Aims: To compare the diagnostic yield of digital rectal examination (DRE), transrectal ultrasound (TRUS) scan, and prostate-specific antigen (PSA) in diagnostic evaluation of advanced carcinoma of the prostate (CAP). Subjects and Methods: A comparative study of sensitivity and specificity of DRE, TRUS, and PSA in the evaluation of advanced CAP. This was done over a 3-year period (January 2010 to December 2012) in a tertiary health institution in Sub-Saharan Africa. All patients presenting with symptoms of prostatic enlargement were recruited, DRE, TRUS, and PSA findings were compared to the histological diagnosis. Statistical Analysis Used: SPSS version 16.0. Results: One hundred and eight cases were analyzed. Histological diagnosis revealed that 52 (48.1%) were CAP whereas 56 (51.9%) were benign. All the patients presented with lower urinary tract symptoms. Surprisingly, some patients with advanced CAP had PSA values in the normal range (0-4 ng/ml) while some with the benign disease also had PSA values above 50 ng/ml. PSA was noted to have the highest sensitivity but lowest specificity. Conclusions: Limitations of PSA are not only seen in screening for early disease, but also in the diagnosis of advanced CAP, and no value of PSA can be considered safe to declare a patient CAP free.

Background: Adolescents are tomorrow’s adult population, hence their health and well-being are crucial. The objective of this study was to determine the nutritional status of in-school adolescents in Ibadan, south-western Nigeria. Method: A descriptive cross-sectional survey was conducted on 93 in-school adolescents attending a diabetes mellitus sensitisation and education programme, selected by simple random sampling (the ballot method) using a self-administered, semi-structured questionnaire. Anthropometric measurements were carried out on the subjects by trained researchers. Data were analysed using SPSS® software, version 17. Results: Study subjects comprised 29 males (31.2%) and 64 females (68.8), with an overall mean age of 15.67 (± 1.25) years. All of them were in senior grades of their secondary education. Approximately 90% of respondents’ parents had attained at least secondary education. The television was the most popular source of health information for the study subjects (33.3%). Nearly a third of them were underweight (body mass index (BMI) < 18.5 kg/m2) and 7.6% of them were overweight or obese (BMI ≥ 25 kg/m2). However, the prevalence of underweight was higher in the male respondents than in their female counterparts (41.4% vs. 23.4%, respectively). Statistically significant differences were also observed when the mean BMI and mean BMI percentiles for age and sex were compared (p < 0.05 in both instances). Conclusion: The study showed that malnutrition, and especially undernutrition, is still a problem in adolescents, with a higher prevalence in boys. Nutrition education in schools, and special programmes like the one attended by the study subjects, would help considerably in improving the health and well-being of the nation’s adolescents; tomorrow’s adult population.

Bladder outlet obstruction describes various urological conditions in which urine outflow from the bladder through the urethra is impeded. It is a common presentation in our practice and often complicated by renal impairment, probably due to late presentation of patient. The objective of present study is to ascertain renal function of patient with BOO at presentation vis-à-vis their duration of symptom and to find out common causes of BOO in our environment. All patients who presented with BOO between January 2010 and December 2012 were studied. Details of their renal function at presentation were reviewed. A total of hundred patients aged 8-90 years were studied, modal age group were 61-70 (43%) in all 41% of patient had urethra stricture, 40% had benign prostatic hyperplasia while 19% had carcinoma of the prostate. All patients had their renal status assessed at presentation, 71% had renal ultrasound scanning while all patient had urea, creatinine and their GFR estimated. Ten percent of patient had poor corticomedullary differentiation, 20% had elevated urea, and 31% had elevated creatinine while 79% of the patient had abnormal estimated GFR. In conclusion, commonest cause of BOO was prostatic diseases and significant number of the patient studied had renal impairment at presentation.

This study assessed awareness and use of modern contraceptives among physically challenged in-school adolescents in Osun State, Nigeria. A cross-sectional study was carried out among 215 adolescents in the special schools in the state. A pretested semi-structured questionnaire was administered by trained interviewers. Data analysis was done using SPSS 17 and statistical level of significance was set at p < 0.05. The mean age of the respondents was 15.5 years and more than half of them (56%) were males. Only about two fifths of them (38%) had ever heard about modern contraceptives. More males, older adolescents and visually impaired respondents had significantly heard about modern contraceptives compared with females, younger ones and those with other challenges at p-values of 0.026, 0.001 and 0.003 respectively. Only 34% of sexually experienced respondents had used a modern contraceptive method. The male condom was the most commonly used method.

