Browsing by Author "Heyns, C. F."
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- ItemBladder cancer documentation of causes: multilingual questionnaire 'bladder cancer doc'(2013) Golka, K.; Abreu-Villaca, Y.; Attar, R. A.; Angeli-Greaves, M.; Aslam, M.; Basaran, N.; Belik, R.; Butryee, C.; Dalpiaz, O.; Dzhusupov, K.; Ecke, T. H.; Galambos, H.; Gerilovica, H.; Gerullis, H.; Gonzalez, P. C.; Goossens, M. E.; Gorgishvili-Hermes, L.; Heyns, C. F.; Hodzic, J.; Ikoma, F.;
- ItemCorrelation between a new visual prostate symptom score (VPSS) and uroflowmetry parameters in men with lower urinary tract symptoms(Health and Medical Publishing Group (HMPG), 2012-04) Heyns, C. F.; Van der Walt, C. L. E.; Groeneveld, A.Objective. A visual prostate symptom score (VPSS) compared with the international prostate symptom score (IPSS) for evaluation of lower urinary tract symptoms (LUTS) can be completed without physician assistance by a significantly larger proportion of men with limited education. We aimed to evaluate the correlation of the VPSS and IPSS with uroflowmetry parameters. Methods. Men with LUTS were requested to complete the IPSS and VPSS, consisting of pictograms to evaluate urinary frequency, nocturia, force of the stream and quality of life. The maximum (Qmax) and average urinary flow rate (Qave), voided volume (VV) and post-void residual (PVR) urine volumes were measured. Statistical analysis was performed using the Mann-Whitney and Spearman’s tests. Results. The study included 93 men (mean age 64 years, range 33 - 85), with VV >150 ml in 66 (71%) and <150 ml in 27 (29%) subjects. In the group with VV >150 ml there were significant negative correlations between the IPSS and Qmax (r=-0.30, p=0.016), the IPSS and Qave (r=-0.29, p=0.018), the VPSS and Qmax (r=-0.38, p<0.002) and the VPSS and Qave (r=-0.37, p<0.003). The VPSS question on the subject’s assessment of his urinary stream showed a significant negative correlation with the Qmax (r=-0.37, p=0.002) and Qave (r=-0.31, p=0.011), but the IPSS question on the subject’s urinary stream did not correlate significantly with the Qmax or Qave. Conclusions. The VPSS is equivalent to the IPSS in terms of correlation with Qmax and Qave and can therefore be used instead of the IPSS to evaluate LUTS in men with limited education.
- ItemDevelopment of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy(Sociedade Brasileira de Urologia, 2010) Zarrabi, A. D.; Conradie, J. P.; Heyns, C. F.; Scheffer, C.; Schreve, K.Purpose: To design a simple, cost-effective system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy (PCNL). Materials and Methods: The design consists of a low-cost, light-weight, portable mechanical gantry with a needle guiding device. Using C-arm fluoroscopy, two images of the contrast-filled renal collecting system are obtained: at 0-degrees (perpendicular to the kidney) and 20-degrees. These images are relayed to a laptop computer containing the software and graphic user interface for selecting the targeted calyx. The software provides numerical settings for the 3 axes of the gantry, which are used to position the needle guiding device. The needle is advanced through the guide to the depth calculated by the software, thus puncturing the targeted calyx. Testing of the system was performed on 2 target types: 1) radiolucent plastic tubes the approximate size of a renal calyx (5 or 10 mm in diameter, 30 mm in length); and 2) foam-occluded, contrast-filled porcine kidneys. Results: Tests using target type 1 with 10 mm diameter (n = 14) and 5 mm diameter (n = 7) tubes resulted in a 100% targeting success rate, with a mean procedure duration of 10 minutes. Tests using target type 2 (n = 2) were both successful, with accurate puncturing of the selected renal calyx, and a mean procedure duration of 15 minutes. Conclusions: The mechanical gantry system described in this paper is low-cost, portable, light-weight, and simple to set up and operate. C-arm fluoroscopy is limited to two images, thus reducing radiation exposure significantly. Testing of the system showed an extremely high degree of accuracy in gaining precise access to a targeted renal calyx.
