Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria

Background: Penile injuries are uncommon. The more severe injuries are often difficult to manage.Objectives: We report our experience with penile injuries from different causes and treatment options available. Patients and Methods: We analyzed retrospectively 23 cases of penile injuries presenting to the Urology Unit of a tertiary hospital in the Southeastern part of Nigeria from January 2007 to December 2012.Results: The management for each patient varied depending on the nature and extent of the injury. The mean age of the patients was 28.9 ± 14.4 years (range 3 weeks to 43 years). The mean duration before presentation was 22.7 ± 17.8 h (range 1–168 h). The causes of penile injuries were categorized as follows: Postcircumcision 3 (13.0%), genital mutilation (self‑inflicted injury/attacks by assailants) 6 (26.1%), accident 4 (17.4%), penile fracture 8 (34.8%), and gunshot injury 2 (8.6%). Isolated blunt injuries to the corporal tissues as occurs in penile fractures was managed successfully with early exploration and closure of the tunical tear, while injuries to the penile skin was managed with dressing and secondary closure. Severe penile injuries resulting in partial or total phallic loss presented the most challenge to treatment.Conclusion: Traumatic penile injuries are not common. Severe penile injuries could be challenging because of the nature of the injuries, delayed presentation and unavailability of modern technological tools and experience required for the treatment of such severe injuries. Expertise in the use of flaps for a neophallus are still been developed, and penile prosthetic devices are not readily available in our setting.Key words: Injuries, management, penile, traumati

Success of nephron-sparing surgery in the treatment of localized renal cell carcinoma

Advancement in imaging techniques has now made it possible for small renal tumors to be detected incidentally. This has led to the use of minimally invasive techniques for treatment of these cases. A 33-year-old woman was diagnosed to have a small renal mass after routine abdominal ultrasonography for epigastric discomfort. Computed tomography scan was used to characterize the mass, and an elective partial nephrectomy was successfully carried out. The procedure is safe, less morbid, and has good oncological outcome

Complication rates of open transvesical prostatectomy according to the Clavien–Dindo classification system

Background: Traditional open prostatectomies either transvesical or retropubic remains the reference standard for managing benign prostatic enlargement in some centers, especially in developing countries. The comparison of complication rates between the various types of open prostatectomies is usually a source of significant debate among urologists, most times with conflicting results. The Clavien–Dindo classification system is an excellent attempt at standardization of reporting complications associated with surgeries. Materials and Methods: We reviewed retrospectively the records of patients who had open transvesical prostatectomy (TVP) in three specialist urology centers in Anambra state, Southeast Nigeria, over a period of 5 years (January 2004–December 2009), with the aim of documenting medical and surgical complications arising from open TVP. These complications were then categorized according to the Clavien–Dindo system. Results: A total of 362 patients had open TVP over the period under review. Of this number, 145 had documented evidence of complications. The mean age of the patients was 66.3 years (SD 9.4 years; range 49–96 years). The mean follow‑up period was 27.8 months (SD 12.6 months; range 6–33 months). The overall complication rate for open TVP in this study was 40.1% (145/362). Complication rates for grades i, id, ii, iiia, and iiib were 0.8%, 0.6%, 35.1%, 0.6%, and 3.0%, respectively. Most complications of open TVP occur in the early postoperative period. Conclusion: Open TVP still remains a valid surgical option in contemporary environment where advanced techniques for transurethral resection of the prostate and laparoscopic prostatectomy are unavailable. Most complications occur in the early postoperative period, with bleeding requiring several units of blood transfusion accounting for the commonest complication. This should be explained to patients during the preoperative counselling.Keywords: Classification, postoperative complications, reference standard, suprapubic prostatectomyNigerian Journal of Clinical Practice •Jan-Mar 2012 • Vol 15 • Issue

Default from neoadjuvant chemotherapy in premenopausal female breast cancer patients: What is to blame?

