Bio

Publications


2010

Magoha, GAO, Ngugi PM, Kiptoon D.  2010.  Urolithiasis in Nairobi, Kenya. East African Medical Journal. 87(10) AbstractNCBI

Background: Urolithiasis is an emerging problem in Kenya previously thought to be very rare and in which the use of modern methods of treatment has not been widely practiced
Objective: To review the presentation and management of patients presenting with urolithiasis in Nairobi, Kenya
Design: A retrospective study Setting: The Nairobi hospital and Upper Hill Medical Centre a day care facility next to the Nairobi hospital
Subjects: One hundred and twenty five males and fifty three females aged 9 to 75 years
Results: One hundred and seventy eight patients were treated for urolithiasis over a five-and- half year period. Their mean age was 44.8 years, and the median was 45 years The 178 patients required 262 procedures to achieve stone clearance. One hundred and two patients had ESWL, with an overall stone clearance rate of 95%. Twentythree
patients had PCNL; 18 as the first procedure and 5 after failed ESWL. Fifty-one patients had ureteroscopic
Management: Fourty seven had laser or pneumatic lithotripsy while four had stone removal by Dormia basket. Seven patients had bladder calculi managed by either cystolitholapaxy or forceps retrieval.
Conclusions: This study demonstrates a higher annual incidence of urolithiasis in Nairobi than earlier literature. Study demonstrates that ESWL and ureteroscopic methods are highly effective in the treatment of renal and ureteral calculi as day care procedures.

2007

Krieger, JN, Bailey RC, Opeya J, Ayieko B, Ndinya-Achola JO, Magoha GA.  2007.  Adult male circumcision outcomes: experience in a developing country setting. Website
Mogoha, GAO.  2007.  Testicular Injuries. . East Afr Med J. . 84(8):353-5. Abstract

In recent years, several reports have underlined the possible existence of chronic appendicitis. Up to 38% of spontaneously resolving acute appendicitis may recur. We studied 41 patients operated on between July 2000 and June 2001 for chronic and recurrent appendicitis at a teaching hospital in the city of Nairobi. The patients comprised 17.8% of all patients undergoing surgery for appendicitis during the study period. The majority (65.9%) were females. The faecolith rate was 51.2%. About half of appendices removed for these symptoms were normal at histology. Nearly 70% of the normal appendices contained faecoliths. Symptoms resolved in 90% of faecolith-containing appendices and 87.5% of non-faecolith-containing appendices that were normal on histology.

Magoha, GAO.  2007.  Early postoperative outcomes of patients undergoing prostatectomy for benign prostatic hyperplasia at Kenyatta National Hospital, Nairobi. East African Medical Journal . 84(9) Abstract

Objective: To describe early postoperative complications of prostatectomy. Design: A descriptive prospective study. Setting: Kenyatta National Hospital between 6thOctober 2003 and 21s1June 2004. Subjects: Eighty five men undergoing prostatectomy for the relief of lower urinary tract obstruction due to benign prostatic hyperplasia. Procedures included suprapubic transvesical prostatectomy, retropubic prostatectomy and transurethral resection of the prostate (TURP).
Main outcome measures: Co-morbidity, intra-operative and early postoperative complications, need for re-operation, 30-day mortality, duration of postoperative catheterisation, and duration of postoperative hospital stay. Results: Eighty five patients were included in the study and their age range was 46-85 years (mean 66 years). Sixty nine (81%) of the patients underwent open prostatectomy, and sixteen (19 %) underwent TURP. Twenty six patients had co-existing medical conditions, the most common being hypertension (29%) and diabetes mellitus (13%). The most common intra-operative complication during prostatectomy was haemorrhage which occurred in ten patients (11.8 %). One patient had perforation of the bladder during transurethral resection and required a laparotomy to repair the bladder. Wound sepsis was the most common postoperative complication following open prostatectomy (35 %

Magoha, GAO.  2007.  Descriptive case series of patients presenting with cancer of the prostate and their management at Kenyatta National Hospital. ;East African Medical Journal . Vol 84(No. 9 ) Abstract

Objective : To study clinical prostate cancer in this locality with particular interest in incidence, clinical presentation and treatment.
Design: A descriptive prospective study.
Setting: Kenyatta National Referral and Teaching Hospital affiliated to College of Health Sciences of the University of Nairobi between November 1998 and October 1999.
Patients: Sixty five patients with clinical prostate cancer were included in the study.Results: Age was reliably confirmed in 64 out of the 65 patients. 87.5 % of the patients were aged over 61 years with a peak incidence in the 66-70 year age group and a mean age of 67 years. Crude hospital incidence of 76.5 patients per 100,000 patients and a crude hospital death rate of 5.8 patients per 100,000 patients is reported. The majority of patients (87.5%) presented late with advanced disease stages III(C) and IV(D) prostate cancer.
Conclusion: The crude hospital incidence of cancer of the prostate is on the increase in this locality with a finding of76.5 per hundred thousand patients, higher than that reported by earlier researchers in this locality and elsewhere. This study suggests that prostate cancer incidence and the magnitude of risk in our locality must have been grossly underestimated in the past. The prostate cancer rate in Kenyans may be as great as noted in black men in the United States, Jamaica, Nigeria and Cameroon which may suggest some common enhancing genetic predisposition. There is need to further investigate this phenomenon. Cancer of the prostate in this locality presents late with clinically advanced disease.

Magoha, GAO.  2007.  The Management of Early Prostate Cancer: A Review.. East African Medical Journal. Vol 84 (No. 9) Abstract

Objective: To carry out a review of the management of early (clinically localised) prostate cancer.
Data Source: Review of all published literature on the management of early prostate cancer was carried out through medline and index medic us searches.
Data Selection: Published data of the management of early prostate cancer over the last three decades were included in the review.
Data Extraction: Abstracts of articles identified were assessed, read and analysed to determine their relevance to the title under review.
Data Synthesis: After establishing relevance from the abstract, the entire paper was read, and the significant points included in the review.
Conclusion: Greater number of men are currently being diagnosed with early prostate cancer. This is due to widespread use of Prostate Specific Antigen (PSA) screening available worldwide. Radical treatment including radical prostatectomy and radical radiation therapy have proven curative value for a significant number of men with localised disease. Survival outcomes indicate that radical prostatectomy offers more reliable cure than radiation therapy for clinically localised disease.

Immediate treatment related morbidity of radical prostatectomy and radiation therapy is currently quite low. Both treatment methods have similar impact on erectile function and continence. Rectal complications are however unique to radiation therapy. Surgical and radiation therapy delivery techniques should be further improved to reduce treatment related morbidity and quality of life outcomes.

Magoha, GAO.  2007.  Overview of prostate cancer in indigenous black Africans and blacks of African ancestry in Diaspora. East African Medical Journal :. Vol 84 No. 9 (Supplement) Abstract

Objective: To carry out an overview of prostate cancer in indigenous back Africans in sub-Saharan Africa and blacks of African ancestry in diaspora.
Data Source: Review of all published literature on prostate cancer on indigenous black Africans and Africans in diaspora was carried out through medline and index medicus searches.
Data Selection: Published data of prostate cancer in indigenous black Africans and black men in diaspora from 1935-2007 were included in the review.
Data Extraction: Abstracts of articles identified were assessed, read and analysed to determine their possible suitability and relevance to the title under review.
Data Synthesis: After establishing relevance from the abstract, the entire paper was read, and the significant points included in the review.
Conclusion: Prostate cancer incidence and magnitude in black Africans was grossly misunderstood and underestimated in the past. Prostate cancer incidence is on the increase and currently is perhaps the most common urological malignancy affecting black Africans. Its incidence and clinical characteristics is similar to that of the Africans in diaspora but different from all other races. There currently exists significant evidence which suggests a common enhancing genetic predisposition in black men to prostate cancer. There is very urgent need for further investigation of this phenomenon through randomised controlled muIticentre studies involving indigenous black Africans and black men in diaspora.

