Fred Ugwumba - Academia.edu (original) (raw)

Papers by Fred Ugwumba

Research paper thumbnail of Testicular Cancer and Testicular Self-Examination; Knowledge, Attitudes and Practice in Final Year Medical Students in Nigeria

PubMed, Nov 1, 2016

The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized inci... more The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized incidence rates up to 7.8/100,000 men in the Western world, although reductions in mortality and increasingly high cure rates are being witnessed at the same time. In Africa, where rates are lower, presentation is often late and morbidity and mortality high. Given this scenario, awareness of testicular cancer and practice of testicular self-examination among future first response doctors is very important. This study was conducted to determine knowledge and attitude to testicular cancer, and practice of testicular self-examination (TSE) among final (6th) year medical students. In addition, the effect of an intervention in the form of a single PowerPoint® lecture, lasting 40 minutes with image content on testicular cancer and testicular self examination was assessed. Pre and post intervention administration of a self-administered structured pre tested questionnaire was performed on 151 medical students, 101 of whom returned answers (response rate of 66.8%). In the TC domain, there was a high level of awareness of testicular cancer, but poor knowledge of the age group most affected, with significant improvement post intervention (p<0.001). Notable also was the poor awareness of the potential curability of TC, this also being improved following the intervention (p<0.001). A poor level of awareness and practice of testicular self-examination pre-intervention was found considering the nature of the study group..Respondents had surprisingly weak/poor responses to the question “How important to men’s health is regular testicular self-examination?” Answers to the questions “Do you think it is worthwhile to examine your testis regularly?” and “Would you be interested in more information on testicular cancer and testicular self-examination?” were also suboptimal, but improved post intervention p<0.001, p<0.001 and p=0.037. Age, gender and marital status were without specific influence. In conclusion, this study showed poor levels of knowledge regarding epidemiology of TCa and its potential curability when detected early. There was also a poor awareness of, practice of, and poor attitudes to TSE. The significant improvement in these parameters post intervention indicates value in educational intervention. We recommend inclusion of TCa coverage and TSE teaching in the secondary school curriculum (targeting adolescents). Greater emphasis should also be given to testicular cancer in the curricula of medical schools and other training institutions for health care personnel.

Research paper thumbnail of Bethune Round Table 2012: 12th Annual Conference: Filling the GapImpact of international collaboration on surgical services in a Nigerian tertiary centreSurgeons OverSeas Assessment of Surgical Needs (SOSAS) Rwanda: a useful rural health experience for medical studentsPreinternship Nigerian medic...

Canadian Journal of Surgery, 2012

Background: Our aim was to highlight the impact of collaboration between 2 linked tertiary hospit... more Background: Our aim was to highlight the impact of collaboration between 2 linked tertiary hospitals in Nigeria and India. Methods: We conducted a review of a collaboration between the

Research paper thumbnail of Acute Urinary Retention in Men with BPH; A Review and Presentation of the Management Policy of the Urology Unit, University of Nigeria Teaching Hospital, Enugu

International Journal of Medicine and Health Development, 2008

Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful ina... more Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful inability to pass urine. Early care usually consists of urethral catheterization, or suprapubic catheterization when the urethral approach fails or earlier attempts have resulted in significant urethral trauma. Following these initial steps significant difference had existed in the secondary management of AUR, between the different units regarding issues such as indications for and duration of admission, antibiotic use, alpha adrenergic blocker use and trial without catheter (TWOC). These differences led to a consensus meeting that produced a management protocol for AUR at the University of Nigeria Teaching Hospital, Enugu, that suits our peculiar conditions. This paper reviews the AUR in general and highlights our management protocol. Keywords : AUR, BPH, Review, Management Policy, UNTH. Journal of College of Medicine Vol. 13 (2) 2008: pp. 138-141

Research paper thumbnail of Prevalence of skeletal-related events in hormone-naive prostate cancer in a low resource setting

Nigerian Postgraduate Medical Journal

Research paper thumbnail of Prostate cancer characteristics: A descriptive analysis of clinical features at presentation in the last decade in a black African community

Annals of African Medicine

Research paper thumbnail of Patterns of Utilization, Surgical Pathology Services, Enug-Umuahia Axis

International Journal of Medicine and Health Development, 2007

Aim: To review the subject of male infertility with emphasis on evaluation and management modalit... more Aim: To review the subject of male infertility with emphasis on evaluation and management modalities. Materials and Methods: A literature search was carried out on MEDLINE, and reference texts consulted, the relevant results were reviewed in line with the aims of the study. Results: Male infertility accounts for a significant proportion of the aetiology of infertility worldwide. Causes range from subtle genetic defects such as microdeletions on the Y chromosome, syndromes such as Kartagener's syndrome to acquired lesions such as varicocoele and pyospermia secondary to urinary tract infections. Evaluation is based on thorough and itemized history taking, focused clinical examination and semen analysis, with the addition of other adjunctive investigations when necessary. Conclusions: Male infertility when properly evaluated can reveal treatable causes that result in good pregnancy rates, and is a cost effective method that should be carried out in most cases, rather than bypassed ...

