Hussaini Yusuf Maitama

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.

Yolk sac tumour of the penile shaft: A rare primary extra-gonadal presentation

Germ cell tumours (GCTs) commonly involve the ovaries, testes, and other midline structures in children and adolescents and comprised a variety of tumours that have a common histiogenetic origin. The yolk sac tumour (YST) variant is the most common one seen in over 80% of testicular GCTs in children. Other sites of occurrence of these tumours include the mediastinum, prostate, retroperitoneum, and sacrococcygeal region. Penile malignancies account for less than 10% of male malignancies in the elderly, while its occurrence in children is rare. We present the case of a 5-year-old child with YST of the penile shaft and uninvolved testes.

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.

Surgical treatment of priapism in sickle cell patients: A noble therapy in preserving erection

Background: Priapism is a pathological condition of erectile tissue tumescence characterized by prolonged erection without any sexual stimulation and excitement. A classification commonly used to differentiate clinical presentation of priapism divides priapism into ischemic (low-flow) and nonischemic (high-flow) priapism. They have different pathological consequences and also differ in the overall management. The present study reviewed the modes of presentation and management and results of treatment of priapism in sickle cell patients. Patients and Methods: All consecutive sickle cell patients with priapism who were managed by surgical intervention at our unit between January 2000 and December 2011 were included in this study. The demographic characteristics, predisposing factors, and mode of treatment were reviewed. The outcomes of the treatment were analyzed using statistical software Statistical Package for the Social Sciences (SPSS) version 16. Results: Thirty-three patients with priapism due sickle cell disease were seen over 12 years; two patients were lost to follow-up and were excluded. Their age range was 2-35 years with a mean of 22.5 years. The patients who had an El-Ghorab cavernospongiosus shunt (ECS) had better results than those who had a conventional perineal cavernospongiosus shunt (PCS). Eleven patients with recurrent previous episodes of priapism had reduced or absent erection. Erection was better in patients with shorter duration of priapism and not more than one previous episode. The mean duration of symptoms from the time of presentation to treatment was 3 days. Of the twenty-one patients who presented in ≤2 days, 18 had normal erections and 3 had reduced erections at 12 weeks. Of the 12 patients who presented in ≥3 days, 5 had normal erections, 2 had reduced erections, and 5 had no erection. Ten patients had treatment with sildenafil during the follow-up period with some improvement. One patient who had PCS developed perineal urethrocutaneous fistula. Conclusion: Early surgical intervention is recommended in patients with ischemic priapism; regardless of the delay in presentation, and immediate unilateral distal venous shunt should be considered the best way to preserve erection. More prospective randomized studies are required to confirm these assertions.

Penile agenesis: A case report

Absence of the penis is a rare congenital anomaly of the male infant that may be associated with other congenital anomalies. Management in the last two decades has changed from initial female gender assignment to penile reconstruction procedures. In our sub-region, training and experience in penile reconstruction are

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.

Urethral duplication: Case report and literature review

Urethral duplication is a rare congenital genitourinary abnormality. The purpose of this report is to add to the scanty literature on the subject. We emphasize the significance of high index of suspicion, thorough evaluation, and to discourage circumcision performed by unqualified individuals. A six year old with a finding of urethral duplication is presented along with the review of the literature.The patient presented with of passage of urine from 2 orifices on the penis following circumcision, six months prior presentation. He voids with double streams - clear urine and the other haematuria. Examination revealed a normal primary urethral meatus and an accessory opening on the corona of the dorsal surface of the phallus. No other abnormality detected. Patient had single stage urethroplasty with good outcome. Urethral duplication is rare. Diagnosis requires a high index of suspicion. Optimal knowledge of the duplication is significant for the managing surgeon in order to avoid complications. The overall outcome is good.

Transrectal ultrasound findings in patients with advanced prostate cancer

Objectives : The objective is to determine transrectal ultrasound (TRUS) findings and their relevance in the diagnosis of prostatic cancer among patients with abnormal digital rectal examination (DRE) and elevated PSA. Materials and Methods : This was a prospective study of 131 patients suspected to have advanced prostate cancer based on clinical presentation, abnormal DRE and elevated PSA (>10 ng/ml), who were evaluated with TRUS prior to prostatic biopsy and the findings correlated with the histologic outcome. Results : The mean prostate size by TRUS was 66.8 g with a range of 15-219 g. The majority of patients with hypoechoic nodules 56.3% (45 of 80) had a malignant histology and the yield was higher among those with both hypoechoic nodules and prostatic capsule invasion 25 (31.3%). Cancer detection in those with mixed echogenicity was next in frequency 33.8% (27 of 80). All the prostates with hyperechoic pattern and most of those with isoechoic appearance had benign histology. Conclusion : Though TRUS findings generally have a low specificity for prostate cancer, the specificity of TRUS findings is probably higher in advanced prostate cancer.