Magoha, GAO.  2007.  Aetiology, diagnosis and management of haemospermia. East Afr Med J. 2007 . (Dec;84(12):):589-94.. Abstract

To provide an overview of the aetiology, investigations and the various treatment methods currently available in the management of haemospermia. DATA SOURCE: Review of literature was effected through medline and index medicus search of major published indexed journals and books. DATA SELECTION: Published data on haemospermia, hemospermia, haematospermia and semen over the last five decades (1967-2007) were utilised. DATA EXTRACTION: Abstracts of selected articles were read and analysed to determine their possible contribution and relevance to this article. DATA SYNTHESIS: All relevant articles were reviewed in full and contribution extracted for this review as necessary. CONCLUSION: Haemospermia (haematospermia) is a relatively frequent, distressing and frightening symptom in sexually active men. It is usually a benign self-limiting condition resolving within several weeks except for the few with underlying aetiology including prostate malignancy and idiopathic. Patients presenting with haemospermia should have a detailed medical history, physical examillation including blood pressure measurement, genital and digital rectal examination. Persistent and recurrent haemospermia is best investigated by TRUS, CT, MRI, urethrocystoscopy, and biopsy and histological confirmation of malignancies. Specific treatment depends on the underlying pathological cause but often involves only minimal investigations and simple reassurance

Magoha, GAO.  2007.  Prostate cancer. East Afr Med J. . :84.

2006

Magoha, GAO.  2006.  Science Technology and Innovation for Africa's development. Journal of Discovery and Innovation . 18(3):269-274. Abstract

To provide an overview of the aetiology, investigations and the various treatment methods currently available in the management of haemospermia. DATA SOURCE: Review of literature was effected through medline and index medicus search of major published indexed journals and books. DATA SELECTION: Published data on haemospermia, hemospermia, haematospermia and semen over the last five decades (1967-2007) were utilised. DATA EXTRACTION: Abstracts of selected articles were read and analysed to determine their possible contribution and relevance to this article. DATA SYNTHESIS: All relevant articles were reviewed in full and contribution extracted for this review as necessary. CONCLUSION: Haemospermia (haematospermia) is a relatively frequent, distressing and frightening symptom in sexually active men. It is usually a benign self-limiting condition resolving within several weeks except for the few with underlying aetiology including prostate malignancy and idiopathic. Patients presenting with haemospermia should have a detailed medical history, physical examillation including blood pressure measurement, genital and digital rectal examination. Persistent and recurrent haemospermia is best investigated by TRUS, CT, MRI, urethrocystoscopy, and biopsy and histological confirmation of malignancies. Specific treatment depends on the underlying pathological cause but often involves only minimal investigations and simple reassurance.

2005

Magoha, GAO, Jani GP.  2005.  Management of Haemorrhoids. Journal of Discovery and Innovation . 18(3):269-274. Abstract

Management of Haemorrhoids – A local experirnce; East and Central African Journal of Surgery, submitted for publication. To be published in their December 2005 issue.

Magoha, GAO.  2005.  Appendicitis at Kenyatta National Hospital, Nairobi. . East Afr Med J. . 82(10):526-30. Abstract

BACKGROUND: Appendicitis still remains a diagnostic challenge particularly in women and extremes of age. The incidence of appendicectomy for suspected appendicitis is higher but declining in the developed countries in contrast with a low but increasing incidence in Africa. OBJECTIVE: To describe the characteristics of appendicitis at Kenyatta National Hospital, with emphasis on epidemiological oddities. DESIGN: A prospective descriptive study. SETTING: Kenyatta National Hospital, a 2000 bed teaching and referral hospital in Nairobi, Kenya SUBJECTS: One hundred and eighty nine patients managed for suspected acute appendicitis between July 2000 and June 2001. RESULTS: There were 116 males and 73 females. The peak incidence was in the third decade. Sixty four percent of patients were below 30 years of age. The elderly (< 60 years of age) accounted for 1.6% of cases. The rate of false appendicectomy was 18.0%. This rate of negative appendicectomies was 12.9% for males and 30.1% for females. The rate of perforation/gangrene was 29.7%. Hospital stay averaged 6.4 days. Overall morbidity was 12.3%. It was 19.4% in perforated appendicitis and 7.6% in non-perforated appendicitis. There was no mortality. CONCLUSION: The incidence of appendicitis has increased at Kenyatta National Hospital over the last 30 years. The disease is common in men in their third decade. These odd characteristics warrant further investigations.

Magoha, GAO.  2005.  Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya. British Journal of Urology. 96:1109-1113. Abstract

OBJECTIVE: To provide an overview of the current global status of female genital mutilation (FGM) or female circumcision practised in various countries. DATA SOURCE: Major published series of peer reviewed journals writing about female genital mutilation (FGM) over the last two decades were reviewed using the index medicus and medline search. A few earlier publications related to the FGM ritual as practised earlier were also reviewed including the various techniques and tools used, the "surgeons or perpetrators" of the FGM ritual and the myriad of medical and sexual complications resulting from the procedure. Global efforts to abolish the ritual and why such efforts including legislation has resulted in little or no success were also critically reviewed.
CONCLUSION: FGM remains prevalent in many countries including African countries where over 136 million women have been 'circumcised' despite persistent and consistent efforts by various governments, WHO and other bodies to eradicate the ritual by the year 2000 AD. This is as a result of deep rooted cultures, traditions and religions. Although FGM should be abolished globally, it must involve gradual persuasion which should include sensitisation and adequate community-based educational and medical awareness campaign. Mere repression through legislation has not been successful, and women need to be provided with other avenues for their expression of social status approval and respectability other than through FGM.

Magoha, GAO.  2005.  Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya. . British Journal of Urology: Vol. 96: 1109-1113, 2005.. 96:1109-1113.: EAMJ Abstract

OBJECTIVE: To provide an overview of the current global status of female genital mutilation (FGM) or female circumcision practised in various countries. DATA SOURCE: Major published series of peer reviewed journals writing about female genital mutilation (FGM) over the last two decades were reviewed using the index medicus and medline search. A few earlier publications related to the FGM ritual as practised earlier were also reviewed including the various techniques and tools used, the "surgeons or perpetrators" of the FGM ritual and the myriad of medical and sexual complications resulting from the procedure. Global efforts to abolish the ritual and why such efforts including legislation has resulted in little or no success were also critically reviewed.
CONCLUSION: FGM remains prevalent in many countries including African countries where over 136 million women have been 'circumcised' despite persistent and consistent efforts by various governments, WHO and other bodies to eradicate the ritual by the year 2000 AD. This is as a result of deep rooted cultures, traditions and religions. Although FGM should be abolished globally, it must involve gradual persuasion which should include sensitisation and adequate community-based educational and medical awareness campaign. Mere repression through legislation has not been successful, and women need to be provided with other avenues for their expression of social status approval and respectability other than through FGM.

