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

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

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

Management of the mass casualty from the 2001 Jos crisis

Background: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001.Materials and Methods: Aretrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care.Results: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients.  Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside.Conclusion: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better  chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.Key words: Challenges, civilian conflicts, crisis, disaster, mass casualty, trauma, violenc

Has the creation of a urology residency programme translated in to more surgical exposure for final year residents?

BACKGROUND: Surgical residency programmes are supposed to enhance resident operative experience.  The impact of urology residency was assessed at our institution before and after establishing a structured urology training programme in 2006.MATERIALS /METHODS: Log books of final year Urological residents presented for the West African College of Surgeons (WACS) and National Postgraduate Medical College (NPMC) final part II exams from January 2007 to December 2011 at Jos University Teaching Hospital (JUTH) were reviewed. All residents had completed mandatory 3 years of urology training. The records of surgeries performed by residents were extracted. These surgeries were categorized as Endoscopic procedures, open kidney / ureter surgeries, open bladder surgeries, open prostate surgeries, open urethral and open testicular / penile sugeries. The records were compared with records of operated cases in the same category before the commencement of Urology residency training from January  2001 to December 2005. Results were presented as tables and charts.  The Students unpaired   t -test was used to assess significance. P value of < 0.05 was taken as significant.RESULTS: There was an overall increase in absolute number of operative cases performed by final year residents in the period after the commencement of the Urology residency programme (n=596) compared to the period before the training began (n=381) this however, was not statistically significant (p=0.3). There was  a decline in endoscopic surgeries done by residents after the training begun compared to the era before the training . CONCLUSION : Whereas creation of the urology training programme in JUTH has resulted in more operative cases done by trainee urologists, the exposure to endoscopic surgeries has declined . This will not augur well for the training programme in the long run. Periodic review of the data should be performed to maintain consistent, positive experiences for residency training.KEY WORDS: Residency training, Urology training, Postgraduate Medical Education

The value of international prostate symptom scoring system in the management of BPH in Jos, Nigeria

Objective: To determine the value of international prostate symptom scoring (IPSS) system in management of patients with benign prostatic hyperplasia (BPH) in Jos, Nigeria.Materials and Methods: This was a prospective study of 104 newly diagnosed patients with BPH from June 2006 to July 2007. Patients’ symptoms were initially evaluated by administering a pretreatment IPSS/Quality of Life Score (QOLS). This categorized patients into mild, moderate, and severe symptom groups. The mild symptom group had watchful waiting as mode of management. The moderate symptom group received doxazosin, an alpha blocker, while the severe symptom group had prostatectomy. A post-treatment IPSS/QOLS was administered 3 months after. Mean changes in IPSS/QOLS was calculated and subjected to paired student’s t- test for significance in changes. Spearman’s correlation coefficient was used to test significance between correlations.Results: Mean age of patients was 64.3 years. 3 patients (2.9%), 53 patients (51.0%), and 48 patients (46.1%) fell into the minor, moderate, and severe symptom categories, respectively. The QOLS correlated with IPSS. There was a mean change in symptom scores of +2.3 for the minor symptom category, -8.1 (P < 0.001) for IPSS and -1.7 (P < 0.001) for QOLS in the moderate symptom category, and -24.6 (P < 0.001) for IPSS and -4.0 (P < 0.05) for QOLS in the severe symptom category.Conclusion: The study has shown that IPSS is a valuable tool in management of patients with BPH.Key words: Value of IPSS, BPH, Jos Nigeri

The Management of Prostatic Haematuria

Background: Prostatic haematuria s a common clinical problem. In this report, we have reviewed the incidence, precipitating/co morbid factors, treatment and outcome of haematuria in patients with benign prostatic hyperplasia and prostate cancer Methods: A two year prospective review of 37 patients who presented with haematuria associated with benign prostatic hyperplasia and prostate cancer. Each patient had full clinical assessment, including any associated precipitating or co morbid factors. All patients had urethral catheterization; and cystoscopy to exclude bladder tumours or bladder stones. Subsequent management depended on severity of bleeding; and consisted of one of the following: observation only, irrigation only, irrigation and blood transfusion and emergency prostatectomy. Upon stabilization, the definitive treatment in each patient was based on primary pathology. Results: A total of 134 patients who had either benign prostatic hyperplasia or prostate cancer were treated. Thirty seven (27.6%) patients presented with haematuria. The incidences of haematuria in benign prostatic hyperplasia and prostate cancer were 26.7% and 29.2% respectively. Haematuria was precipitated in 17 (45.9%) patients; while nine (24.3%) patients had 12 associated co morbidities. Seventeen (45.9%) patients had blood transfusion. A total of 34 (91.8%) patients were managed conservatively. There were four (10.8%) deaths. Conclusion: Prostatic haematuria is a common urologic challenge. In most cases conservative management is the key. In the absence of modern facilities, emergency open prostatectomy may be needed to control bleeding, in those in whom conservative approach has failed; or when specifically indicated based on the individual patient or as dictated by other local factors. Keywords: haematuria, prostatic, common, conservative treatment.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 439-44

The acute scrotum: Aetiology, management and early outcome-preliminary report

No Abstract. Nigerian Journal of Medicine Vol. 14(3) 2005: 267-27