reduced risk of rectal bleeding. There appears to be no significant difference with respect to risk of fever, urethral bleeding,  hematospermia, prostatic abscess and acute retention. Both routes provided sufficient prostate tissue for histology.Key words: Comparative analysis, transperineal prostate biopsy,  transrectal prostate biops

Posttraumatic Urological System Injuries at UNTH, Enugu.

Objective: To describe our experience in the management of and the results of treatment of traumatic injuries to the urogenital system/organs. Methods: This is a retrospective patient record review of the records of 225 patients treated of posttraumatic injuries to the urogenital system in our unit over a period of ten years, i.e. between January 1995 and December 31 2004. Results: The total number of patients treated within 10 years was 225. Only 65 of these patients were women; the remaining were men, majority of them were aged between 30 and 50 years. The male female ratio was 2.5:1 made up as follows, 160 (71.1%) males, and 65 females, (28.9%). A total of 73 patients (32.4%) had definitive treatment as emergency, while 152 patients (67.1%) were operated on as elective cases. Road Traffic Accidents (RTA) accounted for 119 (52.9%), of the cases. One hundred and thirty nine (139) of the patients recovered fully and were discharged. There was improvement with treatment or rehabilitation continued on outpatient basis in 63 (28%) cases. Seven of the patients were lost to follow up and so no definite opinion could be given. There was a mortality of 7.1 %. Only 27 of the patients reported to UNTH as their first port of call after their injury; And all the 27 cases survived. The rest of them came as referrals from various hospitals where they had received some forms of treatment after their injuries before being referred for further management. The commonest cause of trauma was Road Traffic Accident and the kidneys were the organ most frequently injured. Conclusions: Our experience compares favorably with other reports world-wide. However there was a high incidence of nephrectomy in the series. A mortality of 7.1 % for posttraumatic injuries to the urogenital system was quite unacceptably higher than most reports reviewed. To reduce the magnitude of mortality in posttraumatic uro-genital system injuries peripheral hospitals should be encouraged to refer cases early enough rather than delay these patients to the point of death before referring them for “expert management.” Keywords: Urogenital injuries, treatment, outcome. Nigerian Medical Journal Vol. 48 (3) 2007: pp. 62-6

The prevalence pattern of external male genital defects among secondary school students in Enugu state of Nigeria

No Abstract. Nigrian Journal of Clinical Practice Vol. 10 (2) 2007: pp. 120-12

The Relationship between Prostate Volume and International Prostate Symptom Score in Africans with Benign Prostatic Hyperplasia

OBJECTIVE: To determine the relationship between prostate volume and international prostate symptom score (IPSS) in Africans with benign prostatic hyperplasia (BPH).PATIENTS AND METHOD: This was a prospective study of 120 men aged between 45 to 85years, who were referred to the urology outpatient facility for treatment of clinical BPH between July 2007 and October 2008 in Jos University Teaching Hospital. These patients were properly evaluated; a digital rectal examination was done to estimate the prostate size. The pre-treatment IPSS of the patient was also obtained. The prostate volume of each patient was then estimated by transabdominal ultrasound.RESULTS: The mean prostate volume was 372.79±44.38cm. The mean values for the different diameters of the prostate were 5.63±1.17cm (longitudinal diameter), 4.48± 0.95cm (anterior posterior diameter), 4.97±1.06cm (transverse diameter). The Pearson's correlation between pre-treatment International prostate symptom score and prostate volume was -0.0035 (P>0.05).CONCLUSION: This study has shown that there is no significant relationship between international prostate symptom score and prostate volume in Africans. This is same with similar studies done in other parts of the world

Factors that affect medical students’ performance in Anatomy in the University of Nigeria

Background: Much attention has been drawn to the area of medical education in contemporary times with the aim of developing effectiveteaching strategies in our medical schools.Objectives: To identify the problems encountered by students in the study of Anatomy and suggest ways of enhancing their performance in the subject.Materials and Methods: Three hundred structured, pretested self administered questionnaires were applied to medical students of theFaculty of Medical Sciences, University of Nigeria Enugu Campus (UNEC), who had spent at least two years in the medical school. Data analysis was by SPSS version 15.Results: Of the 300 questionnaires, 201(67.0%) were correctly filled and analysed. One hundred and three (51.2%) of the respondents were females, 163 (81.1%) were aged 21 to 30 years and 105(52.3%) hadspent more than two years in the medical school. One hundred and eleven (55.2%) believed that dissection followed by audio-visual aids 101(50.3%) offered students adequate exposure to the learning of anatomy. One hundred and eleven, (55.2%) also implicated overcrowding as a major cause of students’ aversion for dissection leading to inadequate exposure to the subject and the resultant poor performance. One hundred and seven (53.2%) believed that the preparatory period for 2nd MBBS exams should be extended so as to offer students adequate exposure to laboratory specimens.Conclusion: Over-population causes inadequate exposure of students to anatomical specimens and thus affects their performance negatively.Keywords: Anatomy, factors, problems, students’ performanc

Gastrointestinal Kaposi Sarcoma Presenting In A Nigeria African With HIV / AIDS

Adult intussusception is a rare condition that is seen once in a while in surgical practice, 1. In this report we the case of a thirty –five year old Nigeria male on medical treatment of earlier diagnosed AIDS who had no evidence of cutaneous Kaposi sarcoma. He later presented with a palpable right lower quadrant mass and classic symptoms of intestinal obstruction for which he was referred to surgery. The findings at laparotomy were right ileo – colonic intussusception with polypoid lead point. There were also multiple intra – luminal growths involving the entire right colon, the caecum the appendix and the terminal ileum. A right hemi – colectomy with ileo – colonic anastamosis was performed, and the resulting specimen sent for histological examination confirmed Kaposi sarcoma. Assessment of the patient's clinical condition five months post – operatively revealed a significant improvement; patient regained weight from 43 kg on admission to 58.3 kg .We conclude that Kaposi sarcoma be included in the aetipathogenesis of adult intussusception KEY WORDS: Kaposi Sarcoma, Adult Intussusception, Surgical Outcome Nigerian Journal of Clinical Practice Vol.6(2) 2003: 117-11