2004

Magoha, GAO.  2004.  Urological Foot Prints in Kenya: "That Water May Flow": A story about Male Genital Cancer and Dysfunction. Journal of Discovery and Innovation. . 16:5-19. Abstract

The main thrust of my Urological research has been on genital cancer (penis, prostate and testis), torsion of the testis and erectile dysfunction. This lecture will focus on these although I have also researched on many other Urological topics in this locality including chronic prostititis (Magoha, 1996), Scrotal gangrene (Ayumba and Magoha 1998), renal transplantation (Rowe and Magoha 1987, Magoha and Ngumi 2001) and autologous blood transfusion (Magoha et al 2001 among others. The immediate environmental impact of my research works on genital cancer and dysfunction has resulted not only the free flow of water, but the free flow of knowledge from one doctor to another within this country and beyond. These are my Urological footprints in Kenya which I hope have made modest but significant contribution to the surgical history of this country and locality 'that water may flow'.

2001

Magoha, GAO, Ngumi ZW.  2001.  Renal transplantation during the twentieth century. East Afr Med J. . 78(6)::317-21. Abstract

OBJECTIVES: To provide an overview of the various advancements and problems associated with both live and cadaver donor renal allograft transplantation during the twentieth century.
DATA SOURCE: Major published reviews on renal transplantation during the the last five decades of the twentieth century were reviewed using Medline internet search and the Index Medicus. The developments in immunosuppressive therapy associated with renal transplantation, the problem of the shortage of both live and cadaveric organ donors and post-transplant complications were examined. The future of renal transplantation including cross species transplantation (xenotransplantation) is discussed.
CONCLUSION: Renal transplantation has evolved over the years to become a very successful and routine procedure. However, the transplant waiting lists have remained long due to a continuously shrinking kidney donor pool which is due to improved results of neurosurgical procedures, better emergency and intensive care services and the failure to adequately prevent and treat post transplant chronic renal failure.

Magoha, GAO.  2001.  Sterilisation and disinfection of Instruments used in Urology. Nosocomial and Health Care Associated Infections in Urology. :121-150. Abstract

The last two decades have seen a phenomenal increase in the number of urological endoscopic and laparoscopic procedures. An increasing number of operations are now being performed using minimally invasive techniques and consequently it is infeasible to provide one instrument for each patient on the operating list. With the advent of minimally invasive urology the variety of endoscopes and accessories available have also multiplied. However these instruments are costly and many of them are designed for single use. This poses a problem in developing countries where cost containment is imperative. Ideally a single use item should not be reused and reprocessed unless the reprocessor is able to apply and observe all the stringent technical requirements necessary to ensure the integrity and safety in the re-processed item. Patient to patient transmission of infection has been documented after improper disinfections of urological equipment. With increasing workloads in urologic endoscopy and laparoscopy, the need for stringent guidelines for cleaning and disinfection of urological instruments is important in the prevention of health care associated infections. The methods of disinfection, chosen must relate to the risks of infection associated with particular procedure, the availability and affordability of the cleaning, disinfection decontamination and sterilization equipment, the time available for reprocessing. This review will commence with a brief review of sterilization and disinfection processes used for single and multi-use medical devices and instruments employed in urological practice. Industry and hospital standards will be discussed with the emphasis on the outcome for the patient in developed and developing countries. A short discussion of new material in the R & D pipeline will be included with a view to sterilization and disinfection processes in the future. The transmission of infectious organisms is widespread within a hospital or medical office setting. In countries such as many in the African continent, AIDS is so prevalent that risk of contamination of instruments and devices used on patients is very high. Therefore, it is critical that staff responsible for cleaning, disinfecting and sterilizing equipment used in urological and general surgical practise, be well-trained, diligent and thorough. This means ensuring that each device used on every patient has been reliably sterilized. Furthermore, it is essential that proper methodologies be used to process instruments and devices, and that process monitoring be carried out on a continual basis. Manufacturers of devices and instruments need to consider short term and long-term costs for sterilization and disinfection processors. This includes examining whether certain single use devices can in fact be reused under some conditions. While government agencies must regulate and monitor processes, it would be helpful if a United Nations type consensus was created. This would help manufacturers in the global market-place, and would likely make it easier for practitioners to operate.

Magoha, GAO, Afulo OK, Mwanda WO.  2001.  Autologous transfusion in surgical patients at Kenyatta National Hospital, Nairobi. East Afr Med J. . 78(11):564-7. Abstract

OBJECTIVE: To identify autotransfusion strategies and their basis in elective surgery patients. DESIGN: A cross sectional prospective study. SETTING: General surgery and orthopaedic wards, Kenyatta National Hospital, Nairobi. SUBJECTS: Adult patients of both sexes planned for elective surgery. MAIN OUTCOME MEASURE: Forevery patient, the following were enquired about and documented: age in years, sex, ethnicity, religion, occupation and educational standard. Blood values of haemoglobin, platelet counts, total and differential white cell counts, urea, electrolytes and liver function tests were assayed. Others were the number of units of blood donated before the operation, the type of surgery performed, time taken from diagnosis to performing the operation and whether the blood was transfused preoperatively, intraoperatively and postoperatively. RESULTS: A total of sixty three cases constituting five per cent of all surgical patients admitted during the period of study were evaluated. Of these 53 (84%) were males and ten (16%) females. The age range was 15 to 65 years with a peak at 45-49 years. There were more Christians (90%) than Muslims (10%). In all, 32 (51.6%) had primary school education, 23 (36.5%) secondary school education, seven (11.3%) no formal education and one (1.6%) had attained college level. Employment pattern showed 50% were civil servants, 30% were self employed and 20% were unemployed. The duration of disease ranged from 1-24 weeks with two peaks at two weeks and six weeks. Orthopaedic cases constituted 78.7% and general surgery 21.3%. Preoperative haemoglobin ranged from 13.5-14.2 g/dl. Transfusions were given intraoperatively to 41 (66.1%) and to 12 (33.9%) postoperatively. Mean duration of hospitalisation was 13 days (range 5 to 21 days). 98.4% deposited only one unit while 1.6% deposited four units of blood. Only one patient required additional transfusion from homologous donors. CONCLUSION: The strategies and basis for autotransfusion have been demonstrated among a majority of adult patients requiring orthopaedic procedures. Major determinants are shown to be baseline blood count profiles and time to operation.

Magoha, GAO.  2001.  Sterilisation and disinfection of Instruments used in Urology:. In Nosocomial and Health Care Associated Infections in Urology pages 121-150, Eds. Naber K.G., Pechere J.C., Kumizawa J., Khoury S., Gerberding J.L., and Schaeffer A.J., WHO and IUCC Health Publication 2001. : EAMJ Abstract

The last two decades have seen a phenomenal increase in the number of urological endoscopic and laparoscopic procedures. An increasing number of operations are now being performed using minimally invasive techniques and consequently it is infeasible to provide one instrument for each patient on the operating list. With the advent of minimally invasive urology the variety of endoscopes and accessories available have also multiplied. However these instruments are costly and many of them are designed for single use. This poses a problem in developing countries where cost containment is imperative. Ideally a single use item should not be reused and reprocessed unless the reprocessor is able to apply and observe all the stringent technical requirements necessary to ensure the integrity and safety in the re-processed item. Patient to patient transmission of infection has been documented after improper disinfections of urological equipment. With increasing workloads in urologic endoscopy and laparoscopy, the need for stringent guidelines for cleaning and disinfection of urological instruments is important in the prevention of health care associated infections. The methods of disinfection, chosen must relate to the risks of infection associated with particular procedure, the availability and affordability of the cleaning, disinfection decontamination and sterilization equipment, the time available for reprocessing. This review will commence with a brief review of sterilization and disinfection processes used for single and multi-use medical devices and instruments employed in urological practice. Industry and hospital standards will be discussed with the emphasis on the outcome for the patient in developed and developing countries. A short discussion of new material in the R & D pipeline will be included with a view to sterilization and disinfection processes in the future. The transmission of infectious organisms is widespread within a hospital or medical office setting. In countries such as many in the African continent, AIDS is so prevalent that risk of contamination of instruments and devices used on patients is very high. Therefore, it is critical that staff responsible for cleaning, disinfecting and sterilizing equipment used in urological and general surgical practise, be well-trained, diligent and thorough. This means ensuring that each device used on every patient has been reliably sterilized. Furthermore, it is essential that proper methodologies be used to process instruments and devices, and that process monitoring be carried out on a continual basis. Manufacturers of devices and instruments need to consider short term and long-term costs for sterilization and disinfection processors. This includes examining whether certain single use devices can in fact be reused under some conditions. While government agencies must regulate and monitor processes, it would be helpful if a United Nations type consensus was created. This would help manufacturers in the global market-place, and would likely make it easier for practitioners to operate.