Research paper thumbnail of Recall of consent information by day care prostate biopsy patients: An assessment of the role of a third-party check

Nigerian Journal of Clinical Practice, 2020

Background: To evaluate the extent of recall of consent information by daycare prostate biopsy pa... more Background: To evaluate the extent of recall of consent information by daycare prostate biopsy patients in our low-literacy setting. And to evaluate the role of a 3rd party check on patient's recall of consent information. Subjects and Methods: As part of our standard of care, a formal informed consent session for day care prostate biopsy takes place 3 days prior to the procedure. For this study, before leaving the outpatient clinic the same day, the patient acknowledged before a third-party that his concerns were or were not satisfactorily addressed. The extent of recall of consent information was assessed on the morning of the procedure using a researcher-administered questionnaire. Consecutive patients participated in this cross-sectional study for day care prostate biopsy at a tertiary hospital in southeast Nigeria from February to November 2015 after obtaining due consent. Results: The recall of the risks associated with the planned procedure was poorer than the recall of the nature of the disease condition or the nature of the planned procedure. However, it was observed that aggregate recall was significantly poorer among patients who negatively attested to a satisfying consent session (OR 0.125; P < 0.0005). Conclusion: The use of a third-party in determining patient satisfaction after a consent session may be a better indicator of patient comprehension and subsequent recall of consent information, especially in low-literacy settings. Using a third-party, in this manner, may assist in checking paternalism inherent in the patient-doctor relationship.

Research paper thumbnail of Differences, occasioned by an interval of 1 week, in consent information recall by daycare prostate biopsy patients

International Journal of Medicine and Health Development, 2020

Objective: The objective of this study was to evaluate the extent of recall of consent informatio... more Objective: The objective of this study was to evaluate the extent of recall of consent information by daycare prostate biopsy patients in a low-literacy setting and to compare the extent of recall 1 week against the extent of recall 2 weeks after formal consent session. Materials and Methods: This is a cross-sectional study where consecutive patients for daycare prostate biopsy at a tertiary hospital were recruited from February to November, 2017. After giving informed consent for the study, the participants were randomized to receive formal consent session 1 week (Group A) or 2 weeks (Group B) to the planned date of procedure. Extent of recall was ascertained on the procedure day using semi-structured researcher-administered questionnaire from only participants who checked in with Generalized Anxiety Disorder 7 (GAD-7) score ≤ 9. Data were analyzed using Statistical Package for Social Sciences software, version 21.0, IBM Co., Armonk, NY, USA. Results: At 15.8%, the recall of the risks associated with the planned procedure was poorer than the recall of nature of the disease condition (75.8%), and the recall of nature of the planned procedure (54.7%). Aggregate recall on consent information was not influenced by age (P = 0.57) or formal education status (P = 0.13) of participants, and did not vary between the two groups (P = 0.53). Conclusion: Recall of consent information on risk of planned procedure is poorer than that on the nature of disease and on the nature of planned procedure. There is no evidence that aggregate recall on consent information among daycare prostate biopsy patients changes significantly in the short term (one week) irrespective of formal education status and patient age.

Research paper thumbnail of Informed consent for clinical treatment in low-income setting: evaluating the relationship between satisfying consent and extent of recall of consent information

BMC Medical Ethics, 2017

Background: Treatment informed consent aims to preserve the autonomy of patients in the clinician... more Background: Treatment informed consent aims to preserve the autonomy of patients in the clinicianpatient relationship so as to ensure valid consent. An acceptable method of evaluating understanding of consent information is by assessing the extent of recall by patients of the pieces information believed to have been passed across. When concerns are not satisfactorily addressed from the patients' perspective, recall of consent information may be low. Methods: This study is a questionnairebased crosssectional interview of consecutive adult surgical patients who could give their respective medical histories and who were booked for elective major surgical procedures over a period of 7 months in a tertiary health institution in southeastern Nigeria. Four to five days after a formal consent session, during ward admission, extent of recall of information on the nature of the disease condition or diagnosis, the nature of the planned procedure and the risks involved in the planned procedure were assessed and analyzed on the background of how satisfying the consent sessions were from individual patient's perspective. Results: Generally, the recall of nature of disease condition and nature of planned procedure is better than recall of risks involved in the planned procedure. More specifically however, recall in these 3 domains is significantly better among the patients that affirmed that their concerns were satisfactorily addressed. Conclusion: The findings from this study support that no effort should be spared in ensuring that the consent information are satisfying to the patients from the patients' viewpoint.

Research paper thumbnail of Predicting Gleason score using the initial serum total prostate-specific antigen in Black men with symptomatic prostate adenocarcinoma in Nigeria

Clinical Interventions in Aging, 2016

Background: Men of Black African descent are known to have the highest incidence of prostate canc... more Background: Men of Black African descent are known to have the highest incidence of prostate cancer. The disease is also more aggressive in this group possibly due to biologically more aggressive tumor or late presentation. Currently, serum prostate-specific antigen (PSA) assay plays a significant role in making the diagnosis of prostate cancer. However, the obtained value of serum PSA may not directly relate with the Gleason score (GS), a measure of tumor aggression in prostate cancer. This study explores the relationship between serum total PSA at presentation (iPSA) and GS. Patients and methods: The iPSA of patients with histologically confirmed prostate cancer was compared with the obtained GS of the prostate biopsy specimens. The age of the patients at presentation and the prostate volumes were also analyzed with respect to the iPSA and GS. The data were analyzed retrospectively using IBM SPSS Version 20. Pearson correlation was used for numeric variables, whereas Fisher's exact test was used for categorical variables. Significance was set at P#0.05. Results: There were 205 patients from January 2010 to November 2013 who satisfied the inclusion criteria. iPSA as well as age at presentation and prostate volume were not found to significantly correlate with the primary Gleason grade, the secondary Gleason grade, or the GS. However, the presence of distant metastasis was identified to significantly correlate positively with GS. Conclusion: GS may not be confidently predicted by the iPSA. Higher iPSA does not correlate with higher GS and vice versa.

