African Urology (AU) is a peer reviewed, open access and multilingual journal publishing original research articles in all aspects of the prevention, diagnosis and management of urological disorders.
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Revolutionising genitourinary syndrome of menopause (GSM) treatment (new estriol + lactobacilli)
Urogenital atrophy is characterised by the changes in the female urogenital tract due to a marked decrease in ovarian oestrogen production. The usual underlying cause of oestrogen deficiency is natural or surgical menopause but can also be triggered by lactation and premature ovarian insufficiency, radiotherapy, tamoxifen therapy or heavy smoking.1 Oestrogen deficiency results in changes in vaginal physiology, with a decrease in barrier and lubrication functions of the epithelium and lower glycogen content leading to increased penetration by pathogens and symptoms such as a significant increase in vaginal dryness and increased risk of vaginal and urinary tract infections.2 Furthermore, a decrease in sexual desire, arousal, orgasm and dyspareunia may affect a woman’s quality of life, self-esteem, social life and relationship with their partner.1
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Cost-effective anatomical modelling in robot-assisted partial nephrectomy – a case study
Patient-specific preparation before minimally invasive partial nephrectomy is necessary to understand the tumour’s relationship with the hilar and vascular structures of the kidney. Virtual and physical three-dimensional (3D) models of the kidney were constructed for a 56-year-old patient undergoing robot-assisted partial nephrectomy for a small hilar renal mass using open-source software and 3D-printed at minimal cost. The model improved preoperative planning, aided navigation to the tumour, and allowed safe identification of the vascular structures. With open-source software and the improved availability of lower-cost 3D printers, 3D modelling can be achieved with minimal financial, administrative, and time costs.
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Ureterocoele calculi masquerading as multiple vesical calculi with acute presentation: a case report
Ureterocele refers to the cystic intramural ureteral out-pouching with variable presentation. Ureterocoele calculi are a recognised complication. In this case report, a patient presented acutely with this pathology. Other complications are urosepsis and uraemia. The ureterocele calculi can be unilateral or bilateral. It may be asymptomatic, requiring a high index of suspicion to diagnose, or symptomatic, and may masquerade as multiple vesical calculi during clinical evaluation. In asymptomatic patients with ureterocele calculi, symptoms may supervene due to stone impaction. This is a case report of a patient with single-system orthotopic ureterocele calculi and an impacted calculus manifesting with severe episodic and colicky suprapubic pain unabated by combined analgesic management. The patient had emergency bladder exploration, right-sided orthotopic ureterocele deroofing, and stone evacuation with complete symptom resolution. This case highlights the importance of early consideration of a computerised tomography (CT) scan, if available and affordable, to minimise the diagnostic dilemma of urinary stone diseases and the relevance of ureterocele deroofing in selected patients based on clinical presentation.
Complete primary repair of adult bladder exstrophy-epispadias complex without iliac osteotomy: a case report and literature review
Bladder exstrophy-epispadias complex is a rare anomaly of the genitourinary system. Adult presentation is uncommon because most patients would have completed their treatment in early childhood. We report a 32-year-old man with classic bladder exstrophy who underwent complete primary repair with no iliac osteotomy to highlight the possibility of complete repair of adult bladder exstrophy without performing an iliac osteotomy despite a wide pubic symphyseal diastasis. The patient presented with a lower abdominal wall defect and an abnormal penis since birth. On examination, he had a lower abdominal wall defect, exposing the bladder plate with a flat and spade-like phallus. Pelvic X-ray showed a wide pubic symphyseal diastasis. He underwent complete repair of exstrophy without an iliac osteotomy. Horizontally oriented double V-Y flaps were raised to cover the abdominal wall defect.
A suburethral vaginal tumour mimicking cystocele: a case report
Introduction: Vaginal fibroma is an uncommon, benign, and often asymptomatic tumour presenting as a solid nodule located on the anterior median vaginal wall in women aged 35–50 years. The treatment is surgical. This case report describes a rare location of myoma. Observation: We report the case of a multiparous 41-year-old female patient who presented with a suburethral, firm, painless, well-defined, mobile mass on the anterior vaginal wall. The mass was 8 × 6 cm in dimension, protruding from the vulva. The urethral meatus was normal. The patient underwent surgical removal of a whitish and firm nodule of 7 cm in diameter. The histopathological examination confirmed the diagnosis of vaginal fibroma. The postoperative follow-up was unremarkable. Conclusion: Vaginal fibroma is an uncommon, benign tumour occurring in young women and requires complete surgical excision to prevent recurrence.
Giant right ureterocele mimicking ureterohydronephrosis on simplex ureter
Ureterocele is a rare malformative uropathy characterised by pseudocystic dilatation of the submucosal terminal end of the ureter. We report the case of an eight-month-old male infant referred from a rural hospital for management of a right ureterohydronephrosis discovered on ultrasound three days after birth. CT scan confirmed the presence of giant right ureteral-pyelocalic dilatation with extra vesical extension associated with a right ureterocele measuring 104.9 x 63.9 x 178 mm on ureter simplex. Complete excision of the ureterocele and dilated pelvic ureter followed by Politano Leedbetter ureterovesical reimplantation were performed. Postoperative follow-up was normal.
Metastatic inguinal lymph node, squamous and urothelial cell carcinoma in origin: a rare case of carcinoma of unknown primary with two different histopathologic deposits
Cancer of unknown primary (CUP) sites constitutes approximately 5% of all cancers.1,2 The standard treatment for these patients typically involves empirical chemotherapy. However, specific subsets of CUP with unique clinical or pathological features, such as solitary metastatic lesions or isolated nodal CUP, may present a more favourable prognosis and can be effectively managed with excisional surgery or radiation therapy alone.3-5 Metastatic inguinal lymphadenopathy mainly originates from the genitalia and anorectal areas. In this case report, we describe an uncommon case of two different histological types of metastases in inguinal nodes with unknown primary sites.