2000

Magoha, GAO, Z.W.Ngumi.  2000.  Cancer of the penis at Kenyatta National Hospital. . East Afr Med J.. 77(10):526-30. Abstract

OBJECTIVES: To determine how common cancer of penis is in this locality compared to all other malignant tumours and urological malignancies, and to determine and comment on the various methods of treatment available at KNH.
DESIGN: A retrospective case study.
SETTING: Kenyatta National Referral Hospital, Nairobi.
SUBJECTS: All patients with histologically confirmed cancer of penis at the Kenyatta National hospital between January 1970 and December 1999.
RESULTS: There were 55 patients with penile cancer representing 0.1% of all malignancies during the study period. The mean age was 47.9 years with a peak incidence between 40-61 year age groups. Penile cancer was the most rare urological tumour representing 5.1%. The most common was prostate cancer (56.0%), followed by bladder cancer (25.0%), kidney cancer (7.9%), and testicular cancer (6.1%). Thirty eight patients (69.1%) presented with advanced disease, Jacksons stages III and IV. The majority (96.4%) of the patients had glandular and preputial involvement. Histologically, 56.4% had well differentiated squamous cell carcinoma, (23.6%) had moderately differentiated and (20.0%) had undifferentiated carcinoma. Forty patients (72.7%) were circumcised, nine patients (16.4%) were circumcised as adolescents and three patients (5.5%) circumcised as adults. Twenty five patients had partial penectomy with radiotherapy and or chemotherapy. Eight patients had total penectomy and radiotherapy while four patients had local excision and radiotherapy. Eleven other patients had radiotherapy either alone or combined with chemotherapy. Two patients had circumcision only and inguinal lymphadenectomy was effected on five patients after penectomy and radiotherapy.
CONCLUSION: Penile cancer is rare and the least common urological malignancy in this locality. It occurs in younger men with a mean age of 47.9 years, and presents as advanced Jackson's stages III and IV disease. The majority of patients had penectomy and local excision followed by radiotherapy.

Magoha, GAO.  2000.  Management and survival in advanced prostate cancer in Nairobi. East Afr Med J.. 77(5):260-3. Abstract

OBJECTIVE: To evaluate the management and survival of patients with advanced prostate cancer in this locality. DESIGN: A prospective case study. SETTING: Kenyatta National Referral Hospital and the Nairobi and Mater Hospitals. PATIENTS: Fifty nine patients with advanced cancer of prostate (extra prostatic locally advanced and metastatic cancer). RESULTS: Transperineal trucut needle biopsies of the prostate revealed 15 patients (25.42%) had poorly differentiated cancers with Gleasons scores greater than 7. Fifteen patients (25.42%) had moderately differentiated cancers with Gleason scores of 6; and twenty nine other patients (49.2%) had well differentiated cancers with Gleason scores of 4 and below. Surgical castration was effected on 15 patients four of whom also had 50 mg of oral bicalutamide (casodex) daily. Thirty six patients were treated with subcutaneous goserelin (zoladex) depot 3.6 mg every 28 days. Ten of these patients also had 50 mg oral casodex daily in addition to the zoladex. Three patients in this group also had external radiotherapy for severe bone pains. Only eight patients were treated with oral diethylstilboestrol 3 mg daily. All the 15 patients with undifferentiated cancers died within 12 months. Of the 22 patients surviving at 48 months irrespective of the method of treatment, 20 of them had well differentiated cancers with Gleasons scores of 4 or less. CONCLUSION: Survival in the undifferentiated and poorly differentiated prostrate cancer Gleasons grades 4 and 5 with a score of over 7 is poor irrespective of the mode of treatment as all the patients in this group were dead within 12 months of diagnosis. Twenty patients (90.90%) of the surviving patients at 48 months had well differentiated cancers Gleasons grades 1 and 2 with scores of 4 or less indicating better prognosis for these tumours which are known to be slow growing with a much longer tumour doubling time.

East Afr Med J. 2000 May;77(5):260-3.

Magoha, GAO, Magoha OB.  2000.  Current global status of female genital mutilation. East Afr Med J. . 77(5):268-72. Abstract

OBJECTIVE: To provide an overview of the current global status of female genital mutilation (FGM) or female circumcision practised in various countries. DATA SOURCE: Major published series of peer reviewed journals writing about female genital mutilation (FGM) over the last two decades were reviewed using the index medicus and medline search. A few earlier publications related to the FGM ritual as practised earlier were also reviewed including the various techniques and tools used, the "surgeons or perpetrators" of the FGM ritual and the myriad of medical and sexual complications resulting from the procedure. Global efforts to abolish the ritual and why such efforts including legislation has resulted in little or no success were also critically reviewed. CONCLUSION: FGM remains prevalent in many countries including African countries where over 136 million women have been 'circumcised' despite persistent and consistent efforts by various governments, WHO and other bodies to eradicate the ritual by the year 2000 AD. This is as a result of deep rooted cultures, traditions and religions. Although FGM should be abolished globally, it must involve gradual persuasion which should include sensitisation and adequate community-based educational and medical awareness campaign. Mere repression through legislation has not been successful, and women need to be provided with other avenues for their expression of social status approval and respectability other than through FGM.

Magoha, GAO.  2000.  Sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi.. East Afr Med J. 77(2):76-9. Abstract

