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Urological complications of coitus

Objective To ascertain the urological complications of coitus, as the proximity of the lower urinary tract to the organs of coitus exposes the tract to coital trauma.

Genital self-mutilation: there is no method in this madness.

The genital mutilation of John Bobbitt by his wife Lorena was recently sensationalized in the media [1] and human biting of the penis during fellatio has been recorded [2]. Group ritual genital mutilation is a custom of a sect of Australian Aborigines [3], in which the blood is drunk by the in®rm, who believe that it restores health. Genital self-mutilation (GSM) has also been recorded many times; indeed, self-mutilation of the penis has been observed in mice [4]. Male GSM was recorded in Greek mythology; the beautiful god Eshmun castrated himself to evade the erotic advances of the goddess Astronae, and autocastration came to be known as the Eshmun complex [5]. The ®rst reported case of GSM in the English literature was by Strock in 1901. The condition occurs in both sexes but is under-reported [6,7]. Papers on GSM published in the past century are reviewed here to identify the characteristics of this malady.

Extrauterine translocated contraceptive device: a presentation of five cases and revisit of the enigmatic issues of iatrogenic perforation and migration.

Translocation of an intrauterine contraceptive device to an extrauterine site in the peritoneal cavity is an uncommon complication. In cases reported in literature, the timing of extrauterine presentation and the distant sites of translocation often raise the issue of whether iatrogenic uterine perforation or migration of the device was responsible. We present and discuss five referred cases of the extrauterine device inserted in centres outside the University of Port Harcourt Teaching Hospital. The indication for insertion of the intrauterine contraceptive device in the patients (mean age 25.6 years) was contraception in four patients and adhesiolysis for Ashermans syndrome in the fifth. The most common presenting symptom was inability to feel the devices string (in three patients). Four of the patients presented within one month of the insertion. Three of the five translocated intraperitoneal devices were recovered by laparotomy and the forth by laparoscopy. The fifth patient, pregnant, defaulted with the device still retained. We are of the opinion that primary iatrogenic uterine perforation occurs occasionally. Other possible translocatory mechanisms include spontaneous uterine contractions, urinary bladder contractions, gut peristalsis and movement of peritoneal fluid.

An open comparative study of dispersible piroxicam versus soluble acetylsalicylic acid for the treatment of osteoarticular painful attack during sickle cell crisis.

Summary We compared the efficacy and tolerability of oral piroxicam 1 mg/kg/day with soluble aspirin given at 100 mg/kg/day taken four‐hourly in 58 patients with sickle cell anaemia and severe ostcoarticular painful attacks requiring hospitalization in a randomized, paralleled study. Main investigational criteria were pain relief, limitation of movement, fever, and insomnia or agitation. Both groups were well‐matched at the commencement of therapy but most patients on piroxicam showed remarkable and significant pain relief and improvement in other parameters within 24 h. Unwanted effects were absent in the piroxicam‐treated group whereas those treated with aspirin experienced nausea and vomiting. There were no significant changes in liver function tests with both forms of treatment. Oral piroxicam is an effective and safe treatment in the management of the osteoarticular painful crisis in sickle cell anaemia. It might prevent the use of parenteral analgesics and hospitalization and reduce the loss of school hours in patients who are being treated for bone pain crises that characterize sickle cell anaemia.

Female genital mutilation: what can be done?

Female genital mutilation (FGM) is practiced worldwide and the victims exceed 135 million. It is a purposeless and sadistic ritual which is done without anesthesia and with gross disregard for asepsis. The complications of FGM can be classified as mutilatory hemorrhagic infective obstructive and social. Despite the protests of female rights groups and expositions of physicians who encounter the complications of FGM many governments condone this ritual. It is noted that campaigns against FGM are beset with barriers such as inadequate access to education cultural entrenchment and lowly status of women in several cultures. Hence eradication will require reinforced strategies including legal ones in cultures where uncircumcised women are forced to undergo the ritual even after marriage and before childbirth. Public awareness of the complications and the need for eradication of FGM warrant a sustained campaign in schools churches mosques and other public forums. In addition psychological counseling of victims of all forms of FGM is also essential and obstetricians gynecologists proctologists plastic surgeons and urologists should repair functional damage.

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.

Spontaneous knotting of a feeding tube in the bladder

Urinary catheterization is often performed in the pediatric age group. The procedure although safe, is not free of complications. Knotting of the urinary catheter is a rare but serious complication. A seven-year-old boy presented with left-sided neuroblastoma and underwent an exploratory laparotomy during which it was found that he had an inoperable tumor. There was a nodule obstructing the left ureter. This was resected and an end-to-end anastomosis of the ureter was carried out. A size 8 French (Fr) feeding tube was introduced through the urethra to monitor the patients urine output and fluid balance in the absence of a self-retaining pediatric catheter. An attempt at removal 48 h later was unsuccessful. The patient was afterwards, on the sixth postoperative day, anaesthetized and the tube was pulled out. It was noticed that the catheter was knotted. The case is reported with a limited discussion of relevant literature. Spontaneous knotting of a catheter is a rare complication. With availability of appropriate catheters and adequate knowledge and skill, this complication can be reduced to the barest minimum.