Naked But Not Ashamed: Revealing For Good Outcomes in the Management of Genitourinary Disorders.

Abstract

Covering one’s nakedness is one of the early lessons we are given as children and uphold when old. Though some of the dressings of our ladies are getting shorter and shorter and the side slits are getting to the groin, there is still a deliberate attempt to keep the essential parts covered. This up bringing with its cultural and religious re-enforcement makes exposing the Genito-urinary system a Herculean task even when there is a need to do so. Positive outcomes in the management of Genito-urinary disorders are hinged on revealing those parts of the body. Indeed, exposure allows the diagnosis of the disorder and situates it within the context of good urinary tract function and sexual pleasures as a desired outcome. Exposure in this context not only applies to the anatomy of the Genito-urinary system but also how it has been used and sometimes who has been the recipient or had been denied the pleasures, therefore. The areas under consideration in this Lecture are as follows: i. Reveal for good outcomes Covered cannot be cured, exposure offers a great chance of cure. Revealing makes disorders considered uncommon to be seen with pooled publications helping to improve upon our management and outcomes. ii. Revisiting dogmas and embracing technology Benign Prostate Hyperplasia is an enlargement of the prostate. With the patients presenting with difficulty passing urine, straining to pass urine and poor stream. In extreme cases, they are unable to urinate at all, referred to as retention of urine. We mainly performed an open surgery, though there were minimally invasive methods - transurethral resection of the prostate (TURP). The motivation to acquire equipment for minimally invasive methods was low. This was due to the prevailing perception that the Ghanaian, and by extension the prostates of the African was big. Our 2 research revealed that 75% of our prostates were smaller than 60g, which was the cut off for recommending and using this method. Unfortunately, we deployed this method for only 20% of the cases. With this finding, we pushed to adopt this method for more cases with its advantages. At the last review we currently do more cases by TURP than Open, 55% vrs 45 %. iii. Making Genito-urinary procedures pain-free One question patients ask when they have to undergo urology procedures is, ‘is it painful’? Prostate biopsy is one of the common procedures we carry out. The main concern has been pain associated with the procedure. To allay clients’ fears, we conducted a study on patients going for prostate biopsy. The findings were that post procedure pain was minimal with scores averaging 1 to 2 / 10. We could therefore confidently assure them that there was no significant post procedure pain. Currently a course of paracetamol for a day or so is all that is needed, and many clients realised they did not even need it. iv. Preventing infections in Genito-urinary procedures to avoid catastrophic outcomes Infections associated with Genito-urinary disorders and complicated procedures have also been explored. Many who needed prostate biopsies and their attending physicians feared this complication. After reporting on these complications, we found ways of preventing it. We changed our antibiotic prophylaxis in terms of the medications, dosages and duration post-procedure. The result is that the procedure is virtually free of this dreaded complication now. v. Flogging men to submission with the prostate cancer big stick, Is it justified? Prostate cancer if not diagnosed early but seen in an advanced stage, can be deadly. The use of Prostate Specific Antigen (PSA) and digital rectal examinations are good ways of screening, so one can pick it early. The discriminatory effect on prostate cancer risk and chances of cure have been explored. What we have found is that if the PSA (normal 0-4ng/ml) is between 4ng/ml and 10ng/ml, the majority do not have prostate cancer (90%). Do keep your cool if your PSA is in this range, pick an appointment and see your urologist or Genito-urinary surgeon at a convenient time. vi) Rising incidence of urinary stones. 3 Urinary stones, a few decades ago, thought to be uncommon among us as a people, has become a common presentation. Is it a fall out of global warming or rising cost of high-quality water? This is also explored. vii) Be mindful of the hole! Choose right, hit right! Finally, I will discuss our experiences in the management of curved penis, masturbation mishaps and penile fractures. Surgery offers a good outcome as a management option but sometimes needs one to think outside box. This inaugural lecture highlights observations, care plans and research findings that have improved outcomes in Genito-urinary surgery and medicine. It also highlights how promoting the use and deployment of technology, allaying the fears of the population and encouraging them to reveal without shame ensures good outcomes.