Abstract Background: Trans-rectal ultrasound (TRUS) Doppler assessment of the prostate can complement TRUS-guided biopsy of the prostate in the diagnosis of prostate cancer. Aim: This study aimed to correlate the trans-rectal Doppler sonography findings and tumour grade in Nigerian men with prostate carcinoma. Materials and Methods: This was a prospective longitudinal study of men counselled for prostate biopsy after a written informed consent was obtained. Patients who met the inclusion criteria had six (sextant) core biopsy samples taken from the peripheral zone of the prostate. In addition, targeted biopsies from areas of increased vascularity on colour Doppler ultrasound outside the six core areas were also included in the study. Pathological results were correlated with the imaging data. Results: Sixty-nine patients met the inclusion criteria for the study. The mean age was 70.22 ± 8.91 years. The median Gleason grade was 8.0, indicative of a high-grade tumour among the patients. All 69 patients had prostatic adenocarcinoma on histological examination. Overall, 69.6% had high-grade tumours on TRUS Doppler sonography-guided biopsy, indicating a high percentage of high-grade tumours. There was a statistically significant correlation between the Doppler ultrasoundfindings and Gleason score ( r = 0.837; P < 0.0001). Conclusion: Addition of colour Doppler scan to routine TRUS examination can help map out areas for targeted biopsies during prostate biopsies. Areas of increased vascularity correlated with high Gleason’s grade and tumour grade.

Background: Benign prostatic hypertrophy (BPH) is a common urological condition in men older than 50 years. It is important in the aetiologies of life-threatening obstructive uropathies. Ultrasound measurement of prostate volume is non-invasive, easily available, and a cost-effective method, useful in assessing bladder outlet obstruction (BOO). The International Prostate Symptoms Score (IPSS) on the other hand objectively assesses symptoms severity in BOO patients. Aim: This study was aimed at determining the correlation between ultrasound-measured prostate volume and IPSS in men with BPH. Patients and Methods: Following ethical approval from the Nnamdi Azikiwe University Teaching Hospital Ethical Committee, 100 patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled into the study. They had no other identifiable cause of BOO except BPH after clinical evaluation. The IPSS, Quality of life score (QOL), and prostate volumes were measured. Correlation between prostate volume, IPSS, and QOL were done using SPSS version 20. P value <0.05 was considered significant. Results: The mean age of patients was 69.3 ± 10.6 years with a range of 48–100 years. The mean prostate volume, IPSS, and QOL were 96.0 ± 70.5 cm3, 15.63 ± 8.6, and 4.8 ± 1.3, respectively. The highest recorded IPSS was 35 and the lowest was 4, whereas the smallest and largest recorded prostate volumes were 19 cm3 and 350 cm3, respectively. Nocturia was the major IPSS subscore. There was a weak positive correlation between prostate volume and IPSS in men with BPH (r = +0.109; P = 0.28) and between prostate volume and QOL (r = +0.072; P = 0.45). There was also a weak positive correlation between patients with only severe symptoms and corresponding prostate volumes (r = +0.122; P = 0.125). The correlation between patients with severe symptoms and their corresponding QOL was strong (r = +0.537; P = 0.135, respectively). These findings were, however, not statistically significant. Conclusion: There is a weak positive correlation between prostate volume measured by ultrasound and symptoms severity scores in patients with BPH, although not statistically significant. This may be as a result of the small sample size. A larger sample size may be able to achieve statistical significance.

Aims: The purpose of this study is to determine whether bisacodyl rectal suppository can reduce infective complications postprostate biopsy. Patients, Materials and Methods: This was a comparative cross-sectional study done at the urology unit of a tertiary hospital over 12 months. A sample size of 56 was determined using Fisher's formula. Both groups had tablets of ciprofloxacin 500 mg and metronidazole 400 mg at induction of anaesthesia and continued for three days postbiopsy at a dose of 500 mg twice daily and 400 mg thrice daily, respectively. In addition to antibiotics, those in Group 1 had 20 mg of bisacodyl (Dulcolax) suppositories given at night, starting two days before the procedure. The patients underwent digitally guided 10-core transrectal prostate biopsy on an outpatient basis. Blood and urine samples were taken for full blood count and urine culture, respectively, before surgery and three days after the biopsy. Statistical analysis was performed using the SPSS version 21.0. The level of significance was set at P < 0.05. Results: The mean age was 69.64 ± 9.31 with a range of 52–90 years. The peak age distribution was 70–79. In Group 1, two patients had urosepsis, one patient had urinary tract infection (UTI), and seven patients had bacteriuria, while in Group 2, four patients had urosepsis, four patients had UTI, and ten patients had bacteriuria. Conclusions: The addition of bisacodyl rectal suppository to antibiotics reduced the frequency of infective complications following prostate biopsy. The observed difference, however, was not statistically significant.