Research paper thumbnail of Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique

The Annals of African Surgery, 2021

Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our... more Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our objective was to introduce a bone-nibbling technique to accomplish a partial inferior pubectomy (PIP) in a resource-poor setting, and to report the mediumto longterm outcome of using the technique. Methods: Five patients were recruited (mean age: 38.8 years) who presented, over a 30-month period, with posterior urethral fibrosis from a pelvic fracture urethral injury (PFUI). One had failed a previous attempt at posterior urethral reconstruction elsewhere. The length of urethral defect was from 2 to 4 cm. We describe a bone-nibbling technique used to carry out PIP for the delayed repair of PFUI in these patients. The outcomes in the medium to long term of surgical procedures done with this technique are presented. Results: Immediate postoperative complications in all were essentially a Clavien–Dindo grade I. Peak flow rate assessed 12 weeks’ post operation was between 20 mL/s and 23 mL/s...

Research paper thumbnail of Accidental Injuries to the Urinary Bladder: Enugu Experience

International Journal of Medicine and Health Development, 2003

Aim: To study the aetiology, mode of presentation and treatment outcome of accidental bladder inj... more Aim: To study the aetiology, mode of presentation and treatment outcome of accidental bladder injuries in Enugu. Patients and Methods: All patients who were admitted alive to two health institutions in Enugu metropolis – University of Nigeria Teaching Hospital and JAMA Urological Clinic, between January 1993 and December 2002 (10years) were included. Records of all these patients were studied. Results: One hundred and twenty five (125) patients were seen during the study period. The age range was 14-76 years (mean 34.5years). Sixty-six (52.8%) were male while 59 (47.2%) were female. External trauma accounted for majority of cases in males (80.3%) with blunt trauma accounting for 83.0% of these. Iatrogenic injuries accounted for majority of cases in female (6.8.0%) with gynaecological injuries accounting for 85.0% of these. Spontaneous bladder rupture occurred in 8(6.4%) patients and all were intraperitoneal. All the patients were seen within 48hours of the offending injury. Diagnosis was made clinically in most instances. A few patients had intravenous urography (IVU) cystography or abdominal ultrasound. After resuscitation, repair of the bladder was in two layers with urethral catheter drainage of the bladder and wound drainage. One of the patients with spontaneous rupture died 72 hours post-operatively. All the other patients survived. Conclusion:Accidental injury to the bladder is not uncommon. Open gynaecological procedures are the commonest cause in females, while blunt trauma is the commonest in males. Diagnosis can be made clinically and prompt intervention is life saving. Key words: Urinary Bladder, Accidental Injuries, Enugu. [Jnl College Medicine Vol 8(1) 2003: 63-65]

Research paper thumbnail of Bacterial Cystitis in Females: A Review

International Journal of Medicine and Health Development, 2004

Aim: To review the aetiology, clinical features, investigations and treatment of bacterial cystit... more Aim: To review the aetiology, clinical features, investigations and treatment of bacterial cystitis in females. Materials and Methods: A medline search was carried out and the literature reviewed in line with the aims for meaningful findings. Results: Bacterial cystitis is classified into uncomplicated and complicated varieties. Uncomplicated cystitis occurs in an otherwise healthy patient without structural or functional abnormalities in the urinary tract. Complicated cystitis occurs in compromised patient with structural or functional abnormalities that enhance infection acquisition and reduce efficacy of therapy. Bacterial cystitis occurs with varying frequency in females from the neonatal period to old age. Conclusion: Bacterial cystitis is a common and distressing, clinical problem in females, and may be recurrent especially in young women or those with urinary tract anomalies. Risk factors exist, with some being preventable. An appreciation of predisposing factors, aetiopathog...

Research paper thumbnail of Learning transurethral resection of the prostate: A comparison of the weight of resected specimen to the weight of enucleated specimen in open prostatectomy

Nigerian Journal of Clinical Practice, 2017

Background: Minimally invasive procedures in the surgical management of benign prostate enlargeme... more Background: Minimally invasive procedures in the surgical management of benign prostate enlargement (BPE) are of limited use in the resource-poor settings due to nonavailability of the requisite facilities and skills. It has been observed that teaching uroendoscopy inclusive of transurethral resection of the prostate (TURP) can be challenging in the resource-poor settings where the traditional master-apprentice (Halstedian) approach has remained the prevalent training technique. Patients and Methods: We aimed in this retrospective study to assess completeness of resection in TURP by comparing the proportion of prostate tissue resected to the proportion enucleated in open retropubic prostatectomy (ORP). We included all BPE patients on urethral catheter managed in the first 18 months after Halstedian training in TURP. The analysis was done using SPSS® 20 and VassarStats® online software. Results: Twenty patients' files for TURP and twenty-eight patients' files for ORP met the ...

Research paper thumbnail of Priapism: A Review

International Journal of Medicine and Health Development, 2003

Aim: To explore the aetiological factors, pathogenesis and management of priapism and highlight i... more Aim: To explore the aetiological factors, pathogenesis and management of priapism and highlight its peculiar features in Nigerians. Materials & Methods: A literature search was carried out using MEDLINE –, these were reviewed in line with the aims for meaningful findings and case reports. Results: Priapism is currently classified into low flow (Ischaemic) and high flow (nonischaemic) priapism, with low flow being commoner, in all communities and in association with sickle cell disease. Hypoxia associated with low flow priapism is usually associated with varying degress of erectile dysfunction [ED]. High flow priapism is usually associated with trauma and is a non-ischaemic painless event. Low flow priapism also associated with drug treatment of erectile dysfunction, psychiatric disorders and malignant infiltration of the penis. Management ranges from conservative to a spectrum of surgicalinterventions. In Nigeria some patients are noted to have developed priapism following ingestion...