OBJECTIVE: To evaluate the effectiveness of sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi. DESIGN: Prospective open label extension study. SETTING: Urology clinics at the Nairobi Hospital, Kenyatta National Hospital and the author's private clinic in Hurlingham, Nairobi. PARTICIPANTS: Two hundred and nineteen adult male patients with erectile dysfunction. RESULTS: The age range was 33-80 years with a mean of 62.5 years and a peak incidence in the 60-69 year age group. One hundred and nineteen patients (54.34%) had organic causes, 85 patients (38.81%) had psychogenic causes and 15 patients had mixed causes. Two hundred patients (91.32%) had improved sexual function after treatment with viagra. This improvement was sustained during the study period of sixteen weeks and included improved erectile and orgasmic functions and overall sexual satisfaction. One hundred and fifty seven of these patients responded to therapy with 50 mg of viagra; 40 patients with 25 mg and three patients with 100 mg of therapy. Nineteen patients (8.68%) had no improvement in sexual function after viagra administration. Seven patients (3.2%) had adverse effects which were mild and transient. They included mild headaches in three patients, mild dyspepsia in two patients and facial flushing and nausea and vomiting in one patient, respectively. CONCLUSION: Oral sildenafil (Viagra) is an effective well tolerated and simple treatment for male erectile dysfunction in the majority of cases. The cost of treatment at about ten United States dollars for the 50 mg tablet is prohibitive and may limit its wide use by many deserving patients in this locality.
PIP: This prospective open-label extension study was carried out to evaluate the effectiveness of sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi, Kenya. A total of 219 adult male patients with erectile dysfunction were instructed to take 50 mg, 25 mg, or 100 mg of sildenafil orally 1 hour prior to planned sexual activity, but not more than once every 24 hours. Patients were reviewed at 4-week intervals for 16 weeks to assess the efficacy and adverse effects of the drug. The age range was 33-80 years with a mean of 62.5 years and a peak incidence in the 60-69 year age group. The causes of erectile dysfunction were organic (n = 119, 54.34%), psychogenic (n = 85, 38.81%), and mixed (n = 15). 200 patients (91.32%) had improved sexual function after treatment with Viagra. This improvement included improved erectile and orgasmic functions and overall sexual satisfaction. 157 patients responded to the 50-mg treatment regimen; 40, to the 25-mg regimen; and 3, to the 100-mg regimen. No improvement in sexual function was reported in 19 patients (8.68%) after Viagra administration. In addition, 7 patients reported mild and transient adverse effects of the drug, including mild headache, dyspepsia, facial flushing, nausea, and vomiting. In conclusion, oral sildenafil (Viagra) is an effective well-tolerated and simple treatment for male erectile dysfunction in the majority of cases. However, the cost of treatment may prohibit and limit its wide use by many deserving patients in this area.

Magoha, GAO, EN Opot.  2000.  Testicular cancer at Kenyatta National Hospital. East African Medical Journal, 77: 80-85, 2000.. 77(2):80-85.: EAMJ Abstract

OBJECTIVE: To determine the prevalence, clinical characteristics, management methods and prognosis of testicular cancer at Kenyatta National Hospital. DESIGN: Retrospective case study of testicular cancer patients over a fifteen year period. SETTING: Kenyatta National Hospital, a referral and teaching hospital. PARTICIPANTS: All histologically confirmed testicular cancer patients recorded at the Histopathology Department of Kenyatta National Hospital between 1983 and 1997. RESULTS: The mean age was 34.8 years with a peak incidence in the 30-44 year age group. History of cryptochirdism was obtained in 10.26% of the patients. Thirty one patients (79.49%) presented with painless testicular swellings, eleven (28.08%) with pain, nine (23.08%) with scrotal heaviness, six (15.38%) with abdominal swellings and one (2.56%) each with gynaecomastia and eye swelling. On examination 32 patients (82.05%) had testicular masses, ten (25.64%) had abdominal masses, seven (17.91%) had supraclavicular and cervical lymphadenopathy, and one each (2.56%) had gynaecomastia and eye mass respectively. More than eighty nine per cent had germ cell cancers with seminoma accounting for 67.35%, teratoma 12.24%, embroyonal carcinoma 8.16%, rhabdomyosarcoma 6.12% and malignant germ cell tumour, orchioblastoma and dysgerminoma each accounted for 2.04%. Three patients (7.7%) had orchidectomy and radiotherapy and chemotherapy, sixteen (41.03%) had orchidectomy and radiotherapy, six (15.38%) had orchidectomy and chemotherapy, ten (25.64%) had radiotherapy and chemotherapy, three (7.7%) and two (5.13%) had only chemotherapy and radiotherapy respectively. No cisplastin based chemotherapy regime was used. Follow up was effected for eighteen patients (46.15%) and seven patients (38.89%) were alive after five years. CONCLUSION: Prognosis with current regimes was poor with survival of only 38.89% after five years. Cisplastin based chemotherapy with up to 90% cure rates should be included as a component of testicular cancer management at Kenyatta National Hospital. PIP: This retrospective study was undertaken to determine the prevalence, clinical characteristics, management methods and prognosis of testicular cancer at Kenyatta National Hospital, Nairobi. All histologically confirmed testicular cancer patients recorded at the Histopathology Department between 1993 and 1997 were analyzed. The mean age was 34.8 years with a peak incidence in the 30-44 year age group. About 10.26% of patients had history of cryptochirdism. The clinical symptoms presented were painless testicular swelling (n = 31, 79.49%), testicular pain (n = 11, 28.08%), scrotal heaviness (n = 9, 23.08%), abdominal swelling (n = 6, 15.38%), gynecomastia (n = 1, 2.56%), and eye swelling (n = 1, 2.56%). On examination, 32 patients (82.05%) had testicular masses, 10 (25.64%) had abdominal masses, 7 (17.91%) had supraclavicular and cervical lymphadenopathy, 1 had gynecomastia, and 1 had an orbital mass. More than 89% of patients had germ cell cancers with seminoma accounting for 67.35%, teratoma for 12.24%, embryonal carcinoma for 8.16%, rhabdomyosarcoma for 6.12%, and malignant germ cell tumor, orchioblastoma, and dysgerminoma each accounting for 2.04%. The various methods of treatment include orchidectomy and radiotherapy and chemotherapy in 3 patients (7.7%), orchidectomy and radiotherapy in 16 patients (41.03%), orchidectomy and chemotherapy in 6 patients (15.38%), and radiotherapy and chemotherapy in 10 patients (25.64%). No cisplatin-based chemotherapy was used. 18 patients were followed up, of whom 7 were alive after 5 years. Prognosis with current regimens was poor, with a 38.89% survival ratio in 5 years. Hence, cisplatin-based chemotherapy with up to 90% cure rates should be included in the testicular cancer management in this hospital.

Magoha, GAO.  2000.  Sildenafil (Viagra) in the management of male erectile dysfunction in Nairobi. . East African Medical Journal, 77: 76-79, 2000.. 77:76-79.: EAMJ Abstract

OBJECTIVE: To evaluate the effectiveness of sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi.
DESIGN: Prospective open label extension study. SETTING: Urology clinics at the Nairobi Hospital, Kenyatta National Hospital and the author's private clinic in Hurlingham, Nairobi.
PARTICIPANTS: Two hundred and nineteen adult male patients with erectile dysfunction.
RESULTS: The age range was 33-80 years with a mean of 62.5 years and a peak incidence in the 60-69 year age group. One hundred and nineteen patients (54.34%) had organic causes, 85 patients (38.81%) had psychogenic causes and 15 patients had mixed causes. Two hundred patients (91.32%) had improved sexual function after treatment with viagra. This improvement was sustained during the study period of sixteen weeks and included improved erectile and orgasmic functions and overall sexual satisfaction. One hundred and fifty seven of these patients responded to therapy with 50 mg of viagra; 40 patients with 25 mg and three patients with 100 mg of therapy. Nineteen patients (8.68%) had no improvement in sexual function after viagra administration. Seven patients (3.2%) had adverse effects which were mild and transient. They included mild headaches in three patients, mild dyspepsia in two patients and facial flushing and nausea and vomiting in one patient, respectively.
CONCLUSION: Oral sildenafil (Viagra) is an effective well tolerated and simple treatment for male erectile dysfunction in the majority of cases. The cost of treatment at about ten United States dollars for the 50 mg tablet is prohibitive and may limit its wide use by many deserving patients in this locality.
PIP: This prospective open-label extension study was carried out to evaluate the effectiveness of sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi, Kenya. A total of 219 adult male patients with erectile dysfunction were instructed to take 50 mg, 25 mg, or 100 mg of sildenafil orally 1 hour prior to planned sexual activity, but not more than once every 24 hours. Patients were reviewed at 4-week intervals for 16 weeks to assess the efficacy and adverse effects of the drug. The age range was 33-80 years with a mean of 62.5 years and a peak incidence in the 60-69 year age group. The causes of erectile dysfunction were organic (n = 119, 54.34%), psychogenic (n = 85, 38.81%), and mixed (n = 15). 200 patients (91.32%) had improved sexual function after treatment with Viagra. This improvement included improved erectile and orgasmic functions and overall sexual satisfaction. 157 patients responded to the 50-mg treatment regimen; 40, to the 25-mg regimen; and 3, to the 100-mg regimen. No improvement in sexual function was reported in 19 patients (8.68%) after Viagra administration. In addition, 7 patients reported mild and transient adverse effects of the drug, including mild headache, dyspepsia, facial flushing, nausea, and vomiting. In conclusion, oral sildenafil (Viagra) is an effective well-tolerated and simple treatment for male erectile dysfunction in the majority of cases. However, the cost of treatment may prohibit and limit its wide use by many deserving patients in this area.