Background:Benign prostatic hypertrophy (BPH) causes subvesical urinary obstruction in the elderly. It leads to changes in the bladder and upper urinary tract. This may be progressive with subsequent morbidities and mortalities. This study aims at determining the relationship between ultrasound-measured prostate volume and detrusor wall thickness (DWT) in men with BPH.Materials and Methods:One hundred and ten patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled. They had no other identifiable cause of bladder outlet obstruction. The International Prostate Symptoms Score (IPSS), Quality of Life (QOL) score, prostate volume, and DWT were measured. Correlation between prostate volume and DWT was done using SPSS version 20.0 (IBM, SPSS, Chicago, IL, USA). A P-value less than 0.05 was considered significant.Results:The mean age of patients was 68.3 ± 10.2 years, with a range of 40-100 years. The mean prostate volume and DWT were 94.2 ± 68.4 cm3 and 5.9 ± 3.0 mm, respectively. Mean QOL was 4.77 ± 1.35. The highest IPSS was 35 and lowest was 2. Nocturia was the major IPSS subscore. There was a positive correlation between prostate volume and DWT in men with BPH (r = 0.37; P = 0.007). This is statistically significant.Conclusion:Ultrasound-measured prostate volume correlates positively with DWT in men with BPH. This is statistically significant and is able to determine progression of the disease. Coexisting large prostate volume and thickened detrusor wall are an indicator of disease progression and eventual need for surgical intervention. This prevents renal damage.

Introduction: Prostate cancer has an increasing global burden. The clinical course varies from an indolent disease to a rapidly aggressive cancer. It is associated with higher mortality in less developed nations due to late presentation. The Gleason scoring system for prostatic adenocarcinoma has prognostic implications in diagnosed cases. Obesity has been associated with the evolution of many cancers including prostate cancer. There are conflicting reports on the relationship between obesity, as measured by body mass index (BMI), and prostate cancer aggressiveness, as measured by Gleason score. This study is aimed to determine if a correlation exists between BMI and Gleason score in men with prostate cancer. Methodology: This was a prospective, hospital-based, cross-sectional study involving consecutive patients with prostate cancer. Clinical evaluation including anthropometry, digital rectal examination, and relevant investigations were done for each patient and data collected with pro forma. This was followed by prostate needle biopsy and those diagnosed with adenocarcinoma of the prostate had their Gleason grades and scores obtained. Data were analyzed statistically using Spearman Correlation. Results: The mean age of the patients was 69.54 ± 8.61 years (range 47–83 years). The BMI ranged from 16.98 to 36.45 kg/m2, with a mean of 27.03 ± 5.03 kg/m2. Twenty-six of the patients (36.1%) were overweight and 34.7% were obese. The mean total prostate-specific antigen was 118.65 ± 84.43 ng/ml, with a range of 31–406 ng/ml. The modal Gleason score was 9 with a range of 4–10. There was a strong positive correlation between BMI and Gleason score (r = 0.817, P = 0.0003). Conclusion: The BMI of patients with prostate cancer correlated positively with their Gleason score.