Beyond malignancy: recognising testicular adrenal rest tumours
Background: Testicular adrenal rest tumours (TART) are sporadic testicular masses mainly occurring in individuals with congenital adrenal hyperplasia (CAH) due to stimulation by adrenocorticotropic hormone (ACTH).1,2 If not detected early, these masses can lead to testicular dysfunction and infertility.1,3 This report presents two cases of TARTs, one in a child and another in an adult, highlighting differences in clinical presentation, diagnostic challenges, and management approaches. Methods: Both cases with established CAH presented with testicular masses, which were diagnosed through a combination of clinical evaluation, hormonal profiling, and testicular ultrasound. Management focused on optimisation of glucocorticoid therapy and regular follow-up to monitor tumour progression and prevent unnecessary surgical procedures. Results: In both cases, TARTs were confirmed. The paediatric patient had an early-stage TART with preserved testicular function, whereas the adult patient exhibited impaired testicular function with elevated ACTH levels. Following improvement in glucocorticoid therapy, the paediatric patient showed a decrease in tumour size, while the adult patient showed a stable tumour size with no further decline in testicular function. Surgical intervention was not required for either patient, emphasising the significance of early diagnosis and management in preventing long-term complications. Conclusion: Early detection and optimised glucocorticoid therapy are critical in managing TARTs in CAH. Well-timed intervention can protect testicular function and prevent complications, emphasising the need for regular monitoring and clinical awareness.
Ectopic anastomosis of a single ureter into the vagina: a case report in an adult
Ectopic ureter is a condition in which ureter does not open into the bladder trigone but drains outside it. This anomaly occurs congenitally due to abnormal migration of the ureteral bud when it is inserted into the bladder. We present a case involving an ectopic ureter draining into the vagina, with continuous urinary incontinence in an adult woman.
Unravelling bladder cancer in Uganda: insights from the discrepancies in TP53 assessment between immunohistochemistry and whole exome sequencing
Background: Bladder cancer (urothelial carcinoma) is highly heterogeneous. Despite several cutting-edge treatment practices, the prognosis of muscle-invasive urothelial carcinoma (MIUC) remains very poor. Immunohistochemistry (IHC) and whole exome sequencing (WES) have been used to understand the heterogeneous nature of this aggressive cancer. Unfortunately, TP53, the guardian of the genome, is the most mutated gene in MIUC. Overexpression of its gene products is a predictor of poor prognosis in urothelial carcinoma. This study assessed TP53 gene mutations and their protein expression using IHC and WES techniques. Methods: We conducted a cross-sectional study where 50 formalin-fixed paraffin-embedded (FFPE) tissue blocks, processed from biopsy specimens from patients admitted to Mulago National Referral Hospital (MNRH) with MIUC, were consecutively selected and re- examined. TP53 IHC and WES were done according to standard protocols. Results: All patients presented with haematuria and a bladder mass. The female-to-male ratio was 1:1.5. The mean age of the participants was 59.3 years (standard deviation [SD] 12.9). Using IHC, 26 (52%) of the 50 samples stained positive for TP53, yet only one had a TP53 missense gene mutation at WES. Conclusion: In this sample of Ugandan patients, mutations in the TP53 gene do not drive MIUC as they do in various parts of the world. The overexpressed TP53 proteins seen at IHC are possibly from the wild-type gene. Therefore, regarding clinical practice, this high discordance between TP53 immunopositivity and TP53 gene mutations for MIUC makes IHC (a cheaper and readily available option in our setting) a poor surrogate for TP53 WES.
Role of surgery for upper urinary tract stones in low-income countries: semi-rigid ureteroscopy and percutaneous nephrolithotomy in Benin
Background: Percutaneous nephrolithotomy (PCNL) and semi-rigid ureteroscopy (SR-URS) are adequate therapeutic means of treating upper urinary tract stones. This study aimed to evaluate the effectiveness of this approach in managing urinary lithiasis at the National University Hospital Centre of Cotonou (CNHU-Cotonou). Patients and methods: This was a retrospective, descriptive study conducted at the Urology Department of the CNHU-Cotonou from 28 November 2018 to 31 December 2022. The records of patients with upper urinary tract lithiasis treated with PCNL and SR-URS were reviewed and included. Result: A total of 121 patients were included. The average age was 46 years. The average stone size was 32 mm at the renal level and 6 mm at the ureteral level. PCNL was performed in 69 cases and SR-URS in 57 cases, with complete lithotripsy rates of 73.9% and 91.2%, respectively. In 53.6% (n = 37) of cases during PCNL, postoperative drainage was made by nephrostomy. During the SR-URS, a JJ-stent was placed in 92.9% (n = 53). The postoperative course was simple in 78.5%. A postoperative urinary tract infection was observed in 61.5% of cases. The average hospital stay was two days. Conclusion: Endoscopic surgery is now used to treat upper urinary tract stones at CNHU-Cotonou. The combination of PCNL and SRURS gives satisfactory results in our environment with limited equipment.
Five-year review of laparoscopic radical nephrectomies: initial experience with en bloc hilar ligation using an Endo GIA stapler
Purpose: This study aimed to present the outcomes of patients undergoing laparoscopic radical nephrectomy (LRN) and hilar ligation with an endovascular gastrointestinal anastomosis (Endo GIA) stapler for malignant renal tumours. Materials and methods: A retrospective review of patients who underwent LRN at Groote Schuur Hospital, Cape Town, between January 2018 and December 2022, focusing on those with renal cell carcinoma (RCC) and upper tract transitional cell carcinoma. Data on demographics, operative, and histopathological outcomes were collected. Results: The final cohort consisted of 69 patients with a mean (standard deviation) age of 57.9 years (± 12.7), with 49.3% male (34 patients) and 50.7% female (35 patients). The most common presenting complaint was flank pain (49.3%). Of the patients, 29 (41.4%) were asymptomatic and diagnosed incidentally. Of the cohort, 23 (33.3%) were clinical tumour, node, and metastasis (TNM) stage III. All patients underwent LRN and hilar ligation using Endo GIA staplers, mostly performed via the transperitoneal approach. Most patients (63.7%) had no Clavien–Dindo grade complications, and a minority (16, 23.2%) developed complications. The median operating time was 221.58 minutes, with a mean (interquartile range) hospital stay of 5.8 days. The most common histopathological variation was clear-cell carcinoma in patients with RCC, consisting of 56.5%, and 20.3% of patients had transitional cell carcinoma (TCC). Most of the RCC had Fuhrman grade 2 (34.8%) and a negative surgical margin at resection (95.2%). The most common pathological stage of the disease was pT3, constituting 25 (38.5%). Conclusion: The en bloc ligation of the renal hilum using an Endo GIA stapler is a practicable and advocated method that should be institutionalised.