Research paper thumbnail of Health related quality of life in nigerians with complicated diabetes mellitus – a study from Enugu, South East Nigeria

Nigerian Journal of Medicine, 2019

Background: Diabetes mellitus has serious consequences for patients and the presence of complicat... more Background: Diabetes mellitus has serious consequences for patients and the presence of complications increases its morbidity and mortality including reduced quality of life. The health-related quality of life of adults with complicated diabetes in South-East Nigeria is largely unknown.Aim: This study determined the health-related quality of life among adults with complicated diabetes mellitus seen at the foremost public tertiary hospital in South East Nigeria.Methods: Consecutive subjects with complicated diabetes, attending the dedicated out-patient clinic of the University of Nigeria Teaching Hospital were recruited over twelve weeks. Informed consent, socio-demographic and clinical data were obtained. Quality of life was determined for each patient using the validated WHOQoL-BREF instrument. Data was analyzed using the Statistical Package for Social Sciences (version 23).Results: One hundred and twenty patients (54.2% females) with 42.5% aged 18-45 years were recruited. The overall mean quality of life score was reduced for all patients and especially for the very young (aged 26-35 years).The lowest quality oflife score was seen in Domain 1 (physical health). Females had significantly better quality of life scores than males in social relationships domain. Presence of co morbidities had the worst impact on quality of life across all domains.Conclusion: Patients with complicated diabetes mellitus in Enugu, South East Nigeria demonstrated a reduced quality of life across all domains. This was most prevalent in the very young patients. There is a need for optimal management of the condition in Nigeria.Keywords: Diabetes mellitus, complicated, quality of life, Nigeria

Research paper thumbnail of Chronic HIV infection and health related quality of life in resource poor settings-an assessment from South East Nigeria

African Health Sciences, 2020

Background: Health-related quality of life reflects a patient’s general subjective perception of ... more Background: Health-related quality of life reflects a patient’s general subjective perception of the effect of an illness or in- tervention on physical, psychological and social aspects of daily life. HIV infection is a major public health problem especially in developing countries where poor health infrastructure and poverty are prevalent. This paper addresses the quality of life in patients with chronic HIV infection in South East Nigeria and addresses issues that may help improve the current situation. Methods: A cross-sectional survey was carried out at the University of Nigeria Teaching Hospital, Enugu, to assess patients with HIV receiving antiretroviral therapy (ART) using a validated structured questionnaire (WHOQoL-BREF). Ethical clearance for the study was obtained. Study period was from October - December, 2017. Data obtained was analysed. Results: A total of 389 HIV patients consented to the study. Over 70% were aged 18- 45 years and majority were females. Females had a ...

Research paper thumbnail of Health-related quality of life in people with chronic diseases managed in a low-resource setting – A study from South East Nigeria

Nigerian Journal of Clinical Practice, 2019

Background: Assessment of health-related quality of life (HRQOL) in resource-limited settings is ... more Background: Assessment of health-related quality of life (HRQOL) in resource-limited settings is critical to evaluate and improve the burden of morbidity and mortality associated with chronic medical disorders. There is a dearth of data on HRQOL among patients suffering from chronic medical disorders in Nigeria. This study assessed the HRQOL of participants with diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, and cancer in a hospital setting with limited resources and highlighted associated factors. Methods: The WHOQOL-BREF instrument was used to study a cross section of the participants at the University of Nigeria Teaching Hospital, Enugu. Data were analyzed using Statistical Package for Social Sciences (SPSS). Results: The distribution of the 613 study population was diabetes mellitus 120, HIV 389, and various cancers 104. Majority (67.9%) earned less than $1 per day and only 7.5% had any form of health insurance. The HIV group had higher QoL scores. Younger age, higher educational status, being employed, and having a care giver were positively associated with higher QoL. Patients with no comorbidities (76.6%) had an overall higher QoL score. Conclusion: Majority of the patients living with chronic medical diseases in Enugu, Nigeria were poor, vulnerable, and without access to health insurance. People living HIV generally had better quality life than those with other health conditions. There is a huge unmet need for people living with chronic medical conditions in Nigeria, which require strategies to counteract.

Research paper thumbnail of Abstract 4518: Prevalence of high-grade prostatic adenocarcinoma in a black African population

Cancer Research, 2018

INTRODUCTION: Prostate cancer is the second most common type of cancer in men worldwide. Despite ... more INTRODUCTION: Prostate cancer is the second most common type of cancer in men worldwide. Despite this, screening is currently disputed because studies in the western world have shown that more men die with the disease than from it. Black men have been documented to have a greater prevalence of prostate cancer which runs an aggressive course. Therefore, we aimed to determine the prevalence of high grade prostatic adenocarcinoma among Nigerian men. METHOD: This was a retrospective study of Nigerian men attending the urology clinic at University of Nigeria Teaching Hospital, Enugu, south-east Nigeria. Data on prostate histology were retrieved from the histopathology laboratory records for the last 5 years as thus: age, prostate diagnosis, gleason score. Histologic slides from core-needle biopsies had been reviewed by two Pathologists independently. If adenocarcinoma was diagnosed, Gleason system was used to grade the tumors, and a consensus was reached by both Pathologists. The data we...

