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Kyei MY, Adusei B, Klufio GO, Mensah JE, Gepi-Attee S, Asante E. Treatment of localized prostate cancer and use of nomograms among urologists in the West Africa sub-region. Pan Afr Med J 2020; 36:251. [PMID: 33014247 PMCID: PMC7519786 DOI: 10.11604/pamj.2020.36.251.21419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/13/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION there is a high incidence of prostate cancer among men of African descent. The disease tends to occur at an early age with a tendency to be aggressive. The objective was to determine the practice of urologists in the West African sub-region regarding treatment of localized prostate cancer, the use of nomograms and their perception of the usefulness of nomograms. METHODS this was a cross-sectional study that involved urologists practicing in the West African sub-region attending urology and surgery conferences of the "Société Internationale d´Urologie", West African college of surgeons and the Ghana association of urological surgeons. A structured questionnaire was used that sort to ascertain the treatment modalities used for localized prostate cancer and the use of nomograms in the sub-region. The study period spanned the years 2018 and 2019. RESULTS fifty-six urologists practicing in eleven West African countries responded. Fifty percent had been in practice for less than 5 years. Sixty eight percent (38/56) had been involved in the treatment of localized prostate cancer. Radical prostatectomy was widely available and the treatment modality most used 94.7% (36/38). Nomograms was used by 57.9% of them (22/38) with the Partin tables being the most commonly used nomogram (34.2%). No Locally developed nomogram for treatment of localized prostate cancer was identified. CONCLUSION radical prostatectomy is the commonest treatment modality used for the management of localized prostate cancer in the West Africa sub-region. Majority of the urologists used nomograms with the Partin tables being the most used.
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Affiliation(s)
- Mathew Yamoah Kyei
- Department of Surgery and Urology, University of Ghana Medical School, Accra, Ghana
| | - Ben Adusei
- Department of Surgery, 37 Military Teaching Hospital, Accra, Ghana
| | - George Oko Klufio
- Department of Surgery and Urology, University of Ghana Medical School, Accra, Ghana
| | - James Edward Mensah
- Department of Surgery and Urology, University of Ghana Medical School, Accra, Ghana
| | - Samuel Gepi-Attee
- Department of Surgery and Urology, University of Ghana Medical School, Accra, Ghana
| | - Emmanuel Asante
- Department of Surgery and Urology, University of Ghana Medical School, Accra, Ghana
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Yeboah ED, Hsing AW, Mante S, Mensah JE, Kyei MY, Yarney J, Vanderpuye V, Beecham K, Tettey Y, Biritwum RB, Adjei AA, Gyasi R, Asante K, Ampadu KN, Klufio GO, Gepi-Attee S, Owoo C, Kwami D, Ahiaku, Pandra R, Cook MB. MANAGEMENT OF PROSTATE CANCER IN ACCRA, GHANA. J West Afr Coll Surg 2016; 6:31-65. [PMID: 29181364 PMCID: PMC5667721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Africans living with prostate cancer in Africa face problems of early diagnosis and appropriate treatment. AIM To study the clinical incidence of prostate cancer, risk factors, TNM stage, their management and outcomes. METHODS A prospective study of Prostate Cancer cases managed at Korle Bu Teaching Hospital and hospitals in Accra, diagnosed by history, abnormal PSA/DRE, physical examination and histologically confirmed by biopsy from 2004 to 2013 was carried out. The cases were TNM staged and managed by approved protocol. RESULTS There were 669 cases with a mean age 70±0.045SE years, median Gleason Score of 7, organ confined Prostate Cancer(PC) in 415(62%), locally advanced in 167(25%) and metastatic Prostate Cancer in 87(13%) cases. The cases were followed for median of 10 months to ≥ 84 months. Organ confined cases were managed by: Radical Prostatectomy (RP) 92 (13.8%) with a mortality of 0.3%; brachytherapy 70 (10.5%) with a mortality of 0.1% and External Beam Radiotherapy (EBRT) 155 (23%) with a mortality 0.7%. In all, 98 men constituting (14.1%) cases with a mean age of 75+0.25SE years, life expectancy <10 years were treated by hormonal therapy with a mortality of 1.7%. Twenty cases who were for active surveillance (GS6), PSA <10ng/ml, life expectancy <10 years later all opted for EBRT. Locally advanced cases 25% all had neoadjuvant hormonal therapy then Brachytherapy in 3 (0.4%) mortality 0.15% and EBRT in 64 (9.5%), mortality 0.59%. Hormonal therapy was given in 100 (15%) locally advanced cases, mortality 5%. Metastatic prostate cancer cases (13%) were managed by hormonal therapy, mortality 6%. CONCLUSION Improved facilities and dedicated skilled teams led to a significant rise in proportion of organ confined Prostate Cancer from 15.3% to 62% curable by Radical Prostatectomy, brachytherapy or EBRT with longer disease free survival.
