O.B. Shittu

Selenium status of idiopathic infertile nigerian males

Selenium concentration in the sera and seminal plasma of 60 infertile males (40 oligospermia and 20 azoospermia) and 40 males with proven evidence of fertility (normospermia; control group) were estimated using atomic absorption spectrophotometry. Results were correlated with spermatogram and hormonal levels in order to determine their relationship and significance in male infertility. The mean serum concentrations of selenium was found to be significantly increased in oligospermic compared to azoospermic subjects and controls (p<0.01), whereas the seminal plasma level was significantly higher in azoospermic compared to oligospermic subjects and controls (p<0.001). Thus, the ratio of serum selenium to seminal plasma selenium was 1∶1 in controls, 4∶1 in oligospermia, and 1∶2 in azoospermic subject.A significant inverse correlation was observed between serum selenium level and sperm count (p<0.01). Similarly, seminal plasma selenium correlated with spermatozoa motility, viability, and morphology. Serum selenium level shows positive correlation with the serum testosterone level (p<0.01). In conclusion, there appears to be a physiological balance in the distribution of selenium in serum and seminal plasma compartment of control males. A disturbance in this balance has a significant influence on spermatogenesis. Selenium appears to have a positive influence on Leydig cells, thus influencing the secretion of testosterone.

Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density

Objective:  Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia.

BRITISH TRAINING AND UROLOGICAL PRACTICE IN SUB-SAHARAN AFRICA

Allopathic medical care was introduced to Africa by the colonialist powers. Initially only students whose parents had the wherewithal were able to undertake their undergraduate and postgraduate medical training in the relevant colonial country. In Anglophone countries, the establishment of medical schools by the British in Uganda (Makarere, 1924) and Nigeria (Lagos, 1930, which was merged with the new medical school of the University College, Ibadan, in 1948) attracted many native Africans to research and postgraduate medical training [1,2]. However, the limited facilities available on ground in the earlier years meant that all postgraduate medical training was done in the UK (a few graduates chose to go to North America), and urology was no exception. More recently, regional (e.g. West African College of Surgeons, 1960) and national (e.g. Nigeria, 1979; and Ghana, 2003) postgraduate medical colleges have been established on the continent. However, significantly many African doctors continue to undertake part or all of their postgraduate specialist training in Britain, thereby providing a steady stream of ‘Britishers’ (persons trained in Britain or by the British) who return to Africa on completing their training to join in improving the education and health systems of their native countries. Sir Samuel Manuwa KT, CMG, OBE, FRCS, and Professor H. Oritsejolomi Thomas, CBE, CON, FRCS, Hon. FRCSI, were the first Nigerians to earn the FRCS of Edinburgh and England, respectively [3,4], whilst Sir Kofo Abayomi KBE, LLD undertook a postgraduate course in ophthalmic surgery and medicine in 1939 [5]. These early Britishers returned to Nigeria to play a pioneering role in establishing tertiary and postgraduate medical education and the health services of the country [2,6,7].

Ascorbic Acid Supplementation and Spermatogenesis in Nigerian Men

Background: The role of ascorbic acid as an antioxidant nutrient in the maturation of sperm cells has received considerable attention. A previous study from our laboratory showed reduced seminal and plasma ascorbic acid in subfertile patients. Method: Fifteen subfertile male patients mean age 36.4±0.9 years with sperm counts of 31.4±7, 08 x10 6 /cm 3 were given 200mg/day dose of ascorbic acid as supplement for four weeks and ten highly fertile male mean age 35.6±1.7 years with sperm count of 50.9±10.3 x10 6 /cm 3 volunteers were selected as controls. The biochemical parameters and anthropometric measurements were determined using standard methods. Result: Significant decreases were obtained in baseline sperm cell count (p<0.01), percentage (%) motility and %vitality (p<0.01), and the % of morphologically normal sperm cells (p<0.01) in the subfertile compared with the controls. The baseline plasma and seminal ascorbic acid concentrations were significantly reduced (p<0.001). The post-supplementation sperm cell count (p<0.001), % motility and %vitality (p<0.01) were significantly increased compared with the baseline values. Conclusion: The enhanced reversal of poor semen quality and semen ascorbic acid status with dietary supplementation of vitamin C in subfertile is a pointer to its positive role in the maintenance of sperm cell integrity. Further work is therefore required to elucidate our findings. Keyword: Ascorbic acid, high density lipoprotein, cholesterol, semen, infertility subfertile.

Erectile dysfunction among men attending surgical outpatients Department in a Tertiary Hospital in South-Western Nigeria

Background: Erectile dysfunction is becoming a public health issue with high incidences reported in community studies. Objective: To evaluate the characteristics and outcome of treatment in men with erectile dysfunction in a tertiary center in Ibadan southwestern Nigeria. Methods: Data of men with erectile dysfunction was retrieved between July 2004 and June 2014 and analyzed using SPSS version 16 statistical software. Results: Eighty-nine men with erectile dysfunction were managed which constituted 2% of all urological cases seen during the study period. Their median and mean ages were 39 years and 39.6 ± 1.2SD (range 19-76 years). The peak age incidence at 30-44 years was 41.6% and reduced with increasing age after 65 years to 4.5%. The etiologies were psychogenic in 55%, organic in 27%, idiopathic in 17% and 1% was familial. 67.5%, 31.5% and 3.4% were married, single and separated respectively. Seventy percent neither smoked cigarette nor drank alcohol, 21.3% drank alcohol and 9% took both alcohol and smoked cigarette. Seventy seven and half percent of men presented within 5 years of their symptom. The treatments offered were PDE type 5 inhibitors alone or in combination with psychotherapy or modification of medications. The outcome of these treatments ranged from 89% to 91% success rate. Conclusion: The number of men with erectile dysfunction managed in the tertiary hospital is very low though the outcome of treatment is within acceptable range. Increase public enlightenment may encourage increase hospital patronage and access to the available treatments for erectile dysfunction.

Pelvi-ureteric junction obstruction in adults in a resource limited environment: Causes, features and outcome of treatment

Objective: To report our experience with the management and outcome of treatment of adults with pelvi-ureteric junction(PUJ) obstruction Subjects and Methods: This was a retrospective study of adults with PUJ obstruction from January 2009 to December 2013. The study was conducted at a Tertiary Teaching Hospital in Ibadan in Nigeria. All adults with clinical features and radiological evidence of PUJ obstruction were included. Some patients had non operative treatment while others had open surgical treatment. The main outcome of treatment was measured by the relief of symptoms. We are not aware of previous report of the management of PUJ obstruction in adults in Nigeria. Results: Eighteen adult patients were treated. The mean age was 39 ± 11.2 standard deviation years (range 20-65 years). Seventy-two percent presented with loin pain. Thirteen of these patients were treated surgically, and 5 were treated nonoperatively. The operation findings were narrow but patent PUJ that barely admit a probe due to intrinsic muscle fibrosis in six patients, aberrant crossing vessels in 3, severely hydronephrotic kidneys in 3 and one impacted PUJ calculus. Fifty percent of patients had open dismembered pyeloplasty, simple nephrectomy (16.7%) while combined pyelolithotomy and Foley Y-V plasty (5%). All surgically treated patients were pain-free as at last time of review. Conclusion: Intrinsic muscle fibrosis and aberrant crossing vessels are the most common causes of PUJ obstruction in adults. Open pyeloplasty is still the main stay of treatment in our environment with satisfactory symptomatic relief.