IntroductionProstate cancer (CaP) is the most commonly diagnosed cancer among Nigerian men but CaP screening is not a common practice. The true burden of the disease in Nigeria is not known. The study was aimed at studying the community burden of CaP in Lagos.MethodsDuring a community-based prostate cancer awareness program in 13 local government areas of Lagos, men aged >40 years had serum total PSA (tPSA) test and digital rectal examination (DRE). Those with abnormal DRE or tPSA >95th percentile of the cohort or both were selected for prostate biopsy (TRPB).Results4172 men were screened and complete data was available for 4110 (98.5%). The mean age was 60.8 years. DRE was abnormal in 410 men and was significantly correlated with the age of the patient and tPSA (p<0.001). The tPSA ranged from 0 to 438.3ng/ml with a median, mean and 95th percentile of 1.5, 2.5 and 10.0ng/ml respectively. 341 out of the 438(78%) men selected were subjected to TRBP. Forty-three men had histological diagnosis of CaP, giving an estimated prevalence rate of at least 1.046% or 1046 per 100,000 men of age ≥40. Only 11 (26%) had organ-confined disease while 17 (40%) had locally advanced disease and 15 (35%) men had metastatic disease. The majority of the men, 32 (74%) were reported to have Gleason's score of ≥7.ConclusionThe prevalence rate of CaP among men aged ≥40 years in Lagos is higher than previously reported in hospital-based study. Majority have advanced and high-grade disease.

BackgroundAcute urinary retention (AUR) is a common urological problem. We have observed a growing list of patients on indwelling bladder catheter awaiting surgery after AUR. This study was aimed at identifying the health, financial and quality of life (QoL) implications of prolonged use of indwelling catheter in these patientsMethodsWe review the side-effects, QoL and cost of changing an indwelling catheter among patients who were on the waiting list for definitive surgery after AUR. All the 62 patients who presented to weekly catheter clinic for change of the indwelling catheter were recruited over a 3 – week period into the study.ResultsThe mean age of the patients was 57.5 years and the mean catheter use time was 23 months. The aetiology of AUR was BPH in 40 (64%) and urethral trauma in 16 (28.4%) of the patients. The common side effects of prolonged catheterization included urethral/suprapubic pain, bleeding per urethram, loss of dignity, loss of job or being out of school, lack of sexual intercourse, pericatheter leakage of urine and recurrent urinary tract infection. The cost of change of the indwelling catheter to the patient each time ranged from 460.00 – 2500.00 Naira (averaged 789.67 Naira). The total annual cost for the change of indwelling catheter after AUR in our catheter clinic was estimated to be 7,350,000.00 Naira (58,800 US dollars) with 1,890,000.00 Naira (15,120 US dollars) being the cost borne by the patients per annum and the rest being government subsidy. Fifty-three (85.5%) patients described that they were unhappy. There was a significant correlation between QoL and the presence of pain (p = 0.015) and bleeding (p = 0.042) associated with the presence of an indwelling catheter.ConclusionThe need to have an indwelling catheter for a prolonged period after AUR is a painful experience and associated with several side-effects. This has a significant negative effect on the patients' QoL and constitutes a significant financial burden to the patients and the government. We suggest that measures should be put in place to reduce the waiting time for surgery and therefore the catheterization time among the patients with AUR.

Posterior urethral valve (PUV) obstruction is the most common cause of bladder outlet obstruction in boys. Currently, the diagnosis of PUV is commonly made prenatally. In our environment, however, prenatal diagnosis is rare and the diagnosis is usually made postnatally from the clinical and radiological features. This study therefore examines the clinical and radiological spectrum of boys with PUV in our environment. We examined the clinical presentations, ultrasonographic and the micturating cystourethrographic (MCUG) features of boys with PUV in our institution over a 22-month period from June 2006. There were 28 patients with PUV over this period. The age at presentation ranged from 11 days to 11 years (mean age = 2.7 years). Although prenatal ultrasound scan was done in 23 (82.1%) patients, no prenatal diagnosis was made in any of the patients. The diagnosis was made after infancy in 16 (57.1%) patients. Recurrent urinary tract infection (UTI) was the most common mode of presentation occurring in 14 (50.0%) patients with 7 (50.0%) of the patients with UTI presenting with septicaemia. Voiding dysfunctions, which occurred in all the patients, were the primary mode of presentation in 12 (42.9%) patients. Three (10.7%) patients presented with renal insufficiency, which was significantly associated with the age at presentation (P = 0.026). Ultrasound scan done in the postnatal period strongly suggested the diagnosis of posterior urethral valves in 22 (78.6%) patients in whom the posterior urethra was found to be dilated, associated with thick-walled urinary bladder and bilateral hydronephrosis. Trabeculations of the bladder was a constant feature on MCUG. Other features on MCUG included dilatation of the posterior urethra in 26 (92.8%), bladder diverticuli in 15 (53.6%) and unilateral and bilateral vesicoureteric reflux in 3 (10.7%) and 1 (3.6%) patient(s), respectively. The diagnosis of PUV obstruction which is often made late in our environment, is mainly by clinical, sonographic and MCUG features in the postnatal period. A majority of patients present late, with recurrent UTI.

