Status epilepticus (SE) refers to a condition in which there is a failure of the “normal” factors that serve to terminate typical seizures,1 and is a common neurological emergency associated with high mortality and morbidity. It may be classified based solely on the presence or absence of convulsions, into convulsive SE (CSE) and nonconvulsive SE (NCSE). It requires emergent, targeted treatment to reduce the associated morbidity and mortality. The underlying etiology is the important determinant of mortality in SE. This review will discuss the evaluation and management of CSE.

Mortality and Morbidity

OBJECTIVE\nPressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO). A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO.\n\n\nMATERIALS AND METHODS\nPatients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOOI). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The IPP was classified into three stages: grade I under 5 mm; grade II, between 5 and 10 mm; and grade III over 10 mm.\n\n\nRESULTS\nForty-two patients, mean age 64.8 +/- 8.5 years were enrolled. Transabdominal ultrasound determined a mean prostatic volume of 45 +/- 3.2 mL. Achieved IPP's values were the following: grade I - 12 (28.5%), grade II - 5 - (12%) and grade III - 25 (59.5%). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0.016). For IPP, the area under ROC curve was 0.758 (95% confidence interval - 0.601 to 0.876), and the cutoff point to indicate BOO was 5 mm with 95 % sensitivity (75.1 - 99.2) and 50 % specificity (28.2 - 71.8).\n\n\nCONCLUSION\nIPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.

Intravesical protrusion of the prostate as a predicting method of bladder outlet obstruction

Several studies showed that androgen deprivation therapy (ADT) plus local treatment of prostate could improve metastatic prostate cancer (mPCa) patients’ survival. To date there are few studies analyzed the value of prostate cryoablation in mPCa. The objective of our analysis is to evaluate the oncological results and clinical value of prostate cryoablation combined with ADT compared with ADT alone in newly diagnosed mPCa patients. Newly diagnosed mPCa patients undergoing cryoablation plus ADT (group A) between January 2011 and November 2018 were identified. Patients receiving ADT alone (group B) were selected from the same institutional prostate cancer database by propensity score matching based on clinical characteristics. Oncological results and clinical value in symptom control and primary lesion treatment were compared. Fifty-four patients were included in each group. Prostate cryoablation was well tolerated. The median follow-up time was 40 (27–53) and 39 (31–54) months in group A and group B, respectively. Patients in group A had a lower median prostate-specific antigen (PSA) nadir (0.025 ng/mL vs. 0.230 ng/mL, p = 0.001), longer median failure-free survival (FFS) (39 months vs. 21 months, p = 0.005), and median metastatic castration-resistant prostate cancer (mCRPC)-free survival (39 months vs. 21 months, p = 0.007). No difference in cancer-specific survival and overall survival was found between the two groups. Multivariate Cox analysis showed combination therapy reduced the risk of FFS by 45.8% (HR = 0.542 [95% CI 0.329–0.893]; p = 0.016). Patients in group A had better clinical relief of urinary symptoms (79.1 vs. 59.1%, p = 0.044) and required less treatment of primary lesions for symptomatic relief (13.0 vs. 31.5%, p = 0.021). Prostate cryoablation plus ADT decreases PSA nadir, prolongs FFS and mCRPC-free survival, relieves urinary symptoms and reduces the need for treating primary lesions in newly diagnosed mPCa patients compared to ADT alone.

/pdf/prostate-cryoablation-combined-with-androgen-deprivation-1zmvjw6zjp.pdf

Prostate cryoablation combined with androgen deprivation therapy for newly diagnosed metastatic prostate cancer: a propensity score-based study.

Comparison of a Visual Prostate Symptom Score and International Prostate Symptom Score: A Prospective Multicenter Study and Literature Review.