Poor prognostic factors for Gangrene of the External Genital Organs over the last decade in West Africa: case of Ivory Coast
Introduction: External genitalia gangrene (EGG) is a rare pathology today whose mortality rate remains high in sub- Saharan Africa. Objective: To report poor prognostic factors in patients treated for EGG. Patients and Methods: This was a descriptive and analytical cross-sectional study of the files of patients treated for EGG between 2013 and 2022 at the urology department of the CHU of Cocody-Abidjan. The measured variables were obtained from data from the hospitalisation and consultation files of these patients. It aimed to identify risk factors for unfavorable outcomes. Results: The series included 73 male patients whose mean age was 49 years with borderline of 16 to 108 years. The mortality rate was 10.96%. The post-therapeutic follow-up concerned 65 patients alive for 5 months to 10 years after the initial management and the general quality of life overall was preserved. There were more deaths in patients treated within a period greater than or equal to 3 days. Diabetic patients had a hospital stay of up to 30 days. Diabetes and delay in treatment were the main negative factors (X2 = 17,73 and p = 0069 < 0,05 significative). Conclusion: Patients treated for EGG presented a severe alteration of their quality of life before treatment. A multidisciplinary care pathway in emergency, screening for fragility factors could improve the functional and vital prognosis of these patients.
Penile fracture injury: diagnosis, outcome and long-term follow-up in a Cameroon-based population
Background: The incidence of penile fracture is increasing in sub-Saharan Africa. However, it varies considerably among different geographical areas. Early diagnosis and surgery are central to preventing complications such as erectile dysfunction. Objectives: This study aims to present the outcomes and long-term follow-up of patients with penile fractures in Cameroon. Materials and methods: This was a retrospective review of 16 consecutive patients who underwent primary surgical repair following penile fracture between 2012 and 2020. All the patients included were treated at the Yaoundé Central Hospital and followed up for at least six months postoperatively. The mechanism of injury, clinical, paraclinical, and surgery details are presented. The International Index of Erectile Function (IIEF-5) score was used to evaluate erectile function. Results: A total of 16 patients were enrolled with a mean age of 35 ± 1.65 years. The most common cause of injury was vigorous sexual intercourse in 75% of patients (n = 12/16). The “woman-on-top” position occurred in six cases. Ultrasound showed unilateral injury of the corpus cavernosum in 80% of the patients. The location of injury was found in the proximal penis in 87.5% of the study population (n = 14/16). Corpora cavernosa injuries were repaired with simple sutures using 3-0 Vicryl through a sub-coronal approach. The IIEF-5 score 12 months after penile fracture was 23 ± 1.13 (range 22–25). Conclusion: Early clinical and ultrasound diagnosis of penile fractures associated with prompt surgical management through a subcoronal approach offers a good prognosis with preservation of erectile function.
A new treatment for mild erectile dysfunction with Garcinia kola nuts: a phase II randomised clinical trial
Purpose: Our objective was to assess the efficacy of Garcinia kola (G. kola) nuts in treating erectile dysfunction in adult men. Methodology: A phase II single-blind clinical trial was conducted at Yaoundé Central Hospital, Cameroon. Men aged above 25 years who had experienced erectile dysfunction for at least three months were recruited. G. kola nuts were authenticated, cleaned, and bagged according to each participant’s daily dose. We included 40 patients who completed questionnaires, including the International Index of Erectile Function (IIEF-15) and underwent clinical and paraclinical assessments. They were then randomly divided into two comparable groups to receive G. kola: group A (2 × 10 ± 1 g daily, n = 20) and group B (2 × 20 ± 1 g daily, n = 20). Patients were followed up every three weeks for 12 weeks. The primary outcome of the trial was an improvement in erectile function. Secondary outcomes included satisfaction with sexual intercourse, orgasm, sexual desire, overall satisfaction, and overall IIEF-15 score. Results: The mean ages of the participants in groups A and B were 46.95 ± 11.94 and 49.15 ± 14.66 years, respectively. Half of the patients had been complaining of erectile dysfunction for 1–5 years. At baseline, the mean erectile function of groups A and B was 18 ± 3.01 and 19.1 ± 1.60, respectively. From the first appointment, there was a significant difference between the erectile function of group A (18.15 ± 2.94, p = 0.874) and group B (21.7 ± 2.34, p < 0.001). At the trial’s baseline, the overall IIEF-15 scores were 42.7 ± 6.7 and 43.55 ± 4.3 for groups A and B, respectively. After six weeks, this score increased to 45.93 ± 5.96 in group A and reached 51.75 ± 4.34 in group B (p = 0.004). This increase continued until the end of the intervention. No major side effects were reported. Conclusion: The G. kola nuts may improve erectile dysfunction and may be an alternative option for men suffering from mild erectile dysfunction. Long-term studies with a large cohort and optimal dosage are needed to confirm this trend. Trial registration: Pan African Clinical Trial Registry, identifier PACTR202310817915957.
