Range of urologic surgical procedures in two district tertiary care hospitals in Abuja,Nigeria

Objectives  

To assist the surgical workload and the spectrum of urological procedures performed by a single urologist in two tertiary referral hospitals in Abuja, Nigeria, between February 2007 and December 2008.     

From zebrafish to mammal: functional evolution of prestin, the motor protein of cochlear outer hair cells

Prestin is the motor protein of cochlear outer hair cells. It belongs to a distinct anion transporter family called solute carrier protein 26A, or SLC26A. Members of this family serve two fundamentally distinct functions. Although most members transport different anion substrates across a variety of epithelia, prestin (SLC26A5) is unique, functioning as a voltage-dependent motor protein. Recent evidence suggests that prestin orthologs from zebrafish and chicken are electrogenic divalent/chloride anion exchangers/transporters with no motor function. These studies appear to suggest that prestin was evolved from an anion transporter. We examined the motor and transport functions of prestin and its orthologs from four different species in the vertebrate lineage, to gain insights of how these two physiological functions became distinct. Somatic motility, voltage-dependent nonlinear capacitance (NLC), and transporter function were measured in transfected human embryonic kidney (HEK) cells using voltage-clamp and anion uptake techniques. Zebrafish and chicken prestins both exhibited weak NLC, with peaks significantly shifted in the depolarization (right) direction. This was contrasted by robust NLC with peaks left shifted in the platypus and gerbil. The platypus and gerbil prestins retained little transporter function compared with robust anion transport capacities in the zebrafish and chicken orthologs. Somatic motility was detected only in the platypus and gerbil prestins. There appears to be an inverse relationship between NLC and anion transport functions, whereas motor function appears to have emerged only in mammalian prestin. Our results suggest that motor function is an innovation of therian prestin and is concurrent with diminished transporter capabilities.     

Female urethral and bladder neck injury after rape: an appraisal of the surgical management

The aim of this study was to discuss the surgical management of urethral and bladder neck injury after urethral coitus during rape. A 21-year-old lady presented with total urinary incontinence of 1-year duration after being raped. On examination, she had urethral laceration and a patulous urethra and bladder neck suggesting urethral coitus during the rape. Her introitus and vagina were however normal. She had repair of her urethral laceration and plication of her urethra and bladder neck via a vaginal approach. She regained her continence and voids without any residual urine. Urethral coitus is rare. Urethral coitus in the presence of a normal introitus and vagina is very rare. The urethral and bladder neck injury resulting from this can be satisfactorily corrected by urethral and bladder neck plication via a vaginal approach with the vaginal incisions positioned to forestall suture line apposition, which may lead to wound failure.     

Urethral duplication with a perineal opening in a four-year-old boy

Urethral duplication (UD) is a rare congenital anomaly. In UD, there is in addition to a normally positioned urethra an accessory urethra arising from the bladder, bladder neck or the proximal urethra and terminating anywhere between the base of the penis along the ventral surface and the glans penis. The embryologic development of UD remains to be clearly elucidated and the etiology of the condition is unknown. We present our experience with a 4 year old boy who presented with urethral duplication.     

Outcome of the TURP-TUVP sandwich procedure for minimally invasive surgical treatment of benign prostatic hyperplasia with volume larger than 40cc over a 4-year period in Nigeria

