Outcome Of Urethroplasty For Urethral Stricture At Jos Universitry Teaching Hospital.

The treatment of urethral stricture disease has remained a challenge over the years.The outcome has also been varied, with recurrent stricture being a major concern. We determined the outcome of urethroplastywith particular reference to the complications. Thiswas a retrospective study over 10 years(1995 to 2005) done at the JosUniversity Teaching Hospital, a tertiary health institution in themiddle belt region ofNigeria. There were a total of 32 patients whose ages ranged from0.06 to 75 years (mean 25yrs, SD18.8yrs,). Eleven patients had had one form of stricture treatment or the other. Stricture aetiology was traumatic in 21 (66%) and inflammatory in 6(19%) patients. Of the 24 patients in whom the stricture length at operation was specified, six, 11 and sevenwere 4cmrespectively. The stricturewas located in the anterior urethra in 18(58.1%), posterior urethra in 2(6.4%) and bulbomembranous in 11(35.5%) of patients (unspecified in one). The bulbar urethra was the singlemost involved region, occurring in 12(38.7%) patients. Resection and end to end anastomosis was done in 16 patients and replacement urethroplasty in 16 others (Quarteys in 12, Swinney in 3 and Orandi in 1). Complications observed were urinary tract infection in 12(37.5%) patients, recurrent stricture 11(34.4%) wound infection 10(31.3%), oedema of genitalia 7(21.9%), urethrocutaneous fistula 4(12.5%), impotence 3(9.4%), wound haematoma 2(6.3%) and urinary incontinence in 1(3.1%) patient(s). Urinary tract infection, recurrence of the stricture and wound infection remain our major challenges.We recommend that in order to improve outcome, surgeons should regularly audit their practice and make necessary adjustments. In addition, urethroplasty should preferably be carried out by those with the cognate experience,while not compromising the need to teach younger colleagues. Keywords: urethroplasty, outcome, urethra, stricture Nigerian Jouranl of Clinical Practice Vol. 11 (4) 2008: pp. 300-30

Safety of daycare hernia repair in Jos, Nigeria

Objective: To evaluate the safety of day surgery for inguinal hernia.Design: A randomised prospective study of patients presenting for elective inguinal hernia repair.Setting: Jos University Teaching, Jos, Nigeria.Subjects: One hundred and twenty one patients who completed a six-week follow up period.Interventions: Sixty one patients had elective hernia repair as daycares while 60 patients were treated as inpatients. Forty six herniotomies and seventy five herniorrhaphies were performed under local or general anaesthesia.Main outcome measures: Early post-operative complications, including wound complications were evaluated.Results: Early post-operative complications occurred in two of the 61 daycares and 15 of 60 inpatients (p=0.002). There were twelve and ten wound complications in daycares and inpatients respectively (p = 0.668). There was no mortality.Conclusion: Outpatient elective inguinal hernia repair in carefully selected patients is relatively safe in our environment

Traditional eye practices: a facility-based study in North Central Nigeria

Aim: To determine the magnitude and the types of traditional eye treatments among new patients attending COCIN Rehabilitation centre, Mangu, Plateau State, Nigeria.Materials and Methods: This was a cross-sectional, facility-based study conducted between July 2013 and June 2014 on new patients seen in the eye unit of Church of Christ in the Nations (COCIN) Rehabilitation Centre, Mangu. Data was collected on all new patients attending the outpatient eye unit of the hospital using a structured open-ended interviewer questionnaire. Information on patient demographics; use of traditional eye medication and manipulations and factors that determine choice of traditional treatment was recorded.Results: A total of 3,113 consecutive patients who attended the eye unit participated in this study. The use of traditional eye treatment was reported by 134 (4.3%) participants. There was a statistically significant association between the use of traditional eye treatment and residence (÷=33.658, p<0.001), age (÷=17.785, p<0.001) and occupation of patients (÷=423.9, p<0.001). The main type of traditional eye medicine used was the extract from crushed leaves/roots (40; 37.1%) that is instilled into the conjunctiva sac. The providers of traditional eye treatment were mainly traditional healers (88; 65.7%). The main reason reported for the choice of traditional eye treatment was the belief in its potency.Conclusion: Considerable numbers of patients still use traditional eye treatment to meet their eye health needs. There is a need for health education of the general public about the deleterious effects of traditional eye treatment. There is also the need to upgrade primary eye care programs with greater emphasis on eye care during the training of nurses, community health officers (CHO) and community health extension workers (CHEW).Keywords: Traditional, Eye, Medication, Educatio