- ItemEarly diagnosis of prostate cancer in the Western Cape(Health & Medical Publishing Group, 2001-08) Heyns, C. F.; Naude, A. M.; Visser, A. J.; Marais, D. C.; Stopforth, H. B.; Nyarko, J. K.; Stellmacher, G. A.Background. Early stage prostate cancer does not cause symptoms, and even metastatic disease may exist for years without causing symptoms or signs. Whereas early stage prostate cancer can be cured with radical prostatectomy or radiotherapy, the prognosis of patients with locally advanced or metastatic cancer is significantly poorer. Objectives. In view of the high incidence of advanced and therefore incurable prostate cancer seen at the oncology clinic of the Department of Urology, Tygerberg Hospital, we started a prostate clinic with the aim of detecting early stage prostate cancer which is potentially curable. A secondary objective was to investigate the question whether there is a higher incidence of prostate cancer among black African men. Patients and methods. Men aged 50 - 70 years were invited by means of media communications (newspaper and radio) to attend our prostate clinic for a free physical examination, including a digital rectal examination (DRE) and serum prostate specific antigen (PSA) assay. If the DRE was clinically suspicious of malignancy and/or the serum PSA was > 4 ng/ml, the patient was appropriately counselled and referred for transrectal ultrasound (TRUS)-guided sextant prostate biopsy. Results. In the period June 1997 - September 1999 a total of 1 056 men attended the prostate clinic. Biopsies were indicated in 160 cases, and were obtained in 114 (71.3%, i.e. 10.8% of the entire cohort). Prostate cancer was detected on first biopsy in 3.5% of the entire group of men (in 35.9% of those with a clinically abnormal DRE, in 41.3% of those with a serum PSA > 4 ng/ml and in 88.6% of those with an abnormal DRE and serum PSA > 4 ng/ml. In the 37 men with prostate cancer, the clinical tumour stage was T1 - 2 in 83.8% and T3 - 4 in 16.2%. In the group of patients with clinical stage T1 - 2 tumours, the treatment was watchful waiting in 62.5% of cases, radiotherapy in 20.8% and radical prostatectomy in 16.7%. Analysis of the data according to race showed that in the group of 47 black men there was a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ml and biopsies showing malignancy, and a higher overall prostate cancer detection rate (8.5%). Conclusions. Our prostate cancer detection rate of 3.5% is slightly lower than that reported in larger studies (4.7%), which may be due to the fact that prostate biopsy was performed in only 71% of those who had an indication for biopsy. In the men diagnosed with clinically localised prostate cancer, potentially curative treatment was given in only 37.5% of cases. This compares unfavourably with the historical cohort of men seen at our oncology clinic, where 53% received potentially curative treatment, and a large European study where potentially curative treatment was given in 89% of cases. Our finding that black men had a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ml and biopsies showing malignancy and a higher overall detection rate of prostate cancer should be interpreted with caution, since black men comprised only 4.5% of our overall study cohort.
- ItemEarly diagnosis of prostate cancer in the Western Cape(Health and Medical Publishing Group (HMPG), 2001-08) Heyns, C. F.; Naude, A. M.; Visser, A. J.; Marais, D. C.; Stopforth, H. B.; Nyarko, J. K.; Stellmacher, G. A.Background. Early stage prostate cancer does not cause symptoms, and even metastatic disease may exist for years without causing symptoms or signs. Whereas early stage prostate cancer can be cured with radical prostatectomy or radiotherapy, the prognosis of patients with locally advanced or metastatic cancer is significantly poorer. Objectives. In view of the high incidence of advanced and therefore incurable prostate cancer seen at the oncology clinic of the Department of Urology, Tygerberg Hospital, we started a prostate clinic with the aim of detecting early stage prostate cancer which is potentially curable. A secondary objective was to investigate the question whether there is a higher incidence of prostate cancer among black African men.