Introduction: Bladder Outlet Obstruction (BOO) due to prostate- related diseases can lead to changes in bladder wall resulting in detrusor wall thickening. These changes are time-dependent and may reflect the severity of underlying BOO. Although urodynamic tests are considered to be the gold standard for the assessment of the severity of Lower Urinary Tract Symptoms (LUTS), these are time-consuming, invasive and expensive. The Detrusor Wall Thickness (DWT) measurement has emerged as a cheap, non invasive and reproducible alternative means of assessing the severity of LUTS in men with BOO. Aim: To determine the correlation between the DWT and International Prostate Symptom Score (IPSS) in men being evaluated for prostate-related BOO/LUTS. Materials and Methods: A cross-sectional hospital based study was conducted over a period of 12 months (May 2014 to April 2015), at Urology Clinics of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All 100 new consecutive male patients aged ≥40 years with prostate-related LUTS and who can achieve bladder volume of >250 mL were included in the study. The DWT was measured at three different sites (anterior, lateral and dome) at bladder volume >250 mL. Ethical approval was attained from the institutional ethical review board. Severity of LUTS was assessed using a validated IPSS questionnaire. Data was analysed using SPSS version 20. Spearman’s correlation was used to assess the correlation. The p-value <0.05 was considered significant. Results: A total of 100 men with the mean age of 71.02±9.10 years were studied. The mean duration of symptoms was 30.63±26.60 months with the average IPSS being 20.94±6.13. A total of 43 patients and 57 patients had moderate and severe LUTS, respectively. None of the patients had mild LUTS. The mean anterior, lateral, dome and average DWT measurements were 4.95±2.36 mm, 4.96±2.37 mm, 5.02±2.34 mm and 4.97±2.35 mm, respectively. A total of 97 patients had DWT ≥2 mm. There was a significant positive correlation between the DWT and IPSS (r2=0.635 and p<0.001). Conclusion: The positive correlation between the DWT and IPSS has demonstrated that the DWT measurement can be used in assessing the severity of LUTS in men with prostate-related diseases.

BACKGROUND:Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and has been linked to Helicobacter pylori (H. pylori) infection. This condition may be suspected on clinical grounds, but diagnosis is established using upper gastrointestinal endoscopy.AIMS:To determine the correlation between the endoscopic and pathological findings among suspected PUD patients who have been referred for diagnostic upper gastrointestinal endoscopy in National Hospital Abuja.METHODS:This is a hospital-based prospective study conducted among suspected PUD patients at National Hospital Abuja over a one-year period. Clinical, endoscopic, and histological findings were ascertained and documented. Data obtained were analyzed using SPSS version 21.0. Tests of significance were done using the chi-square test and Student t-test at 95% confidence intervals.RESULTS:One hundred and thirty-two patients were included in the study. The ages ranged from 15 to 87 years, mean age 43.30 ± 11.94 years. Seventy-seven (58.3%) patients had abnormal endoscopic findings, of whom 37 (28.0%) had PUD. Prevalence of H. pylori infection was 42.2% and was found in 81.1% of PUD patients. H. pylori was significantly associated with confirmed PUD (p < 0.001) and abnormal endoscopic findings (p < 0.001). No association was found between normal endoscopic findings and histological findings (p = 0.924).CONCLUSION:There is a poor correlation between clinical and endoscopic diagnoses of PUD. H. pylori was found to be significantly associated with PUD and abnormal endoscopic findings. Endoscopic facilities should therefore be made available and accessible for proper PUD diagnosis. Empirical treatment of H. pylori in patients with diagnosed PUD is strongly recommended.

BACKGROUND:Benign prostatic hyperplasia is one of the most common diseases in aging males. For men that need surgical treatment, transurethral resection of the prostate (TURP) is the gold standard. The aim of this article is to retrospectively review the complications of TURP over a 3-year period in Nnamdi Azikiwe University Teaching Hospital Nnewi and a Specialist Urology Center in Awka all in Anambra South-East Nigeria using Clavien-Dindo classification. PATIENTS AND METHODS:The study was a retrospective review of consecutive TURPs done over a 3-year period. Patients' information and complications arising from the procedure were collected and graded using the Clavien-Dindo classification with a pro forma designed for the study and analyzed with the Statistical Package for the Social Sciences software version 20.0. RESULTS:Ninety-seven patients had TURP during the period of this study. Twenty-nine complications were noted in 24 patients. The postoperative morbidity rate was 24.74%, and no mortality was recorded. Most of the complications were grade 2 (55%), followed by grade 1 and 3 (20.69%) each. Grade 4a complication accounted for only 3.45%. No grade 5 complication was recorded. CONCLUSION:TURP is safe, with minimal life-threatening morbidity even in a resource-poor economy where TURP is gradually gaining grounds.