Urethrocutaneous fistula post-circumcision is frequently seen in our practice and the surgical repair is challenging and associated with high recurrence rate in large fistulae. This preventable condition may be avoided by proper education and training of circumcisers.

Patients with FG still present late in our environment. However, appropriate aggressive treatment can help ameliorate the associated mortality and morbidity even in a resource poor setting.

Introduction: Penile fracture though an uncommon urological emergency, can be associated with significant morbidity when it is not properly treated. Its etiology and management vary with geographical location. There are few reports on it in Nigeria. Objective: The aim of our study was to prospectively analyze the aetiological factors, presentation and management of all cases of penile fracture presenting to our hospital over a 5-year period. Subjects and methods: All the patients that presented to our hospital with penile fracture over a 5-year period from October 2008 to September 2013 were studied. The data were collected using a structured proforma documenting patient biodata, presenting complaints, duration of symptoms, aetiological factors, surgery done, intraoperative findings and post-operative complications. Results: There was a total of 15 patients during the study period. The diagnosis was clinical in all cases and confirmed at surgery. The mean age of the patient was 35.2 years. The commonest aetiological factor was vigorous coitus (66.7%). None of the patients presented earlier than 4 h, though most of them (66.7%) presented within 48 h. All the patients (100%) had immediate operative repair. Right sided injuries were Presentation and management of penile fracture at the LASUTH, Nigeria 53 the commonest (53.3%) and overall, there was associated urethral injury in 26.7%. The mean hospital stay was 3.7 days. The identified complications were erectile dysfunction (6.7%) and penile curvature (13.3%). Conclusion: Coitus is the commonest aetiological factor for fracture of the penis in our environment. Though the majority of the patient still present late, immediate surgical repair is associated with a low complication rate.

Background: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are highly prevalent in aging men. It is also necessary to evaluate ED before and subsequent to treatment intervention, when a patient presents with BPH. Current evidence suggests that there is an association between these two clinical conditions independent of age and comorbidities. No study from our environment has looked at this possible association which is therefore the aim of this study. Materials and Method: 132 patients who presented to our urology clinic for evaluation of LUTS/BPH were requested to complete the International Prostate Symptoms Score (IPSS) and International Index for Erectile Function-5 (IIEF-5) questionnaires. Their comorbidities were also noted. Data were evaluated with SPPS 14.0 software and a p value <0.05 was considered significant. Results: The mean age of the patients was 64.8 (range 46–84) years. ED and LUTS/BPH significantly correlated with the age of the patients. ED was present in 71% of the patients. The second question in the IIEF-5 questionnaire (How would you rate your ability to have an erection hard enough for penetration?) showed a significant correlation with total IPSS score (p = 0.022) while the total ED score and other questions showed only weak correlations that did not reach significant levels. However, the sum of the obstructive symptoms scores (p < 0.001), unlike the sum of the irritative symptoms scores (p = 0.202), showed a significant correlation with ED scores. In addition, there was a significant correlation between the quality of life (QOL) due to urinary symptoms and ED scores. Conclusion: ED is highly prevalent and related to LUTS/BPH among our patients. The high prevalence may be due to the obstructive urinary symptoms therefore providing a possible link between BPH and ED through the increased α-adrenergic outflow from the pelvis. The poor QOL associated with LUTS/BPH may also result in ED. It is hoped that this study would form groundwork for further research in this area in our environment.

A small but definite recanalization rate has followed the vas ligation method of partial vasectomy for sterilization. Interposition of the fascial sheath between the divided ends of the vas reduced the recanalization rate to 0. Fulguration of the lumen of the cut vas ends was used but was not the significant factor in this zero recanalization rate.