Magoha, GAO.  2000.  Nocturnal enuresis. East African Medical Journal,. 77:633-634.: EAMJ Abstract

OBJECTIVE: To identify autotransfusion strategies and their basis in elective surgery patients. DESIGN: A cross sectional prospective study. SETTING: General surgery and orthopaedic wards, Kenyatta National Hospital, Nairobi. SUBJECTS: Adult patients of both sexes planned for elective surgery. MAIN OUTCOME MEASURE: Forevery patient, the following were enquired about and documented: age in years, sex, ethnicity, religion, occupation and educational standard. Blood values of haemoglobin, platelet counts, total and differential white cell counts, urea, electrolytes and liver function tests were assayed. Others were the number of units of blood donated before the operation, the type of surgery performed, time taken from diagnosis to performing the operation and whether the blood was transfused preoperatively, intraoperatively and postoperatively. RESULTS: A total of sixty three cases constituting five per cent of all surgical patients admitted during the period of study were evaluated. Of these 53 (84%) were males and ten (16%) females. The age range was 15 to 65 years with a peak at 45-49 years. There were more Christians (90%) than Muslims (10%). In all, 32 (51.6%) had primary school education, 23 (36.5%) secondary school education, seven (11.3%) no formal education and one (1.6%) had attained college level. Employment pattern showed 50% were civil servants, 30% were self employed and 20% were unemployed. The duration of disease ranged from 1-24 weeks with two peaks at two weeks and six weeks. Orthopaedic cases constituted 78.7% and general surgery 21.3%. Preoperative haemoglobin ranged from 13.5-14.2 g/dl. Transfusions were given intraoperatively to 41 (66.1%) and to 12 (33.9%) postoperatively. Mean duration of hospitalisation was 13 days (range 5 to 21 days). 98.4% deposited only one unit while 1.6% deposited four units of blood. Only one patient required additional transfusion from homologous donors. CONCLUSION: The strategies and basis for autotransfusion have been demonstrated among a majority of adult patients requiring orthopaedic procedures. Major determinants are shown to be baseline blood count profiles and time to operation.

1999

Magoha, GAO, Ngumi ZW.  1999.  The training of surgeons in Kenya at the University of Nairobi, Kenyatta National Hospital. . East African Medical Journal, 76: 462-464, 1999.. : EAMJ Abstract

OBJECTIVE: To determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, since its inception in 1967.
DESIGN: This was a retrospective (1975-1987) and prospective study (1988-1999).
SETTING: Kenyatta National Hospital, a National Referral Hospital and University of Nairobi Teaching Hospital.
SUBJECTS: All surgeons trained by the Department of Surgery of the University of Nairobi for postgraduate MMed in general surgery, anaesthesia,
ENT surgery and ophthalmology from 1975 to March 1999. RESULTS: Two hundred and eighty-five surgeons with Master of Medicine degree were trained by the Department of Surgery of the University of Nairobi between 1975 and March 1999. They included 181 (63.51%) general surgeons; 46 (16.14%) anaesthetists; 35 (12.28%) ophthalmologists and 23 (8.07% ear, nose and throat (ENT) surgeons. One hundred and seventy-six, (61.75%) were from retrospective studies; 94 (32.98%) were from prospective studies while 15 (5.26%) were from both retrospective and prospective studies. Two hundred and thirty-two (81.40%) surgeons were Kenyans while 53 (18.60%) were foreigners. The majority, 42 (79.24%) of the foreigners were from other African countries. Thirty one (58.50%) were from neighbouring Uganda, Sudan, Tanzania, Ethiopia and Zambia. There was also one PhD in anaesthesia and one MD in urology during the same period.
CONCLUSION: The University of Nairobi, Department of Surgery based at Kenyatta National Hospital has played a very significant and leading role in the training of surgeons for Kenya and even other African and foreign countries since its inception. Of the forty surgeons who constitute the academic staff in the Departments of General Surgery, Orthopaedic Surgery and Ophthalmology of the University of Nairobi, thirty-five surgeons (87.50%) have been trained by the Faculty of Medicine at KNH.
PIP: This study was carried out as a retrospective (1975-87) and prospective study (1988-99) to determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, Kenya, since its inception in 1967. Over the 25-year period (1975-99), the Department of Surgery of the University of Nairobi trained a total of 285 surgeons with a Master of Medicine degree. These included 181 (63.51%) general surgeons, 46 (16.14%) anesthetists, 35 (12.28%) ophthalmologists, and 23 (8.07%) ear, nose, and throat surgeons. 176 of the dissertations (61.75%) were from retrospective studies, 94 (32.98%) were from prospective studies, and 15 (5.26%) were from combined prospective and retrospective studies. 53 (18.60%) of these surgeons were foreigners, with the majority (79.24%) coming from other African countries. The neighboring countries of Uganda, Sudan, Tanzania, Ethiopia, and Zambia accounted for 31 (58.50%) of the foreign surgeons. There was also one Doctor of Philosophy in anesthesia and one Master's Degree in urology during the same period.

Magoha, GAO.  1999.  Ureteric Injuries. . East African Medical Journal, 76: 181-183, 1999.. 76:181-183.: EAMJ Abstract

OBJECTIVE: To determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, since its inception in 1967.
DESIGN: This was a retrospective (1975-1987) and prospective study (1988-1999).
SETTING: Kenyatta National Hospital, a National Referral Hospital and University of Nairobi Teaching Hospital.
SUBJECTS: All surgeons trained by the Department of Surgery of the University of Nairobi for postgraduate MMed in general surgery, anaesthesia,
ENT surgery and ophthalmology from 1975 to March 1999. RESULTS: Two hundred and eighty-five surgeons with Master of Medicine degree were trained by the Department of Surgery of the University of Nairobi between 1975 and March 1999. They included 181 (63.51%) general surgeons; 46 (16.14%) anaesthetists; 35 (12.28%) ophthalmologists and 23 (8.07% ear, nose and throat (ENT) surgeons. One hundred and seventy-six, (61.75%) were from retrospective studies; 94 (32.98%) were from prospective studies while 15 (5.26%) were from both retrospective and prospective studies. Two hundred and thirty-two (81.40%) surgeons were Kenyans while 53 (18.60%) were foreigners. The majority, 42 (79.24%) of the foreigners were from other African countries. Thirty one (58.50%) were from neighbouring Uganda, Sudan, Tanzania, Ethiopia and Zambia. There was also one PhD in anaesthesia and one MD in urology during the same period.
CONCLUSION: The University of Nairobi, Department of Surgery based at Kenyatta National Hospital has played a very significant and leading role in the training of surgeons for Kenya and even other African and foreign countries since its inception. Of the forty surgeons who constitute the academic staff in the Departments of General Surgery, Orthopaedic Surgery and Ophthalmology of the University of Nairobi, thirty-five surgeons (87.50%) have been trained by the Faculty of Medicine at KNH.
PIP: This study was carried out as a retrospective (1975-87) and prospective study (1988-99) to determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, Kenya, since its inception in 1967. Over the 25-year period (1975-99), the Department of Surgery of the University of Nairobi trained a total of 285 surgeons with a Master of Medicine degree. These included 181 (63.51%) general surgeons, 46 (16.14%) anesthetists, 35 (12.28%) ophthalmologists, and 23 (8.07%) ear, nose, and throat surgeons. 176 of the dissertations (61.75%) were from retrospective studies, 94 (32.98%) were from prospective studies, and 15 (5.26%) were from combined prospective and retrospective studies. 53 (18.60%) of these surgeons were foreigners, with the majority (79.24%) coming from other African countries. The neighboring countries of Uganda, Sudan, Tanzania, Ethiopia, and Zambia accounted for 31 (58.50%) of the foreign surgeons. There was also one Doctor of Philosophy in anesthesia and one Master's Degree in urology during the same period.

