Bio

Publications


2015

Odhiambo, MA, Njuguna S, Waireri-Onyango R, Mulimba J, Ngugi PM.  2015.  Utilization of day surgery services at Upper hill Medical Centre and the Karen hospital in Nairobi: the influence of medical providers, cost and patient awareness., 2015. The Pan African medical journal. 22:28. Abstract

Health systems face challenges of improving access to health services due to rising health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though used widely in developed countries due to its advantages, utilization in developing countries has been low. This study sought to establish how utilization of day surgery services was influenced by medical providers, patient awareness and cost among other factors.

2010

Ngugi, PM, Magoha GAO, Kiptoon D.  2010.  Urolithiasis in Nairobi, Kenya., 2010 Oct. East African medical journal. 87(10):395-9. Abstract

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

2009

Ngugi, PM.  2009.  Urethral stricture disease., 2009 Jan. East African medical journal. 86(1):1-2.
Kiptoon, DK, Ngugi PM, Rana FS.  2009.  Cancer of the penis: case report., 2009 Apr. East African medical journal. 86(4):196-200. Abstract

Two patients with penile carcinoma are presented after management at a district hospital in Kenya. Both had undergone ritual circumcision as teenagers and presented late. HR was a 73 year old who presented with a fungating penile mass for which a partial penectomy was performed after wedge biopsy confirmed malignancy. He thereafter declined to have the surgical specimen sent for histology and took the amputated stump for burial in his compound to avoid bad omen. GK was 25 years old and presented with a fungating mass and underwent partial penectomy after a histological diagnosis was made. He absconded from follow-up after being informed of the need for further surgery due to tumour infiltration of the surgical margins. The history and clinical images are presented and we discuss the difficulties of cancer management at a rural district hospital.

2007

Ngugi, PM.  2007.  An update on the treatment of advanced prostate cancer. Abstract

To obtain an update of the treatment of advanced prostate cancer. DATA SOURCE: Review of all published literature on advanced prostate cancer was carried out through medline and index medicus search. DATA SELECTION: Published data on advanced prostate cancer from June 2005 to June 2007 was included in the review. DATA EXTRACTION: Abstracts of articles identified were assessed, read and analysed to determine relevance to the title under review. DATA SYNTHESIS: After establishing relevance from the abstract, the entire paper was read, and significant points included in the review. CONCLUSION: The mainstay of treatment of advanced prostate cancer remains hormone withdrawal. The introduction of docetaxel based chemotherapy has caused a paradigm shift.

M, DRNGUGIPETER.  2007.  Ngugi PM, Byakika B.Histology of specimens taken by prostatectomy and needle biopsy. East Afr Med J. 2007 Aug;84(8):363-6.. East Afr Med J. 2007 Aug;84(8):363-6.. : Heinrich Boll Foundation. Abstract
OBJECTIVES: To determine the histology of the prostate in prostatectomy done for benign prostatic hypertrology (BPH), and prostate needle biopsy done for raised prostatic specific antigen (PSA). DESIGN: A retrospective study. SETTINGS: Nairobi Hospital, Kenyatta National Hospital and Upper Hill Medical Centre. SUBJECTS: The records of all the patients who had prostatectomy for BPH or trans-rectal needle biopsy of the prostate for raised prostatic specific antigen by the author and whose histology was determined at the Nairobi Hospital between May 2004 and December 2006. RESULTS: A total of 108 specimens from 108 patients were sent to the laboratory. The ages of the patients ranged from 48 years to 83 years with a mean of 71.3 years. Of the 108 specimens submitted 82 were benign prostatic hypertrophy and 26 were carcinoma of the prostate. Out of 78 prostatectomy specimens ten (12.8%) had prostate cancer. In the needle biopsy group 16 out of 30 (53%) had prostate cancer. In total there were 82 (76%) patients with histology of benign prostate enlargement and 26 (24%) with histology of prostate cancer. CONCLUSION: Prostate cancer is a common disease in Kenya and a lot of it is important cancer as it will progress and cause death. In this poor resource setting it is possible to make diagnosis of prostate cancer even in the absence of transrectal ultrasound (TRUS) to help biopsy the prostate. The higher the prostatic specific antigen in asymptomatic patients the higher the yield of prostate cancer on biopsy of the prostate.
M, DRNGUGIPETER.  2007.  Ngugi PM, Saula PW.Open simple prostatectomy and blood transfusion in Nairobi.East Afr Med J. 2007 Sep;84(9 Suppl):S12-23.. East Afr Med J. 2007 Sep;84(9 Suppl):S12-23.. : Heinrich Boll Foundation. Abstract

