S.A. Adebayo

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.

Bilateral Double Ureters with Bladder Neck Diverticulum in a Nigerian Woman Masquerading as an Obstetric Fistula

A 43-year-old woman presented with 20-year history of leakage of urine per vaginam. She had one failed repair attempt. Pelvic examination with dye test showed leakage of clear urine suggestive of ureterovaginal fistula. The preoperative intravenous urogram revealed duplex ureter and cystoscopy showed normally cited ureteric orifices with two other ectopic ureteric openings and bladder diverticula. The definitive surgery performed was ureteric reimplantation (ureteroneocystostomy) of the two distal ureteric to 2 cm superiolateral to the two normal orifices and diverticuloplasty. There was resolution of urinary incontinence after surgery. Three months after surgery, she had urodynamic testing done (cystometry), which showed 220 mLs with no signs of instability or leakage during filling phase but leaked on coughing at maximal bladder capacity. This is to showcase some diagnostic dilemma that could arise with obstetric fistula, which is generally diagnosed by clinical assessment.