- ItemEvaluation of the visual prostate symptom score in a male population with great language diversity and limited education : a study from Namibia(Health & Medical Publication Group, 2014-05) Heyns, C. F.; Steenkamp, B. A.; Chiswo, J.; Stellmacher, G. A.; Fortsch, H.E. A.; Van der Merwe, A.Background. A visual prostate symptom score (VPSS) using pictograms was developed to assess the force of the urinary stream, urinary frequency, nocturia and quality of life (QoL). Objective. To compare the VPSS with the international prostate symptom score (IPSS) and maximum (Qmax) and average (Qave) urinary flow rates in men from diverse language groups with limited schooling. Methods. Men with lower urinary tract symptoms admitted to the urology ward at Windhoek Central Hospital, Namibia, were evaluated. Patients who were unable to complete the questionnaires alone were assisted by a doctor or nurse. Local ethics committee approval was obtained. Statistical analysis was performed using Student’s t-test and Spearman’s rank correlation test. Results. One hundred men (mean age 56.3 years, range 20.1 - 95.4) were evaluated over a period of one year. All the men understood one or more of 15 languages, and 30 were illiterate; 32 had <5 years of schooling, 34 had 5 - 9 years and 34 had >9 years. The VPSS took significantly less time to complete than the IPSS. There were statistically significant correlations between the total VPSS and IPSS scores, between the four VPSS questions and the corresponding IPSS questions, and between Qmax and Qave and the VPSS total and VPSS questions on the force of the urinary stream and QoL. Conclusion. The VPSS pictograms depicting the force of the urinary stream and QoL correlated significantly with Qmax and Qave, indicating that they can be used as single-item questions to rapidly assess bladder outflow obstruction in men with limited education.
- ItemGenetic variations in androgen metabolism genes and associations with prostate cancer in South African men(Health and Medical Publishing Group (HMPG), 2010) Fernandez, P.; De Beer, P. D.; Van der Merwe, L. D.; Heyns, C. F.Background. In South Africa white men have the highest incidence of prostate cancer (PCa), coloured (mixed ancestry) men have an intermediate incidence, and low incidences are reported for black and Asian men. It has been suggested that ethnic differences in incidence and mortality of PCa are related to genetic variations in genes that regulate androgen metabolism. We investigated the role of genetic variants in the androgen metabolism genes and the probability of developing PCa in South African coloured and white men. Methods. Genotype and allele counts and frequencies of single nucleotide polymorphisms (SNPs) in CYP3A5, CYP3A4 and CYP3A43 were assessed in coloured men (160 case individuals, 146 control individuals) and white men (121 case individuals, 141 control individuals). Results. A genetic association indicating an increased probability of developing PCa was observed with the G allele of the SNP rs2740574 in CYP3A4 in coloured men, the A allele of rs776746 (CYP3A5) and the G allele of rs2740574 (CYP3A4) in white men, and the G allele of rs2740574 and the C allele of rs501275 (CYP3A43) in the combined ethnic groups analysis. In addition, we identified allele combinations (termed haplotypes) with significantly higher frequencies in the PCa case individuals than in the control individuals. Conclusions. The findings support the role of variants in genes that regulate androgen metabolism and the probability of developing PCa. The study paves the way to identify other genetic associations in South African men, and to establish genetic profiles that could be used to determine disease progression and prognosis.
- ItemHORTIS-III: Radiation cystitis - a multicenter, prospective, double-blind, randomized, sham-controlled trial to evaluate the effectiveness of hyperbaric oxygen therapy in patients with refractory radiation cystitis(Stellenbosch : Stellenbosch University, 2010) Smit, S. G.; Heyns, C. F.; Cronje, F. J.; Roberts, C. J.Objective: Hyperbaric oxygen therapy (HBOT) for refractory late radiation cystitis has been reported with success rates of 60% to 92%. HORTIS (Hyperbaric Oxygen Radiation Tissue Injury Study) is a multicenter study conducted by the Baromedical Research Foundation, South Carolina, USA. Tygerberg Hospital and University of Stellenbosch is one of 6 centers recruiting patients for the radiation cystitis arm (HORTIS-III). Methods: Patients were prospectively randomized: Group A (treatment) received HBOT (100% oxygen at 2.0 atmospheres). Group B (control) received sham treatment (21% oxygen at 1.0 atmosphere). Patients and referring physicians were blinded to the randomization process. Patients received 30-40 sessions of either HBOT or sham treatment. After unblinding, patients in the control group were offered crossover to the treatment group. Primary outcome measures included clinical evaluation, SOMALENT and EPIC scores. Results: In total, 34 patients were screened, 5 met the inclusion and exclusion criteria and agreed to participate. Two patients were randomized to Group A. One patient received 30 sessions of HBOT. One patient absconded after 26 sessions of HBOT. Three patients were randomized to Group B and received 40 sessions of sham treatment. All 3 control patients elected to cross over: two patients completed 40 sessions of HBOT, one stopped at 24 sessions due to an unrelated medical condition (critical limb ischemia). No serious adverse events occurred. At 14 months follow-up after HBOT, 3 patients showed improvement in SOMALENT and EPIC scores. One patient with a vesicovaginal fistula showed complete radiographic resolution at 14 months follow-up. In total, 13 patients have been recruited internationally. Conclusion: HBOT remains a treatment option for refractory late radiation cystitis. The evidence presented is inconclusive due to the low number of patients, but the ongoing multicenter trial is expected to provide conclusive evidence.