Early outcome and quality of life post-Mainz Pouch II urinary diversion among bladder cancer patients treated at Kilimanjaro Christian Medical Centre: a 10-year experience
Purpose: Mainz Pouch II is the most common continent type of urinary diversion performed after radical cystectomy for muscle invasive bladder cancer (MIBC) at our facility. This study assesses the early outcomes and quality of life (QoL) post-Mainz Pouch II urinary diversion at Kilimanjaro Christian Medical Centre (KCMC). Materials and methods: This retrospective cohort study examined all patients who underwent radical cystectomy and Mainz Pouch II urinary diversion at the KCMC urology department from January 2012 to December 2022. Variables assessed included sociodemographic characteristics, clinicopathological disease stage, histological type, early outcome, and QoL. Data were collected from the urology theatre registry book, the Data-Intensive Systems and Applications (DISA) for laboratory results, and the Electronic Health Management System (EHMS) for follow-up information. Clinical pathological characteristics were captured using a data extraction sheet. The World Health Organization (WHO) health-related quality of life (HRQOL) questionnaire was used for QoL assessment. The Statistical Package for the Social Sciences (SPSS) version 25 was used for data analysis. Results: In this study, 41 subjects underwent Mainz Pouch II, with 78% male. Most patients (97.6%) had T2 clinical stage, while 75.6% had T2 pathological stage, and transitional cell carcinoma (TCC) accounted for 80.5%. Early outcomes included hyperchloremic metabolic acidosis (65.9%), pyelonephritis (4.9%), paralytic ileus (19.5%), wound complications (14.6%), deep vein thrombosis (DVT) (2.4%), acute kidney injury (AKI) (9.8%), and incontinence (12.2%). All subjects had good physical QoL, and 10.7% had poor mental QoL. Conclusion: Mainz Pouch II is safe with minimal adverse early outcomes and overall good QoL. Further studies on long-term outcomes and determinants of survival are recommended.
The patterns of primary male genitourinary cancers in a tertiary referral hospital in northern Ghana
Purpose: There is a lack of published data on male genitourinary cancers (MGUCs) in northern Ghana. We aimed to examine MGUC patterns, the histopathological subtypes, and their clinical presentations to form a basis for further research. Materials and methods: A review of MGUCs at the Tamale Teaching Hospital (TTH) was conducted from 1 January 2012 to 31 December 2021. Data were collected on the age (years), anatomic sites, and clinicopathological characteristics of MGUCs. Statistical Package for the Social Sciences (SPSS) software version 23 was used to enter and analyse the data. A double-tailed Fisher’s exact test was used to identify associations between variables, while a p-value of 0.05 or less was regarded as statistically significant. Results: We found 178 malignant tumours of the male genitourinary tract with a mean age of 60.5 ± 12.4 years. Many (66.9%) were 60 years or older. Cancers of the prostate, urinary bladder, and penis were diagnosed in males older than 40 years. The common cancers by anatomic sites were the prostate gland (66.3%), urinary bladder (25.7%), kidneys (5.1%), and penis (4.5%). The common site-specific presentations were prostate (lower urinary tract symptoms [LUTS], 65.0%), urinary bladder (haematuria, 79.0%), kidney (flank mass, 89.0%), and penis (ulcer, 87.5%). The prevalent histological subtypes were prostatic adenocarcinoma (63.5%) and urinary bladder transitional cell carcinoma (TCC) (9.6%). Conclusion: MGUCs were commonly diagnosed in males older than 40 years, with the prostate and urinary bladder as the common anatomic sites. The common histopathological subtypes were adenocarcinoma, TCC, and squamous cell carcinoma (SCC). A future prospective study of the management and survival rates of MGUCs is recommended.
Morbidity and mortality of endoscopic surgery of the lower urinary tract: 293 cases at the University Clinic of Urology Andrology CNHU-HKM
Introduction: Endoscopic surgery carries the risk of complications that can be life-threatening. The aim of this study was to evaluate the complications secondary to endoscopic surgery of the lower urinary tract. Patients and method: The study was retrospective descriptive. Patients who had undergone endoscopic surgery of the lower urinary tract were included. Endoscopic procedures and postoperative complications were classified according to according to Clavien and Dindo. Results: The mean age of the patients was 55.72 years. TURP was the most common procedure in 62.45% of cases, followed by endoscopic internal urethrotomy (19.80%). We recorded 4 cases of false route and 1 case of haemorrhage during endoscopic internal urethrotomy and 3 cases of haemorrhage and 1 case of lesion of the prostatic capsule during TURP. Immediate postoperative were marked by 2 cases of false tract during endoscopic internal uretrotomy with scrotal oedema classified grade 2 according to Clavien and Dindo. The death rate was 1.3%. Conclusion: Endoscopic surgery procedures, although more efficient, are responsible of significant morbidity and mortality. Optimal management requires perfect proficiency of the technique.
Challenges, terms, and conditions of nursing Fournier’s gangrene in a semi-urban hospital: experience of the Aného Prefectural Hospital Centre in Togo
Introduction: Fournier’s gangrene (FG) is a rare perineogenital necrotising fasciitis with a serious prognosis. Its initial early nursing is based on resuscitation and debridement, which guarantees a good prognosis. However, it is challenged by delayed consultation or a lack of specialists in semi-urban areas. Aim: Take up the challenges and describe the nursing terms and conditions of FG in a semi-rural environment at the Aného Prefectural Hospital Centre (PHC). Method: This was a prospective and descriptive study over five years of patients treated for FG at the general surgery department of the Aného PHC, with a minimum follow-up of four months. The parameters studied were anatomo-clinical, therapeutic, and prognostic. Results: We collected 13 cases of FG, all men, out of 4 127 patients over five years. The average period for admission was 15.15 ± 7.92 days (6–32). Perineoscrotal lesions were noted in eight cases, scrotal in three, and penoscrotal in two. All patients received broad-spectrum antibiotic therapy tailored to their ailment. Debridement under caudal anaesthesia (11 cases) and general anaesthesia (two cases) was performed in all patients. Two patients underwent a colostomy. The follow-up dressings in the ward were moist dressings, leading to four cases of directed healing, two skin grafts, and five medial thigh fasciocutaneous flaps with immediate closure of the donor sites. The average reconstruction period was 33.01 ± 16.08 days (24–68). The average period of hospitalisation was 49.69 ± 26.99 days (21–102). The evolution was uncomplicated in nine patients; two patients presented complications after the reconstructions, and two deaths were recorded. Conclusion: Improving the prognosis of FG in semi-urban environments requires awareness to avoid consultation delays and the provision of more specialists.