Background: Breast cancer is the most frequent cancer among women in most parts of the world including Nigeria. Neoadjuvant chemotherapy has been demonstrated to be a helpful strategy in the context of locally advanced breast cancer.Aims: The purpose of this study was to investigate some factors that may contribute to low rate of acceptance and adherence to neoadjuvant chemotherapy.Materials and Methods: A 1-year prospective study of premenopausal women with locally advanced breast cancer recommended for neoadjuvant chemotherapy from June 2009 to May 2010.Results: Forty-four patients gave consent to be part of the study. The ages ranged from 26 to 51 years with a mean age of 42.1 years ± 7.7 years. Only 31 patients completed the four courses of NAC. Seventeen (38.6%) patients dropped out of treatment, before, during or after completing NAC. Ten of these defaulted due to inadequate funds to procure chemotherapy, three patients because they insisted on immediate mastectomy, and four of these patients refused surgery when they achieved complete clinical response, probably due to fear of mastectomy which is common among women in our environment. Twenty patients had dose deferment.Conclusion: Lack of funds to procure chemotherapy and refusal of additional modality of treatment are the two major factors responsible for default of NAC and its goal in patients with LABC

Diagnosis of prostate cancer with needle biopsy: Should all cases be biopsied before treatment?

Background: The triad of digital rectal examination (DRE), serum prostate specific antigen, and transrectal ultrasound‑guided prostate biopsy is used in the detection of prostate cancer (PCa). It is recommended that all cases of PCa should be diagnosed with needle biopsy before treatment. The exclusion criteria for those that may not be suitable have not yet been defined. Materials and Methods: We reviewed all the patients diagnosed with PCa at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast, Nigeria, from January 2007 to December 2010. Relevant biodata and method of diagnosis of PCa before treatment were reviewed. Results: A total of 133 patients had bilateral orchidectomy over the period. 120 (90.2%) had their diagnosis confirmed by needle biopsy before bilateral orchidectomy (category 1), while 13 (9.8%) had bilateral orchidectomy before diagnosis was confirmed. The method of diagnosis for category 1 patients was with lower urinary tract symptoms (LUTS), abnormal DRE findings, elevated prostate‑specific antigen (PSA), and transrectal needle biopsy. For category 11 patients, diagnosis of PCa was suspected based on LUTS, abnormal DRE findings, and elevated PSA. Of this number, 11 (84.6%) had, in addition, sudden onset paraplegia at presentation, while 2 (15.4%) had severe uncontrolled hematuria at presentation. All the patients in both categories had needle biopsy confirmation of their disease. The sensitivity of PSA was 99.2%. Conclusion: Needle biopsy of the prostate is the preferred method for the diagnosis of PCa in most cases before treatment is undertaken. There are valid reasons why all PCas will not be diagnosed in this fashion. Elevated PSA when combined with an abnormal DRE finding increases the predictive value for cancer. In areas where pathologists are lacking, abnormal DRE and elevated PSA results can be a guide to proceed to treatment especially, where there is severe compromise of patients’ quality of life due to symptoms of advanced PCa while awaiting confirmation.Keywords: Bilateral orchidectomy, needle biopsy, prostate cancerNigerian Journal of Clinical Practice •Jan-Mar 2012 • Vol 15 • Issue

Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa

<p>Abstract</p> <p>Background</p> <p>African American men have the highest prostate cancer morbidity and mortality rates than any other racial or ethnic group in the US. Although the overall incidence of and mortality from prostate cancer has been declining in White men since 1991, the decline in African American men lags behind White men. Of particular concern is the growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry in the Caribbean Islands, United Kingdom and West Africa. This higher incidence of prostate cancer observed in populations of African descent may be attributed to the fact that these populations share ancestral genetic factors. To better understand the burden of prostate cancer among men of West African Ancestry, we conducted a review of the literature on prostate cancer incidence, prevalence, and mortality in the countries connected by the Transatlantic Slave Trade.</p> <p>Results</p> <p>Several published studies indicate high prostate cancer burden in Nigeria and Ghana. There was no published literature for the countries Benin, Gambia and Senegal that met our review criteria. Prostate cancer morbidity and/or mortality data from the Caribbean Islands and the United Kingdom also provided comparable or worse prostate cancer burden to that of US Blacks.</p> <p>Conclusion</p> <p>The growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry follows the path of the Transatlantic Slave Trade. To better understand and address the global prostate cancer disparities seen in Black men of West African ancestry, future studies should explore the genetic and environmental risk factors for prostate cancer among this group.</p