- ItemPrevalence of histological prostatitis in men with benign prostatic hyperplasia or adenocarcinoma of the prostate presenting without urinary retention(South African Journal of Science, 2011-11) Zarrabi, A. D.; Edlin, R. S.; Heyns, C. F.; Van Vuuren, S.Objective. To determine the prevalence of prostatitis on histopathological evaluation of prostatic tissue in men without urinary retention. Design, setting and subjects. The clinical data and histopathology reports of men seen from January 1999 through March 2009 at our institution were analysed using Student’s t-test, the Mann-Whitney test and Fisher’s exact test where appropriate. Values were expressed as means, medians and ranges (p<0.05 accepted as statistically significant). Outcome measures. Data collected included patient age, duration of lower urinary tract symptoms and hospitalisation, findings on digital rectal examination, prostate volume, haemoglobin concentration, serum creatinine and prostate-specific antigen (PSA) levels, and histological findings. Results. Prostatic tissue of 385 men without urinary retention at presentation was obtained via biopsy (48.3% of cases), transurethral prostatectomy (62.9%), retropubic prostatectomy (6.8%) or radical prostatectomy (28.3%). On histological examination, benign prostatic hyperplasia (BPH) was found to be present in 213 patients (55.3%) and adenocarcinoma of the prostate (ACP) in 172 (44.7%). Histological prostatitis was present in 130 patients (61.0%) with BPH and 51 (29.7%) with ACP (p<0.001). A previous study of 405 men presenting with urinary retention at our institution showed histological prostatitis in 98/204 (48.0%) with BPH and in 51/201 (25.4%) with ACP. The group of men with BPH alone had a significantly lower mean serum PSA at presentation (4.5 ng/ml, range 0.3 - 20.8 ng/ml) compared with the group with BPH and prostatitis (11.2 ng/ml, range 0.2 - 145 ng/ml, p=0.011). The mean PSA level at presentation did not differ significantly between the group with ACP only (40.9 ng/ml, range 0 - 255 ng/ml) and the group with ACP plus prostatitis (1 672 ng/ml, range 0.3 - 38 169 ng/ml, p=0.076). Conclusions. Among men presenting without urinary retention, histological prostatitis was significantly more prevalent in those with BPH than in those with ACP (61% v. 30%), similar to the previous study of men presenting with retention at our institution, in which histological prostatitis was significantly more prevalent in BPH than in ACP (48% v. 25%). This finding suggests that histological prostatitis is not significantly associated with the causation of ACP or urinary retention. Serum PSA at presentation was significantly higher in the group with BPH plus prostatitis compared with BPH alone, but not in the group with ACP plus prostatitis compared with ACP alone.
- ItemProstate cancer among different racial groups in the Western Cape : presenting features and management(Health and Medical Publishing Group (HMPG), 2011-04) Heyns, C. F.; Fisher, M.; Lecuona, A.; Van der Merwe, A.Objectives. We aimed to compare the presenting features and management of prostate cancer among different racial groups. Patients and methods. We studied all patients diagnosed with prostate cancer at the Urological Oncology Clinic, Tygerberg Hospital, from January 1995 to December 2005. Most presented symptomatically as PSA screening is not readily available in the referral area of the hospital. Race was self-defined as white, coloured or black. Statistical analysis was performed using Student’s t-test or Fisher’s exact test, where appropriate. A two-tailed p-value <0.05 was accepted as statistically significant. Results. There were 901 patients: 291 (32.3%) white, 539 (59.8%) coloured and 71 (7.9%) black. Mean age at presentation was significantly higher in the white than the coloured and black groups (69.7, 67.9 and 68.9 years, respectively). Grade 1 adenocarcinoma was most common in the white (37%) and coloured groups (38%), and grade 2 was most common in the black group (39%). There was a significantly lower percentage of patients with T3-4 disease at diagnosis in the white group (47%) than the coloured (61%) and black (62%) groups. Mean serum PSA at diagnosis was significantly higher in the black than the coloured and white groups (766.1, 673.3 and 196.1 ng/ml, respectively). Potentially curative therapy (radical prostatectomy or radiotherapy) was chosen by 31% of white, 23% of coloured and only 12% of black patients. The mean duration of follow-up was significantly shorter in the black than in the white or coloured groups (24.0, 31.5 and 35.0 months, respectively). Conclusions. Black men presented with higher grade and stage disease and higher serum PSA, received potentially curative treatment less often, and had a shorter follow-up (probably owing to shorter survival) than the white and coloured groups. Greater prostate cancer awareness and education among patients and physicians and more widespread use of PSA screening of presymptomatic men at risk of prostate cancer is needed.