Relationship between prostate volume and IPSS in African men with prostate disease.

Background: Most frequently encountered diseases affecting the prostate include benign prostatic hyperplasia, prostate cancer and prostatitis. Lower urinary tract symptoms (LUTS), including voiding, storage, and post-micturition symptoms, are highly prevalent in men with prostate diseases. This study is aimed at determing the relationship between prostate volume and lower urinary tract symptoms in African men with prostate diseases using the International prostate symptom score as a tool.Methodology: The study was conducted among 103 men with lower urinary tract symptoms due to prostate disease, who presented at the outpatient department of Jos University teaching hospital between January 2013 and December 2013. The men were evaluated and categorized according to prostate disease. The IPSS of the men were obtained while prostate volume was determined using transabdominal ultrasonography.Results: During the period January 2013 to December 2013 about 103 men were enrolled into the study. The mean age of the patients was 62.6yrs (range 21 - 85yrs). Eighty patients (77.7%) had benign prostatic hyperplasia, 20 men had Carcinoma of the Prostate (19.4%) while 3 patients had prostatitis. The mean total IPSS was 15.3 (range 3 – 34). Seventy-two of the men, representing 69.9% had moderate symptoms while the mean prostate volume was 57.8ml (range 20 – 195mls). The Pearson correlation between prostate volume and IPSS = 0.13 with a p-value of 0.18.Conclusion: This study illustrates that there's no significant relationship between prostate volume and International prostate symptom score in African men with prostatic disease.Key words: Prostate diseases, prostate volume, International Prostate Symptom Score

Patient satisfaction with trichiasis surgeryin Jigawa State, Nigeria

Purpose: Following the implementation of the SAFE (Surgery, Antibiotics, Facial Cleanliness, Environmental improvements) strategy for the control of trachoma in Jigawa state, ophthalmic nurses trained as lid surgeons perform trichiasis surgery in the state. This study aims to assess patient satisfaction with surgical results and trichiasis surgery services in the state.Methods: A retrospective cohort study of patients operated on for the first time between December 2012 and April 2013. Patients were examined for presence of recurrent trichiasis, eyelid contour abnormality and eyelid closure defects. Aspecially designed and pretested questionnaire was administered to each participant with questions about satisfaction with services, results, their opinion and recommendation.Results: Seventy-seven patients were examined. Fifty-six (73%) participants were female. The mean age of the participants was 54.9 years (±17.8 years) with a range of 8 to 90 years; females tended to be older but not statistically significantly so. We found that 97% were satisfied with the timing of operation and 97% were satisfied with staff conduct; subjective vision was better in 66%, post operative appearance was good in 82%; while expectation was met in 95%. Overall, 96% were of the opinion that surgery was helpful, while 97% of patients were willing to recommend the surgery to their family and friends.Conclusion: Patient satisfaction with results of trichiasis surgery and services in Jigawa state is high.Keywords: patient, satisfaction, trichiasis surgery, Jigawa State, Nigeri

Outcome of Open Surgery for Urinary Tract Calculi at Jos University Teaching Hospital

