Abstract
Purpose: We describe the commonest pathology responsible for lower urinary tract obstruction (LUTO) and associated symptoms such as UTI, etc. among males at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. Materials and Methods: Between January and December 2009, prospective cross sectional hospital based study was conducted involving 103 subjects. Patients with symptoms of LUTO and who were on short admission (up to 48 hours) at the accident and emergency unit of KATH were identified as potential study subjects. All the patients presented with acute retention of urine at the emergency unit of KATH and urethral catheterization was attempted to relieve them of the retention under sterile conditions. Those patients whose initial catheterization failed went through suprapubic cystostomy (suprapubic catheterization). Urine specimens for culture and sensitivity tests were then collected into sterile urine containers immediately after the catheterization (irrespective of type). Ultrasound Scan was requested for all the patients to assist in diagnosing enlargement of the prostate and other associated urological pathologies. Retrograde urethrogram was however, requested for those patients with suprapubic catheterization and which helped in the diagnosis of the urethral stricture. For a particular child, urethral catheter was passed under sterile condition and Micturicting Cysto-Urethrogram (MCUG) was done to assist in diagnosing posterior urethral valve and other conditions. Those subjects whose urinalysis revealed pyuria and positive urine culture and who had voluntarily agreed to enter the study were enrolled. Subjects whose urine culture had multiple bacteria growth that was deemed to be contaminants were excluded from the study. Results: The mean age for males with LUTO was 62 years. The youngest male with LUTO was aged 2 years whilst the maximum age was 93 years. LUTO due to prostatic hyperplasia was found in 79 (76.7%) men; 23 (22.3%) had LUTO due to urethral stricture and 1 (1.0%) (youngest male). The mean age of patients that had LUTO due to urethral stricture was approximately 39 years. The youngest patient with LUTO due to urethral stricture aged 22 years whilst the maximum age was 72 years. Microbiological results indicated that Escherichia coli caused 53 (51.5%) of urinary tract infection (UTI) due to LUTO; Klebsiella = 23 (22.3%); Staphylococcus aureus = 14 (14.6%); Pseudomonas spp. = 8 (7.8%) Proteus = 2 (2.0%); Citrobacter = 1 (1.0%) and Salmonella spp. =1 (1.0%). Conclusion: The most common cause of lower urinary tract obstruction (LUTO) in Kumasi, Ghana is prostatic hyperplasia and the commonest causative organism of the associated UTI symptom is Escherichia coli.
Highlights
With advancing age, the lower urinary tract becomes an increasingly important source of medical and social con
All the study subjects were in patients who were on short admissions at the accident and emergency unit of Komfo Anokye Teaching Hospital (KATH) as described at the methods section above
Our study showed that patients with lower urinary tract infection (UTI) and lower urinary tract obstruction (LUTO) came from varied occupational background
Summary
The lower urinary tract becomes an increasingly important source of medical and social con-. Ment of bladder outlet obstruction (BOO), the disease still remains a major clinical problem in most developing countries including Ghana. Lower urinary tract symptoms (LUTS) are common in elderly men and have a negative impact on quality of life. Bladder outlet obstruction can occur in both women and men, the condition is most common in older men. There are unique risk factors for the development of UTI among men, which include urinary stasis from bladder outlet obstruction (BOO) due to benign prostatic hyperplasia, instrumentation such as cystoscopy and catheterization [10]. To the best of our knowledge the causes of BOO in males with associated symptoms like the urinary tract infections at KATH, Kumasi, Ghana has not yet been reported. This study was set out to establish the commonest pathology precipitating BOO and the associated symptoms at KATH, Kumasi, Ghana
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