Background: Prostate cancer (PCa) may be asymptomatic at an early stage and may run an indolent course that requires minimal or no treatment. Early diagnosis through screening reduces the rate of advanced diseases. Whereas, in the western countries where screening is more prevalent, many presents early with a chance for curative treatment. In Africa, late presentation is often the case with palliative treatment sadly the only choice. Objective: To evaluate the associated complications in patients with prostate cancer and assess the Gleason’s grade as a risk factor for complications observed in patients with prostate cancer, in Port Harcourt, Rivers, Nigeria. Method and Methodology: This was a retrospective study carried out over ten years, between January 2011 and December 2020. All patients with histologically confirmed prostate cancer who presented to the University of Port Harcourt Teaching Hospital, Sophia clinic, and Rosivylle clinic were evaluated. The folders were retrieved and their age, presenting complaints, skeletal survey, and biopsy reports were evaluated. Patients with incomplete records were excluded from the study. These data were collated using Microsoft Excel 2016 version and they were analyzed using SPSS version 20. Results: There were 335 patients with PCa with a mean age of 68.71year. The commonest complication was urinary symptoms observed in 192 with urine retention 119(35.5%) and nephropathy 73(21.8%). The spine was the commonest site of bone spread observed in 160(47.8%) followed by the femur 62(18.5%). Anaemia was the next common. There was an association between age, presence of urinary symptoms, and bone involvement with the Gleason’s Grade. However, there was a strong association of the overall presence of complications with Gleason’s score. Conclusion: Men with prostate cancer tend to present with advanced disease in Port Harcourt. The most common presentation was lower urinary tract symptoms followed by low back pain. Complications are associated with high Gleason’s grade cancers. Screening may aid in early diagnosis and cure of the disease especially for men of African descent.

https://doi.org/10.36348/sjm.2022.v07i02.002

Retrospective Analysis of Complications from Prostate Cancer among Nigerians

https://www.ajol.info/index.php/aju/article/download/182250/171628

The value of intravesical prostatic protrusion in evaluation of bladder outlet obstruction from benign prostatic enlargement in Nigeria

BACKGROUND:Transurethral resection of the prostate (TURP) is the current gold standard for the operative management of symptomatic Benign prostatic hyperplasia (BPH) and has excellent long term efficacy. Currently there is a gradual shift towards bipolar TURP and Holmium enucleation of the prostate (HoLEP) due to fear of complications, particularly transurethral resection (TUR) syndrome associated with monopolar TURP. However, bipolar generator and high powered holmium laser resectoscpe remain very expensive and make the bipolar TURP/HoLEP out of reach for majority of our patients.This study seeks to review our experience with monopolar TURP with a view to appraising its outcomes and complications seen in our patients.PATIENTS AND METHODS: Records of 42 patients, who underwent monopolar TURP for BPH between October, 2013 and September, 2016 were reviewed retrospectively.The data of patients who had undergone monopolar TURP,following standardized technique,were retrieved and subjected to statistical analysis.RESULTS:The mean age of the 42 patients was 67.07±9.38 (range 51 – 86).Those in the age range 60-69 years had most of the procedure.The mean prostate volume was 70±23.74 (ml);the mean prostate specific antigen (PSA) was 5.32±5.4ng/ml. All the patients had spinal anaesthesia.The mean intraoperative time was 71.05±19.07 (mins), while the mean hospital stay for the patients was 61.14±27.13 (hrs).The mean volume of 5% dextrose-water used for irrigation at surgery was 30L.Most of the patients,33(78.6%) had their catheters removed at 3-5 postoperative days. Only, 9(21.4%) had catheter for more than 5 days.The mean weight of resected prostatic chips was 29±9.2g. Intraoperatively, 1(2.4%) patient had bleeding that needed blood transfusion, 6(14.3%) had capsular perforations while none of our patients had TUR syndrome. Postoperatively, 3(7.2%) patients had clot retention while 2(4.8%) had UTI and 32(76%) had retrograde ejaculation. All patients except 1(2.4%) had satisfactory voiding at removal of catheter and subsequent follow up visits.CONCLUSION: Improved antibiotics, perioperative care and instrumentation have greatly improved the morbidity of modern monopolar TURP and make it still useful for our patients.KEY WORDS: TURP, BPH,Prostatectomy

Monopolar transurethral resection of the prostate for benign prostatic hyperplasia: What are the outcomes and complications in our patients?

