African Urology Journal Volume 2 Issue 1 2022

Introduction

Enhanced recovery protocol for radical cystectomy: a primer

A 2014 editorial in European Urology posed the question: “Enhanced recovery after surgery: are we ready, and can we afford not to implement these pathways for patients undergoing radical cystectomy?”1 Until recently, our uro-oncology unit would have had to answer clearly that we were not ready. However, perhaps more tellingly, until recently we were unaware of the cost to our patients of not implementing enhanced recovery after surgery (ERAS).

Can risk factors distinguish pure and combination struvite stone formers in a South African cohort?

Struvite nephrolithiasis is associated with infection by urea-splitting organisms and represents approximately 5–15% of renal calculi in published series and 24% of staghorn calculi. In South African series, 4–9% of stones are reported as struvite. These are reported more often in women (2:1 ratio) due to their higher susceptibility to urinary tract infections (UTIs) and also in patients with anatomical abnormalities, urinary stasis, neurogenic bladder dysfunction and immunosuppression. Urease-producing organisms hydrolyse water and urea into ammonia and carbon dioxide. Ultimately, urinary pH is increased by the generation of ammonium. Proteus mirabilis is the most commonly implicated organism in struvite nephrolithiasis. However, Haemophilus influenza, Klebsiella pneumoniae, Pseudomonas species, Providencia, Staphylococcus aureus and Ureaplasma urealyticum have also been reported. Although Escherichia coli is a common cause of (UTIs), it rarely produces urease and is not usually associated with the pathogenesis of struvite stones. The increase in urinary pH (pH > 7.2) allows the precipitation of naturally occurring ions in urine (magnesium, calcium and phosphate) into struvite, and carbonate apatite when the pH is 6.8–7.2. Struvite calculi are composed primarily of magnesium ammonium phosphate hexahydrate but may also contain carbonate apatite.

Early results from South African men with low-risk, clinically localised prostate cancer managed with active surveillance

Prostate cancer (PCa) is the second most common cancer and the fifth leading cause of cancer death among men worldwide. In South Africa, PCa is the most common histologically diagnosed cancer in men according to the National Cancer Registry. PCa was the leading cause of cancer-related death in the Free State, North West, Mpumalanga and Limpopo provinces in 2014 and was second only to lung cancer in the other six provinces of South Africa. Widespread use of PSA screening has resulted in an increase in the overall incidence of PCa worldwide, an increase in localised disease and a decrease in locally advanced and metastatic disease. This has not translated into improving cancer specific and overall survival as demonstrated by a recent meta-analysis. One possible reason for this is that screening has resulted in an increased incidence of predominantly low-risk disease. Low-risk PCa is defined as clinical stage T1–T2a, serum PSA level < 10 ng/ml and Gleason score ≤ 6.5 It is well known that low-risk localised PCa may pursue a relatively indolent course as autopsy studies have demonstrated. Active surveillance (AS) involves the identification and close follow-up of men with low-risk disease with the intent to offer curative therapy should there be signs of progression to clinically significant disease. Even though several strategies have been described and a lack of standardisation exists, AS has become an established option for management of patients with low-risk PCa in the developed world.

The association between urodynamic findings and chronic kidney disease in children with neurogenic lower urinary tract dysfunction: A potential model for a standardised risk-based surveillance tool in South Africa

Neurogenic lower urinary tract dysfunction (NLUTD) is defined by the International Continence Society (ICS) as lower urinary tract dysfunction due to disturbance of the neurological control mechanism. Patients with NLUTD have an increased risk of upper tract damage with chronic kidney disease (CKD)2 frequency of 25%. CKD may develop insidiously and go unrecognised in these patients, which can further progress to end-stage renal disease (ESRD). This is a devastating disorder associated with cardiovascular morbidity and high mortality. The impact of CKD on the quality of life of patients and their families, as well as the resources required to manage these patients, in a resource constrained country like South Africa (SA), is concerning. Appropriate assessments should be conducted in children with NLUTD to enable upper urinary tract function preservation/ improvement. Urodynamic studies (UDS) have played a central role in risk-stratifying patients with NLUTD for renal deterioration. The landmark study by McGuire et al., for example, introduced detrusor leak point pressure (DLPP) higher than 40 cm H2O as an objective measure to define high risk for upper tract deterioration. Galloway et al. formulated a hostility scoring system from 0 to 10 using the sum of five measurable UDS parameters from 0 (absence) to 2 (worst pattern). The parameters assessed were vesicoureteral reflux (VUR), neurogenic detrusor overactivity (NDO), compliance, leak point pressure and detrusor sphincter dyssynergia. A hostility score ≥ 5 was significantly related to the upper urinary tract damage (p < 0.05).3 Low functional bladder capacity has also been reported to be associated with upper tract deterioration. In addition, urinary tract infections are known to cause renal damage. There is, however, limited research conducted in Africa.

Relationship between prostate volume, age and body mass index among patients with benign prostatic hyperplasia in the Niger Delta region, Nigeria

Benign prostatic hyperplasia (BPH) is a benign prostate pathology with a negative impact on the health-related quality of life of patients and their sexual function. It is a common benign neoplastic condition affecting middle-aged and elderly men. Approximately 40% of men older than 60 years of age present with lower urinary tract symptoms (LUTS) as a result of benign prostatic hyperplasia.2 Nwafor et al.3 reported that BPH was the most common prostate pathology, accounting for 62.85% of cases.

An unusual presentation of metastatic prostatic adenocarcinoma: a case report

A 58-year-old male, not known to have any chronic medical conditions, presented to the dermatology clinic at Groote Schuur Hospital (GSH) with a three-month history of multiple asymptomatic skin nodules and unquantifiable weight loss. The nodules started as a single truncal lesion which gradually progressed in size and number to involve the skin of his abdomen, chest, arms, neck and back. He admitted to a six pack-year history of cigarette smoking. There was no reported family history of prostate or breast cancer. His HIV rapid test and Treponema pallidum antibodies serum test were both negative.

Subcapsular renal haematoma of unusual cause: a case report

Laser ureteroscopic lithotripsy is currently the technique of choice for the treatment of ureteral stones. The postoperative complication rate of this procedure is low. The main complications described are fever, pain and ureteral trauma. Subcapsular renal haematoma (SCRH) is a rare complication of ureteroscopic lithotripsy. We report here a 42-year-old woman who was treated by percutaneous nephrostomy with a favourable outcome.

Eosinophilic solid and cystic renal cell carcinoma – an emerging renal tumour with a good prognosis

Renal cell carcinoma (RCC) is recognised as one of the most common cancers worldwide. Advances over the past few decades have brought about recognition of an increasing number of new renal cancer entities, many of which are not formally classified in the 2016 World Health Organization (WHO) classification of renal tumours. Eosinophilic solid and cystic renal cell carcinoma (ESC RCC) is one of these newly recognised entities which has a generally more favourable prognosis and important genetic associations. We present two recent cases seen at our institutions, to highlight the most important diagnostic features and the clinical importance of recognising this uncommon emerging renal tumour.