Ahmad Tijjani Lawal

Rapid and complete decompression of chronic urinary retention: a safe and effective practice.

Summary We carried out a prospective study of consecutive patients who presented with chronic urinary retention over a period of 2 years in order to determine the safety and effectiveness of rapid and complete decompression of chronic urinary retention. A total of 22 patients met the inclusion criteria. Although slow decompression is thought to reduce complications, it harbours the disadvantages of impracticability, time and labour demands and an increased risk of infection. Post-obstructive diuresis, haematuria and hypotension are relatively frequent in rapid and complete decompression of chronic urinary retention. However, they are mild, transient and clinically insignificant. Rapid and complete decompression of the chronically obstructed urinary bladder not only saves time, it is safe and effective and should be adopted as the standard practice.

Variable presentation of retrocaval ureter: Report of four cases and review of literature

Retrocaval ureter is a rare anomaly in which the ureter passes behind the inferior vena cava due to abnormal embryogenesis. Very few cases have been reported from Africa. Although the anomaly is congenital, patients become symptomatic in the third or fourth decade of life. We reviewed the records of four patients with the diagnosis of retrocaval ureter and managed in our centre between January 2010 and December 2016. Three patients presented with recurrent colicky right flank pain while one was asymptomatic. Two patients each had Type I and Type II retrocaval ureters, respectively. Surgical repairs were achieved in the three symptomatic cases and recovery was uneventful. Retrocaval ureter, though congenital, manifests in young adults and it may be symptomatic. Pre-operative diagnosis may be difficult when the lesion is high and mimics pelviureteric junction obstruction. Thus, a high index of suspicion is required for pre-operative diagnosis. Under-reporting and asymptomatic cases may account for the low incidence.

Normative ultrasonographic values for testicular volumes in Nigerian boys aged 0-15 years

Background: Pediatric testicular volume is an important index in determining the start of puberty, its progress, and/or any subsequent disorder of puberty. It is also important in detecting and monitoring local testicular pathologies. This study is aimed at obtaining reference values for testicular volume measured by ultrasound in normal pediatric age group 0-15 years. Materials and Methods: This cross-sectional study was conducted at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Boys numbering 450 without any evidence of testicular pathology were recruited for this study. The testicular volume was measured by ultrasound (Aloka SSD 3500) utilizing the testicular length, width, and thickness of the ultrasound images. All measurements were analyzed using Statistical Package for Social Sciences (SPSS 17). A P ≤ 0.05 was considered statistically significant. Results: The testicular volume shows no significant increase before the age of 9 years with an average volume of 0.74 ml and then increased to 1.1 ml at 9 years. Afterward, it shows marked increase in volume to reach a value of 8.99 ml at 15 years. Strong correlations were established between the right and left testicular parameters, except for the anteroposterior diameter. However, no statistically significant difference was observed between them, except for length (P = 0.000). Conclusion: The study provides contemporary reference values for testicular volume of the pediatric age group.

Postpartum urinary retention mimicking Fowler's syndrome: A case report

Urinary retention (UR) is relatively uncommon in women; however, it may occur following childbirth and is termed as postpartum urinary retention (PPUR). PPUR has been variably defined as the abrupt onset of painful or painless inability to completely micturate, requiring urinary catheterization, over 12 hours after giving birth or unable to void spontaneously within 6 hours of vaginal delivery. This is a case of a 22-year-old woman presenting with 12 days history of intractable UR following spontaneous vaginal delivery and repair of episiotomy. The UR persisted despite repeated trial without catheter (TWOC) and bladder training. The absence of an identifiable cause and the failure of the bladder neck to open on micturating cystourethrogram (MCUG) lead to the suspicion of Fowlers syndrome thus the patient was referred to our urology unit. She was seen with an indwelling urethral catheter and there was no significant finding on evaluation except the presence of hard, impacted feces in the rectum. She had rectal enema with evacuation of feces and was able to void spontaneously without catheter. Normal voiding was maintained at 2 months of follow-up.

Ureterocele as a cause of recurrent loin pain

Ureterocele is a congenital saccular dilatation of the terminal portion of the ureter within the urinary bladder. It is an uncommon cause of urinary tract obstruction in the young patient and one of the more challenging anomalies to the urologists. Ureterocele poses a diagnostic and therapeutic dilemma as it manifests a wide spectrum of perplexing clinical symptoms. We report a case of single system ureterocele in a patient presenting with acute severe transformation of recurrent loin pain.

Unusual presentation of a rare case of posterior urethral valves in a nine-year-old boy

Posterior urethral valves are tissue leaflets fanning distally from the prostatic urethra to the external urinary sphincter. It is the most common obstructive uropathy leading to childhood renal failure. It constitutes a clinical spectrum ranging from severe forms to milder forms. When obstruction can be overcome by detrusor contraction, it may remain silent until later life

Determination of prostatic volume and characteristics by transrectal ultrasound among patients with lower urinary tract symptoms in Zaria, Nigeria

Background: To determine the average volume and ultrasonographic characteristics of the prostate with transrectal ultrasound (TRUS) among adult male patients presenting with lower urinary tract symptoms (LUTS). This is because the size and characteristics of the prostate may suggest the specific pathology and guide the urologist on subsequent investigations and the choice of the most appropriate treatment. Patients and Methods: All male patients, 30 years or older, presenting with LUTS in the absence of non-prostatic causes of LUTS between 2006 and 2010 were included in the study. Patients with clinical suspicion or confirmed cause of LUTS other than the prostate were excluded from the study. They were all evaluated by TRUS and the findings recorded. Results: A total number of 602 patients met the inclusion criteria. The mean age of the patients was 62.5 years with a standard deviation (SD) of 13.70. The average prostate volume for all patients was 56.2 (12.5-325) and SD 42.70, while the average prostate volume among patients with suspected benign prostatic hyperplasia (BPH) (317) was 68.7 g and SD 47.52. Diagnosis based on ultrasound features was BPH (52.7%, 317) in majority of the patients, 27.6% (166) suggested carcinoma of the prostate (CaP). The TRUS characteristics of patients with suspected BPH was predominantly mixed echo (51.7%), CaP commonly appeared hypoechoic (70.5%), while prostatitis appeared hyperechoic in most patients (69.4%). Conclusion: The mean prostate size of 68.7 g among patients with BPH is consistent with most studies among Nigerians, but greater than the mean volume among Caucasians. Thus, open prostatectomy remains relevant in our environment and accurate prostate volume estimation by TRUS is required for proper patient′s selection for endoscopic treatment. The predominant ultrasonic features of BPH and CaP are mixed echo and hypoechoic appearance, respectively.