Copyright (c) 2025 A Sogan, EV Sewa, TE Kouevi-Koko, EG Amouzou, K Tengue, K Adabra https://creativecommons.org/licenses/by-nc/4.0
Risk factors for recurrence of urethral strictures in urology at the Cocody-Abidjan University Hospital in Ivory Coast from 2014 to 2023
Objective: To identify factors that promote recurrence of urethral strictures. Methods: This was a retrospective cohort study that included 104 patient records from the Urology Department of the Cocody-Abidjan University Hospital (CHU) for urethral strictures from April 1, 2014, to March 31, 2023, a period of 10 years. Results: The prevalence of urethral strictures was 3.20%, with a mean age of 54.45 years and a range of 17 to 90 years. More than half of the patients were from disadvantaged social classes. All patients presented with dysuria, 81% of which was associated with urinary retention. Strictures were post-infectious in 66% of cases and iatrogenic in 21% of cases. Endoscopic internal urethrotomy (EUI) was the most commonly used treatment in 45% of cases, followed by end-to-end anastomotic resections (ETAR) in 25%, 1-stage urethroplasty (1ST) in 14%, and 2- stage urethroplasty (2ST) in 11%. The recurrence rate was 32.7% (34/104). Infectious causes dominated the recurrence cases with 32 out of 34 cases. Patients who underwent EUI with 22 out of 34 cases had more recurrences. There was a statistically significant relationship between the occurrence of recurrence and infectious etiology There was also another significant relationship between previous treatment (endoscopy) and recurrence, with a chi-square value of 12.59 higher than the observed chi-square value of 10.18. Conclusion: Urethral stricture affects adults and the elderly from disadvantaged backgrounds. EIU performed for infectious causes is marked by adverse outcomes, with a high recurrence rate.
Retrospective descriptive study of radical prostatectomy for localised prostate cancer in Benin: epidemiological and diagnostic aspects over five years
Objective: Prostate cancer is a major public health problem in sub-Saharan Africa. This study aims to provide a detailed analysis of the epidemiological characteristics and diagnostic aspects of patients undergoing radical prostatectomy for prostate cancer located at two university hospitals in southern Benin to improve the early management of this pathology in our context. Methods: This was a monocentric, descriptive, retrospective study conducted over five years (1 January 2018 to 31 December 2022) at the University Urology and Andrology Clinic of Centre National Hospitalier Universitaire Hubert Koutoukou Maga (CNHU-HKM) in Cotonou and the Centre Hospitalier Universitaire Départemental de l’Ouémé-Plateau (CHUD-OP) surgical department. All patients who underwent radical prostatectomy for localised prostate cancer with complete clinical documentation were included. Incomplete records were excluded. Data were collected from patients’ medical records using a standardised collection form. Variables studied included sociodemographic data, history and comorbidities, clinical data including International Prostate Symptom Score (IPSS), results of biological (prostate-specific antigen [PSA]) and imaging tests, and anatomical pathology analyses. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 23.0 software. Results: Of the 38 cases identified, 35 were selected according to our inclusion criteria. The mean age was 65 years. Most patients (57.1%) were asymptomatic. Among symptomatic patients, the mean IPSS was 12.3 ± 4.6, indicating moderate lower urinary tract symptoms (LUTS). On digital rectal examination (DRE), 71.4% of patients had an adenomatous prostate. The median PSA level was 14.6 ng/ml (range 4.6–62.5 ng/ml). Of the patients, 45.7% had PSA levels between 10 and 20 ng/ml. Pathological analyses revealed a predominance of Gleason score 6 (77.1%). TNM (tumour, node, and metastasis) analyses showed a majority of T2N0M0 stages (48.8%). Most patients (74.3%) had a low D’Amico score. Conclusion: The epidemiological and diagnostic profile of patients undergoing radical prostatectomy in our setting is characterised by a predominance of forms with a good prognosis, diagnosed in patients in their 60s with few symptoms. These results suggest a gradual improvement in the early detection of prostate cancer in Benin, contrasting with the late presentation usually observed in developing countries. This trend could be attributed to increased awareness and better access to specialist urological care in our region, although further efforts are needed to optimise early detection and management.
Expression patterns of EGFR, PD-L1, and Ki-67 among Ugandan patients with muscle-invasive bladder cancer
Introduction: Bladder cancer ranks as the ninth most common cancer globally, with muscle-invasive urothelial carcinoma (MIUC) exhibiting poor survival rates. Biomarkers such as epidermal growth factor receptor (EGFR), programmed death-ligand 1 (PD-L1), and Ki-67 have been studied for their potential in guiding management. However, limited data exists on their expression in Ugandan populations. This study examines the expression of these biomarkers in MIUC patients to provide insights for improved management. Methods: A descriptive, cross-sectional study was conducted on 52 archived formalin-fixed, paraffin-embedded (FFPE) tissue samples of MIUC patients at Mulago National Referral Hospital (MNRH). Immunohistochemistry (IHC) was performed using the Ventana BenchMark ULTRA system with antibodies against PD-L1, EGFR, and Ki-67. Expression thresholds were set at > 5% for PD-L1, > 10% for EGFR, and > 15% for Ki-67. Data were analysed using RStudio, with associations assessed using Cramér’s V matrix. Results: Among the 52 samples, Ki-67 showed the highest expression (55.8%), followed by EGFR (13.5%) and PD-L1 (5.8%). Most associations between categorical variables were weak, with a moderate association demonstrated between variant histology and lymphovascular invasion (LVI). Conclusion: This study highlights the low expression of PD-L1 and EGFR in contrast to the high expression of Ki-67. These findings emphasise the importance of considering Ki-67 as a potential biomarker for aggressiveness in urothelial carcinoma (UC). The low PD-L1 expression raises questions about the applicability of immunotherapy in Ugandan populations. Future research with larger cohorts and genomic analysis is recommended.