BACKGROUND:Scrotal ultrasonography has high sensitivity in the detection of intra-scrotal abnormalities. Various ultrasonographic parameters such as the spermatic cord diameter, venous diameter, and venous retrograde flow in either supine or upright positions with or without Valsalva maneuver have been investigated to assess patients suspected of having varicocele.AIMS:This study aimed at comparing testicular vein diameter in supine and upright positions using ultrasonography.METHODOLOGY:This is a prospective multicenter study conducted between September 2018 and June 2019. Eighty-two consenting suspected cases of varicocele, 20 years and above, referred for scrotal ultrasonography were included in this study.RESULTS:The study population had a mean age of 42.9 + 14.89 (SD) with a range of 20-96 years. The highest number of participants fell within the age range of 30-39 years 23 (28%). Varicocele was demonstrated in 96.3% of the patients. More patients showed sonographic evidence of varicocele in the upright position, on the right 50 (61%) as well as left 50 (61%). Bilateral varicocele had a higher frequency in the upright position 45 (54.9%), while supine was 23 (28%). Upright position had the widest diameter in 72% of participants on the right and 82% on the left. The upright position also showed higher average vein diameter of 2.6 mm and 2.9 mm on the right and left, respectively, while it was 2.2 mm and 2.3 mm for right and left in the supine position.CONCLUSION:The upright position is more predictive of varicocele in scrotal ultrasound examination for suspected cases of varicocele. We recommend an upright position where one position is to be used.

Introduction: Available literature suggests an association between Lower Urinary Tract Symptoms (LUTS) and sexual dysfunction especially Erectile Dysfunction (ED). LUTS, either alone or in combination with ED, represents a considerable problem for ageing men. An understanding of correlation between LUTS and ED in these ageing men will be useful in their routine care. Aim: To determine the incidence of ED and its correlation with LUTS in adult male patients attending the Urology clinic in a Tertiary Care Hospital. Materials and Methods: This was a cross-sectional study of 110 consecutive patients with LUTS recruited from the urological clinic. The data were collected, while ED and LUTS were assessed with the 5-Item Version of the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaire forms respectively. Findings were subjected to linear regression and Pearson’s chi-square tests, using Statistical Package for Social Sciences (SPSS) version 17. Results: The mean age of patients was 65.8±7.95 years. The incidence of ED among LUTS patients was 63.6%. There was positive correlation between ED scores and voiding phase, filling-storage phase and total LUTS scores. The severity of ED and graded LUTS score revealed no significant association between the severity of ED and that of voiding phase and filling-storage phase LUTS. Conversely, severity of ED was significantly related to the severity of total LUTS score. Conclusion: ED is common amongst adult patients with LUTS. Its severity worsens with worsening LUTS. The management of patients with LUTS should therefore involve evaluation and treatment for ED. This calls for increased awareness of these conditions to both the doctor and the patient.

Background: Intravesical prostatic protrusion (IPP) is a noninvasive test that can predict bladder outlet obstruction in patients with benign prostatic hyperplasia (BPH). Objective: The objective of this study was to determinethe correlation between IPP and International Prostate Symptom Score (IPSS) in patients with BPH. Patients and Methods: A cross-sectional prospective study of new patients with symptomatic BPH who presented to the urology clinics of NAUTH, Nnewi. Ethical approval and informed consent were obtained. Participants had abdominal ultrasonography measurements of IPP from midline sagittal image of the prostate (at bladder volume ≥100 mL) using Prosound SSD3500 with abdominal probe frequency of 3.5 MHz. IPP was divided into three grades (grade I: 0–4.9mm, grade II: 5.0–9.9 mm, and grade III: ≥10.0 mm). Data were analyzed using SPSS version 20. The data were subjected to analysis of variance, and Pearson's correlation was used to assess correlation where necessary. P value < 0.05 was considered significant. Results: In all, 101 men with a mean age of 67.09 ± 10.93 years were included in the study. The average IPSS, storage symptoms IPSS (IPSS-S), voiding symptoms IPSS (IPSS-V), Quality of Life (QoL) index, and IPP were 17.05 ± 7.62, 7.81 ± 5.17, 9.24 ± 3.16, 4.75 ± 1.59, and 13.50 ± 7.47 mm, respectively. There were significant differences between the mean IPSS (P = 0.000), mean IPSS-S (P = 0.000), and mean IPSS-V (P = 0.002) among the three grades of IPP. There were significant positive correlations between IPP and IPSS (P = 0.000), IPSS-S (P = 0.000), IPSS-V (P = 0.000), and IPSS QoL index (P = 0.000). Conclusion: There were significant positive correlations between IPP and IPSS, IPSS-S, IPSS-V, and IPSS QoL index.