Background: Urinary tract calculi are common affliction of humans. Surgeries to remove stones from the urinary tract are among the oldest forms of open surgery. These surgeries have evolved and minimally invasive procedures are now the choice procedures. Developing countries still depend on open surgeries to treat urinary stone disease due to lack of equipment or high cost. This study aims to review the treatment outcome of open stone surgery in a tertiary health institution in North-Central Nigeria.Materials and methods: A retrospective review of open surgeries for urinary tract calculi done between December 2007 and December 2011 was done and demographics, type of open procedure , stone free rates and complications of surgeries were analysed with Epi-info 3.4.1. Being stone-free was defined as complete extraction of stone which had been preoperatively diagnosed on Intravenous Urogram (IVU) and/or Computed Tomogram Urography (CTU).Results: Forty-seven open procedures for urinary stone disease were done. Age range was 3-81 years with a mean of 40.95±17.39 years. Five (10.6%) Nephrolithotomies, 11(23.4%) Pyelolithotomies, 9(19.1%) Ureterolithotomies, 20(42.6%) Cystolithotomies, 1(2.1%) Nephrectomy and 1(2.1%) Poucholithotomy was done. There was 100% stone-free rate for all the procedures except Pyelolithotomies where stone free rate was 90.9 %. There was a complication rate of 31.9% which included urinary tract infections (UTI), incisional hernia and surgical site infections.Conclusion: For developing countries open stone surgery still remains the main option of treatment. Stone free rates are high following open surgeries, but these surgeries are inundated with morbidities

Prevalence, pattern and risk factors for retinal vascular occlusions in a tertiary hospital in Jos, Nigeria

Introduction: Retinal vascular occlusions are the second most common retinal vascular diseases following diabetic retinopathy. They are associated with several systemic and ocular pathologies and are significant causes of visual loss.Objective: This study aims to determine the prevalence, pattern and risk factors for retinal vascular occlusions in a tertiary hospital in Jos,Nigeria.Methodology: A retrospective review of all cases of retinal vascular occlusions seen in the eye clinic from January 2011 to December 2014 was carried out.The patients were identified from the clinic register and their case folders retrieved.The following data were then extracted from the files; patients' age, sex, presenting visual acuity, presence of any systemic disorders and type of retinal vascular occlusion.Data analysis was done using Epi Info 7.Results: Three thousand eight hundred and twenty one new patients were seen during the study period and there were 52 (1.36%) cases of retinal vascular occlusions.Only the case files of 44(84.6%) patients were available and were analysed. These were made up of 17 (39%) males and 27 (61%) females.These had a total of 46 retinal vascular occlusions made up of 37 (80.4%)retinal vein occlusions,8 (17.4%) central retinal artery occlusions and a case (2.2%) of combined central retinal artery and vein occlusion. Hypertension and diabetes were the most common systemic risk factors while glaucoma was the most common ocular association.Conclusion: Retinal vascular occlusions are uncommon in our centre butlead to severe visual loss and are associated with significant systemic pathologies.Keywords: Retinal vein occlusion,retinal artery occlusio

Reasons for cancellations of urologic day care surgery

Objective: The numerous economic and social benefits associated with the practice of day care surgery could be eroded by frequent cancellations. We therefore determined the reasons for such cancellations in a tertiary care centre in Nigeria.Patients and Methods: This was a prospective study of all consecutive urologic day cases seen at Jos University Teaching hospital, Nigeria from January 2003 to December 2004.Results: A total of 270 patients were seen during the study period with ages from 2 weeks to 100 years (median 55 years) and male to female ratio of 14:1. The procedures carried out were mainly urethroscopy/urethrocystoscopy in 103 (38.2%) patients, visual internal urethrotomy in 48 (17.8%) and trucut prostatic biopsy in 33 (12.2%) patients. Sixteen (5.9%), 16(5.9%), 9(3.3%) and 8(3.0%) patients had examination under anaesthesia / bladder biopsy for suspected bladder carcinoma, urethral dilatation, testicular biopsy and total orchidectomy for carcinoma of the prostate respectively.There was a cancellation rate of 15.6% (n=42) mainly due to the inability of the patients to come (24 patients, 57.1%), inadequate materials in the theatre (9 patients, 21.4%), power failure (4 patients, 9.5%), strike action (3 patients, 7.1%) and financial difficulties (2 patients, 4.8%).Conclusion: We are still faced with a high cancellation rate of urologic day cases and these are mainly due to avoidable reasons. Patient as well as physician education and provision of adequate materials andinfrastructural development are recommended to reduce these; so as to gain maximally from urologic day surgery practice