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Affiliation(s)
- E D Yeboah
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - A W Hsing
- Stanford University - Stanford Cancer Institute, CA, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute(NCI),National Institute of Health(NIH), Bethesda, Maryland, USA
| | - S Mante
- 37 Military Hospital, Accra, Ghana
| | - J E Mensah
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - M Y Kyei
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - J Yarney
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - V Vanderpuye
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - K Beecham
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - Y Tettey
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - R B Biritwum
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - A A Adjei
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - R Gyasi
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - K Asante
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - K N Ampadu
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - G O Klufio
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - S Gepi-Attee
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - C Owoo
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | - D Kwami
- University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana
| | | | - R Pandra
- Visiting Surgeon, Indian Forces Hospital
| | - M B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute(NCI),National Institute of Health(NIH), Bethesda, Maryland, USA
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Kyei MY, Klufio GO, Mensah JE, Gepi-Attee S, Ampadu K, Toboh B, Yeboah ED. Determinants of peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia. BMC Urol 2016; 16:17. [PMID: 27020662 PMCID: PMC4810510 DOI: 10.1186/s12894-016-0134-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/17/2016] [Indexed: 12/01/2022] Open
Abstract
Background The objective of this study was to determine the factors responsible for peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia and thus offer a guide for blood product management for the procedure. Methods This was a prospective study of 200 consecutive patients who underwent open prostatectomy for BPH from January 2010 to September 2013 at the Korle Bu Teaching Hospital, Accra. The data analyzed included the pre-operative blood haemoglobin level (Hb), presence of co-morbidities, the case type, indication for the surgery, ASA score, anaesthetic method used, systolic blood pressure, status of the operating surgeon, duration of surgery and the operative prostate weight. The transfusion of blood peri-operatively was also documented. Results The mean age of the patients was 69.1 years. Elective cases formed 83.5 % with refractory retention of urine being the commonest indication for surgery (68.0 %). The mean pre-operative Hb was 12.1 g/dl. Consultants performed 56.0 % of the prostatectomies. Transvesical approach was used in 90.0 % of the cases. The mean operative time was 101.3mins (range 35.0–240.0) with a mean operative prostate weight of 110.8 g (range 15–550 g). Most of the patients (82.0 %) had spinal anaesthesia. The blood transfusion rate was 23.5 %. The transfusion rate was significantly higher in patients with anaemia (p = .000), emergency cases (p = .000), the use of general anaesthesia (p = .002), a resident as the operating surgeons (p = .034), prostate weight >100 g (p = .000) and duration of surgery (p = .011). In a multivariable logistic regression analysis however only the pre-operative Hb (p = .000. OR 0.95, 95 % CI [0.035–0.257]) and the duration of surgery (p = .025, OR 1.021, 95 % CI [1.003–1.039]) could predict blood transfusion in open prostatectomy for BPH in this series. Conclusions A ‘group and save’ policy should be the preferred blood ordering procedure for patients with Hb ≥ 13.0 g/dl scheduled for an elective open prostatectomy for BPH under spinal anaesthesia. A long operative time however may increase the need for blood transfusion.