OBJECTIVE:To determine the correlation between severity of symptoms using the International Prostate Symptom Score (IPSS) and uroflowmetry in patients with lower urinary tract symptoms-benign prostatic hyperplasia (LUTS-BPH). PATIENTS AND METHODS:We prospectively collected data from 51 consecutive men, who presented with LUTS-BPH at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2012 through December, 2014. Symptom severity was assessed using the self-administered IPSS questionnaire. We also performed uroflowmetry using the Urodyn 1000 (Dantec, serial no. 5534). RESULTS:The mean age of the patients was 67.2 ± 9.7 years (range 40-89 years). The most common presenting IPSS-LUTS was nocturia (100%) followed by urinary frequency (98%), straining (92.0%), weak stream (84.3%), urgency (41.2%), incomplete voiding (39.2%), and intermittency (35.3%) Most of the patients had moderate symptoms (58.8%) on IPSS with a mean value of 13.5 ± 3.0. The mean Qmax was 15.6 ± 18.7 mL/s and the mean voided volume was 193.0 ± 79.2 mL. About one-third of the patients (39.2%) had an unobstructed flow pattern based on Qmax. Correlation analysis showed a weak correlation between IPSS and voiding time (r = 0.220, P > 0.05), flow time (r = 0.128, P > 0.05), and time to maximum flow (r = 0.246, P > 0.05). These correlations were not significant (P > 0.05). IPSS showed a negative correlation with maximum flow rate (r = 0.368; P < 0.0075), average flow rate (-0.203, P > 0.05), and voided volume (r = -0.164, P > 0.05). This negative correlation was significant for maximum flow rate. CONCLUSION:Correlation between IPSS and Qmax was negative but statistically significant. This implies that an inverse relationship exists between IPSS and Qmax, and remains the only important parameter in uroflowmetry. There was no statistically significant correlation between IPSS and the other variables of uroflowmetry.

Background: Medical certificates of cause-of-death are essential public health documents needed in proof of death, crime prevention, health planning, setting of priorities, monitoring of the health of the population, outcome review studies and others. When cause-of-death forms are filled out erroneously, they provide misleading and inaccurate information; and thus not useful in cause-of-death statistics.Objective: This retrospective study was to answer the following questions: how frequent is death certificates issued for deaths occurring at a tertiary hospital in Nigeria, and are death certificate forms completed correctly by physicians?Methods: All deaths occurring at the hospital over a 5-year-period were stratified by ward and sex. Errors in death certificate’s completion were grouped into 4 categories according to the classification system adopted by Tsung-Hsueh Lu et al. We also extracted other information such as decedents’ ages and qualifications of the certifiers from the reviewed forms.Results: A total of 5,392 deaths were recorded, 53.3% of whom were males; only 350 (6.5%) death certificates were issued - 299 (85.4%) in males and 51 (14.6%) in females - out of which only 125 (35.7%) were completed correctly as regards the section on cause of death. Less than 1% of these certificates were issued in decedents less than 20 years of age. The most common type of error was Minor Error, 2 (41.3%). A total of 321 (91.7%) of the certifiers included their qualifications in the forms. Consultants in charge of the cases directly completed the cause-of-death forms in only 3.1% of the cases. Also, very insignificant proportion (0.6%) of the certificates was issued following autopsies.Conclusion: Death certification forms are not routinely issued by physicians; more than half of the issued certificates completed by both the lowest and highest echelons of medical professionals contained no useful information for epidemiological studies. Thus, there is a strong reason for a continuous medical education on the need for a vigorous and systematic documentation of causes of deaths in Nigeria.Keywords: Death, Certificate, Request, Accuracy, Clinicians, Hospital-based

Background: Like many countries in Africa, Nigeria is improving the quality and coverage of its cancer surveillance. This work is essential to address this growing category of chronic diseases, but is made difficult by economic, geographic and other challenges. Purpose: To evaluate the completeness, comparability and diagnostic validity of Nigeria's cancer registries.Methods: Completeness was measured using children's age-specific incidence (ASI) and an established metric based on a modified Poisson distribution with regional comparisons. We used a registry questionnaire as well as percentages of death-certificate-only cases, morphologically verified cases, and case registration errors to examine comparability and diagnostic validity.Results: Among the children's results, we found that over half of all cancers were non-Hodgkin lymphoma. There was also evidence of incompleteness. Considering the regional completeness comparisons, we found potential evidence of cancer-specific general incompleteness as well as what appears to be incompleteness due to inability to diagnose specific cancers. We found that registration was generally comparable, with some exceptions. Since autopsies are not common across Nigeria, coding for both them and death-certificate-only cases was also rare. With one exception, registries in our study had high rates of morphological verification of female breast, cervical and prostate cancers.Conclusions: Nigeria's registration procedures were generally comparable to each other and to international standards, and we found high rates of morphological verification, suggesting high diagnostic validity. There was, however, evidence of incompleteness. (C) 2015 Elsevier Ltd. All rights reserved.