BACKGROUND: Open simple prostatectomy has long been associated with large blood losses; hence allogeneic blood transfusion in this procedure is a standard practice world over. A review of literature suggests significant association between perioperative blood loss accompanying open simple prostatectomy and certain patient factors. The shortage of blood and blood products in our blood transfusion centres as well as the alarming risks of transfusion reactions and disease dissemination demanded a review of these factors with the aim of reducing morbidity associated with peri-operative blood loss and blood transfusion. OBJECTIVES: To assess blood loss, determine blood transfusion rate, and define some of the factors associated with peri-operative blood loss and blood transfusion in open simple prostatectomy. DESIGN : A prospective cohort study. SETTINGS: The urology units of Kenyatta National Hospital, Kenya. RESULTS: Ninety five patients who underwent open simple prostatectomy for benign prostatic hyperplasia were enrolled into the study. Their median age was 70 years (Range 50 to 97). The mean decrease in haemoglobin concentration, which was the main indicator of peri-operative blood loss, was 2.1 g/dl (+/- 1.4). The peri-operative blood transfusion rate was 36.8 %. Twenty four (68.6%) of the patients who received either one or two units of blood had a pre-operative haemoglobin level above 13.5g/ dl and a post-operative haemoglobin level above 11.5 g/dl, while 11 (31.4%) had severe peri-operative bleeding, that necessitated immediate surgical re-intervention. A total of 68 units of blood was transfused, 42 (61.8%) allogeneic and 26 (38.2%) autollogous blood. The post-operative median hospitalisation time was eight days (Range 4 to 35). There were two (2.1%) post-operative deaths and both patients had intractable intra- and post-operative bleeding, massive blood transfusion and disseminated intravascular coagulopathy. The factors that were significantly associated with peri-operative blood loss and blood transfusion in open simple prostatectomy were patient's aged above 70 years, pre-operative use of acetylsalicylate or warfarin sodium, pre-operative systolic blood pressure above 140 mmHg, general anaesthesia, Freyer's (transvesical) technique and the weight of resected prostatic tissue above 70 grams. CONCLUSION: Open simple prostatectomy performed under spinal anaesthesia using Millin's (retropubic) technique is associated with minimal blood loss. The perioperative blood transfusion rate was 36.8%.

M, DRNGUGIPETER.  2007.  Ngugi PM, Magoha GA.The management of early prostate cancer: a review. East Afr Med J. 2007 Sep;84(9 Suppl):S24-30.. East Afr Med J. 2007 Sep;84(9 Suppl):S24-30.. : Heinrich Boll Foundation. 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 medicus 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.
M, DRNGUGIPETER.  2007.  Ngugi PM.An update on the treatment of advanced prostate cancer.East Afr Med J. 2007 Sep;84(9 Suppl):S36-9.. East Afr Med J. 2007 Sep;84(9 Suppl):S36-9.. : Heinrich Boll Foundation. Abstract
OBJECTIVE: To obtain an update of the treatment of advanced prostate cancer. DATA SOURCE: Review of all published literature on advanced prostate cancer was carried out through medline and index medicus search. DATA SELECTION: Published data on advanced prostate cancer from June 2005 to June 2007 was included in the review. DATA EXTRACTION: Abstracts of articles identified were assessed, read and analysed to determine relevance to the title under review. DATA SYNTHESIS: After establishing relevance from the abstract, the entire paper was read, and significant points included in the review. CONCLUSION: The mainstay of treatment of advanced prostate cancer remains hormone withdrawal. The introduction of docetaxel based chemotherapy has caused a paradigm shift.
M, DRNGUGIPETER.  2007.  Ngugi PM, Kassim A.Clean intermitent catheterisation in the management of urethral strictures.East Afr Med J. 2007 Nov;84(11):522-4.. East Afr Med J. 2007 Nov;84(11):522-4.. : Heinrich Boll Foundation. Abstract
OBJECTIVE: To compare clean intermittent self-catheterisation and urethral dilatation with sounds in the management of recurrent urethral strictures. Design: A prospective randomised control trial between repeated urethral dilatation with sounds and use of clean intermittent self-catheterisation in the management of recurrent urethral strictures. SETTING: Kenyatta National Hospital, urology clinics. SUBJECTS: Forty nine patients with recurrent urethral strictures were randomised between clean intermittent catheterisation (CISC) and urethral dilatation with sounds. RESULTS: The urinary flow rates were better in patients on the CISC arm compared to the dilatation arm. Seventy three percent of patients having clutton sounds dilatation developed urinary tract infections compared to 25% of those on CISC. The patients in the CISC arm had a uniformly higher quality of life score than those having sounds dilatation of the urethra. CONCLUSION: Clean intermittent self-catheterisation is an effective and safe way of managing recurrent urethral strictures. It is a better method than repeated clutton sounds dilatation.

