Lower urinary tract pathology evaluation in Nigeria: practice and limitations at a private urology centre

To review the pattern of lower urinary tract (LUT) pathology, showcase the evaluation and management of these conditions and identify if any, limitations to the evaluation and management of these conditions at a private urology centre in Nigeria.

We reviewed the medical records of all patients presenting with LUT pathology between February 2007 and March 2011. Data such as age, sex, patterns of presentation, findings from evaluation, and surgical pathology were extracted.

In all, 412 patients were seen and evaluated. There were 398 males (age range = 40-86 years) with a mean age of 65 +/-12 yrs and 14 females (age range = 27-71 years) with a mean age of 45 +/-19 yrs. The commonest symptom seen in the female patients was urge urinary incontinence in (13, 92.8%) while the remaining female had stress urinary incontinence. All fourteen female patients were evaluated with cystoscopy and urodynamic studies. Pressure-flow studies revealed overactive bladder syndrome in only 4 patients (28.5%) with urge incontinence with no cause of incontinence found in the rest. The most common symptoms in the male patients included LUTS (352, 85.4%), hematuria, (21, 5%) and urinary incontinence (6, 1.4%). Evaluation consisted of uroflometry, post-void residual (PVR) urine measurement and International Prostate Symptom Score (IPSS) assessment respectively in 374 patients (90%), whereas 303 patients (73%) underwent PSA testing. Seventy five patients with LUTS who had PVR > 150 mls under went transrectal ultrasonography (TRUS) of the prostate, of whom 61(81%) underwent further TRUS-guided prostate biopsies.

Evaluation of LUT conditions using modern medical technology is feasible in a developing country such as Nigeria. While there are no unique technological limitations, the costs of treatment in a private urology centre may present specific challenges to such comprehensive evaluation of patients. Additionally, we show in this study that lower urinary tract conditions are predominantly prostate-related and as in other parts of the world, screening with PSA increases the detection of organ confined prostate cancer.