JAMES MENSAH

Uretero-vesical anastomosis is the connection of the ureter to the urinary bladder at a new site to achieve unimpeded flow of urine from the ureters into the urinary bladder. A rare complication of this procedure is the development of stricture at the anastomotic site. This report is on a 62-yr. old female with one year history of left flank pain and a prior left uretero-vesical anastomosis done 14 years earlier. She had been managed for recurrent urinary tract infections, but the left flank pain was persistent. Abdominal and pelvic CT scan with intravenous urogram helped establish the diagnosis of uretero-vesical anastomotic stricture. This was successfully managed with endoscopic dilatation after retrograde placement of guide wire under fluoroscopy followed by serial dilation. In a patient presenting with flank pains after a previous uretero-vesical anastomosis, stricture at the anastomotic site is an important differential diagnosis. Endoscopic management is the preferred initial...

Although prostate cancer is the leading cause of cancer mortality for African men, the vast majority of known disease associations have been detected in European study cohorts. Furthermore, most genome-wide association studies have used genotyping arrays that are hindered by SNP ascertainment bias. To overcome these disparities in genomic medicine, the Men of African Descent and Carcinoma of the Prostate (MADCaP) Network has developed a genotyping array that is optimized for African populations. The MADCaP Array contains more than 1.5 million markers and an imputation backbone that successfully tags over 94% of common genetic variants in African populations. This array also has a high density of markers in genomic regions associated with cancer susceptibility, including 8q24. We assessed the effectiveness of the MADCaP Array by genotyping 399 prostate cancer cases and 403 controls from seven urban study sites in sub-Saharan Africa. We find that samples from Ghana and Nigeria cluster...

Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostate cancer in Africa, focusing on building strategic and operational capacity. Applying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical center-specific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics. The PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local...

The aim of this study was to investigate urinary tract infections among patients with Bladder Outlet Obstruction (BOO) at the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana, including the prevalence, risk factors, aetiological agents and their antibiogram. Urine specimens were collected from 188 male patients presenting with BOO and cultured for bacteria. The bacterial isolates were identified using standard microbiological methods and tested against a spectrum of antimicrobial agents using the Kirby Bauer method. Demographic information and the clinical history of study participants were also recorded. The prevalence of urinary tract infection among the BOO patients was 76.6% and the main risk factor identified was catheterization ( < 0.0001). A wide range of bacterial organisms was isolated from urine specimens and they were predominantly, Enterobacteriaceae; was the most frequent cause of bacteriuria (33.3%), followed by (17.3%). Bacterial isolates were most resistant to Au...

Purpose Data on prostate cancer (PCa) treatment in Africa remains under-reported. We present a review of the management of PCa at the cancer center of the largest tertiary referral facility in Ghana, with emphasis on curative treatment. Methods We retrospectively reviewed data on 1,074 patients seen at the National Center for Radiotherapy and Nuclear Medicine from 2003 to 2016. Patient and disease characteristics at presentation are presented using descriptive statistics. The χ and Fisher's exact tests and Mann-Whitney U test were used to analyze differences between categorical and continuous variables, respectively. Methods of survival analysis were used to evaluate the relative risk of biochemical disease-free survival (bDFS). Results Seventy percent of the study population presented with localized disease. High-risk disease presentation accounted for 64.4% of these patients. Only 57.6% of patients with localized disease received curative radiotherapy. The 5-year overall survi...

ABSTRACT Urethral stricture is a common cause of morbidity and sometime mortality in West Africa. A variety of investigative tool and techniques are currently available to evaluate and manage this condition. Major urological societies have issued evidence based guidelines for the evaluation and management of this disease. In Ghana and West Africa the resources available in the developed world may not be available. The patient population is different with most patients presenting with complications like acute urinary retention. Therefore evidence based guidelines may not be strictly adhered to. We performed a retrospective audit of the evaluation and management of urethral stricture at Korle Bu Teaching hospital in Accra Ghana between November 2011 and November 2012 and compared our findings with published studies from the sub region. Post inflammatory strictures predominate but the percentage is decreasing due to the rapid increase in the incidence of pelvic fracture urethral injury. To reduce the cost of investigation a thorough history and physical examination is essential, imaging tests performed are those that will influence management plan. Although urethrotomy and dilatation are not curative, patients who otherwise would have benefited from urethroplasty are still offered repeated urethrotomy because of lack of theatre space and trained surgeons to perform urethroplasty. For the same reason many patients in the sub region spend many months to years with a suprapubic catheter.

