Identifying the Clinical and Histological Risk Factors affecting Post-Biopsy Voiding Efficiency: An Observational Closed Cohort Study

BACKGROUND

There is a variability in the reported rate of post-prostate biopsy voiding inefficiency. The burden and potential predictors of this morbidity is not well studied in African patients. This study aimed to evaluate the incidence as well as the clinical and histological factors affecting voiding function in patients undergoing trans-rectal prostate biopsy in an African population.

SUBJECTS, MATERIALS AND METHODS

An observational cohort study was carried out in 68 adult males, 40 years and above, scheduled for trans-rectal prostate biopsy for suspected prostate cancer. Those who could not void spontaneously, had either neurological conditions or were on drugs that could affect voiding, were excluded from the research. Data on demographic characteristics of the patients were collected. Uroflowmetry was done to obtain the peak urine flow rate of the patients at baseline and seven days after the procedure. The prostate volume was determined and the presence of other potential clinical and histological risk factors were recorded. The presence of other bleeding-related biopsy complications was also recorded. Statistical analysis was done using SPSS with a p-value of less than 0.05 reported as significant.

RESULTS

Voiding inefficiency was recorded in 28 (41.2%) of the patients with majority, 21 (75.0%), experiencing a five to nine-point decrease in their seventh day peak flow rate values. Post-biopsy haematuria occurred in 37 (54.4%) of the population. The presence of haematuria with blood clots was associated with a 10.9 times increased risk of voiding inefficiency after the procedure (p = 0.006).

CONCLUSION

About two in five patients developed post-prostate biopsy voiding inefficiency. Blood clot presence was independently. associated with the occurrence of this morbidity.

Ultrasound guided percutaneous nephrostomy: Experience at ahmadu bello university teaching hospital, Zaria

BACKGROUND

Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound-guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, affordable, and not associated with radiation exposure. We present our experience with ultrasound-guided PCN.

PATIENTS AND METHODS

We studied all patients who had ultrasound-guided PCN in our center between January 2013 and January 2017. Information obtained included the patients' demographics, clinical details, primary pathology, indications, outcome, and complications within 30 days. Relevant data were extracted and analyzed using descriptive statistics.

RESULTS

A total number of 35 PCNs were performed in 26 patients within the period of study. The median age was 44.5 years. There were 17 females and 9 males. About 88.2% of the females had ureteric obstruction from advanced carcinoma of the cervix while the predominant cause of obstruction in the males was advanced carcinoma of the bladder. Kidney access under ultrasound guidance required well dilated collecting systems for success and ease of puncture. The most common complication was hematuria, which resolved within 24-48 h in all patients uneventfully.

CONCLUSION

PCN is an important and common procedure for temporary relief of upper urinary tract obstruction. While fluoroscopic guidance provides superior image guidance, ultrasound guidance is comparatively reliable, albeit with a longer learning curve. Adequate training, careful patients selection, and patience are key to success.

Rapid and complete decompression of chronic urinary retention: a safe and effective practice

We carried out a prospective study of consecutive patients who presented with chronic urinary retention over a period of 2 years in order to determine the safety and effectiveness of rapid and complete decompression of chronic urinary retention. A total of 22 patients met the inclusion criteria. Although slow decompression is thought to reduce complications, it harbours the disadvantages of impracticability, time and labour demands and an increased risk of infection. Post-obstructive diuresis, haematuria and hypotension are relatively frequent in rapid and complete decompression of chronic urinary retention. However, they are mild, transient and clinically insignificant. Rapid and complete decompression of the chronically obstructed urinary bladder not only saves time, it is safe and effective and should be adopted as the standard practice.