- ItemProstate specific antigen : brief update on its clinical use(AOSIS, 2008) Heyns, C. F.; Van der Merwe, A.Prostate specific antigen (PSA) testing of asymptomatic men enables the diagnosis of localised prostate cancer which is potentially curable, but it also poses certain risks. Doctors run the risk of litigation for failure to diagnose cancer at a curable stage, while patients run the risk of being diagnosed with non-significant cancer, incurring costs and possible complications without any survival benefit. PSA reflects a 'range of risk' for prostate cancer: the higher the PSA, the greater the risk. There is no 'normal' PSA, because even with a PSA below 4 ng/ml cancer can be detected on biopsy in up to 20% of men. However, the prevalence of high-grade (life-threatening) cancer is relatively low at low PSA values. The following recommendations appear reasonable: • PSA testing should be offered to all men aged 50 years or more (45 years in those with a family history of prostate cancer and - possibly - African men); • Alternatively, PSA testing should be done at 40, 45 and 50 years and then every two to four years (the lower the baseline value, the lower the risk of ever developing prostate cancer); • PSA testing should be repeated annually if it is more than 2 ng/ml and every two years if less than 2 ng/ml; • Stop PSA testing in asymptomatic men over 75 years or with less than 10 years' life expectancy, and in those aged over 65 years with PSA less than 0.5 to 1 ng/ml. The free-to-total PSA ratio and PSA density (PSA divided by prostate volume) can be used to decide which patients need prostatic biopsy. PSA velocity (increase of PSA per year) can predict which men are likely to develop prostate cancer or to die of it (the higher the PSA velocity, the greater the risk). PSA doubling time (the period it takes for the PSA to double) correlates with the prognosis both before and after treatment (the shorter the doubling time, the worse the prognosis). An internet Prostate Cancer Risk Calculator is available which calculates a man's risk by taking into account his age, race, family history, PSA level, findings on rectal examination and prior negative biopsy. Although this is a very convenient tool, it should be used with caution, especially at low PSA values, because there is a real risk of overdiagnosis.
- ItemRecurrent spontaneous bladder rupture : a case report(Health & Medical Publishing Group, 1989) Heyns, C. F.; Rimington, P. D.Spontaneous (non-traumatic) intraperitoneal rupture of the bladder in a 37-year-old pregnant woman was repaired at laparotomy. Nine months later she again presented with an intraperitoneal bladder rupture during pregnancy and fatal sepsis. Histological examination of the resected bladder wall showed acute ulcerative and necrotising cystitis. All patients with apparently spontaneous bladder rupture should undergo full urological evaluation to identify possible disease which might lead to recurrent rupture.
- ItemRetroperitoneoscopic live donor nephrectomy : review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa(Health & Medical Publishing Group, 2014-06) Van der Merwe, A.; Heyns, C. F.Background. Changing from an open to a laparoscopic live renal donor programme poses challenges and may affect donor and graft outcomes. Objectives. To evaluate donor safety and graft outcomes for the first 50 retroperitoneoscopic live donor nephrectomies performed at Tygerberg Hospital, Cape Town, South Africa. Methods. The procedures were performed by a single surgeon from 8 April 2008 to 3 April 2012. Operative and anatomical data were prospectively collected. A flank approach with lateral and posterior placements was used. Vascular control was achieved with Hem-o-lok clips in the majority of cases. Results. The mean age of the donors was 31.5 years (range 18 - 50), 28 (56.0%) were male, and the left kidney was harvested in 28 (56.0%) of cases. The mean operating time was 149.8 minutes (range 75 - 250), mean warm ischaemic time (WIT) 181.3 seconds (107 - 630), mean blood loss 139.7 ml (5 - 700) and mean hospital stay 3.2 days (2 - 5). Mean WIT was significantly longer for right-sided than left-sided nephrectomy (213 v. 162 seconds). In two right-sided cases the renal vein was too short and vena profunda femoris was used to create length. No donor received a blood transfusion. Comparing the last 25 with the first 25 cases showed a significant decrease in mean WIT (158 v. 204 seconds, respectively) and operating time (128 v. 172 minutes, respectively). No major complications occurred. Conclusion. Our initial 50 retroperitoneoscopic live donor nephrectomies were performed without major complications. Donor safety was maintained during the early learning curve of the transition to minimal-access donor nephrectomy.