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

Cancer Of The Prostate: Experience At Nnewi, Southeast, Nigeria

Objective: To evaluate the clinical presentation, method of diagnosis, treatment and outcome of prostate cancer patients. Patients and Methods: A 5-year retrospective study of all patients seen with the diagnosis of cancer of the prostate at the Urology Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi from January1, 1996 to December 31, 2000. The demographic pattern, clinical features, laboratory findings, treatment modalities and outcome were studied. Results: A total of 54 cases were seen. Cancer of the prostate was the commonest urological tumour accounting for 77.1%. There was a 4-fold increase in annual incidence between 1996 and 2000. Mean age was 71.0+10.9 years with a range of 44-92 years. Average duration of symptoms before presentation was 8 months while the commonest mode of presentation was Lower Urinary Tract Symptoms (LUTS). Digital Rectal Examination (DRE) had a predictive value of 66.7%. PSA was obtained only in 17 patients. Values of < 4ng/ml was obtained in 11.7%, values between 4-10ng/ml in35.2%, between 10-20ng/ml 5.8% while 47.1% had values above 20ng/ml. Biopsy obtained in 14 patients showed poorly differentiated adenocarcinoma in 78.6%, well differentiated adenocarcinoma in 7.1% while 14.3% were unclassified. Commonest mode of treatment was bilateral orchidectomy in 46.3%. Follow up was variable from 3months to 6 years. Mortality was 22.2% while 33.3% were lost to follow up. Conclusion: Prostate cancer is a major problem facing the aging male. Inadequate facilities make early detection difficult. Treatment is mainly palliative because of late presentation. Key Words: Prostate cancer, Incidence, Presentation, Diagnosis, Palliation. Nigerian Journal of Clinical Practice Vol. 7(2) 2004: 65-6

Ethnicity and Prostate Cancer in Southern Nigeria: A Preliminary Report

Introduction: The natural history of prostate cancer varies among patients. The aim of this study is to detect any variations in clinical and pathological characteristics of the tumor in patients from different ethnic groups in Southern Nigeria.Patients and Methods: Consecutive patients who presented with features of prostatic diseases at the Urology Units of University of Port Harcourt Teaching Hospital, Port Harcourt and Nnamdi Azikiwe University Teaching Hospital, Nnewi, were evaluated prospectively with history, physical examination, and relevant investigations using a proforma. Data obtained were collated and analyzed statistically using the Chi‑square test and Microsoft Excel. Results: Of 187 patients studied, 169 were analyzed. Eighty‑six were Ibos, 31 Ijaws, 25 Ikwerres, and 12 Ogonis. Two were from each Etche, Urhobo, Opobo, and Effik; 4 from Andoni, and 3 Ibibio. Fifty‑seven (66.3%) Ibos presented with the disease at higher ages (70–80 years) than 19 (61.3%) Ijaws and 11 (91.7%) Ogonis. These age differences were statistically significant with 95% and 99.9% confidence, respectively. All cases were adenocarcinomas. Clinical features, pattern of serum prostate‑specific antigen levels, grades of the tumors, tumor metastases, and complications were similar for all ethnic groups. Although more Ibos had tumors with relatively more aggressive metastatic features, there was no statistical significance. Conclusion: Clinical and pathological features of adenocarcinoma of the prostate in Ibos, Ikwerres, Ijaws, and Ogonis were found to be similar. However, Ibos presented with the disease at older ages than Ijaws and Ogonis.Keywords: Ethnicity, prostate cancer, Southern Nigeri