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Affiliation(s)
- Mathew Y Kyei
- Department of Surgery and Urology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P. O. Box 4236, Accra, Ghana.
| | - George O Klufio
- Department of Surgery and Urology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P. O. Box 4236, Accra, Ghana
| | - James E Mensah
- Department of Surgery and Urology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P. O. Box 4236, Accra, Ghana
| | - Samuel Gepi-Attee
- Department of Surgery and Urology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P. O. Box 4236, Accra, Ghana
| | - Kwabena Ampadu
- Department of Surgery and Urology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P. O. Box 4236, Accra, Ghana
| | - Bernard Toboh
- Department of Surgery and Urology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P. O. Box 4236, Accra, Ghana
| | - Edward D Yeboah
- Department of Surgery and Urology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P. O. Box 4236, Accra, Ghana
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Kyei MY, Klufio GO, Mensah JE, Gyasi RK, Gepi-Attee S, Ampadu K. Nephrectomy in adults: Experience at the Korle Bu Teaching Hospital, Accra, Ghana. Saudi J Kidney Dis Transpl 2015; 26:638-42. [PMID: 26022047 DOI: 10.4103/1319-2442.157438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objective of this study was to analyze nephrectomies performed in adults over a 12-year period at the Korle Bu Teaching Hospital, Accra and to compare our findings with reports from other institutions. In this retrospective study, medical records of 97 consecutive adult patients who underwent nephrectomy from January 2000 to December 2011 were reviewed. The parameters extracted included the patients' age, gender, indication for nephrectomy and the side of nephrectomy. Also considered were the histology of the nephrectomy specimen and the peri-operative mortality. The data were analyzed using the Statistical Package for Social Sciences for Windows (Version 19.0). Of the 97 nephrectomies performed, 62 were performed for suspected malignant renal tumors and 35 were performed for clinically benign renal conditions. Malignancy was confirmed in 85.5% (53/62) of the suspected cases. The mean age of this group was 52.2 ± 15.5 years and the male to female ratio was 1:0.9. Thirty-two tumors (60.4%) were in the right kidney and 21 (39.6%) tumors were in the left kidney; the mean tumor size was 16.8 ± 4.0 cm. The predominant presenting complaints included flank pain (67.9%), flank mass (50.9%) and hematuria (24.5%). In one case (1.9%), the renal mass was found incidentally. Among patients who had benign disease, non-functioning kidney due to renal cystic disease was the most common lesion (11/44; 25.0%). A peri-operative mortality rate of 3.1% was recorded. Our study suggests that malignant renal tumors constitute the main indication for nephrectomy in our institution. Non-functioning kidney due to renal cystic disease was the most common benign renal indication for nephrectomy.
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Affiliation(s)
- Mathew Y Kyei
- Department of Surgery/Urology, University of Ghana Medical School, Accra, Ghana
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Kyei MY, Mensah JE, Morton B, Gepi-Attee S, Klufio GO, Yeboah ED. SURGICAL MANAGEMENT OF BPH IN GHANA: A NEED TO IMPROVE ACCESS TO TRANSURETHRAL RESECTION OF THE PROSTATE. East Afr Med J 2012; 89:241-245. [PMID: 26845803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Open prostatectomy for benign prostate hyperplasia (BPH) is widely practiced in Ghana and Africa. Some of the reasons include lack of expertise and facilities for Transurethral Resection of the Prostate (TURP) and digital rectal examination assessment of prostates as greater than 50 grams. OBJECTIVES To assess the prostate volumes of patients for surgical management of BPH by transrectal ultrasound (TRUS) and to determine, on the basis of prostatic volume, what percentage of those who had open prostatectomy could have been managed by TURP. DESIGN Prospective cohort study. SETTING The Korle Bu Teaching Hospital, Accra, Ghana. SUBJECTS Patients for elective surgical management of BPH from March to September 2010 were studied. RESULTS Fifty-eight. patients had surgical management of BPH. Forty-six of them (79.3%) had open prostatectomy whilst twelve (20.7%) had TURP with a mean age of 70.4 and 65.2 years respectively. The most common reason for the open prostatectomy was refractory retention of urine (76.0%) while that for TURP was lower urinary tract symptoms (58.3%). The mean prostate volume for the patients who had open prostatectomy was 64.2ml ± 28.7mls (range 23.0-121.0ml) while that of the TURP group was 40.1g ± 16.2mls (range 18.5-70.0mls). Of the open prostatectomy group, 67.4% of them had prostate volumes 75 mls or less. The blood transfusion and peri-operative complication rates for the open prostatectomy and TURP groups were 13% versus 8.3% and 8.7% versus 8.3% respectively. There was no mortality. CONCLUSION Access to TURP in the surgical management of BPH in Ghana is low (20.7%). With improved facilities including routine use of TRUS for assessing prostate size and availability of expertise for TURP, 67.4% of patients offered open prostatectomy presently could benefit from TURP, using prostate volumes 75mls (75g) or less as indication for TURP.