Research paper thumbnail of Abstracts of papers presented at the joint association of surgeons of Nigeria and Nigeriansurgical Research Society Meeting, Umuahia, Nigeria, July 2018

Nigerian Journal of Surgery, 2019

Research paper thumbnail of Testicular Cancer and Testicular Self-Examination; Knowledge, Attitudes and Practice in Final Year Medical Students in Nigeria

PubMed, Nov 1, 2016

The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized inci... more The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized incidence rates up to 7.8/100,000 men in the Western world, although reductions in mortality and increasingly high cure rates are being witnessed at the same time. In Africa, where rates are lower, presentation is often late and morbidity and mortality high. Given this scenario, awareness of testicular cancer and practice of testicular self-examination among future first response doctors is very important. This study was conducted to determine knowledge and attitude to testicular cancer, and practice of testicular self-examination (TSE) among final (6th) year medical students. In addition, the effect of an intervention in the form of a single PowerPoint® lecture, lasting 40 minutes with image content on testicular cancer and testicular self examination was assessed. Pre and post intervention administration of a self-administered structured pre tested questionnaire was performed on 151 medical students, 101 of whom returned answers (response rate of 66.8%). In the TC domain, there was a high level of awareness of testicular cancer, but poor knowledge of the age group most affected, with significant improvement post intervention (p<0.001). Notable also was the poor awareness of the potential curability of TC, this also being improved following the intervention (p<0.001). A poor level of awareness and practice of testicular self-examination pre-intervention was found considering the nature of the study group..Respondents had surprisingly weak/poor responses to the question “How important to men’s health is regular testicular self-examination?” Answers to the questions “Do you think it is worthwhile to examine your testis regularly?” and “Would you be interested in more information on testicular cancer and testicular self-examination?” were also suboptimal, but improved post intervention p<0.001, p<0.001 and p=0.037. Age, gender and marital status were without specific influence. In conclusion, this study showed poor levels of knowledge regarding epidemiology of TCa and its potential curability when detected early. There was also a poor awareness of, practice of, and poor attitudes to TSE. The significant improvement in these parameters post intervention indicates value in educational intervention. We recommend inclusion of TCa coverage and TSE teaching in the secondary school curriculum (targeting adolescents). Greater emphasis should also be given to testicular cancer in the curricula of medical schools and other training institutions for health care personnel.

Research paper thumbnail of Bethune Round Table 2012: 12th Annual Conference: Filling the GapImpact of international collaboration on surgical services in a Nigerian tertiary centreSurgeons OverSeas Assessment of Surgical Needs (SOSAS) Rwanda: a useful rural health experience for medical studentsPreinternship Nigerian medic...

Canadian Journal of Surgery, 2012

Background: Our aim was to highlight the impact of collaboration between 2 linked tertiary hospit... more Background: Our aim was to highlight the impact of collaboration between 2 linked tertiary hospitals in Nigeria and India. Methods: We conducted a review of a collaboration between the

Research paper thumbnail of Acute Urinary Retention in Men with BPH; A Review and Presentation of the Management Policy of the Urology Unit, University of Nigeria Teaching Hospital, Enugu

International Journal of Medicine and Health Development, 2008

Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful ina... more Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful inability to pass urine. Early care usually consists of urethral catheterization, or suprapubic catheterization when the urethral approach fails or earlier attempts have resulted in significant urethral trauma. Following these initial steps significant difference had existed in the secondary management of AUR, between the different units regarding issues such as indications for and duration of admission, antibiotic use, alpha adrenergic blocker use and trial without catheter (TWOC). These differences led to a consensus meeting that produced a management protocol for AUR at the University of Nigeria Teaching Hospital, Enugu, that suits our peculiar conditions. This paper reviews the AUR in general and highlights our management protocol. Keywords : AUR, BPH, Review, Management Policy, UNTH. Journal of College of Medicine Vol. 13 (2) 2008: pp. 138-141

Research paper thumbnail of Prevalence of skeletal-related events in hormone-naive prostate cancer in a low resource setting

Nigerian Postgraduate Medical Journal

Research paper thumbnail of Prostate cancer characteristics: A descriptive analysis of clinical features at presentation in the last decade in a black African community

Annals of African Medicine

Research paper thumbnail of Patterns of Utilization, Surgical Pathology Services, Enug-Umuahia Axis

International Journal of Medicine and Health Development, 2007

Aim: To review the subject of male infertility with emphasis on evaluation and management modalit... more Aim: To review the subject of male infertility with emphasis on evaluation and management modalities. Materials and Methods: A literature search was carried out on MEDLINE, and reference texts consulted, the relevant results were reviewed in line with the aims of the study. Results: Male infertility accounts for a significant proportion of the aetiology of infertility worldwide. Causes range from subtle genetic defects such as microdeletions on the Y chromosome, syndromes such as Kartagener's syndrome to acquired lesions such as varicocoele and pyospermia secondary to urinary tract infections. Evaluation is based on thorough and itemized history taking, focused clinical examination and semen analysis, with the addition of other adjunctive investigations when necessary. Conclusions: Male infertility when properly evaluated can reveal treatable causes that result in good pregnancy rates, and is a cost effective method that should be carried out in most cases, rather than bypassed ...

