Objective: To review iatrogenic ureteric and urinary bladder injuries from obstetric and gynaecological surgeries treated in the urology department analysing; ureteric anatomy, aetiologic factors, diagnosis, treatment and outcomes. Design: A retrospective study.
Background: Hypospadias is one of the commonest congenital penile abnormalities in newborn males. The external urethral opening can be located anywhere from the glans penis along the ventral aspect of the shaft of the penis up to the scrotum or the perineum in extreme cases. The condition has a huge impact on the patient's psychological, emotional and sexual well-being. Aim: To determine the proportion of patients who develop long-term complications after hypospadias repair and its associated risk factors. Methods: This was a hospital-based analytical cross-sectional study, conducted at KCMC Urology Institute from January 2009 to December 2018 and all children were followed up for 1-year post-operatively. A structural data sheet was used to collect information from patients' files. Study parameters include age, location of hypospadias, surgical technique, surgeon experience, chordee, suture size, materials to assess the association with long-term complications. Results: A total of 254 patients were included in the study, the majority were aged more than 2 years (71.83%) with mean age at operation (SD) of 4.74 ± 2.99 years. Distal types were the most common type of hypospadias (125 patients; 50%), and 51 patients (20%) had severe chordee. Tubularized incised plate (TIP) repair was the most common technique (130 patients; 51.59%). The number of patients with long-term complications following hypospadias repair was 156 (61.60%) and urethrocutaneous fistula(UCF) accounted for 40.5%. The surgeon's experience, location of hypospadias, surgical technique and associated chordee were significant predictors of long-term complications of hypospadias repair. Conclusion: Tubularized incised plate urethroplasty is a safe and reliable method of hypospadias repair. Proximal hypospadias with severe chordee still remain a challenge.
Prostate cancer is one of the commonest cancers among men contributing significantly to the overall cancer burden globally. Most patients present with lower urinary tract symptoms. Metastasis to supraclavicular lymph nodes is unusual presentation, which has been rarely reported particularly as the primary presentation. We report two rare cases of advanced prostatic adenocarcinoma presenting with firm, non-tender lump in the left supraclavicular region between the two heads of the sternocleidomastoid muscle, (that is Virchow’s node) as initial primary symptom. Examination of the patients revealed an elevated prostatic-specific antigen (PSA) of > 100 ng/ml levels, and the diagnosis was confirmed by histological evaluation and immunostaining with PSA of the supraclavicular lymph nodes and prostate biopsies. This case series emphasizes the importance of considering prostate cancer in the differential diagnosis of male patients with supraclavicular lymphadenopathy.
Highlights Theoretically, prostate cancer can spread to any part of the body. Metastasis to axillary lymph node in a patient with normal urologic examination is rare. It may delay the diagnosis. A high suspicion index is essential in males presenting with symptoms suggestive of chest and abdominal-pelvic cancer.
Prostate cancer is a leading cause of cancer death in men, second only to lung cancer. Bone metastasis is a common complication in prostate cancer patients that can cause bone pain and pathological fracture. PSA, Gleasons score, clinical T stage have been developed to integrate multiple clinical metastatic disease in prostate cancer patients. Bone radiography is used to rule out bone metastasis. It's common to have bone metastasis when PSA level is high and histology of poorly differentiated adenocarcinoma. Aim: To determine the prevalence of osteoblastic lesions and analyze the correlation of PSA levels, on lumbar sacral radiography in patients diagnosed with prostate cancer. Methods: This was a hospital based crosssectional retrospective study, conducted at KCMC urology institute from June 2108 to May 2019 and all prostate cancer patients diagnosed at KCMC during the study period both inpatients and outpatients attending urology department within the study period. The structural data sheet was used to collect information from patient file. Study parameters include Age, Gleason's score, PSA level used to assess the correlation with osteoblastic lesion on lumbar sacral x-ray. Results: A total of 97 patients included in the study, with mean age was 74.5 (SD) 8.97.6 yrs. Patients with Gleason score of 8-10 were 56 (57.8%) and the median PSA level was 126ng/mL with IQR (58.9-402.2) and The prevalence of bone metastases was 57.7%. There were 56 (49.5%) patient had osteoblastic lesions on lumbar sacral x-ray with PSA >100. Conclusion: The prevalence of bone metastasis is 57.7% with 49.5% of the patients had total serum PSA of >100ng/ mL. So lumbar sacral X ray can be used as a diagnostic tool when PSA is more than 100ng/ml. There is a need to avoid unnecessary lumbar sacral X rays in patients with carcinoma of the prostate who have no symptoms and sign metastatic disease and has PSA of less than 100ng/ml.
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