Muhammed Ahmed

Prostate cancer diagnosis in a resource-poor setting: the changing role of digital rectal examination

We undertook this study in order to determine the current role of digital rectal examination (DRE) in the diagnosis of prostate cancer in a resource-poor setting. The diagnosis of prostate cancer has been revolutionized by the introduction of prostate-specific antigen (PSA), transrectal ultrasound (TRUS) for biopsy guidance and more efficient biopsy equipment, but they are not readily available in most developing countries. This is a prospective study of 131 patients with suspected prostate cancer based on clinical presentation, DRE and elevated PSA. The presence or absence of cancer was confirmed by biopsy and histologic examination. Patients with screen- or incidentally-detected prostate cancer were excluded. The most common symptom was the development of lower urinary tract symptoms (LUTS). All patients had abnormal DRE and indurated prostate was the most frequent finding (50%). The mean PSA was 33.9ng/mL: of the 131 patients, 80 (61.1%) had a malignant histology following biopsy, 47 (35.9%) were benign and four (3.0%) were prostate intraepithelial neoplasia (PIN). The low specificity of DRE in the diagnosis of prostate cancer requires that it should be combined with other diagnostic modalities such as PSA and TRUS-guided prostate biopsy. Thus government and health-care providers in resource-poor countries must strive to make these facilities available in order to improve prostate cancer diagnosis.

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.

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.

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.

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.