Barriers to kidney transplantation among patients on maintenance haemodialysis at the Jos University Teaching Hospital, Nigeria

Introduction: Chronic kidney disease (CKD) is a major public health problem. End-stage renal disease(ESRD), represents the final stage of CKD and is best treated by Kidney Transplantation. However KidneyTransplantation in Sub-Saharan Africa is beset by a myriad of problems.Objective(s): To identify the limitations to kidney transplantation as the preferred option for treatment ofESRD among patients on maintenance haemodialysis at a tertiary-care hospital in Nigeria.Materials and Methods: This was a questionnaire based descriptive, cross-sectional hospital-basedstudy carried out in the dialysis unit of the Jos University Teaching Hospital, Jos, Nigeria over a 6 months period, from June to December,2015Results:A total of 39 patients were enrolled for the study.The mean age of the patients was 45.7 ± 14.6 years. There were 25(64.1%) male and 14(35.9%) female. Financial constraint was the main reason limiting kidney transplantation in 66.7% majority of the patients. Five patients (12.8%) were medically unfit either due to advanced age or presence of comorbidities while 3 (7.7%) patients could not find a compatible donor.Other reasons given for not having had kidney transplant include religious belief,and a previously failed kidney transplant.Conclusion: Whereas awareness of kidney transplantation is high among patients with ESRD onmaintenance haemodialysis, financial constraint remains the main hindrance to kidney transplantation amongpatients with End Stage Renal Disease in our setting.Keywords: Kidney transplantation;Haemodialysis

Correlation of Level of Serum 25-Hydroxy Vitamin D and Gleason Score as a Measure of Aggressiveness of Prostate Cancer in Black Africans

Background Cancer of the prostate (CaP) is the second most commonly diagnosed cancer worldwide and the sixth leading cause of death from cancer in males. . Black men of African descent have higher risk for developing prostate cancer and are most likely to present at a younger age with more advanced disease and a poorer disease prognosis. Objective To determine if there is a relationship between the level of serum 25 hydroxy vitamin D and aggressiveness of prostate cancer using the Gleason score in black Africans in Jos. Methods A cross sectional study conducted among fifty patients presenting at the urological surgical out-patient clinics of the Jos University Teaching Hospital who were evaluated to have a clinical diagnosis of prostate cancer and scheduled for prostate biopsy. Blood samples for serum 25-hydroxy vitamin D were assayed using the ELISA technique, prostate biopsy was done and only those histologically confirmed to be prostate cancer were analysed. Data was collected using a proforma with statistical analysis done using SPSS(R) version 23 and Spearman’s rank correlation test used with a p-value < 0.05 considered significant. Results Fifty patients with histologically proven prostate cancer was studied whose age ranged from 50-89 years with a predominant age group 70-79 years (70.0±7.9).The mean level of serum 25-hydroxy vitamin D was 37.90ng/ml±17.92. All patients in the study had adenocarcinoma as the histologic type with a mean Gleason score of 9.36±13.14. A Spearman’s rank order correlation was statistically significant (rs (50) = -0.423, p = 0.002). Conclusion A Spearman’s rank order correlation shows a moderate negative correlation between the serum 25- hydroxy vitamin D and Gleason score (rs (50) = -0.423, p = 0.002.Thus, serum 25-hydroxy vitamin D assay can be used to prognosticate in patients with cancer of the prostate