Verrucous carcinoma of the scrotum is very rare and most cases are thought to result from poor hygiene and chronic irritation. Regional lymph node metastasis is rare and distant metastasis has yet not been reported1.. Surgery with a negative resection margin offers the best hope of cure as adjunctive therapy has not proved useful. We report a case of verrucous carcinoma in a 60 year man with epigastric secondary. A 60 year old farmer with multiple sexual partners presented to our clinic on account of extensive scrotal ulcer which started 8 years prior to presentation as multiple swellings in form of blisters but increased progressively to the perineum after bursting to form ulcers. About a year prior to presentation he developed an epigastric mass that increased in size slowly. Incisional biopsy of the scrotal lesion with excisional biopsy of the epigastric mass showed verrucous carcinoma of squamous cell type. An extensive surgical excision with at least 2 cm margin was performed and a split thickness skin graft was done. Wound healed almost completely before he was discharged home but he was lost to follow-up.

Herniorrhaphy is a common surgery worldwide. Common complications include hemorrhage, infection, chronic pain, and recurrence. Ureteric injury from herniorrhaphy is unusual. We present a case of ureteric injury complicating an inguinal herniorrhaphy for a huge right inguino-scrotal hernia. Patient had primary uretero-neocystostomy but died from septicemia in the postoperative period.

Introduction:Penile entrapment with strangulation is a unique clinical entity which has remained a challenge because of lack of standard treatment modality.treatment of reported cases has been based on an individual physicians approach depending upon the circumstances and facilities available.some of these are cumbersome and some involve use of non-medical facilities.We report a novel simple surgical approach used in the management of a case of penile entrapment.case report: A 16-year-old male adolescent presented with four days history of entrapment of his penile shaft in a hard steel metal ring.there was associated swelling of penile shaft distal to the ring with progressive diminution of urine stream.All initial attempts for removing mettalic ring were abortive till surgical degloving of penile shaft was done in the operating room with immediate reduction of swelling and removal of constricting ring intact.there was no postoperative complication and outcome was satisfactory.conclusion

Purpose: To describe peculiarities of pendulous urethral stricture in South Western Nigeria and how prevalent social and environmental factors have made longitudinal distal penile island flap the preferred option for reconstruction of pendulous urethral stricture in such a poor resource community.Materials and Methods: All patients presenting with stricture located in the pendulous urethra in 3 hospitals in south western Nigeria, over a 5 year period were interviewed and had urethral reconstruction using longitudinal distal penile fascio-cutaneous island flap under spinal anesthesia.Results: Thirty four cases were treated by this method during this period. Complications were found in 4 patients (11.8%) which include urethrocutaneous fistula, penile skin necrosis and wound infection. All cases had satisfactory overall outcome.Conclusion: Longitudinal penile fascio-cutaneous flap remains a viable option for a single stage repair of pendulous urethral stricture especially in poor resource communities.

BACKGROUND:Management of urethral stricture has evolved over the years with better understanding of the pathology, advancement in imaging, and introduction of several techniques of urethral reconstruction. In sub-Saharan Africa, advancement in management of urethral stricture may not be comparable with what obtained in most developed nations because of problems like late presentation and persistence of rare complications still reported in recent literature from the region.OBJECTIVES:We set to evaluate the challenges faced by urologists involved in the management of urethral strictures in Osogbo, a poor resource community in south western Nigeria.PATIENTS AND METHODS:A retrospective study was performed in the urology unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria between July 2007 and July 2012. Information was retrieved from patients' clinical notes and analyzed using statistical package for social sciences (SPSS) version 16.0.RESULTS:Eighty-four patients were treated during the period of study, their ages ranged between 19 and 89 years with the mean age of 52.3 years. The mean duration of symptoms before presentation was 3 years and 1 month. Inflammation resulting from sexually transmitted infection was the commonest etiology and more than 50% of the patients presented with complications. Sixteen patients (19.1%) received no treatment due to lack of fund. More than 90% were dependent, unemployed or underemployed. Single stage reconstruction by urethral substitution was the commonest form of repair with the restenosis rate of 4.4%.CONCLUSIONS:Prevalent socio-cultural and economic situation in south western Nigeria have added some peculiar challenges to the management of urethral stricture in the region.