Research paper thumbnail of Recall of consent information by day care prostate biopsy patients: An assessment of the role of a third-party check

Nigerian Journal of Clinical Practice, 2020

Background: To evaluate the extent of recall of consent information by daycare prostate biopsy pa... more Background: To evaluate the extent of recall of consent information by daycare prostate biopsy patients in our low-literacy setting. And to evaluate the role of a 3rd party check on patient's recall of consent information. Subjects and Methods: As part of our standard of care, a formal informed consent session for day care prostate biopsy takes place 3 days prior to the procedure. For this study, before leaving the outpatient clinic the same day, the patient acknowledged before a third-party that his concerns were or were not satisfactorily addressed. The extent of recall of consent information was assessed on the morning of the procedure using a researcher-administered questionnaire. Consecutive patients participated in this cross-sectional study for day care prostate biopsy at a tertiary hospital in southeast Nigeria from February to November 2015 after obtaining due consent. Results: The recall of the risks associated with the planned procedure was poorer than the recall of the nature of the disease condition or the nature of the planned procedure. However, it was observed that aggregate recall was significantly poorer among patients who negatively attested to a satisfying consent session (OR 0.125; P < 0.0005). Conclusion: The use of a third-party in determining patient satisfaction after a consent session may be a better indicator of patient comprehension and subsequent recall of consent information, especially in low-literacy settings. Using a third-party, in this manner, may assist in checking paternalism inherent in the patient-doctor relationship.

Research paper thumbnail of Differences, occasioned by an interval of 1 week, in consent information recall by daycare prostate biopsy patients

International Journal of Medicine and Health Development, 2020

Objective: The objective of this study was to evaluate the extent of recall of consent informatio... more Objective: The objective of this study was to evaluate the extent of recall of consent information by daycare prostate biopsy patients in a low-literacy setting and to compare the extent of recall 1 week against the extent of recall 2 weeks after formal consent session. Materials and Methods: This is a cross-sectional study where consecutive patients for daycare prostate biopsy at a tertiary hospital were recruited from February to November, 2017. After giving informed consent for the study, the participants were randomized to receive formal consent session 1 week (Group A) or 2 weeks (Group B) to the planned date of procedure. Extent of recall was ascertained on the procedure day using semi-structured researcher-administered questionnaire from only participants who checked in with Generalized Anxiety Disorder 7 (GAD-7) score ≤ 9. Data were analyzed using Statistical Package for Social Sciences software, version 21.0, IBM Co., Armonk, NY, USA. Results: At 15.8%, the recall of the risks associated with the planned procedure was poorer than the recall of nature of the disease condition (75.8%), and the recall of nature of the planned procedure (54.7%). Aggregate recall on consent information was not influenced by age (P = 0.57) or formal education status (P = 0.13) of participants, and did not vary between the two groups (P = 0.53). Conclusion: Recall of consent information on risk of planned procedure is poorer than that on the nature of disease and on the nature of planned procedure. There is no evidence that aggregate recall on consent information among daycare prostate biopsy patients changes significantly in the short term (one week) irrespective of formal education status and patient age.

Research paper thumbnail of Informed consent for clinical treatment in low-income setting: evaluating the relationship between satisfying consent and extent of recall of consent information

BMC Medical Ethics, 2017

Background: Treatment informed consent aims to preserve the autonomy of patients in the clinician... more Background: Treatment informed consent aims to preserve the autonomy of patients in the clinicianpatient relationship so as to ensure valid consent. An acceptable method of evaluating understanding of consent information is by assessing the extent of recall by patients of the pieces information believed to have been passed across. When concerns are not satisfactorily addressed from the patients' perspective, recall of consent information may be low. Methods: This study is a questionnairebased crosssectional interview of consecutive adult surgical patients who could give their respective medical histories and who were booked for elective major surgical procedures over a period of 7 months in a tertiary health institution in southeastern Nigeria. Four to five days after a formal consent session, during ward admission, extent of recall of information on the nature of the disease condition or diagnosis, the nature of the planned procedure and the risks involved in the planned procedure were assessed and analyzed on the background of how satisfying the consent sessions were from individual patient's perspective. Results: Generally, the recall of nature of disease condition and nature of planned procedure is better than recall of risks involved in the planned procedure. More specifically however, recall in these 3 domains is significantly better among the patients that affirmed that their concerns were satisfactorily addressed. Conclusion: The findings from this study support that no effort should be spared in ensuring that the consent information are satisfying to the patients from the patients' viewpoint.

Research paper thumbnail of Predicting Gleason score using the initial serum total prostate-specific antigen in Black men with symptomatic prostate adenocarcinoma in Nigeria

Clinical Interventions in Aging, 2016

Background: Men of Black African descent are known to have the highest incidence of prostate canc... more Background: Men of Black African descent are known to have the highest incidence of prostate cancer. The disease is also more aggressive in this group possibly due to biologically more aggressive tumor or late presentation. Currently, serum prostate-specific antigen (PSA) assay plays a significant role in making the diagnosis of prostate cancer. However, the obtained value of serum PSA may not directly relate with the Gleason score (GS), a measure of tumor aggression in prostate cancer. This study explores the relationship between serum total PSA at presentation (iPSA) and GS. Patients and methods: The iPSA of patients with histologically confirmed prostate cancer was compared with the obtained GS of the prostate biopsy specimens. The age of the patients at presentation and the prostate volumes were also analyzed with respect to the iPSA and GS. The data were analyzed retrospectively using IBM SPSS Version 20. Pearson correlation was used for numeric variables, whereas Fisher's exact test was used for categorical variables. Significance was set at P#0.05. Results: There were 205 patients from January 2010 to November 2013 who satisfied the inclusion criteria. iPSA as well as age at presentation and prostate volume were not found to significantly correlate with the primary Gleason grade, the secondary Gleason grade, or the GS. However, the presence of distant metastasis was identified to significantly correlate positively with GS. Conclusion: GS may not be confidently predicted by the iPSA. Higher iPSA does not correlate with higher GS and vice versa.