Background: The genitourinary system has been shown to be involved in 10% of patients presenting after trauma and is therefore a significant factor in trauma induced morbidity and mortality. It affects all age groups and both sexes. The aim of this study is to determine the aetiology, mechanism of injury and management of genitourinary injuries in a tertiary trauma centre. Methods: This is a prospective study carried out at the Jos University Teaching Hospital between 2012 and 2017. All patients who presented at the A and E with genitourinary trauma were recruited into the study. Initial assessment involved taking an AMPLE history and resuscitation, using the Advanced Trauma Life Support (ATLS) protocol of the American College of Surgeons. Physical examination and investigation were carried out to localize and determine extent of injury. Investigations carried out were complete blood count, blood grouping, serum electrolyte, urea and creatinine and radiography where applicable. Surgical intervention was carried out where indicated. Results: A total of 104 patients were involved in this study. The mean age was 32.14±15.5 years with a range of 3 to 75yrs. Median age was 28yrs. Eighty-nine (85.6%) were males while fifteen (14.4%) were females. The genitalia were the most affected in 34% (n=35) of the patients. Gunshot was the commonest mechanism of injury (37.5%, n=39). Operative and non-operative management were employed depending on mechanism and extent of injury. Conclusions: Gunshot was the commonest cause of genitourinary trauma. These injuries require specialized attention for proper assessment and management.

/pdf/contemporary-management-of-genitourinary-injuries-in-a-18ufa8dfk2.pdf

Contemporary management of genitourinary injuries in a tertiary trauma centre in Nigeria

Background: Urethral stricture may be defined as a narrowing of the lumen of the urethra due to scar tissue formation. It results from fibrosis and loss of compliance of the urethra leading to bladder outlet obstruction. Treatment of long segment urethral stricture is a huge challenge to the reconstructive Urologist. This study is to determine the aetiology of long segment urethral stricture, location of the stricture, use of distal transverse penile fasciocutaneous flap and the complications associated with the use of the flap. Methods: Twenty two patients with long segment anterior urethral stricture from 2014 to 2017 at the Jos University teaching hospital were included in the study. Patient assessment included complete history including past interventions for the urethral stricture disease, physical examination and radiological examination. Patient’s age, aetiology of stricture, stricture length, location of stricture, surgical management and complications were recorded. Results: Twenty two consecutive patients were involved in the study. The mean age was 48.8years with a range of 35 to 70 years. Post infection accounted for 64% of the strictures while catheter induced inflammatory stricture accounted for 36%. The mean length of the stricture was 9.4cm, with a range of 5cm to 15cm. Penile fasciocutaneous flap was used in all the repairs. Overall complication was 27.3%. Conclusions: Transverse penile fasciocutaneous flap is a well-vascularized pedicle and skin island. It is mobile and can be adapted to repair long segment anterior urethral strictures. Surgical complications include ring stenosis, penile skin necrosis and urethrocutaneous fistula.

/pdf/use-of-transverse-penile-fasciocutaneous-flap-in-management-4n3zv4zwsv.pdf

Use of transverse penile fasciocutaneous flap in management of long segment anterior urethral stricture at the Jos university teaching hospital, Jos Nigeria

Background: To evaluate the correlation of Visual Prostate Symptom Score (VPSS) with International Prostate Symptom Score (IPSS) and Maximum Urinary Flow (Qmax). To investigate the effect of educational level on the ability to independently complete the VPSS versus the IPSS and time taken to do so.Methods: Bio data was taken from men with lower urinary tract symptoms (LUTS) due to Benign Prostatic Enlargement (BPE) who presented at the Urology clinic of Jos University Teaching Hospital. They were administered the IPSS questionnaire and VPSS pictogram, which they completed with or without physician assistance and the time taken to do so was noted. They subsequently had uroflowmetry done on same visit and the data was recorded in a structured proforma. Statistical analysis was done using SPSS(R) version 20. Correlation test was done for VPSS, IPSS and Qmax while the paired t-test was used for the average time spent in completing both questionnaires. A p-value <0.05 was considered as significant.Results: Eighty-five men (aged 42 to 94 years) were enrolled in the study. The VPSS correlated significantly with the IPSS in terms of total score (r = +0.684, p<0.001) and QoL (r = +0.570, p<0.001), as well as with the Qmax (r = -0.222, p = 0.041). A greater proportion (21.2%) of men with limited education could complete the VPSS without physician assistance as compared to the IPSS (6.0%) and the average time taken to complete the VPSS (170.51 seconds) was significantly shorter than the time taken to complete the IPSS (406.42 seconds).Conclusions: The VPSS correlates significantly with the IPSS and Qmax. It can be completed without physician assistance by a greater proportion of men with limited education within a shorter time period.

/pdf/value-of-the-visual-prostate-symptom-score-in-evaluation-of-hw68vay0pa.pdf

Value of the visual prostate symptom score in evaluation of symptomatic benign prostatic enlargement: prospective study in a Nigerian population

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