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Affiliation(s)
- M Y Kyei
- Department of Surgery and Urology, University of Ghana medical School, Accra, Ghana
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Mensah J, Klufio G, Ahiaku F, Osafo C, Gepi-Attee S. Delayed recognition of bilateral ureteral injury after gyneacological surgery. Ghana Med J 2008; 42:133-136. [PMID: 19452019 PMCID: PMC2673835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Iatrogenic bilateral ureteric injury is a rare complication of pelvic surgery, which if not recognised immediately results in significant morbidity and even mortality OBJECTIVE To describe the presentation, aetiology and treatment of iatrogenic bilateral ureteric injuries recognised late following gynaecological surgery. METHODS The case notes of 14 consecutive cases of bilateral ureteric injury managed between October 2000 and January 2007 were studied. RESULTS Thirteen cases resulted from abdominal hysterectomy and one from vaginal repair of vesicovaginal fistula. Excessive bleeding with difficult haemostasis was the predominant predisposing factor. The indication for referral included oliguria, anuria, and urinary ascites or azotaemia. The time interval between the original surgery and the recognition of the injury ranged between 1 and 92 days. Patients in whom deterioration in renal function was ascribed to obstructive uropathy from bilateral ligation (postrenal renal failure) were referred much earlier than those in whom a diagnosis of prerenal renal failure was made (mean of 2 vs. 10 days). Five patients (36%) required dialyses before repair. All the repairs were done at open surgery. Thirteen survived with no loss of kidney. One patient died of overwhelming sepsis. CONCLUSIONS Late recognition and referral of bilateral ureteric injury was associated with serious complications. Post operative deterioration in a patient's renal function following pelvic surgery should be assumed to be due to ureteric obstruction until proven otherwise. Such patients should be promptly referred to centres with the facility for further investigation and management. Early open repair for these injuries is advocated.
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Affiliation(s)
- Je Mensah
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
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Coveney VA, Gepi-Attee S, Gröver D, Painter D. Suprapubic track pressure and force--deformation measurements in a (live) human subject and in animal models post-mortem. Proc Inst Mech Eng H 2001; 215:39-49. [PMID: 11323984 DOI: 10.1243/0954411011533517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tests have been performed on animal models shortly post-mortem and on a healthy human subject in order to obtain estimates of the forces which act on suprapubic urinary catheters and similar devices and to develop an abdominal wall simulator. Such data and test methods are required for the systematic design of suprapubic devices because of the dual need to maintain the functionality of devices and to avoid excessive pressure on soft body tissue which could lead to ischaemia and in turn necrosis. In the post-mortem animal models, electrical excitation was applied to the abdominal wall in order to stimulate muscle activity. Two types of transducers were used: a soft membrane transducer (SMT) for pressure measurement and novel instrumented 'tongs' to determine indentation stiffness characteristics in the suprapubic track or artificial pathway created for a device. The SMT has been extensively used in the urethras and bladders of human subjects while the tongs were built specifically for these tests. Only the well-established SMT was used with the human subject; a peak pressure of 22 kPa was obtained. In the animal models the pressure profile given by the SMT had a peak whose position corresponded well with the estimated location of the rectus muscle measured on the fixed tissue section. The peak value was 5.5 kPa, comparable with values likely to cause necrosis if maintained for more than 1 day. Remarkably consistent indentation stiffness values were obtained with the instrumented tongs; all values were close to 0.45 N/mm (33 kPa/mm).
