Oral mucosa grafts for urethral reconstruction

Background: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are flexible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution

Primary Hyperparathyroidism Presenting with Multiple Pathological Fractures and Normocalcaemia

The diagnosis of primary hyperparathyroidism (PHPT) is a rarity in developing countries. We report a 30-year old Nigerian farmer seen at the Usmanu Danfodiyo University Teaching Hospital, Sokoto with multiple pathological fractures. The diagnosis of PHPT was made based on these bone changes and the elevated parathyroid hormone level. The patient however had normocalcaemia. Computerised tomography localised a left inferior parathyroid adenoma. He had uneventful parathyroidectomy but developed hungry bone syndrome that was successfully treated with active vitamin D and oral calcium. The differences in presentation between patients from developed countries as well as the apparent rarity of PHPT in tropical countries are stressed

Schistosomiasis and Urinary Bladder Cancer in North Western Tanzania: A Retrospective Review of 185 Patients.

Worldwide, cancers of the urinary bladder are well known to be associated with environmental chemical carcinogens such as smoking and occupational exposure to polycyclic aromatic hydrocarbons. These cancers are typically transitional cell carcinoma (urothelial carcinoma). In areas where schistosomiasis is endemic there is a high incidence of squamous cell carcinoma of the urinary bladder. Schistosomiasis causes chronic granulomatous cystitis leading to squamous metaplasia of transitional epithelium, and subsequently development of squamous cell carcinoma. The western part of Tanzania on the shores of Lake Victoria is such an endemic area. This study was done to document the burden of urinary bladder cancer associated with schistosomiasis in this region. This was a descriptive retrospective study of histologically confirmed cases of urinary bladder cancer seen at the Department of Pathology Bugando Medical Centre (BMC) over a period of 10 years. Data were retrieved from the records of the Departments of Pathology, Medical Records and Surgery. Data were analyzed by the use of contingency tables. A total of 185 patients were diagnosed with cancer of the urinary bladder during the study period, where as 90 (48.6%) were males and 95 (51.4) were females. The mean age at diagnosis was 54.3 years. Squamous cell carcinoma was the most frequent histological type (55.1%), followed by conventional transitional cell carcinoma (40.5%). Eighty three of all cancer cases (44.9%) were found to have schistosomal eggs. Schistosomiasis was commonly associated with squamous cancers compared to non squamous cancers. Most of the cancers associated with schistosomiasis had invaded the muscularis propria of the urinary bladder at the time of diagnosis (p<0.001) and such cancers were frequent below 50 years of age with a significant statistical difference (p<0.001). Poorly differentiated tumors were more frequent in females than males with a significant statistical difference (p=0.006). The majority of urinary bladder cancers seen in the Lake Region were squamous cell carcinoma associated with schistosomiasis. These cancers showed an aggressive behavior and were commonly seen in the younger age groups. Effective control of schistosomiasis in this region should significantly reduce the burden of urinary bladder cancer

Immunomodulatory Effects of Neem (Azadirachta indica) Leaf Aqueous Extracts in Cockerels Vaccinated and Experimentally Infected with Infectious Bursal Disease Virus

The aim of the present work was to study the immunomodulatory potentials of aqueous extract of Neem (Azadirachta indica) leaf in cockerels vaccinated and/ or infected with infectious bursal disease virus (IBDV). Four hundred and eighty (480) day old cockerels were used and allocated into 8 groups. The birds were grouped as vaccinated/ unvaccinated, challenged/ unchallenged, neem leaf treated/ untreated groups. The IBD vaccines (intermediate plus strain) were given at 14 and 28 days of age while the experimental infection using very virulent IBD virus (vvIBDV) was inoculated at 35 days of age and the extracts were given from day old to 6 week old.Serum samples were collected on first day and on weekly intervals while post challenge, onset of the disease, clinical signs and mortality rate were recorded. The results obtained showed higher antibody titre, faster seroconversion, mild clinical sign and very low mortality in the neem leaf treated groups. These results indicated that the neem leaf aqueous extract has immunomodulatory potentials by increasing the antibody titre post vaccination and the ability to prevent mortality

Management of \'watering-can\' perineum

No Abstract. East African Medical Journal Vol. 84 (6) 2007: pp. 283-28

Oral mucosa grafts for urethral reconstruction

Background: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are flexible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution

The Pattern of Penile Gangrene in Sokoto, Nigeria

Objective: To examine the presentation and outcome of management of penile gangrene. Patients and Methods: The health records of all patients admitted for penile gangrene in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria between January 1994 and December 2003 were reviewed Results: The patient group consisted of 16 patients aged between 6 and 62 years (mean: 42.5 years), of whom 7 (44%) presented in an advanced stage of gangrene. The main etiological factors were urethral stricture in 8 (50%) patients, associated with diabetes mellitus in 2 (13%), impacted urethral calculus in 3 (19%), circumcision in 2 (13%), priapism in sickle cell disease in 2 (13%) and trauma in 1 (6%). All patients were initially treated by suprapubic catheterization, broadspectrum antibiotics, intravenous fl uids and wound debridement. Surgical treatment included total penectomy in 3 (19%), phalloplasty in 3 (19%), neomeatoplasty in 5 (31%) and urethroplasty in 5 (31%) patients. Following treatment, 8 (50%) patients had a functional entire penis, while 5 (31%) had a functional penile stump and 3 (19%) no penis. Erectile dysfunction was found in 3 (19%) patients. Conclusion: Penile gangrene has a unique pattern of causes and presentation. The main cause in our series was urethral stricture. The risk of penile loss is high. Early presentation, aggressive antibiotic therapy and urinary diversion can prevent or minimize penile loss. Some patients with partial penile loss require surgical reconstruction of the urethra and penis. Keywords: Penile gangrene, Fournier's gangrene, necrotizing fasciitis, phalloplasty, urethroplasty, neomeatoplasty African Journal of Urology Vol. 13 (4) 2007: pp. 255-26

Cystic lymphangioma in an unusual site: The misdiagnosed scrotal mass

Background : Cystic lymphangioma (CL) is a congenital lymphatic malformation that is a rare cause of extratesticular scrotal masses in children, frequently misdiagnosed preoperatively. Complete excision is curative, but recurrence may result following incomplete excision. Aim: This case is presented to alert the medical fraternity on the possibility of CL in a rare site as the scrotum, and to consider same in the differential amongst commoner causes of scrotal masses in children and adults. Methods : A case report, Results : We report a case of cystic lymphangioma of the scrotum in a 7-year-old boy, which had been previously diagnosed as an epididymal cyst. Scrotal ultrasonography and operative findings were consistent with cystic lymphangioma, which was confirmed by histological examination of the excised specimen. The mass was completely excised and the child is free of recurrence at 3 years of follow-up. Conclusion : Scrotal masses may result from unusual causes like cystic lymphangioma, which must be taken into account in the differential diagnosis in such cases. High-resolution ultrasonography, followed by Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI), are useful tools in diagnosis

Vesical Gossypiboma Mimicking Calculus: A Report of two Cases

No Abstract. African Journal of Urology Vol. 13 (2) 2007: pp. 136-13