Urethral stricture, a common urologic condition, is probably the most common cause of urinary retention in tropical Africa and a frequent cause of lower urinary tract symptoms worldwide. This study aimed at presenting our experience with one-stage urethroplasty at the Ladoke Akintola University of Technology Teaching Hospital Osogbo, Nigeria.

Introduction Benign prostatic hyperplasia is a common disease of ageing men worldwide. Though transrectal ultrasonography (TRUS) is the standard in most parts of the world in evaluation of benign prostatic hyperplasia (BPH), it is rarely done in some less developed countries because of non availability of appropriate probes and or specialists. Transabdominal ultrasonography (TAUS) remains the mainstay in these areas. Some controversies still exist in literature about the accuracy of TAUS evaluation of prostatic volume in patients with BPH. This study aimed at comparing the transition zone volume estimation of the prostate on transrectal and transabdominal ultrasound with post-operative enucleated adenoma volume in Nigeria patients with BPH and to suggest better predictor of prostate volume in evaluation of BPH. Methods Forty-six (46) patients with lower urinary tract symptoms due to BPH attending the urologic clinic were evaluated ultrasonographically and eventually managed with open surgery (prostatectomy) after due counselling. The post operative samples were weighted using a sensitive top loading weighing balance and converted to volume. Since the specific gravity of the prostate is equivalent to that of water,the weight is the same as volume. Results Patients’ ages ranged between 59 and 90 years with a peak age incidence at seventh decade. Transition Zone (TZ) volume estimation on both transrectal and transabdominal ultrasound showed positive correlation with the post operative enucleated adenoma(r = 0.594, p < 0.001) but the transrectal method was more accurate. There was no significant relationship between the TZ volume and patients’ symptoms(r = 0.491, p = 0.007). Conclusion Both TRUS and TAUS are comparable at TZ volume estimation and therefore TAUS can be utilized in regions where intracavitary probes and or the expertise is/are not available.

Schistosomiasis is one of the oldest and commonest parasitic infestations of mankind and one of the leading infestations of public health concern. Hitherto, praziquantel has been the only drug for mass eradication of Schistosomiasis. Few reports have shown possible resistance of the schistosome to praziquantel in some part of the world with global concern about the future of the drug. We report this case to illustrate progression of Schistosomiasis to surgical complication despite treatment, with bizarre presentation misleading attending physicians. Diagnosis was finally confirmed at post-operation histological examination of specimen.

Adolescent health needs behaviors and expectations are unique and routine health care services are not well geared to provide these services. This study explored the perceived reproductive health problems amongst in-school adolescents in Ile-Ife Nigeria determined their health seeking behaviors assessed their knowledge of available reproductive health services and identified existing barriers to its access. In a descriptive cross-sectional study 392 respondents were recruited by multi-stage sampling and utilized a semi-structured questionnaire for data collection. Most respondents lived with both parents. The mass media especially the television and radio were found to be their main sources of health information. About two in five of respondents (39.5%) were currently in relationships. One in four (25.5%) were sexually experienced whereas only one in ten (10.7%) had ever tested for HIV. A statistically significant association was found between the respondents’ age group and sexual experience (p = 0.02). The most commonly perceived adolescent health problems included menstrual problems unwanted pregnancy HIV/AIDs and lack of sexuality education. Most schools attended by respondents had no health facility and the few with clinics had inadequate/unfriendly staff and inadequate drugs. Respondents’ most preferred places of seeking healthcare were government hospitals (37.8%) and private hospitals (28.1%). The study showed that the adolescents had little or no access to youth-friendly services even with their preference for government hospitals as their place of choice for seeking healthcare. We recommend that school health services be revamped by government with the aim of improving access to youth-friendly services geared towards their identified health problems.

BACKGROUND:Violence is universal; it occurs in schools (both public and private). The study aim was to assess the rates of violence as well as existing violence prevention strategies in public and private schools in Osun state.METHODOLOGY:A cross sectional study was conducted among 800 secondary school students (599 in public and 201 in private schools) selected by multistage sampling technique using quantitative and qualitative methods of data collection.RESULTS:The mean age for all the respondents was 14.26 years +/- 2.001 Males make up about 51% of the respondents in both public and private schools. Respondents from public schools assaulted other students and staff with a weapon more than their colleagues in private schools (24.7% and 9.7% against 12.9% and 6.5% respectively). The commonest violence 'prevention' strategy in both schools was punishment for violent acts (>90%).CONCLUSION:Respondents in public schools perpetrated and experienced virtually all forms of school-related violence more than those in private, schools. There were mild differences in existing violence prevention strategies in both schools. School connectedness seems to be a major factor in the differential rates of violence between both groups of schools.