Research paper thumbnail of Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique

The Annals of African Surgery, 2021

Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our... more Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our objective was to introduce a bone-nibbling technique to accomplish a partial inferior pubectomy (PIP) in a resource-poor setting, and to report the mediumto longterm outcome of using the technique. Methods: Five patients were recruited (mean age: 38.8 years) who presented, over a 30-month period, with posterior urethral fibrosis from a pelvic fracture urethral injury (PFUI). One had failed a previous attempt at posterior urethral reconstruction elsewhere. The length of urethral defect was from 2 to 4 cm. We describe a bone-nibbling technique used to carry out PIP for the delayed repair of PFUI in these patients. The outcomes in the medium to long term of surgical procedures done with this technique are presented. Results: Immediate postoperative complications in all were essentially a Clavien–Dindo grade I. Peak flow rate assessed 12 weeks’ post operation was between 20 mL/s and 23 mL/s...

Research paper thumbnail of Accidental Injuries to the Urinary Bladder: Enugu Experience

International Journal of Medicine and Health Development, 2003

Aim: To study the aetiology, mode of presentation and treatment outcome of accidental bladder inj... more Aim: To study the aetiology, mode of presentation and treatment outcome of accidental bladder injuries in Enugu. Patients and Methods: All patients who were admitted alive to two health institutions in Enugu metropolis – University of Nigeria Teaching Hospital and JAMA Urological Clinic, between January 1993 and December 2002 (10years) were included. Records of all these patients were studied. Results: One hundred and twenty five (125) patients were seen during the study period. The age range was 14-76 years (mean 34.5years). Sixty-six (52.8%) were male while 59 (47.2%) were female. External trauma accounted for majority of cases in males (80.3%) with blunt trauma accounting for 83.0% of these. Iatrogenic injuries accounted for majority of cases in female (6.8.0%) with gynaecological injuries accounting for 85.0% of these. Spontaneous bladder rupture occurred in 8(6.4%) patients and all were intraperitoneal. All the patients were seen within 48hours of the offending injury. Diagnosis was made clinically in most instances. A few patients had intravenous urography (IVU) cystography or abdominal ultrasound. After resuscitation, repair of the bladder was in two layers with urethral catheter drainage of the bladder and wound drainage. One of the patients with spontaneous rupture died 72 hours post-operatively. All the other patients survived. Conclusion:Accidental injury to the bladder is not uncommon. Open gynaecological procedures are the commonest cause in females, while blunt trauma is the commonest in males. Diagnosis can be made clinically and prompt intervention is life saving. Key words: Urinary Bladder, Accidental Injuries, Enugu. [Jnl College Medicine Vol 8(1) 2003: 63-65]

Research paper thumbnail of Bacterial Cystitis in Females: A Review

International Journal of Medicine and Health Development, 2004

Aim: To review the aetiology, clinical features, investigations and treatment of bacterial cystit... more Aim: To review the aetiology, clinical features, investigations and treatment of bacterial cystitis in females. Materials and Methods: A medline search was carried out and the literature reviewed in line with the aims for meaningful findings. Results: Bacterial cystitis is classified into uncomplicated and complicated varieties. Uncomplicated cystitis occurs in an otherwise healthy patient without structural or functional abnormalities in the urinary tract. Complicated cystitis occurs in compromised patient with structural or functional abnormalities that enhance infection acquisition and reduce efficacy of therapy. Bacterial cystitis occurs with varying frequency in females from the neonatal period to old age. Conclusion: Bacterial cystitis is a common and distressing, clinical problem in females, and may be recurrent especially in young women or those with urinary tract anomalies. Risk factors exist, with some being preventable. An appreciation of predisposing factors, aetiopathog...

Research paper thumbnail of Learning transurethral resection of the prostate: A comparison of the weight of resected specimen to the weight of enucleated specimen in open prostatectomy

Nigerian Journal of Clinical Practice, 2017

Background: Minimally invasive procedures in the surgical management of benign prostate enlargeme... more Background: Minimally invasive procedures in the surgical management of benign prostate enlargement (BPE) are of limited use in the resource-poor settings due to nonavailability of the requisite facilities and skills. It has been observed that teaching uroendoscopy inclusive of transurethral resection of the prostate (TURP) can be challenging in the resource-poor settings where the traditional master-apprentice (Halstedian) approach has remained the prevalent training technique. Patients and Methods: We aimed in this retrospective study to assess completeness of resection in TURP by comparing the proportion of prostate tissue resected to the proportion enucleated in open retropubic prostatectomy (ORP). We included all BPE patients on urethral catheter managed in the first 18 months after Halstedian training in TURP. The analysis was done using SPSS® 20 and VassarStats® online software. Results: Twenty patients' files for TURP and twenty-eight patients' files for ORP met the ...

Research paper thumbnail of Priapism: A Review

International Journal of Medicine and Health Development, 2003

Aim: To explore the aetiological factors, pathogenesis and management of priapism and highlight i... more Aim: To explore the aetiological factors, pathogenesis and management of priapism and highlight its peculiar features in Nigerians. Materials & Methods: A literature search was carried out using MEDLINE –, these were reviewed in line with the aims for meaningful findings and case reports. Results: Priapism is currently classified into low flow (Ischaemic) and high flow (nonischaemic) priapism, with low flow being commoner, in all communities and in association with sickle cell disease. Hypoxia associated with low flow priapism is usually associated with varying degress of erectile dysfunction [ED]. High flow priapism is usually associated with trauma and is a non-ischaemic painless event. Low flow priapism also associated with drug treatment of erectile dysfunction, psychiatric disorders and malignant infiltration of the penis. Management ranges from conservative to a spectrum of surgicalinterventions. In Nigeria some patients are noted to have developed priapism following ingestion...