IntroductionTransurethral resection of the prostate (TURP) remains the reference standard for the surgical treatment of infravesical obstruction due to benign prostatic hyperplasia (BPH). While TURP has proven long-term efficacy, it has some associated morbidities. This has fuelled the drive to develop alternative cost-effective options with comparable functional outcomes and a superior safety profile.ObjectivesThe aim of this study was to evaluate transurethral electro-vaporization of the prostate (TUVP) combined with TURP as a “sandwich” procedure in relieving the obstruction caused by BPH with volume of 40-80cc.Patients and MethodsThe medical notes of 57 consecutive patients with moderate to severe bladder outflow symptoms due to BPH who underwent TURP-TUVP as a sandwich procedure from April 2007 to March 2011 were reviewed for prostatic volume, duration of surgery, volume of irrigation fluid used intra-operatively and post-operative hospital stay. Similarly, the patients IPSS, Qmax and PVR were evaluated pre- and postoperatively.ResultsThe mean patient age was 64.1 years (SD = 9.1), mean prostatic volume was 56.8 cc (SD = 8.9), mean resection time was 69.5 minutes (SD = 23.9) and mean volume of irrigation fluid (1.5% Glycine) used was 21.5 L (SD = 4.9).The mean post-operative hospital stay was 3.5 days (range 3- 4 days). Overall, 11 (19%) patients had blood transfusion, there was no incidence of TUR syndrome and one mortality was recorded from primary plasminolysis. Compared with baseline values, on follow-up at 3 months the IPSS, Qmax and PVR had improved significantly. Bladder neck stenosis occurred in 3 patients and was successfully treated with bladder neck incision.ConclusionsThe sandwich combination of TURP and TUVP for the surgical treatment of BPH with volume larger than 40cc had satisfactory patient safety profile and resulted in significant improvement in IPSS, Qmax and PVR on follow-up at 3 months.     

Preoperative analgesia in emergency surgical care in Ibadan

Pain is the main complaint of patients presenting as surgical emergencies. However, preoperative analgesia has not been studied in developing countries. The adequacy of preoperative analgesia in 106 consecutive acute surgical cases admitted to the Accident and Emergency Department of The University College Hospital, Ibadan, was evaluated using the visual analogue scale and the verbal rating scale. In all, 58% of cases were trauma victims, and the male-to-female ratio was 2.5:1. Analgesia was not prescribed in 45.2% of the patients, 65% of whom were in severe pain. In addition, 81% who were given preoperative analgesia had 'moderate to severe' residual pain. The results showed that provision of preoperative analgesia is inadequate in emergency surgical cases in Ibadan.     

Congenital complex penile curvature

Congenital complex penile curvature is a rare deformity that arises from asymmetry of the corpora cavernosa. The deformity is generally not severe enough to interfere with sexual intercourse but can be a source of great concern to the patient and may cause him to avoid sexual contact altogether. We report a case of congenital complex penile curvature in a 21-year-old man who was satisfactorily corrected using the modified Nesbit procedure.     

Hypospadias repair and outcome in Abuja,Nigeria: A 5-year single-centre experience

Background:

To determine the outcome of hypospadias repair in children.

Patients and Methods:

This was a retrospective study of all patients with hypospadias managed at the University of Abuja Teaching Hospital, Abuja, Nigeria from January 2009 to December 2013.

Results:

Twenty-four cases of hypospadias had corrective surgery during the 5-year period under review. Seventy-five percent of the patients (n = 18) were seen after the 1^st year of life. There were two peaks of ages at corrective repair; 45.8% between age 1 and 3 years and 29.1% between age 5 and 10 years. The average age at time of surgery was 44.9 months. Distal hypospadias were more common (58.4%), followed by glanular (20.8%) and proximal (20.8%) hypospadias. Associated anomalies included chordee, maldescended testicles and inguinal hernia in 20.8%, 4.1% and 8.3% cases, respectively. Operative techniques were single-stage procedures in 79.1% of patients consisting of simple circumcision in two cases (10.5%), Mathieu''s peri-meatal based flap in four cases (21%), meatal advancement and glanuloplasty incorporated in three cases (16%) and Snodgrass tubularised incised urethral plate tubularised incised plate in 10 cases (52.5%). The remaining 20.9% (n = 5) had multi-staged procedures. The most common post-operative complications were urethrocutenous fistula in nine patients (33.3%) and metal stenosis in 3 patients (12.5%).

Conclusions:

Our results show that hypospadia repair is froth with attendant high complications in our setting.