Introduction: Mathieu’s technique (peri-meatal based flap) makes use of the urethral plate in the repair of anterior hypospadias, thereby creating an almost natural neo-urethra. In a circumcised baby or after previous unsuccessful repair, Mathieu’s flap may be one of the few options left to repair anterior hypospadias. Objectives: To evaluate the result of Mathieu’s flap repair for anterior hypospadias in a resource poor setting. Materials and Method: This is a retrospective review of post-circumcision anterior hypospadias managed by Mathieu’s flap repair between January 1996 and December 2006 in the paediatric surgical unit of the Obafemi Awolowo University Teaching Hospital, a tertiary hospital in the South Western Nigeria. Results: Mathieu’s flap repair was performed in 16 patients with isolated anterior hypospadias; 15 (93.8%) were circumcised before presentation. The complications were urethrocutaneous fistula in 3 (18.8%), wound infection in 2 (12.5%) and flap necrosis in 1 patient (6.3%). Final outcome was satisfactory in all patients. Conclusion: Mathieu’s flap remains a viable option in the repair of anterior hypospadias even after circumcision.

PURPOSE To report the complications of transverse distal penile island flap urethroplasty for urethral reconstruction in adult patients with long/multiple segments anterior urethral stricture. MATERIALS AND METHODS This prospective study was carried out on 55 patients with complex anterior urethral stricture to study complications of transverse distal penile island flap urethroplasty in two teaching hospitals between June 2002 and December 2008. Pre-, intra- and postoperative information were collected on a pro forma to generate data, which was analyzed. RESULTS The patient's mean age was 43.83 years (range, 19 to 73 years). The leading etiology of the stricture was urethral inflammation (76.4%) with the commonest complication being infection: wound infection in 9.1%, urosepsis in 3.6%, and epididymo-orchitis in 1.8% of the subjects. CONCLUSION Transverse distal penile island flap urethroplasty has a remarkable outcome in treatment of a long/multiple segment urethral stricture with few manageable complications.

Objective To document the presentation, outcome and challenges of management of hypospadias in a resource-limited setting. Patients and Methods For this retrospective study we analyzed the files of all patients with hypospadias managed at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria between 1996 and 2006. The parameters studied were the patients’ bio-data, clinical presentation, treatment and outcome. Results During the 10-year period under review 51 cases of hypospadias were managed. The majority of the patients (n=39, 76.5%) presented within the first year of life with a mean age at presentation of 1 year and 8 months, though most of the repairs were done in the 2 nd , 3 rd and 4 th years of life. Of the 51 patients 46 (90.2%) came from rural and semi-urban areas and 18 (35.3%) had been circumcised before presentation. Surgical repair consisted of preputial island flap in 22 patients (43.1%) followed by a peri-meatal based flap (Mathieu procedure) in 16 patients (31.4%). The MAGPI procedure was used in 5 patients (9.8%) and the Snodgrass procedure in 1 (2%). Staged repair was necessary in 7 patients (13.7%). Post-operative complications were encountered in 15 patients with urethrocutaneous fistula being the commonest one (11 patients, 21.6%). Conclusion Our results show that hypospadias can be successfully managed in a low-resource setting

OBJECTIVE:To review our experience with the use of transverse preputial island flap in the repair of hypospadias in the paediatric surgical unit of our University Teaching Hospital, Nigeria.PATIENTS AND METHODS:We reviewed the cases of hypospadias managed by transverse preputial island flap repair over a ten year period (1996 and 2006) in the paediatric surgical unit of our institution. Data was retrieved from the case notes and analysed.RESULTS:Fifty-one patients had hypospadias repair during the period, 22 of whom were by transverse preputial island flap repair. Hypospadisas were in penile shaft in 16 (72.7%), penoscrotal in 5 (22.7%) and perineal in 1 (4.55%). All the patients had intact prepuce at presentation and chordee was present in 18 (81.8%). The commonest complication was urethrocutaneous fistula in five patients, which closed spontaneously in three leaving 2 patients (9.1%) with persistent urethrocutaneous fistular.CONCLUSION:Transverse preputial island flap urethroplasty remains a viable option in the management of hypospadias especially when the meatal opening is proximal, with associated chordee limiting the options in the repair.