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Objectives: This review paper presents the current trends in the evaluation and treatment of anterior urethral strictures. Stricture disease is recorded as one of the oldest afflictions of mankind and even in the millennium; it is the one disease associated with rapid turn over in treatment options and continuous evolution of new options. The stricture is still a significant burden on the urologist workload right from initiation of treatment and follows up. It may be associated with significant morbidity and deteriorating quality of life and may be frustrating to treat. Current trends are to discover a long lasting satisfactory treatment suitable in most cases 'the gold standard'. Methods A review of current concepts in anatomy and the patho-physiologic mechanisms of the anterior stricture has been done. A structured literature search through a MEDLINE search was performed. New urethral substitutes have been compared to other techniques of urethroplasty as seen over the. last decade. Expert surgical consensus and opinion have been reviewed. Results The anterior urethral stricture is a consequence of major peri-urethral fibrosis and may be very complex if the inflammation is complicated or prolonged. It can be satisfactorily assessed by routine retrograde urethrography and endoscopic assessment for type and complexity. The urethral ultrasound appears to provide more information about the extent of fibrosis and the length of strictures. In review of recent experience, it has proven to be accurate convenient and a cheap complement to already established studies. Oral mucosa, rectal mucosa, bladder mucosa , dermal grafts, tunica vaginalis, tissue culture and synthetic polymers have all been applied over the last decade in the search for the suitable urethral substitute. The bucccal mucosa is outstanding among several options in the repair of the diseased anterior urethra as popularized by Barbagli. It appears to provide the solution for most situations in the anterior urethral stricture.. Conclusions:The Bucccal mucosal graft(BMG) may as well be the new 'gold standard' in the management of anterior urethral stricture .

Background :Enuresis is a common but usually under reported developmental urologic disorder affecting children most commonly .There is evidence of affectation of normal development and social stigmatization of the enuretics apart from it being a real social nuisance. Among the African children this problem is often neglected and the preferred types of treatment are traditional methods. There may be serious implications in the child including ,emotional ,social and mental maladjustment. Method This study was carried out during a six month period in four densely populated primary schools in Zaria.. Native African Children aged above 5 years were included in the study and children with history of neuropsychiatric or obvious urologic disorders were excluded. A structured closed-ended questionnaire was administered to the target group. Results . Enuresis was found in 214/1416(22.2%) of the children. The age range was 5-14 years with a median of 8 years. The male: female ratio of 2:1. 96.6 % (211/214) of affected children had nocturnal enuresis while (1.4%)3/214, had day time enuresis only. Both day time and nocturnal enuresis were seen in 2.8%(6/214) of the children. 75%(160/214) enuretics were mild-moderate and wetted bed less than 10 times /month. The ratio of the female to male ratio in this group was 1:1. 25.4%54/214) enuresis was severe and could not quantify the number of wet nights/month. Only 4/54(7.4%) children in the group considered severe were female the 50 others were male. 74.6%(160/214 ) of the children were enuretic from birth with no describable dry periods . 25.4%(54/214) enuresis commenced long after birth and symptoms were recurrent with long dry spells. In 200/214(88.%) children the mother had received conventional Ante Natal Care(ANC) and subsequent delivery was supervised in the Hospital while in 14/214(6.5%) of the children the mothers did not have ANC and delivery was un-supervised at home. There was no significant correlation between(ANC) ,mode of delivery and enuresis although two children delivered by caesarean section have severe enuresis among a group of 52 children with sever enuresis whose mothers had routine ANC before an uneventful delivery. (20/214) 3% had co -morbidities: asthma and epilepsy. The majority of parents were mostly low income workers. Most patients were managed preferably by varied traditional techniques with usually unsatisfactory outcomes. Only (74/214) 43% performed above average in school. Conclusion: Enuresis is a common and usually neglected urologic condition in our environment. The significant prevalence in the older child may have important implications on quality of the child's development. Health education will encourage parents to present early to avoid crippling associated complications.

One hundred and seventy-eight patients presenting with an acute scrotum during a period of 18 years (1978-1997) were reviewed retrospectively. Fifty per cent had testicular torsion, with a mean age of 23 years (range 3 weeks-55 years). Torsion was significantly more common in the cold harmattan season (October-early March). The salvage rate of torted testes was 52%. Inguinoscrotal hernia was the cause of testicular infarction in 10% and is an important contributor to male infertility. Twelve per cent of cases of suspected torsion were found to have epididymo-orchitis, at exploration. Twenty-three (13%) patients presented with scrotal gangrene (Fournier's gangrene) which did not result in testicular loss. There was significant morbidity following intervention by non-doctors, and misdiagnosis from unsuspecting physicians. The acute scrotum affecting young patients is a significant cause of male infertility and morbidity in Zaria. Early recognition, prompt treatment and re-education of those who may provide the first line care for such patients will reduce the morbidity and pathologic consequences following neglect.

Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed.

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Schizophrenia is a serious psychiatric disorder that requires long-term treatment. Poor adherence to medication can lead to serious and possibly life-threatening complications. Genital selfmutilation has been reported in some schizophrenic patients in response to delusions or command auditory hallucination. We report two patients with schizophrenia who carried out genital selfmutilation in response to delusional belief.

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