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Introduction: Prostate cancer (CaP) is the second most common cancer in men and the fifth most common cancer worldwide. The incidence in Nigeria is rising. Numerous challenges exist that prevent the successful management of these patients in this subregion. Aims and Objectives: This study aimed to report on the modes of presentation and difficulties encountered in managing patients with CaP in our environment with a view to finding solutions to these challenges. Materials and Methods: This was a retrospective study of all CaP patients who were managed in Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria over a 10-year period from 2012 to 2021. Data were collated using a pro forma. Numerical data were summarized as means, median, and standard deviation, whereas categorical data were summarized as frequencies. Statistical significance was pegged at P < 0.05. Results: Seventy-three patients were analysed. The mean age of the patients was 71.48 ± 8.15 years. The three most common presenting complaints were lower urinary tract symptoms (LUTSs) 23 (31.5%), acute urinary retention 9 (12.3%), and LUTS with low back pain 9 (12.3%). The median duration of symptoms was 6.5 months. No difference was noted among educational level, occupation, and stage of CaP, (P=0.222 and P=0.548), respectively. The median total prostate-specific antigen was 85.0 ng/mL. Sixty-seven patients (91.8%) had an abdominopelvic ultrasound scan. Fifty patients (68.5%) had stage 4 disease. Thirty-eight (52.1%) had financial constraints. Forty-nine (67.1%) patients were lost to follow-up. Bilateral orchidectomy was offered to 28 (38.4%) patients. Conclusion: Financial constraint was a huge barrier in the management of CaP patients in this study. Late presentation was common in this study.

Background: Open suprapubic prostatectomy is attended by significant perioperative haemorrhage and need for blood transfusion. Aim: To share our experience on how the adoption of a modified suprapubic prostatectomy technique has led to improved hemostasis and decline in the blood transfusion rate after open suprapubic prostatectomy in our center. Patients and Methods: This was a retrospective study comparing two open prostatectomy techniques. The patients in group 1 had Freyer's suprapubic prostatectomy while the patients in group 2 had a modified suprapubic prostatectomy technique. The groups were compared for the effectiveness of hemostasis using change in packed cell volume, clot retention, blood transfusion, and requirement of continuous bladder irrigation. Results: Both groups were similar concerning age, body mass index (BMI), total prostate-specific antigen (PSA), prostate volume, presence of comorbidities, duration of surgery, and duration of follow-up. The clot retention rate was 34% in group 1 versus 16.4% in group 2, P = 0.030. The clot retention requiring bladder syringe evacuation occurred in 32.1% of the patients in group 1 versus 14.8% in group 2, P = 0.048. The mean change in the packed cell volume (PCV) in group 1 was 8.0 ± 5.3 versus 6.9 ± 3.5 in group 2, P = 0.175. The blood transfusion rate in group 1 was 40.0% versus 13.3% in group 2, P = 0.040. The complication rate in group 1 was 67.2% versus 41.9% in group 2, P = 0.004. A general decline in blood transfusion was noted from January 2011 to December 2019. Conclusion: The modified suprapubic prostatectomy technique was associated with better hemostasis compared to the standard Freyer's prostatectomy technique. It should be a worthwhile addition to the numerous modifications of the original Freyer's suprapubic prostatectomy technique.

Background: Retrocaval Ureter (RCU) is a rare congenital anomaly that often presents with obstructive changes in the upper urinary tract which may or may not symptomatic. It arises as a result of an aberration in embryologic development of Inferior Vena Cava (IVC). Commonly occurs in isolation but can occur in association with other anomalies. Few studies have reported RCU co-existing with upper tract Transitional Cell Carcinoma (TCC) but there is no literature report so far of its co-existence with Renal Cell Carcinoma (RCC). Case summary: Hence, we report a case of a 65 year old man with right sided RCC coexisting with RCU. The anomaly was discovered intra-operatively and the patient was offered open right radical nephrectomy with a good post-operative recovery and uneventful follow-up. Conclusion: Retrocaval ureter is a rare congenital anomaly that may occur in isolation or with other associated conditions. To the best of our knowledge, we report the first case of RCU coexisting with renal cell carcinoma. Proper pre-operative evaluation will help to identify these associated anomalies so as to adopt a holistic approach to patient care in order to ensure good treatment outcome. Keywords: radical nephrectomy; renal cell carcinoma; retrocaval ureter; nephroureterectomy.