Browsing by Author "Morton, B."
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Item Early surgical repair of penile fractures(2010-09) Mensah, J. E.; Morton, B.; Kyei, M.OBJECTIVES: To present our experience with diagnosis and surgical management of penile fracture PATIENTS AND METHODS: We present six cases of penile fracture managed at our unit between 2003 and 2008. The diagnosis was based on clinical presentation and physical examination. The treatment was surgical in all cases with Subcoronal circumferential degloving incision, evacuation of hematoma and reconstruction of the rupture with absorbable suture. RESULTS: The clinical diagnosis of penile fracture was accurate in all six cases. All patients had a successful outcome, with preservation of erectile function CONCLUSION: Penile fracture is a clinical diagnosis and immediate surgical repair offers complete recovery of sexual function.Item Organ Transplantation in Ghana(Transplantation, 2018-04) Osafo, C.; Morton, B.; Ready, A.; Jewitt-Harris, J.; Adu, D.There is a growing burden of end-stage kidney disease (ESKD) in sub Saharan Africa, driven by a genetic predisposition to kidney disease and an increasing prevalence of hypertension and diabetes mellitus. It is estimated that 13.9% (95% confidence interval, 12.2-15.7) African Blacks have chronic kidney disease1 with a significant fraction progressing to ESKD, a harbinger of imminent death in Africa due to the scarcity and the lack of affordable dialysis. Kidney transplantation is the best treatment for ESKD, conferring superior survival, quality of life in addition to being more cost effective than dialysis.2 A recent systematic literature review in sub-Saharan Africa (excluding South Africa and Sudan) showed that only few adults (16 studies) and children (6 studies) received kidney transplants (1.1% and 2.5%, respectively).3 The report of The Transplantation Society meeting in 2013 emphasized the lack of kidney transplantation in sub-Saharan Africa.4Item Penile Strangulation by Self Placement of Metallic Nut: Corporal Cavernosa Tissue Showed Resilience to Thermal Burns Sustained at Removal(Ghana Medical Journal, 2015-03) Kyei, M.Y.; Asante, E.K.; Mensah, J.E.; Klufio, G.O.; Paintsil, A.; Gepi-atee, S.; Morton, B.; Ampadu, K.; Toboh, B.We report a case of a 37-year-old male who presented with a 12-hour history of a strangulating 2cm wide by 0.8 cm thick metallic nut on the penile shaft at the peno- scrotal junction. Unlike instances where these metallic objects are placed to enhance sexual stimulation this nut was rather placed to prevent intercourse. A Bosch electric circular grinder was successfully used for removal but a thermal burn to the penile tissues was sustained in the process as the hardness of the nut required a high energy to cut and its thickness did not allow for effective cooling during the process of removal. This resulted in a circumferential denudation of penile skin, a urethro-cutaneous fistula at the penoscrotal junction and a mid-bulbar urethral stricture. The penile wound was subsequently covered with a split skin graft with a delayed closure of the urethrocutaneous fistula and a buccal mucosa patch urethroplasty for the mid bulbar stricture. Despite the degree of thermal burns sustained the patient has maintained good erectile function with grade four rigidity. The tunica albuginea and the underlying corpora cavernosa have shown a significant degree of resilience to thermal burns compared to the corpora spongiosum where the thermal burns led to a urethrocutaneous fistula.Item Penile Strangulation by self-Placement of Metallic Nut(Ghana medical journal, 2015-03) Kyei, M.Y.; Asante, E.K.; Mensah, J.E.; Klufio, G.O.; Paintsil, A.; Gepi-Atee, S.; Morton, B.; Ampadu, K.; Toboh, B.We report a case of a 37-year-old male who presented with a 12-hour history of a strangulating 2cm wide by 0.8 cm thick metallic nut on the penile shaft at the peno-scrotal junction. Unlike instances where these metallic objects are placed to enhance sexual stimulation this nut was rather placed to prevent intercourse. A Bosch electric circular grinder was successfully used for removal but a thermal burn to the penile tissues was sustained in the process as the hardness of the nut required a high energy to cut and its thickness did not allow for effective cooling during the process of removal. This resulted in a circumferential denudation of penile skin, a urethro-cutaneous fistula at the peno-scrotal junction and a mid-bulbar urethral stricture. The penile wound was subsequently covered with a split skin graft with a delayed closure of the urethrocutaneous fistula and a buccal mucosa patch urethroplasty for the mid bulbar stricture. Despite the degree of thermal burns sustained the patient has maintained good erectile function with grade four rigidity. The tunica albuginea and the underlying corpora cavernosa have shown a significant degree of resilience to thermal burns compared to the corpora spongiosum where the thermal burns led to a urethrocutaneous fistula.Item Retrocaval ureter: Two case reports.(2011-12) Kyei, M.Y.; Yeboah, E.D.; Klufio, G.O.; Mensah, J.E.; Gepi-Atee, S.; Zakpaa, L.; Morton, B.; Adusei, B.Retrocaval ureter also referred to as pre-ureteral vena cava is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava. Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life from a resulting hydronephrosis. We present the first two cases to be reported in Ghana; a 36-year-old male and a 40-year-old female both with right flank pains and associated right hydronephrosis. Diagnoses were confirmed with retrograde ureteropyelogram and both had an open surgical repair of the anomaly.Item SURGICAL MANAGEMENT OF BPH IN GHANA: A NEED TO IMPROVE ACCESS TO TRANSURETHRAL RESECTION OF THE PROSTATE(East African medical journal, 2012-07) Kyei, M.Y.; Mensah, J.E.; Morton, B.; Gepi-Attee, S.; Klufio, G.O.; Yeboah, E.D.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.