PELVI-URETERIC JUNCTION OBSTRUCTION - A TEN YEAR SINGLE CENTER REVIEW IN NORTH CENTRAL NIGERIA

Background: PUJ obstruction (PUJO) is a functional or anatomic obstruction to urine flow from the renal pelvis to the proximal ureter. Late presentation is common in our environment. It is a common cause of neonatal and prenatal hydronephrosis, occurring in one per 1500 live births. It is less common in adults than in children but it is not rare in either population. Congenital causes of PUJO is more in males than females, 2-4:1 with left sided obstruction being commoner than the right. Most common etiology of PUJO is congenital obstruction (narrowing, crossing vessels). Acquired causes include calculi and stricture. Objectives: We reviewed the outcome of our management of congenital and acquired PUJ obstruction over a 10-year period at University of Abuja Teaching Hospital Nigeria. Methodology: This study was retrospective in nature, from January 2006 to December 2015. All patients who presented with clinical and radiological features of PUJO at any age of life were included in the study. Information obtained included age, sex, presenting symptoms, duration of symptoms, side of obstruction, the nature of the intervention performed, as well as whether a ureteric stent was used or not and if yes what type. The results of relevant clinical, laboratory and radiological investigations were noted. The data obtained was tabulated and analysed in the form of mean, median, mode, and percentages using Microsoft Excel and SPSS version16. Results: Forty-one patients with PUJO were seen, 18 with congenital PUJO, 21 with renal calculi and 2 with strictures. The age range was 3 to 67 years, and mean age of 33.1 +/-15.7 years. The range of symptom duration was between 1 month to 180 months (15years), mean duration of 17.6 +/- 30.3 months. Anderson hynes pyeloplasty was done in 16 patients (14 patients with congenital PUJO and 2 with strictures). One patient with congenital PUJO had foley YV pyeloplasty. Three patients with congenital PUJO had simple nephrectomies for nonfunctional kidneys with severe flank pains. The 21 patients with calculi all had open pyelolithotomy. Twenty-two patients had ureteric stents inserted either using double J or improvising with small size feeding tubes intraoperatively. All patients had remarkable improvements in symptoms during followup. Conclusion: PUJ obstruction is a common abnormality of the upper urinary tract. Presentation in later life is common in our environment even for congenital pathology. Renal pelvic stones were the most common aetiological cause of PUJ obstruction in our centre (51%), followed closely by congenital causes (39%)

Urological emergencies at the University of Abuja Teaching Hospital Gwagwalada, Nigeria: Spectrum and initial outcome

Introduction:Urological emergencies are urologic conditions that may require urgent treatment.With the exception of acute urinary retention, urological emergencies are not common compared to other fields of medicine.Immediate management of urologic emergencies will forestall complications.Aims and Objectives: To present the spectrum of urological emergencies and the initial outcome in the emergency unit.Methods: This is a prospective study carried out in the emergency department of UATH. The authors conducted a 6month study starting from January 2014. Data collected were age, sex,working diagnosis and initial outcome in the emergency room within the first 24 hours.Results:A total of 92 patients were seen, most of them (65.2%) were above 40 years.The majority of the patients (53.3%) had acute urinary retention.The conditions that presented as emergencies were benign prostatic enlargement (42.4%), prostate cancer (16.3%), genitourinary infections (13.1%), urethral stricture diseases (9.8%), urolithiasis (3.3%), testicular torsion (9%). Of these patients, 51.1% were admitted for further treatment while 44.6% were treated and discharged from the emergency room.Conclusion: Acute urinary retention was the commonest urological emergency in our center. The incidence of benign prostatic enlargement was quite high. The large number of patients discharged from the emergency room after treatment implied they could have had medical attention at other nearby health facilities and not overburdens the emergency services at our center which is a referral center or perhaps they preferred the services in our center. Keywords: Urological emergencies,emergency room,acute urinary retention

Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data

Background: Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. Methods: Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. Results: Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63–3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19–1.74), p < 0.001); history of transfusion (1.48(1.13–1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21–1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47–0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47–0.76), p < 0.001); younger-age (1.07 (1.03–1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46–0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23–2.44) and 1.46(1.18–1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. Conclusions: Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. Trial registration: ISRCTN ISRCTN84086586. Keywords: Severe anaemia, Readmissio

Giant adrenal cyst in a young female patient: A case report

AbstractAdrenal cysts are rare cystic masses that arise from the adrenal gland. They are usually non-functional, asymptomatic and less than 10cm in diameter when discovered incidentally. However, giant adrenal cysts are cysts of the adrenal gland which are larger than 10cm in diameter. They pose a diagnostic conundrum to the surgeon as localization of the origin of the cyst is very difficult. Indications for surgical intervention include a size exceeding 10cm in diameter, the presence of symptoms, endocrine abnormalities, intracystic bleeding and suspicion of malignancy. The current treatment of choice is adrenalectomy, either open or laparoscopic. Ultrasound-guided percutaneous drainage is an alternative, especially when there is no doubt regarding the diagnosis. Following, we report on one of the rare cases of a giant adrenal cyst

Prevalence of Erectile Dysfunction and Awareness of Its Treatment in Abuja, Nigeria

Introduction: Erectile dysfunction (ED) is the most common male sexual dysfunction all over the World. It is underestimated in developing countries including Nigeria because it is assumed not to be a life threatening condition which is associated with stigmatization and poor health seeking behavior. The Prevalence rate of ED among specific age groups has not been reported in most available local studies. This study was aimed at determining the prevalence rates of ED and the severity of ED among different age groups and patients’ awareness of its treatment.&#x0D; Methods: The study was a descriptive cross-sectional hospital based survey among men aged 18 years and above seen in the outpatient clinics of University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria. Self reported erectile dysfunction was obtained using proforma. The prevalence and severity of ED was obtained using International Index of Erectile Function-5 Questionnaire (IIEF-5).&#x0D; Results: A total of 378 subjects were recruited for this study with age range of 18-76 years. The prevalence of ED in this study using IIEF-5 was 66.4%. The prevalence of ED was noted to increase with increasing age as ED was more prevalent (59%) among men aged 60-79 year. ED was least common among the young subjects (15.7%) and the most severe ED found among the elderly There was a positive correlation between age and ED (rho =0.306). There was statistically significance association between ED and co-morbidities with hypertension accounting for 22.5% and diabetes 16.7%. The percentage of subjects aware of treatment for ED was 39.4% and 20.4% of the subjects had sought help from doctors. Only about a quarter (26.5%) of the subjects had their sexual challenges discussed with the doctor.&#x0D; Conclusion: ED is a common medical and social problem in our environment though still shrouded in secrecy. ED is more prevalent and severe among age 60-79 years. Awareness of treatment seeking behavior and the ability of the attending physicians to discuss with men about their sexual health remains quite poor in our environment.</jats:p