Research paper thumbnail of Health related quality of life in nigerians with complicated diabetes mellitus – a study from Enugu, South East Nigeria

Nigerian Journal of Medicine, 2019

Background: Diabetes mellitus has serious consequences for patients and the presence of complicat... more Background: Diabetes mellitus has serious consequences for patients and the presence of complications increases its morbidity and mortality including reduced quality of life. The health-related quality of life of adults with complicated diabetes in South-East Nigeria is largely unknown.Aim: This study determined the health-related quality of life among adults with complicated diabetes mellitus seen at the foremost public tertiary hospital in South East Nigeria.Methods: Consecutive subjects with complicated diabetes, attending the dedicated out-patient clinic of the University of Nigeria Teaching Hospital were recruited over twelve weeks. Informed consent, socio-demographic and clinical data were obtained. Quality of life was determined for each patient using the validated WHOQoL-BREF instrument. Data was analyzed using the Statistical Package for Social Sciences (version 23).Results: One hundred and twenty patients (54.2% females) with 42.5% aged 18-45 years were recruited. The overall mean quality of life score was reduced for all patients and especially for the very young (aged 26-35 years).The lowest quality oflife score was seen in Domain 1 (physical health). Females had significantly better quality of life scores than males in social relationships domain. Presence of co morbidities had the worst impact on quality of life across all domains.Conclusion: Patients with complicated diabetes mellitus in Enugu, South East Nigeria demonstrated a reduced quality of life across all domains. This was most prevalent in the very young patients. There is a need for optimal management of the condition in Nigeria.Keywords: Diabetes mellitus, complicated, quality of life, Nigeria

Research paper thumbnail of Chronic HIV infection and health related quality of life in resource poor settings-an assessment from South East Nigeria

African Health Sciences, 2020

Background: Health-related quality of life reflects a patient’s general subjective perception of ... more Background: Health-related quality of life reflects a patient’s general subjective perception of the effect of an illness or in- tervention on physical, psychological and social aspects of daily life. HIV infection is a major public health problem especially in developing countries where poor health infrastructure and poverty are prevalent. This paper addresses the quality of life in patients with chronic HIV infection in South East Nigeria and addresses issues that may help improve the current situation. Methods: A cross-sectional survey was carried out at the University of Nigeria Teaching Hospital, Enugu, to assess patients with HIV receiving antiretroviral therapy (ART) using a validated structured questionnaire (WHOQoL-BREF). Ethical clearance for the study was obtained. Study period was from October - December, 2017. Data obtained was analysed. Results: A total of 389 HIV patients consented to the study. Over 70% were aged 18- 45 years and majority were females. Females had a ...

Research paper thumbnail of Health-related quality of life in people with chronic diseases managed in a low-resource setting – A study from South East Nigeria

Nigerian Journal of Clinical Practice, 2019

Background: Assessment of health-related quality of life (HRQOL) in resource-limited settings is ... more Background: Assessment of health-related quality of life (HRQOL) in resource-limited settings is critical to evaluate and improve the burden of morbidity and mortality associated with chronic medical disorders. There is a dearth of data on HRQOL among patients suffering from chronic medical disorders in Nigeria. This study assessed the HRQOL of participants with diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, and cancer in a hospital setting with limited resources and highlighted associated factors. Methods: The WHOQOL-BREF instrument was used to study a cross section of the participants at the University of Nigeria Teaching Hospital, Enugu. Data were analyzed using Statistical Package for Social Sciences (SPSS). Results: The distribution of the 613 study population was diabetes mellitus 120, HIV 389, and various cancers 104. Majority (67.9%) earned less than $1 per day and only 7.5% had any form of health insurance. The HIV group had higher QoL scores. Younger age, higher educational status, being employed, and having a care giver were positively associated with higher QoL. Patients with no comorbidities (76.6%) had an overall higher QoL score. Conclusion: Majority of the patients living with chronic medical diseases in Enugu, Nigeria were poor, vulnerable, and without access to health insurance. People living HIV generally had better quality life than those with other health conditions. There is a huge unmet need for people living with chronic medical conditions in Nigeria, which require strategies to counteract.

Research paper thumbnail of Abstract 4518: Prevalence of high-grade prostatic adenocarcinoma in a black African population

Cancer Research, 2018

INTRODUCTION: Prostate cancer is the second most common type of cancer in men worldwide. Despite ... more INTRODUCTION: Prostate cancer is the second most common type of cancer in men worldwide. Despite this, screening is currently disputed because studies in the western world have shown that more men die with the disease than from it. Black men have been documented to have a greater prevalence of prostate cancer which runs an aggressive course. Therefore, we aimed to determine the prevalence of high grade prostatic adenocarcinoma among Nigerian men. METHOD: This was a retrospective study of Nigerian men attending the urology clinic at University of Nigeria Teaching Hospital, Enugu, south-east Nigeria. Data on prostate histology were retrieved from the histopathology laboratory records for the last 5 years as thus: age, prostate diagnosis, gleason score. Histologic slides from core-needle biopsies had been reviewed by two Pathologists independently. If adenocarcinoma was diagnosed, Gleason system was used to grade the tumors, and a consensus was reached by both Pathologists. The data we...

Research paper thumbnail of Abstracts of papers presented at the joint association of surgeons of Nigeria and Nigeriansurgical Research Society Meeting, Umuahia, Nigeria, July 2018

Nigerian Journal of Surgery, 2019