Bladder calculi presenting as urinary incontinence mimicking obstetric urinary fistula: a case report

The presence of calculi in the urinary tract is usually a silent morbidity, which may present as an incidental finding on evaluation of the  genitourinary or renal tract for other pathologies. Failure to identify this early is associated with more grievous effects on the function of the renal system, especially the kidneys. Bladder calculi may be asymptomatic, but when symptomatic, may present with abdominal pains, urinary symptoms including haematuria or recurrent urinary tract infection. Urinary incontinence is an unusual symptom of bladder calculi. This case study describes a 25-year-old woman with bladder calculi presenting with leakage of urine following an antecedent history of a Caesarean section for prolonged obstructed labour, thus mimicking urinary obstetric fistula. She had appropriate evaluation and successful surgical removal of the bladder stone. Keywords: bladder stone, bladder calculi, urinary incontinenc

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

Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria

Background: The postnatal period is a critical in the lives of mothers and babies due to the risk of maternal and perinatal morbidity and mortality. According to the Nigeria Demographic Health Survey 2018, only 38 % of women and 42;% of newborns received a postnatal check in the first 2 days after birth. The World Health Organisation (WHO) recommends that postpartum women should have contact with healthcare providers within 24 h, at day 3, days 10–14 and 6 weeks post-delivery. Multiple postnatal clinic (PNC) visits will allow assessment and prompt treatment of complications arising from delivery. This study assessed the attitude of postpartum women towards multiple PNC schedule. Methods: This descriptive cross-sectional study assessed the attitude of postpartum women towards multiple PNC schedules. A total of 167 respondents participated in the study and data was collected using a semi-structured interviewer administered questionnaire. Information on awareness, knowledge and purpose of postnatal care, preference for multiple schedules and the timing of postnatal care visits were obtained. Data was analysed using IBM SPSS version 23; and the level of significance was set at p < 0.05. Results: Of the respondents, 71.9 % had poor or incorrect knowledge. About 87.4 % perceived PNC as beneficial; and that mothers and newborns should be seen at least three times (47.9 %) in the postnatal period. A high proportion of women were willing to come for PNC on day 3 (74.3 %), days 10–14 (86.2 %) and six weeks postpartum (91.6 %). Also, 69.5 % were willing to come for multiple PNC visits. Parity was significantly associated with willingness to attend multiple PNC visits. Conclusion: Despite suboptimal knowledge of the components of postnatal care services, postpartum women have a good attitude to postnatal care and are willing to attend scheduled and multiple PNC schedules. However, fewer women wanted the multiple PNC schedules. Health education and quality postnatal care will enhance postpartum surveillance with prompt detection and treatment of maternal and neonatal complications to forestall life-threatening complications or mortality

Histolopathological patterns of cervical carcinoma seen at a radiotherapy centre in Ibadan, Nigeria

Background: The treatment of cervical carcinoma is dependent on many factors including histological types and degree of differentiation. Degree of differentiation is an important consideration in determining the prognostic outcome.Objective: The study investigates the histological pattern and grades of cervical cancer tumours seen at a radiotherapy centre in Ibadan, Nigeria.Patients and Method: This retrospective study was carried out within Radiotherapy Department of University College Hospital, Ibadan. The records of patients diagnosed of cervical cancer seen between July 2008 and June 2010 were analysed. Data pulled out included age, disease stage at presentation, histological variant and degree of differentiation.Results: 206 patients were seen during the period of which 196 had complete data. Squamous cell carcinoma (SCC) was seen in 178 patients (i.e. 90.8%) while 14 patients (7.1%) had adenocarcinoma. One patient each had adenoid cystic carcinoma, adenosquamous carcinoma, clear cell carcinoma and mucinous carcinoma. Majority of the patients, 99 (50.5%) had poorly differentiated tumours, 64 (32.7%) had well differentiated tumours, while the rest 33 (16.8%) had moderately differentiated tumours. Of the SCC tumours, 95 (53.4%) were poorly differentiated, 58 (32.6%) well differentiated while the remaining 25 (14%) were moderately differentiated. In comparison only 3 of the 14 adenocarcinoma cases (21.4%) were poorly differentiated, 5 cases (35.7%) were well differentiated, while 6 (42.9%) were moderately differentiated. The difference in the degree of differentiation between squamous histology and adenocarcinoma was statistically significant (p value=0.002).Conclusion: Poorly differentiated squamous cell carcinoma remains the leading variants of cervical cancer seen in our environment.Keywords: Cervical cancer, histology, tumour gradin

Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors

Background. Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. Methods. A retrospective data collection of UVF cases managed from January 2012–December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. Results. Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. Conclusion. Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved

Comparative study of proguanil and sulphadoxine–pyrimethamine in the prevention of malaria in pregnancy

Background: Intermittent preventive treatment of malaria in pregnancy with sulphadoxine–pyrimethamine (SP) is recommended for prevention of malaria in pregnancy. However, chemoprophylaxis with proguanil (PG) is being used in pregnancy for preventing malaria in selected cases. Objective: To compare the efficacy of daily PG and intermittent monthly SP in preventing malaria and its complications during pregnancy. Patients and Methods: This was a prospective comparative study conducted among 270 consenting pregnant women with parity ≤2 at gestational age of 18–24 weeks. Participants were enrolled and randomized to PG or SP group following a baseline hemoglobin estimation and blood film negative for malaria parasite. At 36 weeks of gestation, maternal blood sample was checked for hemoglobin concentration and malaria parasitaemia, and the infant birth weight was assessed at delivery. Statistical Analysis: Appropriate univariate, and bivariate analysis employed and level of significance set at P < 0.05. Results: One hundred and thirty-five participants in each group (246) completed the study. Ten (8.5%) had malaria parasitaemia in the PG group at 36 weeks compared to 15 (11.7%) in the SP group (P = 0.40); 5 (4.3%) in the PG compared with 6 in SP group (4.7%) had anemia (Hb <10 g/dl) at 36 weeks (P = 0.86). In addition, 6 (5.1%) participants in the PG group developed clinical malaria compared to 3 (2.3%) in the SP group (P = 0.25). The mean infant birth weight in the PG and SP groups were 3.05 kg and 3.00 kg, respectively (P = 0.24). Conclusion: PG and SP were comparable in efficacy and outcome for malaria prevention during pregnancy. IPT-SP is recommended for prevention of malaria in pregnancy. However, PG is beneficial in selected patients with known adverse reactions to sulphonamide

Bilateral ovarian serous cystadenocarcinoma in a teenager: a case report

Epithelial ovarian cancers are uncommon among young girls and teenagers  compared to germ cell tumors. We report a case of bilateral ovarian serous cystadenocarcinoma in a teenage girl with the attendant challenges of diagnosis, management and follow up. HT, 19 year old had presented at a secondary care level with features suggestive of benign ovarian tumor and had ovariectomy done. However, histology report revealed a malignant epithelial cancer, necessitating a repeat exploration. She was found to have surgical stage 3c disease and subsequently has total abdominal hysterectomy with bilateral salpingectomies, right oophorectomy and omentectomy. She was further managed with  paclitaxelcarboplatin combination chemotherapy but defaulted after the 3rd cycle on account of financial constraints. She succumbed to the disease 11months post diagnosis. Though uncommon, detailed evaluation of teenage patients for malignant ovarian cancer is expedient. The financial burden of cancer care in our environment is also highlighted.Key words: Adolescent, ovarian epithelial cancer, ovariectomy, serous cystadenocarcinom

Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria

A 16-year review of causes, clinical presentation and management outcomes of Acquired gynatresia (AG) at University College Hospital, Ibadan, Nigeria. Information was obtained using a proforma and data analysed using SPSS version 20.0. The mean age of the 31 women with AG was 35.6 ± 6.2 years. The majority (90.3%) were married and had a tertiary level of education. The mean parity was 0.74 ± 1.1 and 54.8% were nulliparous while 29.0% were primiparous women. The commonest cause of AG was the insertion of caustic substances into the vagina and this was mainly for the treatment of uterine fibroid (68.2%) and infertility (54.5%). Over three-quarters presented with dyspareunia while 54.8% had infertility. A majority (87.1%) had one-stage surgery with dissection/excision of fibrotic tissue being the commonest (45.2%) and sigmoid vaginoplasty the least performed. Postoperative complications were seen in 29.0% of cases. Acquired gynatresia remains a condition of public health interest despite an increase in female education and relatively improved health care in Nigeria.Impact statement What is already known on this subject? Acquired gynatresia (AG) could be of chemical and non-chemical origin and result from certain cultural beliefs and practices. What do the results of this study add? Irrespective of the women’s level of education, there is inadequate awareness of the implications of inserting caustic materials into the vagina. However, there is a high success rate of treatment of AG. What the implications are of these findings for clinical practice and/or further research? There is a need to increase health education and awareness of the populace on the causes of AG and its associated complications