PROF. OLIECH JOSEPH S

A 72 year old African male presented with a 2 weeks history of haematurla with clots, dysuria, nocturia, frequency and subsequently 2 day history of acute urinary retention (AUR). There were no colonic symptoms of mucus discharge, blood per rectum or malaena stools. Imaging studies demonstrated a tumour mass invading the roof of the urinary bladder whilst cyctoscopic finding were inconclusive. Following surgical intervention, the mass was subjected to histopathological evaluation which confirmed colonic adenocarcinoma matastasis in the urinary bladder. It is now 4 ½ years since surgery was carried out and follow up shows good prognosis.

Objective: Benign prostatic hyperplasia (BPH) incidence and progression has been shown to vary by race, geography and ethnicity with African-Americans having a more aggressive disease than other races. Combination drug therapy has been shown to be a favorable option for medical therapy of symptomatic BPH but data is lacking on the effects of this therapy in black race patients locally. This study aims to assess the early (six months) response, by both International-Prostate Symptom Score (IPSS) and peak urinary flow rate (QMax), to combination drug therapy of Tamsulosin and Dutasteride for management of symptomatic BPH in a predominantly African black race population cohort as a pilot study.
Patients and Methods: Dutasteride 0.5mg and Tamsulosin 0.4mg once daily were administered orally to 52 patients aged 45years and above of black race with confirmed BPH for six months. The main outcome measures of change in mean QMax and IPSS were assessed at three months and six months. Secondary outcome measures were mean Total Prostate Specific Antigen (tPSA) and Prostate Volume (PV) changes. Drug compliance by Modified Morisky Scores (1) and adverse/side effects reported were documented. Paired sample t test and Pearson correlation as well as ANOVA were used to analyze the data.
Results: There was a statistically and clinically significant increase in mean QMax by 13.3ml/sec and decrease in mean IPSS by 14.5 points at six months. There was a fairly rapid reduction in mean Total PSA of 0.9ng/ml as early as two months and a slower fall in mean PV of 10.224mls most evident at the last follow-up. Safety and tolerability of the drugs was consistent with previous experience and majority of the patients portrayed an excellent drug compliance profile.
Conclusion: These results suggest the efficacy of combination drug therapy of Dutasteride and Tamsulosin for moderate-to-severe BPH in the black race. These patients seem to have a more drastic and rapid mean IPSS, QMax and PV response to therapy than reported for other races but their mean total PSA decrease was less. Combination drug therapy is therefore recommended as a useful alternative to surgery in management of BPH in the black race.
Key Words: Benign Prostatic Enlargement, Urinary flow rate, Prostate Specific Antigen, IPSS
Corresponding Author: Professor J.S. Oliech Professor of General Surgery/Urology
Department Of Surgery, University Of Nairobi, Nairobi, Kenya.Email:

Combination use of alpha-adrenergic blockers (tamsulocin or alfuzocin) and 5 alpha iso-enzyme 1&2 inhibitor (dutasteride) in symptomatic benign prostatic hyperplasia (BPH) is the best first optional mode of treatment giving good results with minimal treatment  adverse effects especially for those at risk for surgical intervention and those who are still sexually active. 

OBJECTIVE: To evaluate the use of medical therapy in the management of patients with mild, moderate and severe symptoms of benign prostatic hyperplasia. DESIGN: Prospective study. SETTING: Private urology clinic in Mater Hospital, Nairobi between 1995 and 2005. PATIENTS: Six hundred and eighty patients with benign prostatic hypertrophy aged 50-80 years. RESULTS: Two hundred and eighty (43.8%) patients benefited from the drug treatment alone and were released from the clinic follow up after five years. Two hundred and seventy (42.2%) cases could not complete the five years follow up on drugs alone due to symptoms recurrence or severity or unavailability of drugs. They were removed from the drugs alone treatment and put on other interventions. Ninety (15.9%) cases were operated on based on their decision and insistence or severity of their symptoms or no drugs response. CONCLUSIONS: This observational study confirms that medical treatment is beneficial in the management of benign prostatic hyperplasia (BPH) and is cheap and gives better first line option of treatment choice to many patients. It also gives hopes to the surgical risk patients. The quality of life (QOL) of patients and their family disturbance is also improved.

Background: Thermal injuries are a major cause of morbidity and mortality in Kenya. Though a lot is known about burns, the morbidity patterns and mortality rates of burns in this country have not been established. This study was designed with the general objective of investigating the outcome of moderate and severe burns managed at the Kenyatta National Hospital (KNH). It was also the aim of the authors to try to validate an existing simple clinical burn injury score, based on the Abbreviated Burn Severity Index (ABSI) score.
Methods: This was a retrospective study of burn patients treated at KNH between January 1999 and December 2000. The main parameters studied included the age, sex, and depth of burn injury, inhalation injury and percentage total burn surface area (%TBSA). Other parameters recorded were the type of burn, pre-morbid or co-morbid illnesses, specimen culture and sensitivity and the length of hospital stay. Single variable analyses (χ2-test) were used to determine the value and influence of single variables on burn mortality. Multiple stepwise logistic regression analysis was performed on all the variables used in the ABSI score, as well as on hospital stay and type of burn (scald or flame), to determine their influence on burn mortality.
Results: Out of the 1205 patient records retrieved, 1157 satisfied the inclusion criteria for the study. The findings confirmed the role of percentage total burn surface area, associated inhalation injury and depth of burn as the strongest prognostic variables (multivariate analysis); while age and sex have prognostic significance on single variable analysis. This data was then used to validate the ABSI score, which performed very accurately as a prognostic score.
Conclusion: It is recommended that the ABSI score be adopted into clinical practice in this country, as an objective and accurate predictive clinical score.

Review of twenty cases of live-donor kidney transplants in Kenya for a period of 5 years (1985-1989) and the follow up study results revealed that there were both high graft losses, high morbidity and mortality due to various complications pertaining to surgery and immunosuppression. The most serious complications were intercurrent infections, acute or chronic rejection, pulmonary embolism, steroid induced diabetes, pneumonia, and myocardial infarction. At the end of the first year follow up, there were only twelve graft patients alive. Magnetic Resonance Imaging (MRI) was not available for assessing the anatomical and functional behaviour of the transplanted kidneys. This would have assisted in early diagnosis of the degree and onset of rejection for appropriate treatment before the death of the allografts. It would also assist in differentiating perfusional problems from rejection.

A study of 14 proven cases of phaeochromocytoma operated on at the Kenyatta National Hosspital was done.The management problems and the difficulty in diagnosis is disscussed

Review of twenty cases of live-donor kidney transplants in Kenya for a period of 5 years (1985-1989) and the follow up study results revealed that there were both high graft losses, high morbidity and mortality due to various complications pertaining to surgery and immunosuppression. The most serious complications were intercurrent infections, acute or chronic rejection, pulmonary embolism, steroid induced diabetes, pneumonia, and myocardial infarction. At the end of the first year follow up, there were only twelve graft patients alive. Magnetic Resonance Imaging (MRI) was not available for assessing the anatomical and functional behaviour of the transplanted kidneys. This would have assisted in early diagnosis of the degree and onset of rejection for appropriate treatment before the death of the allografts. It would also assist in differentiating perfusional problems from rejection.