BACKGROUND:Seminiferous tubules comprise 80-90% of testicular mass. Thus, the testicular volume is believed to be an index of spermatogenesis. Therefore, accurate testicular volume is one way to assess testicular function.OBJECTIVE:To determine the accuracy of Prader orchidometer for measuring the testicular volume by comparing the resultant measurement with the actual testicular volume in humans.MATERIALS AND METHODS:The testicular volumes of 121 testes from 62 patients with prostate cancer (mean age 72.74 ± 9.38 years) were measured using Prader orchidometer before therapeutic bilateral orchidectomy. The actual testicular volumes were then determined by water displacement of the testis.RESULTS:The mean testicular volume of the 121 testes was 10.60 ± 3.5 ml and 13.26 ± 5.2 ml for water displacement and Prader orchidometer measurements, respectively. A strong correlation was found between the actual testicular volume and volumes obtained by Prader orchidometer ( r = 0.926, P = 0.0001). The Prader orchidometer however, over-estimated the mean actual testicular volume by 2.66 ± 2.37 ml (25.10%).CONCLUSION:The result of this study has shown that measuring the testicular volume by Prader orchidometer overestimates the actual testicular volume.

CONTEXT Breast cancer is the most frequent cancer among women in most part of the world and in Nigeria. Neoadjuvant chemotherapy (NAC) has been demonstrated to be a helpful strategy in the context of locally advanced breast cancer (LABC). AIMS To determine if the use of four courses of doxorubicin based neoadjuvant chemotherapeutic regimen will result in significant primary tumor down-staging. SETTINGS AND DESIGN One year prospective study of premenopausal breast cancer patients presenting to the specialty breast clinic. METHODS The patients were recommended for four courses of doxorubicin based NAC and response assessed using response evaluation criteria in solid tumors (RECIST) methodology. STATISTICAL ANALYSIS USED Simple frequency and descriptive statistics were used to analyze data using SPSS statistical software. RESULTS One hundred and fourteen patients presented with breast cancer. Their ages ranged from 26 to 51 years with a mean age of 42.1 years ± 7.7 years. Thirty-one patients completed the four courses of NAC. At the end of NAC, 23 (74.2%) patients had more than 30% reduction in primary tumor size and 8 (25.8%) had no response (NR). The response according to the modified RECIST methodology was 12.9% for a complete clinical response, 61.3% for partial response, and 25.8% for NR. Significant clinical response was seen in 74.2% of patients (P < 0.0001) (one sample t-test). CONCLUSIONS Four courses of antracycline based NAC is effective in premenopausal patients with LABC in our environment.

Objective: To determine the accuracy of various ultrasound formulas for measuring the testicular volume in humans by comparing the resultant measurements with the actual testicular volume.Subjects and methods: The testicular volume of 121 testes from 62 patients with prostate cancer (mean age 72.7 +/- 9.4) was measured using ultrasonography before therapeutic bilateral orchidectomy. The ultrasound measurements of the testicular volume were calculated using the following three formulas: (a) length (L) x width (W) x height (H) x 0.52; (b) L x W-2 x 0.52 and (c) L x W x H x 0.71. The actual testicular volume was determined by water displacement of the testis.Results: The mean actual testicular volume was 10.6 +/- 3.5 ml. A strong correlation was found between the actual testicular volume and the volume calculated by the three-ultrasound formulas (r = 0.853-0.871, p = 0.0001). The smallest mean difference from the actual testicular volume was observed with the formula L x W x H x 0.71, which underestimated the actual volume by 0.4 ml (3.9%).Conclusion: The results of this study show that ultrasonography and the formula L x W x H x 0.71 are the most accurate method for the calculation of the testicular volume. (C) 2013 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B.V.