- ItemSerum prostate specific antigen (PSA) as surrogate for the histological diagnosis of prostate cancer(Health and Medical Publishing Group (HMPG), 2001-08) Heyns, C. F.; Naude, A. M.; Ahmed, G.; Stopforth, H. B.; Stellmacher, G. A.; Visser, A. J.Introduction. To determine whether there is a cut-off value of serum prostate-specific antigen (PSA) which can be used confidently to make the diagnosis of prostate cancer, thereby obviating the need for biopsy. Patients and methods. During the period October 1991 to March 1998 the Department of Chemical Pathology at Tygerberg Hospital performed a total of 6 733 serum PSA assays on 3 960 patients. The histopathological and clinical diagnoses of these patients were obtained from records in the departments of Anatomical Pathology, Urological Oncology and Radiation Oncology. The serum PSA levels were correlated with the histopathology reports, using different PSA cut-off values ranging from 5 to 500 ng/ml, to calculate the sensitivity, specificity, and positive and negative predictive values of each cut-off value of PSA in predicting the presence of prostate cancer.
- ItemShould baseline PSA testing be performed in men aged 40 to detect those aged 50 or less who are at risk of aggressive prostate cancer?(Health and Medical Publishing Group (HMPG), 2011-09) Heyns, C. F.; Fisher, M.; Lecuona, A.; Van der Merwe, A.We aimed to evaluate the presenting features and treatment outcome of prostate cancer in men aged <50 years, in a region where prostate specific antigen (PSA) screening is not readily available and most men present with symptoms. Methods. We analysed the data of 1 571 men with prostatic adenocarcinoma treated between January 1997 and December 2008 at our institution, a tertiary level public sector hospital serving a largely indigent population. Statistical analysis was performed using Student’s, the Mann-Whitney and Fisher’s exact tests where appropriate (p<0.05 accepted as statistically significant). Results. Of 1 571 men, 47 (3%) were aged <50 years. The group aged <50 years, compared with that aged >50 years, had a significantly greater proportion with poorly differentiated adenocarcinoma (53%), locally advanced (stage T3 - 4) tumours (56%), haematogenous metastases (75%), significantly higher serum PSA at diagnosis (mean 621, median 74 ng/ml) and shorter survival. Conclusions. Men aged <50 years presenting with symptoms owing to prostate cancer had significantly higher-risk disease, higher mean PSA, and poorer prognosis than men aged >50 years. To diagnose prostate cancer at a potentially curable stage in men aged <50 years, it is necessary to initiate baseline PSA testing at age 40 and 45 years, and to select high-risk men for PSA surveillance in order to diagnose potentially curable cancer in those with a life expectancy >20 - 25 years.