Comparing the antibacterial effectiveness of chlorhexidine and methylated spirit with povidone-iodine and methylated spirit for skin preparation in paediatric groin surgeries
Background: Surgical site preparation is a standard part of the preoperative preparations done to reduce contamination of the surgical wound by skin-borne bacteria. This research aimed to determine the antibacterial effectiveness of two skin preparation methods (0.3% chlorhexidine and 3% cetrimide scrub, followed by 70% methylated spirit paint, and 7.5% povidone-iodine in 70% methylated spirit scrub and paint) for groin surgery in paediatric surgical patients. The study compared the antibacterial effectiveness of both preoperative skin preparation methods in paediatric groin surgery in Ile-Ife, Nigeria. Methods: This was a prospective, parallel group, randomised trial, without any control, of children aged between one day and 15 years, who required elective groin surgery. The patients were recruited from the paediatric surgery outpatient clinic of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The patients were manually randomised into two arms. The patients’ groin skin at the site of the proposed surgery was swabbed with two moistened swab sticks at anaesthesia induction before skin preparation, three minutes after skin preparation, and at the end of the surgery. The samples collected were cultured. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 20. Data were expressed as the mean and standard deviation as required. A criterion of p < 0.05 was used to determine statistical significance. Results: A total of 70 patients were recruited for the study. The patients’ age range was two months to 15 years, with a mean of 4.66 years. There were 63 males (90%) and seven females (10%), resulting in a male-to-female ratio of 9:1. Both skin preparation methods significantly affected the bacterial colony count, as demonstrated by McNemar’s chi-square test. Conclusion: This study’s findings indicate that both skin preparation methods have significant antibacterial effects, with no statistically significant difference in their antibacterial effectiveness.
Assessing disease-specific health-related quality of life in patients with stones in the urinary tract (urolithiasis) using the Wisconsin Stone Quality of Life Questionnaire at Groote Schuur Hospital renal stone service
Purpose: This study aimed to assess the disease-specific health-related quality of life (HRQOL) of patients with urolithiasis using the Wisconsin Stone Quality of Life (WISQOL) questionnaire at the Groote Schuur Hospital (GSH) renal stone service. Materials and methods: This was a prospective, descriptive study using the validated WISQOL questionnaire. Participants were recruited from the GSH urology department, urology ward, and metabolic stone clinic. The primary objectives were to assess the disease-specific HRQOL of patients with urolithiasis and record their demographic information. Secondary objectives were to record patients’ double J (DJ) stent status, body mass index (BMI), and the number of stone procedures. Results: A total of 100 questionnaires were administered. Participants’ median age was 46 years, and 60% were males and 40% were females. The average BMI was 28 kg/m2. The median total score on the WISQOL questionnaire was 62/140 points (53–91). The most affected domains were energy, daily function, and psychological health. There was no statistical difference in HRQOL between patients with or without a DJ stent. Of the participants, 66% had a history of urolithiasis, and 88% had one or more urological procedures. Conclusion: Using the WISQOL questionnaire, we found that patients with urolithiasis have poor HRQOL. The domains mostly affected were energy, daily function, and psychological health. Risk factors contributing towards stone formation in our study were increased BMI, male gender, and age. Understanding the holistic effects of urolithiasis on patients’ health can assist in providing more comprehensive patient-centred healthcare.
Evaluation of prostatic adenomectomy using the Millin technique: single-centre experience at Tanguiéta Zone Hospital, Benin
Introduction: Benign prostatic hyperplasia (BPH) affects up to 80% of elderly men. In sub-Saharan Africa, limited access to minimally invasive techniques means that open adenomectomy remains the treatment of choice for large prostates. The Millin technique, which uses an anterior transcapsular approach, offers better haemostatic control. Methods: This was a prospective, monocentric study conducted over four years (February 2020 to February 2024), including 83 patients with clinically confirmed BPH (prostate-specific antigen [PSA] ≤ 4 ng/ml) and treated surgically by the same surgeon at the Tanguiéta Zone Hospital, Benin. The International Prostate Symptom Score (IPSS) and quality of life related to urinary symptoms were assessed before and after surgery. Results: The mean age in our series was 64.01 years. The mean prostate volume was 76.04 cc. The mean preoperative IPSS was 24.23. The mean operating time was 58.23 minutes. The transfusion rate was 6%. The average hospital stay was 6.45 days. The postoperative complication rate was 10.8%, mainly surgical site infections (6%). At six months, the mean IPSS was 1.96, representing an improvement of 91.9%. Notably, 100% of patients reported satisfaction with their quality of life. Conclusion: Millin adenomectomy is an effective and safe treatment option for BPH in a context of limited resources. It produces excellent functional results and has low complication rates, without requiring sophisticated equipment.