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Affiliation(s)
- V A Coveney
- Faculty of Engineering, University of the West of England, Coldharbour Lane, Frenchay, Bristol BS16 1QY, UK
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Abstract
The efficacy and safety of oral sildenafil, a potent inhibitor of phosphodiesterase type 5, were evaluated in men with diabetes mellitus and erectile dysfunction (ED). Twenty-one men (aged 42-65 years) were enrolled in a double-blind, placebo-controlled, three-way crossover study conducted in two parts. In part I, the effect of a single dose (25 mg or 50 mg) of sildenafil or placebo on penile rigidity was assessed by penile plethysmography during visual sexual stimulation. In part II, daily diary records of erectile activity and a global efficacy question were used to evaluate once-daily dosing with 25 mg or 50 mg of sildenafil or placebo for 10 days. After a single 50 mg dose of sildenafil, the adjusted geometric mean duration (min) of penile rigidity >60% at the base of the penis during visual sexual stimulation was significantly increased (10.1 min) compared with placebo (2.8 min; p = 0.0053). In part II, sildenafil significantly increased the number of erections considered sufficiently hard for vaginal penetration compared with placebo (p = 0.0005). Improved erections were reported by 50% and 52% of patients treated with 25 mg and 50 mg of sildenafil, respectively, compared with 10% of those receiving placebo (p values < 0.05). Adverse events were mostly mild or moderate in nature and included muscular pains, headache, and dyspepsia. Sildenafil is a well-tolerated and potentially efficacious oral treatment for ED in men with diabetes mellitus.
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Abstract
In vitro study of encrustation is an important part of assessment of materials as potential alloplasts or devices in the urinary tract. This modified semi-automated technique comprises a circular reaction chamber with an encrustation mixture, the level of which is controlled by a float switch which operates the exit peristaltic pump. The composition of the reactants used simulates infected urine with alkaline pH. Results of a preliminary study of the deposits by scanning electron micrography (SEM) and energy dispersive X-ray (EDX) microanalysis are consistent with struvite and hydroxyapatite, similar to the main minerals deposited on urinary catheters. It is a relatively simple, effective and inexpensive set-up for study of encrustation on materials.
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Affiliation(s)
- S Gepi-Attee
- Bristol Urological Institute, Department of Urology, Southmead Hospital
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Wootton M, Gepi-Attee S, Patton DT, Griffin R, Feneley RC. The use of X-rays as a rapid method to select areas of interest in encrusted urinary catheters. Br J Biomed Sci 1998; 55:13-5. [PMID: 9684413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Wootton
- Department of Microbiology, Southmead Hospital NHS Trust, Westbury on Trym, Bristol, UK
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Abstract
OBJECTIVES To determine the efficacy and safety of sildenafil, a novel orally active inhibitor of the type-V cyclic guanosine monophosphate-specific phosphodiesterase (the predominant isoenzyme in the human corpus cavernosum) on penile erectile activity in patients with male erectile dysfunction of no established organic cause. PATIENTS AND METHODS Twelve patients (aged 36-63 years) with male erectile dysfunction of no established organic cause were entered into a double-blind, randomized, placebo-controlled, crossover study which was conducted in two phases. In the first phase (four-way crossover), treatment efficacy was evaluated by measurements of penile rigidity using penile plethysmography during visual sexual stimulation at different doses of sildenafil (10, 25 and 50 mg or placebo). In the second phase (two-way crossover), efficacy was assessed by a diary record of penile erectile activity after single daily doses of sildenafil (25 mg) or placebo for 7 days. RESULTS The mean (95% confidence interval, CI) duration of rigidity of > 80% at the base of the penis was 1.3 min (0.4-3.1) in patients on placebo, 3.5 min (1.6-7.3; P = 0.009) on 10 mg, 8.0 min (3.7-16.7; P = 0.003) on 25 mg and 11.2 min (5.6-22.3; P < 0.001) on 50 mg of sildenafil. The mean (95% CI) duration of rigidity of > 80% at the tip of the penis was 1.2 min (0.4-2.7) on placebo and 7.4 min (2.4-8.5; P = 0.001) on 50 mg sildenafil. From the diary record of daily erectile activity, the mean (95% CI) total number of erections was significantly higher in patients receiving sildenafil was 6.1 (3.2-11.4), compared with 1.3 (0.5-2.7) in those on placebo; 10 of 12 patients reported improved erectile activity while receiving sildenafil, compared with two of 12 on placebo (P = 0.018). Six patients on active treatment and five on placebo reported mild and transient adverse events which included headache, dyspepsia and pelvic musculo-skeletal pain. CONCLUSION These results show that sildenafil is a well tolerated and effective oral therapy for male erectile dysfunction with no established organic cause and may represent a new class of peripherally acting drug for the treatment of this condition.