1995

M, DRNGUGIPETER.  1995.  Harrison NW, Eshleman JL, Ngugi PM.Ethical issues in the developing world.. Br J Urol. 1995 Nov;76 Suppl 2:93-6. Review.. : Heinrich Boll Foundation. Abstract
OBJECTIVES: To determine the histology of the prostate in prostatectomy done for benign prostatic hypertrology (BPH), and prostate needle biopsy done for raised prostatic specific antigen (PSA). DESIGN: A retrospective study. SETTINGS: Nairobi Hospital, Kenyatta National Hospital and Upper Hill Medical Centre. SUBJECTS: The records of all the patients who had prostatectomy for BPH or trans-rectal needle biopsy of the prostate for raised prostatic specific antigen by the author and whose histology was determined at the Nairobi Hospital between May 2004 and December 2006. RESULTS: A total of 108 specimens from 108 patients were sent to the laboratory. The ages of the patients ranged from 48 years to 83 years with a mean of 71.3 years. Of the 108 specimens submitted 82 were benign prostatic hypertrophy and 26 were carcinoma of the prostate. Out of 78 prostatectomy specimens ten (12.8%) had prostate cancer. In the needle biopsy group 16 out of 30 (53%) had prostate cancer. In total there were 82 (76%) patients with histology of benign prostate enlargement and 26 (24%) with histology of prostate cancer. CONCLUSION: Prostate cancer is a common disease in Kenya and a lot of it is important cancer as it will progress and cause death. In this poor resource setting it is possible to make diagnosis of prostate cancer even in the absence of transrectal ultrasound (TRUS) to help biopsy the prostate. The higher the prostatic specific antigen in asymptomatic patients the higher the yield of prostate cancer on biopsy of the prostate.
M, DRNGUGIPETER.  1995.  Harrison NW, Eshleman JL, Ngugi PM.Ethical issues in the developing world.Br J Urol. 1995 Nov;76 Suppl 2:93-6.. Br J Urol. 1995 Nov;76 Suppl 2:93-6.. : Heinrich Boll Foundation. Abstract
OBJECTIVES: To determine the histology of the prostate in prostatectomy done for benign prostatic hypertrology (BPH), and prostate needle biopsy done for raised prostatic specific antigen (PSA). DESIGN: A retrospective study. SETTINGS: Nairobi Hospital, Kenyatta National Hospital and Upper Hill Medical Centre. SUBJECTS: The records of all the patients who had prostatectomy for BPH or trans-rectal needle biopsy of the prostate for raised prostatic specific antigen by the author and whose histology was determined at the Nairobi Hospital between May 2004 and December 2006. RESULTS: A total of 108 specimens from 108 patients were sent to the laboratory. The ages of the patients ranged from 48 years to 83 years with a mean of 71.3 years. Of the 108 specimens submitted 82 were benign prostatic hypertrophy and 26 were carcinoma of the prostate. Out of 78 prostatectomy specimens ten (12.8%) had prostate cancer. In the needle biopsy group 16 out of 30 (53%) had prostate cancer. In total there were 82 (76%) patients with histology of benign prostate enlargement and 26 (24%) with histology of prostate cancer. CONCLUSION: Prostate cancer is a common disease in Kenya and a lot of it is important cancer as it will progress and cause death. In this poor resource setting it is possible to make diagnosis of prostate cancer even in the absence of transrectal ultrasound (TRUS) to help biopsy the prostate. The higher the prostatic specific antigen in asymptomatic patients the higher the yield of prostate cancer on biopsy of the prostate.

1994

  1994.  Problems of indwelling Foley catheters. Abstract

One hundred patients undergoing urinary bladder catheterization for various reasons were studied. 42 patients received Sewoon catheters of various sizes. 38 received Eschmann catheters of various sizes and 20 received Bard catheters of various sizes. The duration of catheterization ranged from a few hours to 21 days. Various problems associated with catheterization were recorded whenever encountered. Stuck catheter was found to occur in 15 of the 40 patients who received Sewoon catheters. There were no stuck catheters recorded for Eschmann or Bard catheters. Infections occurred in 9 out of 100 patients, 7 of whom had Sewoon catheters. Leakage was recorded in 12 of the 100 patients, 9 of whom had Sewoon catheters. Blockage of balloon occurred in 5 patients, 3 of whom had Sewoon catheters. Painful spasms occurred in 8 patients, 4 with Bard, 4 with Sewoon catheters. It is concluded that Sewoon type of Foley catheters was associated with more problems than the other types studied

1991

Ngugi, PN, MCLIGEYO SO, KAYIMA JK, Otieno LS, Mogere R.  1991.  Vascular access for haemodialysis. Abstract

In a fifteen month period (August 1987 to November 1988) forty patients requiring haemodialysis had 83 angioaccess procedures performed. Arteriovenous (AV) shunts and arteriovenous fistulae were the commonest procedures, comprising 56 (67%) and 20 (24%) of the patients respectively. Subclavian catheters and artificial grafts were used less frequently. Nephrologists and senior house officers attached to the Renal Unit were responsible for fashioning A-V shunts and inserting subclavian catheters while the A-V fistulae were fashioned by the urologists and vascular surgeons. The commonest complication of A-V shunts were clotting, occurring in 31 (55.4%) followed by bleeding in 14 (25%). Eight (32%) of the A-V fistulae never functioned from the beginning. It is noted that we are still very dependent on A-V shunts for vascular access in end stage renal disease (ESRF) patients and this is associated with an unacceptable level of complications. This dependency on A-V shunts in ESRD patients should be stopped or phased out. A-V fistulae should be used more frequently. Their constructions should be well thought out, executed and supervised by the few surgeons who are versed in them together with their follow-ups

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