Healthcare workers’ knowledge and practice of proper adult male urethral catheterisation and resource availability at district hospitals in Kilimanjaro
Background: Urethral catheterisation is a common, standard and sterile procedure used to drain the urinary bladder through the urethra. The procedure is done with caution and care, since complications arising from it may be devastating. In Tanzania, the number of iatrogenic urethral catheterisation injuries resulting in urethral stricture disease is increasing. Consequently, healthcare workers (HCWs) need to know the appropriate techniques for male urethral catheterisation. Objectives: This study aims to determine HCWs’ levels of knowledge and practice in adult male urethral catheterisation, and whether the district hospitals in the Kilimanjaro region in Tanzania have adequate resources for the procedure. Methodology: This is an analytical, cross-sectional study conducted from January to June 2024. A questionnaire was used to obtain information from HCWs. Results: A total of 354 HCWs participated, of which 73.4% were nurses and 26.6% were doctors. Of the participants, 76% had a low level of knowledge; nurses had 7.25 times the odds of having a low knowledge level. A poor level of practice was found in 92.4% of the participants. Nurses had 2.02 times the odds of having poor practice. A statistically significant positive correlation of 0.112 was seen between the levels of knowledge and practice. Equipment for catheterisations was available in all district hospitals. Conclusion: HCWs in district hospitals have a low level of knowledge and poor practice of proper adult male urethral catheterisation. A statistically significant positive correlation was observed between HCWs’ levels of knowledge and practice. Most district hospitals have appropriate equipment for proper adult male urethral catheterisation.
The parameters of predicting kidney function recovery after obstructive uropathy management: a case–control study
Introduction: Hydronephrosis is the renal pelvis dilation due to urinary tract obstruction resulting from physiological or pathological factors. Delayed treatment leads to permanent kidney damage, and kidney function recovery does not always occur after treatment. Therefore, determining the parameters of kidney function recovery after hydronephrosis treatment is crucial. Methods: A retrospective case–control study to evaluate the parameters that predict kidney function recovery after obstructive uropathy management in adult patients at Prof. Dr. R. D. Kandou General Hospital, Manado. Data were collected from medical records and analysed using descriptive, bivariate, and multivariate analyses to evaluate factors influencing kidney function recovery. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value for each parameter, along with cross validation and statistical power calculations. Results: This study involved 72 patients with obstructive uropathy. Kidney function improvement was observed in 63.9% of the patients. Most patients (61.1%) did not undergo haemodialysis (HD). The Kruskal–Wallis test (p < 0.001) showed significant differences in outcomes across HD status groups’ prognoses. The ROC analysis revealed the optimal cut-off values for urea (93.0 mg/dl, 5.2 mmol/L), creatinine (33.9 mg/dl, 1.88 mmol/L), and haemoglobin (9.4 g/dl, 5.83 mmol/L). Urea, creatinine, and haemoglobin also showed good sensitivity and specificity in predicting kidney recovery (urea: 77.78% sensitivity and 72.22% specificity, creatinine: 63.89% sensitivity and 94.44% specificity, haemoglobin: 75% sensitivity and 61.11% specificity). Conclusion: This study demonstrated that HD status and laboratory parameters, including urea, creatinine, and haemoglobin, play important roles in predicting kidney function recovery after obstructive uropathy management.
Evaluating various aetiologies of chronic orchialgia and the response to multimodal therapy in central India: a prospective observational study
Background: Chronic orchialgia, defined as scrotal or testicular pain persisting for more than three months, significantly affects quality of life and presents diagnostic and therapeutic challenges. This study aims to evaluate the various aetiological factors of chronic orchialgia and assess the outcomes of multimodal management strategies in a tertiary care setting. Methods: This prospective observational study was conducted at the All India Institute of Medical Sciences (AIIMS) in Bhopal from March 2023 to September 2024. A total of 181 male patients aged 18–80 years with chronic orchialgia were enrolled. The comprehensive evaluation included a history, clinical examination, laboratory workup, imaging, and psychiatric assessment. Multimodal management involved pharmacological therapy (nonsteroidal anti-inflammatory drugs [NSAIDs], amitriptyline, pregabalin), physical therapy, surgical interventions, pain clinic referrals, and psychological counselling. Follow-up was performed at 15 days, six weeks, and three months using the Visual Analogue Scale (VAS) to assess pain. Results: Among 181 patients, the mean age was 37.5 years. Common aetiologies included varicocele (28%), epididymal cysts (14%), hydrocele (11%), hernia (10%), infections (9%), neuropathic pain (8%), and idiopathic cases (20%). Conservative management resulted in a significant improvement in VAS scores, with a mean reduction from 3.64 ± 1.66 to 1.17 ± 1.09 (p < 0.001). Surgery was performed in 15 patients with structural causes, resulting in further improvement, with a mean VAS score of 1.6. Factors such as younger age, shorter symptom duration, and identifiable aetiology predicted better outcomes. Conclusion: Chronic orchialgia requires a multimodal, individualised approach that integrates pharmacological, surgical, psychological, and physiotherapeutic interventions. Early diagnosis and targeted therapy significantly improve patient outcomes and quality of life.
Urethrocutaneous fistula following hypospadias repair: recurrence rate and its determinants
Background: Urethrocutaneous fistula (UCF) is a common complication following hypospadias repair. It may be associated with frequent recurrences after repair, ultimately increasing treatment costs and leading to poor cosmetic outcomes due to multiple surgeries. Aim: This study aimed to evaluate the recurrence rate of post-hypospadias UCF and its determinants following repair among patients treated at the Urology Department of Kilimanjaro Christian Medical Centre (KCMC) from January 2011 to December 2023. Methodology: We conducted a hospital-based, retrospective study that reviewed the case notes of all patients who developed UCF post-hypospadias repair. Patients were followed up for at least six months postoperatively. Various factors were analysed to assess their influence on recurrence. Results: The study included 44 patients with UCF after hypospadias repair. The recurrence rates after repair were 30% (13/44) after the first, 30% (4/13) after the second, 50% (2/4) after the third, and none after the fourth repair. Our results demonstrated a significant association between UCF recurrence and the hypospadias grade and UCF location. Multivariate analysis using a modified Poisson regression model identified a history of grade III or IV hypospadias as an independent risk factor for UCF recurrence. Conclusion: UCF post-hypospadias repair is associated with at least one-third of recurrence following repair. A history of grade III or IV hypospadias is an independent risk factor for this recurrence. Age at first UCF repair, catheter/stent duration, and suture material were not related to UCF recurrence after surgical repair.