Magoha, GAO.  1999.  Circumcision in various Nigerian and Kenyan hospitals. . East African Medical Journal, 76: 583-586, 1999.. 76:583-586.: EAMJ Abstract

OBJECTIVE: To present and evaluate circumcision practices in Nigerian and Kenyan Africans.
DESIGN: Continuous prospective study involving:- two hundred and forty-nine consecutive circumcisions performed from 1981 to 1998 and; fifty patients with post circumcision complications referred for further management during the same period.
SETTING: Lagos University Teaching Hospital, Duro-Soleye Hospital and First Foundation Medical Centre in Lagos, Nigeria; and Kenyatta National Hospital, Mater Misericordiae and Nairobi Hospital in Nairobi, Kenya. SUBJECTS: Males of all ages presenting for circumcision and males of all ages referred with post circumcision complications.
RESULTS: One hundred and fifty-two (61.04%) of circumcisions performed were in adolescents and young adults for cultural initiation into 'manhood'. The remaining seventy-nine (31.73%) neonates were circumcised for religious, parental, cultural and medical reasons. Eighty per cent of the patients referred with circumcision complications were initially circumcised by unqualified traditional "surgeons". One patient (2%) died from septicaemia; two patients (4%) lost their penis from gangrene and five other patients (10%) remained with permanent disability from complete or partial amputation of the penis or glans.
CONCLUSION: This study shows that circumcision is a commonly performed operation but can have serious, life shattering and prolonged complications sometimes resulting in death. It should therefore be performed only in medical institutions under sterile conditions and by suitably trained surgeons for specific medical indications. Ritual circumcision whether mass or single for cultural or religious reasons remains controversial without medical benefit and should be discouraged.

Magoha, GAO.  1999.  Missed Torsion of the testis. Health Journal.. 3:52-55.: EAMJ Abstract

Thirty patients with a mean age of 21.3 years were referred to the urologist with missed testicular torsion. Twenty four patients first presented to medical doctors, whereas six patients presented to paramedical staff. Only eight patients had their external genitalia examined. All the 30 patients were empirically placed on antibiotics and analgesic therapy on assumption that they had orchitis. Fourteen patients presented to the author with unilateral complete disappearance of the testis (atrophy); seven patients presented with unilateral reduction in testicular size, and another seven presented with both testes disappeared (atrophied) after various episodes of missed acute torsion of testis.

1998

Magoha, GAO.  1998.  Management of Fournier's gangrene at the Kenyatta National Hospital, Nairobi.. East Afr Med J. 1998 Jun;75(6):370-3.. : EAMJ Abstract

A prospective study involving the management of forty six patients with Fournier's gangrene was carried out at the Kenyatta National Hospital, Nairobi over a period of two years. The age range was nine to 81 years with a mean of 40.27 years indicating that the lesion is common and affects all age groups in this locality. The majority of patients (60.86%) presented with advanced lesions involving scrotal ulcers (45.65%) and gangrene (15.22%). Results of bacterial culture from scrotal wound swabs isolated multiple organisms in 8.15% of the patients, a point which should be taken into consideration during antibiotic selection. Forty one patients (89.13%) had surgical procedures in addition to antibiotics and other supportive measures. Five other patients (10.87%) who presented with early lesions had medical treatment only with antibiotics, antipyretics and analgesics. The average duration of hospitalisation was sixteen days. Two patients (4.35%) one of whom was HIV positive died from septicaemia during the study period. Recurrent scrotal infection occurred in two patients (4.35%) after discharge from the hospital and were treated satisfactorily at the surgical outpatient clinic.

Magoha, GAO, Ayumba BR.  1998.  Epidemiological aspects of Fournier's gangrene at Kenyatta National Hospital, . East Afr Med J. 1998 Oct;75(10):586-9.. 75(10):586-9.: EAMJ Abstract

This was a retrospective epidemiological study of 171 patients with scrotal (Fournier's gangrene) at Kenyatta National Hospital over eleven year period. The age range was 11 days to 90 years with a mean of 35.38 years. This is different from other reports of a mean of 40.6 years in the older literature and a mean of 50 years in the more recent series. The ethnic distribution of Fournier's gangrene revealed equal susceptibility among all ethnic groups in this locality. Scrotal and genitourinary symptoms were the commonest being present in one hundred and two patients (59.7%). The onset of symptoms was insidious in 95 patients (55.6%), and abrupt in 76 patients (44.4%). Most patients (84.2%) presented after more than 48 hours of the onset of symptoms. One hundred and two patients (59.65%) presented with localised physical signs compared to sixty nine patients (40.35%) who presented with extended lesions. Sources of the lesion were known in 82.5% of the patients. Genitourinary sources accounted for 42.1%, extragenitourinary 29.2%, and mixed 11.11% among the known causes. Diabetes mellitus was the leading major illness associated with Fournier's gangrene, presenting in 11 patients (6.42%). Seven other patients (4.09%) had HIV infection.

Magoha, GAO.  1998.  Finasteride in the treatment of patients with moderate symptoms of benign prostatic Hyperplasia.. East African Medical Journal, 75: 260-263, 1998.. : EAMJ Abstract

This was a prospective study involving 27 patients with moderate symptoms of benign prostatic hyperplasia (BPH) treated continuously with 5 mg of finasteride daily for one year. There was improvement in clinical BPH symptoms in 22 patients (81.48%), increase in urinary flow rates by a mean of 2.2 mls/sec in 20 patients (74.07%) and a mean decrease in prostate volume of 20.9% in 25 patients (92.59%) comparable to the findings of the other investigators. No patient on finasteride therapy developed acute urinary retention suggesting reduced risk. The reversal in BPH progression stems from the ability of finasteride to reduce prostate volume thus relieving urinary obstruction and to decrease BPH symptoms and increase urinary flow rates. Finasteride therapy was well tolerated in this study. No adverse effect was observed except impotence in one patient (3.7%) and loss of libido in another patient (3.7%). For symptomatic relief in men with moderate obstructive symptoms of BPH, finasteride should be considered an effective alternative to watchful waiting. These findings warrant further investigations and may signal a positive change in the role of medical therapy in the future long term management of BPH.