The prevalence of TMPRSS2-ERG fusions in prostate cancer varies by race. However, such somatic aberration and its association with prognostic factors have neither been studied in a West African population nor been systematically reviewed in the context of racial differences. We used immunohistochemistry to assess ERG expression as the established surrogate of ERG fusion genes among 262 prostate cancer biopsies from the Ghana Prostate Study. Poisson regression with robust variance estimation provided prevalence ratios and 95% confidence intervals of ERG expression in relation to patients' characteristics. We found 47 of 262 (18%) prostate cancers were ERG-positive, and negative ERG staining was associated with higher Gleason score. We further conducted a systematic review and meta-analysis of TMPRSS2-ERG fusions in relation to race, Gleason score, and tumor stage, combining results from Ghana with 40 additional studies. Meta-analysis showed the prevalence of TMPRSS2-ERG fusions i...

The objective of this study was to analyze nephrectomies performed in adults over a 12-year period at the Korle Bu Teaching Hospital, Accra and to compare our findings with reports from other institutions. In this retrospective study, medical records of 97 consecutive adult patients who underwent nephrectomy from January 2000 to December 2011 were reviewed. The parameters extracted included the patients' age, gender, indication for nephrectomy and the side of nephrectomy. Also considered were the histology of the nephrectomy specimen and the peri-operative mortality. The data were analyzed using the Statistical Package for Social Sciences for Windows (Version 19.0). Of the 97 nephrectomies performed, 62 were performed for suspected malignant renal tumors and 35 were performed for clinically benign renal conditions. Malignancy was confirmed in 85.5% (53/62) of the suspected cases. The mean age of this group was 52.2 ± 15.5 years and the male to female ratio was 1:0.9. Thirty-two tumors (60.4%) were in the right kidney and 21 (39.6%) tumors were in the left kidney; the mean tumor size was 16.8 ± 4.0 cm. The predominant presenting complaints included flank pain (67.9%), flank mass (50.9%) and hematuria (24.5%). In one case (1.9%), the renal mass was found incidentally. Among patients who had benign disease, non-functioning kidney due to renal cystic disease was the most common lesion (11/44; 25.0%). A peri-operative mortality rate of 3.1% was recorded. Our study suggests that malignant renal tumors constitute the main indication for nephrectomy in our institution. Non-functioning kidney due to renal cystic disease was the most common benign renal indication for nephrectomy.

Genome-wide association studies (GWAS) have mapped risk alleles for at least 10 distinct cancers to a small region of 63 000 bp on chromosome 5p15.33. This region harbors the TERT and CLPTM1L genes; the former encodes the catalytic subunit of telomerase reverse transcriptase and the latter may play a role in apoptosis. To investigate further the genetic architecture of common susceptibility alleles in this region, we conducted an agnostic subset-based meta-analysis (association analysis based on subsets) across six distinct cancers in 34 248 cases and 45 036 controls. Based on sequential conditional analysis, we identified as many as six independent risk loci marked by common single-nucleotide polymorphisms: five in the TERT gene (Region 1: rs7726159, P = 2.10 × 10(-39); Region 3: rs2853677, P = 3.30 × 10(-36) and PConditional = 2.36 × 10(-8); Region 4: rs2736098, P = 3.87 × 10(-12) and PConditional = 5.19 × 10(-6), Region 5: rs13172201, P = 0.041 and PConditional = 2.04 × 10(-6); a...