In a combined study from the USA and Kenya, the safety of adult male circumcision in the latter country was reviewed, particularly with the purported association between this procedure and a lower incidence of HIV and other sexually‐transmitted infections. It was found that safe and acceptable adult male circumcision services could be delivered in developing countries should this be advocated as a public health measure. OBJECTIVE To develop a standard procedure for male circumcision in a resource‐poor medical setting and prospectively evaluate the outcome in a randomized, controlled trial with the incidence of human immunodeficiency virus (HIV) as the main outcome, as studies suggest that circumcision is associated with a lower incidence of HIV and other sexually transmitted infections in high‐risk populations. SUBJECTS AND METHODS Healthy, uncircumcised, HIV‐seronegative men aged 18–24 years from Kisumu District, Kenya, were offered participation in a clinical trial using a standard circumcision procedure based on ‘usual’ medical procedures in Western Kenya. The follow‐up included visits at 3, 8 and 30 days after circumcision, with additional visits if necessary. Healing, satisfaction and resumption of activities were assessed at these visits and 3 months from randomization. RESULTS Overall, 17 (3.5%) of the 479 circumcisions were associated with adverse events judged definitely, probably or possibly related to the procedure. The most common adverse events were wound infections (1.3%), bleeding (0.8%), and delayed wound healing or suture line disruption (0.8%). After 30 days, 99% of participants reported being very satisfied with the procedure; ≈ 23% reported having had sex and 15% reported that their partners had expressed an opinion, all of whom were very satisfied with the outcome. About 96% of the men resumed normal general activities within the first week after the procedure. CONCLUSION Safe and acceptable adult male circumcision services can be delivered in developing countries should male circumcision ultimately be advocated as a public‐health measure.
Objectives: To determine how common cancer of penis is in this locality compared to all other malignant tumours and urological malignancies, and to determine and comment on the various methods of treatment available at KNH. Design: A retrospective case study. Setting: Kenyatta National Referral Hospital, Nairobi. Subjects: All patients with histologically confirmed cancer of penis at the Kenyatta National hospital between January 1970 and December 1999. Results: There were 55 patients with penile cancer representing 0.1% of all malignancies during the study period. The mean age was 47.9 years with a peak incidence between 40-61 year age groups. Penile cancer was the most rare urological tumour representing 5.1%. The most common was prostate cancer (56.0%), followed by bladder cancer (25.0%), kidney cancer (7.9%), and testicular cancer (6.1%). Thirty eight patients (69.1%) presented with advanced disease, Jacksons stages III and IV. The majority (96.4%) of the patients had glandular and preputial involvement. Histologically, 56.4% had well differentiated squamous cell carcinoma, (23.6%) had moderately differentiated and (20.0%) had undifferentiated carcinoma. Forty patients (72.7%) were circumcised, nine patients (16.4%) were circumcised as adolescents and three patients (5.5%) circumcised as adults. Twenty five patients had partial penectomy with radiotherapy and or chemotherapy. Eight patients had total penectomy and radiotherapy while four patients had local excision and radiotherapy. Eleven other patients had radiotherapy either alone or combined with chemotherapy. Two patients had circumcision only and inguinal lymphadenectomy was effected on five patients after penectomy and radiotherapy. Conclusion: Penile cancer is rare and the least common urological malignancy in this locality. It occurs in younger men with a mean age of 47.9 years, and presents as advanced Jackson's stages III and IV disease. The majority of patients had penectomy and local excision followed by radiotherapy.
Objective: To determine the prevalence, clinical characteristics, management methods and prognosis of testicular cancer at Kenyatta National Hospital. Design: Retrospective case study of testicular cancer patients over a fifteen year period. Setting: Kenyatta National Hospital, a referral and teaching hospital. Participants: All histologically confirmed testicular cancer patients recorded at the Histopathology Department of Kenyatta National Hospital between 1983 and 1997. Results: The mean age was 34.8 years with a peak incidence in the 30-44 year age group. History of cryptochirdism was obtained in 10.26% of the patients. Thirty one patients (79.49%) presented with painless testicular swellings, eleven (28.08%) with pain, nine (23.08%) with scrotal heaviness, six (15.38%) with abdominal swellings and one (2.56%) each with gynaecomastia and eye swelling. On examination 32 patients (82.05%) had testicular masses, ten (25.64%) had abdominal masses, seven (17.91%) had supraclavicular and cervical lymphadenopathy, and one each (2.56%) had gynaecomastia and eye mass respectively. More than eighty nine per cent had germ cell cancers with seminoma accounting for 67.35%, teratoma 12.24%, embroyonal carcinoma 8.16%, rhabdomyosarcoma 6.12% and malignant germ cell tumour, orchioblastoma and dysgerminoma each accounted for 2.04%. Three patients (7.7%) had orchidectomy and radiotherapy and chemotherapy, sixteen (41.03%) had orchidectomy and radiotherapy, six (15.38%) had orchidectomy and chemotherapy, ten (25.64%) had radiotherapy and chemotherapy, three (7.7%) and two (5.13%) had only chemotherapy and radiotherapy respectively. No cisplastin based chemotherapy regime was used. Follow up was effected for eighteen patients (46.15%) and seven patients (38.89%) were alive after five years. Conclusion: Prognosis with current regimes was poor with survival of only 38.89% after five years. Cisplastin based chemotherapy with up to 90% cure rates should be included as a component of testicular cancer management at Kenyatta National Hospital.
Eighty five men undergoing prostatectomy for the relief of lower urinary tract obstruction due to benign prostatic hyperplasia. Procedures included suprapubic transvesical prostatectomy, retropubic prostatectomy and transurethral resection of the prostate (TURP).
Background: Fournier's gangrene is a devastating condition that affects mostly patients whose immunity has been reduced. There is increasing evidence for increasing incidence of the disease in those with HIV disease. Objective: To evaluate the presentation, bacteriology and outcome of Fournier's gangrene in our area in recent times in view of the high prevalence in Nairobi and its environs. Results: One hundred and forty six patients were treated for Fournier's gangrene during the study period; all were male. They had a mean age of 38.6 years (range 2 months -86 years). HIV infection was the most common associated underlying illness (16.4 %), followed by diabetes mellitus and alcoholism (11%). Conclusions: HIV infection is emerging as leading predisposing factor and has overtaken diabetes in predisposing for Fournier's gangrene in Kenyatta National Hospital.
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