BACKGROUNDTraditional open prostatectomies either transvesical or retropubic remains the reference standard for managing benign prostatic enlargement in some centers, especially in developing countries. The comparison of complication rates between the various types of open prostatectomies is usually a source of significant debate among urologists, most times with conflicting results. The Clavien-Dindo classification system is an excellent attempt at standardization of reporting complications associated with surgeries.MATERIALS AND METHODSWe reviewed retrospectively the records of patients who had open transvesical prostatectomy (TVP) in three specialist urology centers in Anambra state, Southeast Nigeria, over a period of 5 years (January 2004-December 2009), with the aim of documenting medical and surgical complications arising from open TVP. These complications were then categorized according to the Clavien-Dindo system.RESULTSA total of 362 patients had open TVP over the period under review. Of this number, 145 had documented evidence of complications. The mean age of the patients was 66.3 years (SD 9.4 years; range 49-96 years). The mean follow-up period was 27.8 months (SD 12.6 months; range 6-33 months). The overall complication rate for open TVP in this study was 40.1% (145/362). Complication rates for grades i, id, ii, iiia, and iiib were 0.8%, 0.6%, 35.1%, 0.6%, and 3.0%, respectively. Most complications of open TVP occur in the early postoperative period.CONCLUSIONOpen TVP still remains a valid surgical option in contemporary environment where advanced techniques for transurethral resection of the prostate and laparoscopic prostatectomy are unavailable. Most complications occur in the early postoperative period, with bleeding requiring several units of blood transfusion accounting for the commonest complication. This should be explained to patients during the preoperative counselling.

Background: The triad of digital rectal examination (DRE), serum prostate specific antigen, and transrectal ultrasound-guided prostate biopsy is used in the detection of prostate cancer (PCa). It is recommended that all cases of PCa should be diagnosed with needle biopsy before treatment. The exclusion criteria for those that may not be suitable have not yet been defined. Materials and Methods: We reviewed all the patients diagnosed with PCa at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast, Nigeria, from January 2007 to December 2010. Relevant biodata and method of diagnosis of PCa before treatment were reviewed. Results: A total of 133 patients had bilateral orchidectomy over the period. 120 (90.2) had their diagnosis confirmed by needle biopsy before bilateral orchidectomy (category 1), while 13 (9.8) had bilateral orchidectomy before diagnosis was confirmed. The method of diagnosis for category 1 patients was with lower urinary tract symptoms (LUTS), abnormal DRE findings, elevated prostate-specific antigen (PSA), and transrectal needle biopsy. For category 11 patients, diagnosis of PCa was suspected based on LUTS, abnormal DRE findings, and elevated PSA. Of this number, 11 (84.6) had, in addition, sudden onset paraplegia at presentation, while 2 (15.4) had severe uncontrolled hematuria at presentation. All the patients in both categories had needle biopsy confirmation of their disease. The sensitivity of PSA was 99.2. Conclusion: Needle biopsy of the prostate is the preferred method for the diagnosis of PCa in most cases before treatment is undertaken. There are valid reasons why all PCas will not be diagnosed in this fashion. Elevated PSA when combined with an abnormal DRE finding increases the predictive value for cancer. In areas where pathologists are lacking, abnormal DRE and elevated PSA results can be a guide to proceed to treatment especially, where there is severe compromise of patients quality of life due to symptoms of advanced PCa while awaiting confirmation.

Introduction and objectives: Early detection of prostate cancer (PCa) with prostate-specific antigen (PSA) has led to a stage migration with increased detection of early stage, potentially curable disease. Knowledge about PSA screening for PCa among men will lead to increased detection of potentially curable disease.Subjects and methods: Male public servants in Anambra State, Southeast, Nigeria, were invited to complete a self-administered questionnaire on their knowledge of PCa and PSA screening. Results were analyzed using Microsoft Excel (R) 2007.Results: A total of 652 men completed the questionnaire. Their mean age was 45.1 years (range 20-69). Overall, 74.1% of the respondents were aware of the existence of PCa, while 76.1% were able to identify one or more symptoms of the disease. Difficulty in passing urine was identified as the most common presenting symptom by 45.3% of the respondents, while 87% were able to identify risk factors for PCa. Whereas 56.7% were aware of PSA screening and 92% expressed interest in having PCa screening if recommended only 6.4% had undergone PSA screening in the preceding year.Conclusion: Despite a high awareness of PCa among public servants in Anambra State, Nigeria, a very small proportion of these men had undergone PSA screening. To achieve a stage migration in PCa detection in Nigeria, early detection using PSA screening should be actively driven by health personnel using the media. (C) 2012 Production and hosting by Elsevier B. V. on behalf of Pan African Urological Surgeons' Association. Open access under CC BY-NC-ND license.