Bladder tumours in Togo from 2011 to 2021: epidemiological and anatomo-pathological aspects
Introduction: The authors report this study with the aim of evaluating the epidemiological and histopathological aspects of bladder tumours in Togo. Methods: This was a cross-sectional study with retrospective data collection conducted in the anatomy and cytopathology laboratory of Togo. During the period from January 2011 to November 2021, 82 cases of bladder tumours were diagnosed. For each patient, the following variables were studied: age, sex, and histopathological nature. Results: Bladder tumours accounted for 75.2% of all bladder pathologies diagnosed during our study period, including 68.3% of cancers and 31.7% of benign tumours. Men were majority, the sex ratio, male/female, was 1.83. The mean age of the patients was 53.80 ± 15.17 years, with a range of 17 to 85 years. Squamous cell carcinoma was the most common histological type of cancers, accounting for 75% of the cases, while benign tumours were dominated by urothelial papillomas (69.2%). Conclusion: Bladder tumours are common in Togo, with a clear male predominance. Squamous cell carcinoma remains the most common histological type of cancer.
Spectrum, antibiotic susceptibility pattern, and predisposing factors for urinary tract infections among patients with bladder outlet obstruction due to benign prostatic hyperplasia at a tertiary hospital in northern Tanzania
Introduction: Urinary tract infections (UTI) are one of the most common infectious conditions encountered by clinicians globally. However, in ageing men, it is uncommon until after 50 years due to bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH). This study aimed to evaluate the bacterial spectrum, antibiotic susceptibility pattern, and predisposing factors for UTIs in patients with BOO due to BPH at a tertiary hospital in Tanzania. Materials and methods: This was a hospital-based, analytical, cross-sectional study conducted at a Tanzanian northern zone tertiary hospital from January 2021 to December 2023, including 464 patients whose urine culture results were analysed using structured data and the Statistical Package for the Social Sciences (SPSS) version 25. Results: Of the 464 patients, the majority were aged 61–80 years, with a mean age of 72.8 ± 9.10. About 44.8% had comorbid conditions. Bacterial isolates were found in 214 patients (44.1%), and 31.5% had indwelling urinary catheters. Escherichia coli (29.9%) was the most prevalent organism. The isolated bacteria showed a high sensitivity to meropenem (90%), amikacin (81%), piperacillin/tazobactam (71%), and nitrofurantoin (79%), but high resistance to amoxicillin/clavulanic acid (71%), ceftriaxone (78%), and ciprofloxacin (76%). Catheter use was the only independent predictor for UTIs (p = 0.05). Conclusion: UTIs in men with prostate enlargement are worsened by the rising antibacterial resistance (ABR), with catheterisation being the main predicting factor. Recommendations include limiting the empirical use of fluoroquinolones, encouraging nitrofurantoin use, and improving catheter care.
Outcome of urological injuries associated with pelvic trauma in two hospitals in Douala, Cameroon
Introduction: Urological injuries are anatomical alterations resulting from an attack on the urogenital tract. Delayed diagnosis can lead to adverse outcomes. Their management remains challenging, controversial, and multidisciplinary. This study aimed to outline the epidemiological, clinical, therapeutic, and evolutionary particularities of urological injuries associated with pelvic trauma in Douala. Methods: We conducted a retrospective study at the Douala General Hospital (DGH) and Laquintinie Hospital of Douala (LHD) from 1 January 2012 to 31 December 2022. We included records of patients with pelvic trauma with a clinical, radiological, and/or postoperative diagnosis of associated urological lesions, managed and followed up during the study period. Our survey form contained sociodemographic, clinical, therapeutic, and follow-up information. Results: We collected 121 records of patients aged 4–77 years. The mean age was 32.61 ± 13.43 years, with 92 male patients (76%). Students were the most affected (26.4%). Road traffic accidents were the most frequent (76.9%). Clinical signs were haemodynamic instability (28.9%), urethrorrhagia (25.6%), haematuria (24.8%), and acute urinary retention (15.7%). Tile B classification was the most common type of pelvic fracture (53.7%). Urethral injury was the most frequent (62.8%). Orthopaedic treatment was the priority (74.4%). Suprapubic cystostomy was performed urgently (53.7%), and endoscopic internal urethrotomy was performed electively (55.8%). Common complications were decubitus ulcers (6.6%) and urethral strictures (41.7%) in the long term. The mortality rate was 4.1% (n = 5). The longterm survival rate was 90.8%. Conclusion: Urological injuries associated with pelvic trauma are uncommon and occur in young male patients. Urethrorrhagia and haematuria are almost always present. Their long-term prognosis is favourable.
Highlights from the 5th UCT Robotic and Endourology workshop
A few years ago, I co-wrote an editorial in this journal making the case for the benefits of live surgery broadcast (LSB) as a means to teach.1 Investigating the literature on LSB (much of it urological) made me think critically about its educational value and the importance of adhering to the EAU guidelines on LSB to ensure patient safety.
Twenty past six and it has been dark for an hour already. We have just arrived to see the patients for tomorrow’s theatre list after finishing our TURP workshop at the private clinic. The single audible fluorescent tube in the corridor of the paediatric ICU at Hospital Central de Maputo (HCM) disturbs the otherwise quiet ward. Down the corridor I catch a glimpse of a ventilated head injury child being prepared for transfer. “Transfer to where?” I ask myself. Hopefully to the theatre complex, on the other side of this 1 500 bed Art Deco hospital complex spanning a whole city block in the centre of the capital. We find the ultrasound machine we came looking for and negotiate with a young nurse to take it next door, where there is an empty treatment room. The mother and child train in tow.
Copyright (c) 2025 K Jehle https://creativecommons.org/licenses/by-nc/4.0
Focal therapy for prostate cancer — ready for prime time?
For most of my career, focal therapy (FT) of prostate cancer has been a concept rather than a therapeutic option. I recently attended the World Congress of Endourology and Technology in Phoenix, Arizona. Quite by accident I stepped into a Focal Therapy Society session. What I learned surprised me.