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Affiliation(s)
- M Boolell
- Department of Urology, Southmead Hospital, Westbury on Trym, Bristol, UK
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Boolell M, Allen MJ, Ballard SA, Gepi-Attee S, Muirhead GJ, Naylor AM, Osterloh IH, Gingell C. Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impot Res 1996; 8:47-52. [PMID: 8858389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Sildenafil (Viagra, UK-92,480) is a novel oral agent under development for the treatment of penile erectile dysfunction. Erection is dependent on nitric oxide and its second messenger, cyclic guanosine monophosphate (cGMP). However, the relative importance of phosphodiesterase (PDE) isozymes is not clear. We have identified both cGMP- and cyclic adenosine monophosphate-specific phosphodiesterases (PDEs) in human corpora cavernosa in vitro. The main PDE activity in this tissue was due to PDE5, with PDE2 and 3 also identified. Sildenafil is a selective inhibitor of PDE5 with a mean IC50 of 0.0039 microM. In human volunteers, we have shown sildenafil to have suitable pharmacokinetic and pharmacodynamic properties (rapid absorption, relatively short half-life, no significant effect on heart rate and blood pressure) for an oral agent to be taken, as required, prior to sexual activity. Moreover, in a clinical study of 12 patients with erectile dysfunction without an established organic cause, we have shown sildenafil to enhance the erectile response (duration and rigidity of erection) to visual sexual stimulation, thus highlighting the important role of PDE5 in human penile erection. Sildenafil holds promise as a new effective oral treatment for penile erectile dysfunction.
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Affiliation(s)
- M Boolell
- Pfizer Central Research, Sandwich, Kent, UK
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Gepi-Attee S. A simple method for checking J-J stent position. Br J Urol 1996; 77:170-1. [PMID: 8653307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Recurrent urinary retention in a bladder with a diverticulum after transurethral resection of the prostate is identified as a definite indication for diverticulectomy. Two cases are reported and a safe technique for the procedure is reviewed.
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Affiliation(s)
- S Gepi-Attee
- Department of Urology, Southmead Hospital, Bristol, United Kingdom
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Gepi-Attee S, Gingell JC. Bilateral vasography--a simplified method. Br J Urol 1994; 73:709-10. [PMID: 8032842 DOI: 10.1111/j.1464-410x.1994.tb07562.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S Gepi-Attee
- Department of Urology, Southmead Hospital, Bristol, UK
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Gepi-Attee S, Gingell JC. Wolfram's (DIDMOAD) syndrome. Br J Urol 1994; 73:112. [PMID: 8298892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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18
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Affiliation(s)
- S Gepi-Attee
- Department of Urology, Southmead Hospital, Bristol
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Abstract
Reports of malignant tumors in enterocystoplasties have recently been accumulating. To date no case of benign tumors has been recorded. We present a case of villous adenoma in a sigmoid colocystoplasty. The possible etiological factors and pathogenesis are discussed, and recommendations are made about followup.
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Affiliation(s)
- S Gepi-Attee
- Department of Urology, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
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20
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Affiliation(s)
- S Gepi-Attee
- Department of Urology, Southmead Hospital, Bristol
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21
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Affiliation(s)
- S Gepi-Attee
- Department of Urology, Southmead Hospital, Bristol
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Gepi-Attee S, Ganabathi K, Gingell JC. Confirmation of position of double J stent inserted at open operation. Br J Urol 1990; 66:439-40. [PMID: 2224448 DOI: 10.1111/j.1464-410x.1990.tb14979.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Gepi-Attee
- Department of Urology, Southmead Hospital, Bristol
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Gepi-Attee S, Gingell JC. Penile-rods--the Southmead experience. West Engl Med J 1990; 105:72-3. [PMID: 2093351 PMCID: PMC5115043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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