- ItemTreatment of male urethral strictures - possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty(Centre of African Studies, University of Cape Town, 2012-08) Heyns, C. F.; Van der Merwe, J.; Basson, J.; Van der Merwe, A.Objective. To investigate the possible reasons for repeated urethral dilatation or optical internal urethrotomy rather than urethroplasty in the treatment of male urethral strictures. Patients and methods. Men referred to the stricture clinic of our institution during the period April 2007 - March 2008 were reviewed and the operative urological procedures performed in the same period were analysed. Statistical analysis was performed using Student’s t-test and Fisher’s exact test (p<0.05 statistically significant). Results. The mean age of the 125 men was 49.9 years (range 12.8 - 93.4 years). Previous stricture treatment had been given 1 - 2, 3 - 4 and 5 - 6 times in 52%, 32% and 12% of patients, respectively (4% had not undergone treatment). In these groups, previous treatment was dilatation in 70%, 76% and 72%, urethrotomy in 26%, 15% and 28%, and urethroplasty in 4%, 9% and 0, respectively. The group with 5 - 6 compared with 1 - 2 previous treatments was significantly older (mean age 60.2 v. 46.6 years) and had a significantly greater proportion with underlying co-morbidities (80% v. 52%). The group that had undergone urethroplasty compared with 5 - 6 repeated dilatations or urethrotomies was significantly younger (mean age 48.2 v. 60.2 years) with a lower prevalence of co-morbidities (47% v. 80%). During the study period urethroplasty was performed in 16 (2%) of 821 inpatients, whereas 55 men were seen who had undergone ≥3 previous procedures, indicating that urethroplasty was performed in less than one-third of cases in which it would have been the optimal treatment. Owing to limited theatre time, procedures indicated for malignancy, urolithiasis, renal failure and congenital anomalies were performed more often than urethroplasty. Conclusions. Factors that possibly influenced the decision to perform repeated urethrotomy or dilatation instead of urethroplasty were limited theatre time, increased patient age and the presence of underlying co-morbidities.
- ItemUrinary retention in women(Health and Medical Publications Group (HMPG), 2012-05) Basson, J .; Van der Walt, C. L. E.; Heyns, C. F.Urinary retention in women is uncommon, with a much lower incidence than in men. It may be acute (with suprapubic pain) or chronic (typically painless). Urinary retention in females is frequently transient, with no apparent cause, which makes the management of these patients more challenging.
- ItemVaricella zoster virus infrection causing urinary retentin in a child with HIV infection(SA HIV Clinicians Soc, 2012-11) Wessels, G. S.; Heyns, C. F.An 11-year-old boy receiving antiretroviral therapy for HIV infection and antibacterial therapy for pulmonary tuberculosis presented with urinary retention due to varicella zoster virus infection involving the sacral nerves, confirmed on serological testing. The perineum over dermatomes S2 - S4 on the left was involved with a vesicular and superficially erosive rash. A transurethral catheter was inserted and the patient was treated with acyclovir (300 mg 6-hourly for 5 days). At follow-up 4 weeks later, the perineal skin lesions had healed, the catheter was removed and the patient was able to pass urine.
- ItemVasectomy under local anaesthesia performed free of charge as a family planning service : complications and results(Health and Medical Publishing Group (HMPG), 2009-04) Trollip, G. S.; Fisher, M.; Naidoo, A.; Theron, P. D.; Heyns, C. F.Objective. To evaluate the safety and efficacy of vasectomy performed under local anaesthesia by junior doctors at a secondary level hospital as part of a free family planning service. Method. Men requesting vasectomy were counselled and given written instructions to use alternative contraception until two semen analyses 3 and 4 months after vasectomy had confirmed azoospermia. Bilateral vasectomy was performed as an outpatient procedure under local anaesthesia by junior urology registrars. Statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, Fisher's exact or Spearman's rank correlation tests as appropriate. Results. Between January 2004 and December 2005, 479 men underwent vasectomy at Karl Bremer Hospital, Western Cape, South Africa; their average age was 36.1 (range 21 - 66) years, they had a median of 2 (range 0 - 10) children, and only 19% had 4 or more children. The average operation time was 15.5 (range 5 - 53) minutes. Complications occurred in 12.9%; these were pain (7.3%), swelling (5.4%), haematoma (1.3%), sepsis (1%), difficulty locating the vas (1%), vasovagal episode (0.6%), bleeding (0.6%), wound rupture (0.4%) and dysuria (0.2%) (some men had more than one complication). Of the men 63.3% returned for one semen analysis and 17.5% for a second. The vasectomy failure rate ranged from 0.4% (sperm persisting >365 days after vasectomy) to 2.3% (sperm seen >180 days after vasectomy and/or in the second semen specimen). No pregnancies were reported. The complication (5.6%) and failure rates (0%) were lowest for the registrar who had performed the smallest number of vasectomies and whose average operation time was longest. Comparing the first one-third of procedures performed by each of the doctors with the last one-third, there was a significant decrease in average operating times but not in complication rates. Conclusions. Vasectomy can be performed safely and effectively by junior doctors as an outpatient procedure under local anaesthesia, and should be actively promoted in South Africa as a safe and effective form of male contraception.