Magoha, GAO.  1998.  Benign and malignant prostatic obstruction. East African Medical Journal, 75: 257-259, 1998.. East African Medical Journal. 75:257-259.: EAMJ Abstract

This was a prospective study involving 27 patients with moderate symptoms of benign prostatic hyperplasia (BPH) treated continuously with 5 mg of finasteride daily for one year. There was improvement in clinical BPH symptoms in 22 patients (81.48%), increase in urinary flow rates by a mean of 2.2 mls/sec in 20 patients (74.07%) and a mean decrease in prostate volume of 20.9% in 25 patients (92.59%) comparable to the findings of the other investigators. No patient on finasteride therapy developed acute urinary retention suggesting reduced risk. The reversal in BPH progression stems from the ability of finasteride to reduce prostate volume thus relieving urinary obstruction and to decrease BPH symptoms and increase urinary flow rates. Finasteride therapy was well tolerated in this study. No adverse effect was observed except impotence in one patient (3.7%) and loss of libido in another patient (3.7%). For symptomatic relief in men with moderate obstructive symptoms of BPH, finasteride should be considered an effective alternative to watchful waiting. These findings warrant further investigations and may signal a positive change in the role of medical therapy in the future long term management of BPH.

Magoha, GAO.  1998.  Local infiltration and spermatic cord block for inguinal, scrotal and testicular surgery. . East African Medical Journal, 75: 575-577, 1998.. : EAMJ Abstract

This was a prospective study involving 372 male patients. Surgical procedures including simple inguinal hernia repair, inguinal lymph node biopsy, hydrocelectomy, testicular biopsy, testicular fixation, orchidectomy and scrotal exploration were performed under local anaesthesia using various quantities of 0.5% xylocaine with adrenaline depending on the procedure, in the form of spermatic cord block and local infiltration nerve blocks. No premedication was given to any patient and only five patients (1.34%) were given intraoperative sedation due to anxiety. No complication directly attributed to the anaesthetic agent used or the technique of spermatic cord and nerve blocks were reported during the study. Three hundred and sixty patients (96.77%) were operated on as outpatients and were happy and satisfied to return home on the same day. This experience confirms that spermatic cord block accompanied by local infiltration with 0.5% xylocaine with adrenaline is simple, safe and effective technique that should be used more widely in outpatient urological and general surgical settings in this locality. It provides excellent intra-scrotal and inguinal anaesthesia. Furthermore, the technique is cost effective, and personnel effective since no anaesthetist is required for the procedure which is usually carried out by the surgeon. This would enable many more people to afford the surgical procedures.

Magoha, GAO.  1998.  The Management of male erectile dysfunction: A review. . East African Medical Journal, 75: 623-627, 1998.. : EAMJ Abstract

Male erectile dysfunction is common although some patients are embarrassed and delay seeking medical advice. Recent improvements in the understanding of the anatomy, physiology and pharmacotherapy of penile erections, and the introduction of intracavernosal pharmacotherapy has resolved most of the controversies regarding the aetiology of erectile dysfunction. Impotence is equally divided into organic and psychogenic causes. Arterial insufficiency, alcoholism, venosinusoidal, neurological and endocrine disorders are known to cause organic erectile dysfunction. Two most popular options in the management of erectile dysfunction are intracavernosal injections with vasoactive drugs like papavarine, phentolamine, and prostaglandin EI with discontinuation rates of 40-50%, and the use of external vacuum devices whose limitations include failure to achieve and maintain full erection. The use of inflatable penile prostheses is successful but limited with periprosthetic infection and cylinder erosion through the skin or urethra. Surgical procedures have included revascularisation of penile vessels without good results. Surgical ligation of penile veins for venosinusoidal incompetence has been successful compared to excision and embolisation which has disappointing results. Currently the role of oral medications in the treatment of erectile dysfunction is limited. However, there are now several new agents including sildenafil, a phosphodiasterase inhibitor, which is undergoing clinical trials that appear to be effective.

1997

Magoha, GAO.  1997.  Screening and Early detection for prostate cancer.. East African Medical Journal.. 74:664-666.: EAMJ Abstract

Prostate cancer is the most common malignancy in men. Mortality due to prostate cancer has continued to increase over the past five decades despite all the different options of treatment at the disposal of the urologist, such as, surgery, radiotherapy, chemotherapy and biotherapy. Presently, effective therapy for prostate cancer is only possible with early diagnosis of the disease still localised within the prostate. Recent studies have demonstrated that the present screening techniques including Digital Rectal Examination (DRE), Serum Prostate Specific Antigen (PSA) concentration, Transrectal Ultrasound (TRUS) and Random Ultrasonically guided multiple prostatic biopsies can detect some potentially curable asymptomatic localised cancers. The main goal of a cancer screening test is to help reduce mortality. To date, it has been established that screening increases early detection and survival but there is no evidence that screening reduces mortality. If in future early detection and intervention is proved to provide real benefit apart from the overdiagnosis of latent non aggressive tumours, then the mortality from prostate cancer could begin to decline in the next decade. However, if our current armamenteria of therapies continue to be ineffective in treating men with prostate cancer, the current emphasis on screening and early detection will decline.

Magoha, GAO.  1997.  Effect of Ageing on androgen levels in elderly males.. East African Medical Journal, 74: 642-644, 1997.. : EAMJ Abstract

The past four decades have brought with it modern medical technology accompanied by better quality and longer life resulting in the increase in number of aged males in this locality. It has now been well established by various investigators that there is a statistically significant decline of the biologically available level of serum testosterone with ageing. This decline in androgen levels is more manifest in the free testosterone levels compared to the total serum testosterone levels which are routinely measured in the laboratory. Not withstanding this statistical decline the serum testosterone levels in the majority of aged men often fall within the normal range (300-1000 ng/dl) of eugonadal young males. This age related decline is usually associated with decline in sexual function in ageing men manifesting as erectile dysfunction. However, it has now been established beyond doubt that age itself rather than the androgen decline is the most influential variable of sexual activity in old men.

Magoha, GAO.  1997.  Nosocomial infection of the urinary tract: Pattern of antibiotic use and drug Resistance. East African Medical Journal, 74: 190-194, 1997.. East African Medical Journal, 74: 190-194, 1997.. : EAMJ Abstract

Nosocomial infection of the urinary tract is a long standing problem that pre-dates the antibiotic era. Hospitals have remained veritable reservoirs of bacteria with increased numbers and types resistant to antibiotic treatment. Most hospitals have epidemiologists and infection control manuals but unfortunately most hospital staff do not follow infection control protocols. Whenever a new class of antibiotics become available, enthusiastic physicians rush to use them discarding the older and slightly less potent ones which are subsequently regarded as obsolete. Some individuals claim that "good medicine is supposed to be practiced by those physicians who give their patients the most up to date drugs available". However, the resistance and sensitivity pattern of bacteria have changed and continue to do so, varying widely even among facilities within the same community. Furthermore, within several years of each antibiotic advancement, a parallel increase in the resistant strains of previously sensitive bacteria has been observed. The problem of resistant pathogens has become particularly important within the context of nosocomial infection of the urinary tract. Reduced hospital stay and avoidance of bacterial resistance by rational and selective use of antibiotics for preoperative prophylaxis and definitive therapy and strict enforcement of the hospital disease control protocols must be encouraged.

1996

Magoha, GAO.  1996.  Bilateral primary malignant lymphoma of the testis: A case report. . East African Medical Journal, 73: 151-152, 1996.. : EAMJ Abstract

A nineteen year old Kenyan male presented with a twelve month history of rapidly progressing painless swelling of both testicles. Pre-operative clinical and laboratory evaluation resulted in clinical suspicion of bilateral testicular tumour confirmed by ultrasonography. Bilateral inguinal orchidectomy was effected and histology confirmed bilateral primary malignant lymphoma of the testis in a nineteen year old regarded as a rare and unusual presentation.

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