Urethrocutaneous fistula complicating circumcision in children

Introduction: Urethrocutaneous fistula is an unusual but preventable complication following circumcision. We describe our experience with the management of this potentially challenging condition.Materials and Methods: We reviewed all patients who had surgical repair of post‑circumcision urethrocutaneous fistula from September 2008 to September 2011 in our institution.Results: Thirty‑one cases presenting at age 4 weeks to 12 years were managed. Twenty‑six (84%) had had circumcision in the neonatal period. Most circumcisions (81%) were carried out by nurses using the dissection method and without anesthesia. In 30 (97%) patients, the fistula was single. The fistula size ranged from 1.5 to 12 mm in the widest diameter. Modified Mathieu’s flap procedure was used in the repair of 18 (56%) fistulae and 9 (28%) fistulae were by simple closure. Recurrence of the fistula was seen in 8 (25%) patients with large fistulae > 5 mm in diameter. The recurrent fistulae were small and were repaired by simple closure.Conclusion: Urethrocutaneous fistula post‑circumcision is frequently seen in our practice and the surgical repair is challenging and associated with high recurrence rate in large fistulae. This preventable condition may be avoided by proper education and training of circumcisers.Key words: Circumcision, complication, repair, urethrocutaneous fistul

Urologic daycase surgery: A five year experience

Background: Expectedly, daycase surgery (DCS) is today witnessing a boom in developing countries as a reasonable option in the face of global economic recession, although with limited scope.Aim: The aim of this study was to describe the urologic day surgery experience at the Lagos State University Teaching Hospital, Ikeja.Materials and Methods: All day-case urologic surgeries done between January 2006 and December 2010 were retrospectively studied. Data obtained were patients’ personal details, diagnoses, procedures performed, mode of anesthesia, and surgical complications as well as admission rate.Results: A total of 1070 operations were performed. The patients were aged 7 days to 92 years. Local anesthesia was employed in 42.2% while general anesthesia was used in 1.7% of patients, mostly pediatric cases. Caudal block anesthesia (55.8%) was administered for transrectal prostate biopsy and urethrocystoscopic procedures. The diagnostic and therapeutic urologic procedures in adults were mainly prostate biopsy (n = 344, 32.1%), urethrocystoscopy (n = 218, 20.4%), varicocelectomy (n = 143, 13.4%), and orchidectomy (n = 93, 8.7%). Mohan’s valvotomy was the most common pediatric operation (n = 19, 1.8%). Postoperative morbidities that warranted hospital admission were observed in 17 (1.6%) cases.Conclusion: Urologic day surgery is feasible with minimal morbidities. The provisions of a dedicated day-case unit or a mobile DCS service may further improve on the volume of cases that can be operated on a  day-case basis and has the potential of further reducing the waiting time for surgery.Key words: Daycase, surgery, urolog

Surgical Management of Prepubertal Urethral Prolapse: A report of 3 cases.

Background: Urethral Prolapse is rare but a differential diagnosis of interlabial masses in prepubertal females. It usually presents with vaginal bleeding and may heighten the suspicion of sexual abuse.Methods: Our series of 3 cases all presented with vaginal bleeding and all had primary surgical excision of the prolapsed urethral mucosa.Results and Conclusion: Surgical management is definitive and should be considered as the first line treatment in our environment.Parents, caregivers and medical personnel in our environment should be able to identify and recognise it

Prevalence and characteristics of prostate cancer among participants of a communitybased screening in Nigeria using serum prostate specific antigen and digital rectal examination

Introduction: Prostate cancer (CaP) is the most commonly diagnosed cancer among Nigerian men but CaP screening is not a common practice. The true burden of the disease in Nigeria is not known. The study was aimed at studying the community burden of CaP in Lagos. Methods: During a community-based prostate cancer awareness program in 13 local government areas of Lagos, men aged >40 years had serum total PSA (tPSA) test and digital rectal examination (DRE). Those with abnormal DRE or tPSA >95th percentile of the cohort or both were selected for prostate biopsy (TRPB). Results: 4172 men were screened and complete data was available for 4110 (98.5%). The mean age was 60.8 years. DRE was abnormal in 410 men and was significantly correlated with the age of the patient and tPSA (p<0.001). The tPSA ranged from 0 to 438.3ng/ml with a median, mean and 95th percentile of 1.5, 2.5 and 10.0ng/ml respectively. 341 out of the 438(78%) men selected were subjected to TRBP. Forty-three men had histological diagnosis of CaP, giving an estimated prevalence rate of at least 1.046% or 1046 per 100,000 men of age ≥40. Only 11 (26%) had organ-confined disease while 17 (40%) had locally advanced disease and 15 (35%) men had metastatic disease. The  majority of the men, 32 (74%) were reported to have Gleason's score of ≥7. Conclusion: The prevalence rate of CaP among men aged ≥40 years in Lagos is higher than previously reported in hospital-based study. Majority have advanced and high-grade diseaseKey words: Prostate, cancer, prevalence, screening, Nigeri

An Estimate of the Incidence of Prostate Cancer in Africa: A Systematic Review and Meta-Analysis

Prostate cancer (PCa) is rated the second most common cancer and sixth leading cause of cancer deaths among men globally. Reports show that African men suffer disproportionately from PCa compared to men from other parts of the world. It is still quite difficult to accurately describe the burden of PCa in Africa due to poor cancer registration systems.We systematically reviewed the literature on prostate cancer in Africa and provided a continentwide incidence rate of PCa based on available data in the regio

A Survey of the Awareness of Prostate Cancer and its Screening among Men Attending the Outpatient Clinics of a Tertiary Health Center in Lagos, Nigeria

Background: Prostate cancer is the most common cancer among Nigerian men and the second most common cause of death from cancer in men worldwide. The aim of this study was to assess the level of awareness of prostate cancer among men attending the various outpatients’ clinics of the Lagos State University Teaching Hospital, Ikeja. Materials and Methods: This study is a descriptive cross‑sectional study. Self‑administered structured questionnaires were used to collect information from consecutives patients attending the various outpatient clinics of the hospital. Results: One hundred and forty‑six respondents with an age range of 40–80 years participated in this study. Sixty‑nine (47.3%) respondents were aware of prostate cancer while 77 (52.7%) have never heard of the disease. Twenty (13.7%) participants were aware of the availability of a screening test for the disease and only 12 (8.2%) have had any form of screening for prostate cancer. Conclusion: There is a low level of awareness of prostate cancer among patients seen at our center and also level of voluntary screening for the disease is low.Keywords: Awareness, Lagos, Nigeria, prostate cance

Clinical presentation and outcome of management of patients with symptomatic spinal metastasis from prostate cancer: A five-year experience

No Abstract. African Journal of Urology Vol. 12 (3) 2006: 134-13