1.2 Gravitational-wave Data Analysis
1.2.4 Continuous Wave Searches
(1) Health education should be intensified to enlighten the members of the public on measures to prevent some common causes of UR identified in this study such as bladder tumour and urethral strictures.
(2) Members of the public should be educated on the dangers of prolonged difficulty in passing urine without seeking medical attention. Patients with difficulty in passing urine should be treated early to avoid progression into CUR and its attendant sequelae.
(3) Health institutions should draw a local protocol that will guide all members of staff to a safe practice in treatment of UR.
(4) The cost of the drugs for commencement of TWOC and subsequently medical management of BPH should be subsidized by the government as they are mostly used by elderly patients who are usually retired / under care.
(5) More studies are needed along this line so that a uniform and more universally accepted protocol for management of UR can be drawn.
69 GLOSSARY
Anal reflex- Is the contraction of the external anal sphincter upon stroking the skin around the anus. The stimulus is detected by the nociceptors in the perineal skin to the pudendal nerve, where a response is integrated by the spinal cord sacral segments S2-S4.
Bulbocarvanosus reflex - In the male patient, this can be done by squeezing the glans of the penis while performing DRE.
Contraction of the anus, felt by the physician’s palpating finger,indicates that the afferent and
efferent sacral nerves (S1 and S2) and the sacral cord are intact. In women, Once catheterized, the ‘same’
reflex can be elicited by gently tugging the catheter onto the bladder neck, again while doing a DRE.
Catheter - Is a flexible tube made of plastic, silicon or metal that is inserted into part of the body (in our case the urethra or bladder) to inject or drain away fluid or keep a passage patent.
Catheterization- Is the process of inserting a catheter.
Saccule - Is a small pocket of mucosal out pouching within muscle fibres of the wall of a hollow organ.
Chemotherapy(cytotoxic)- The use of chemical agents to treat diseases especially cancer.
70
Cystoscopy - Is endoscopic examination of the urinary bladder.
Cystostomy- Is the process of making an opening into the bladder with the aim of draining urine or injecting fluid into the bladder.
Cystolithotomy - Is the method of removing a bladder stone through a suprapubic opening into the bladder.
Diverticulum- Out pouching of the mucosa of a hollow organ through its wall (in this case the detrusor muscles of the bladder)
Epididymo-orchitis- Inflammation of the testis and epididymis usually following infection.
Gibbus- Is a short-segment structural thoraco-lumbar sharp angulation. It can be a sequelae of advanced
skeletal tuberculosis and is the result of collapse of vertebral bodies.
Glomerular filteration rate (GFR)- Describes the flow rate of filtered fluid through the kidney. It is approximated by Creatinine clearance rate.
Haematuria- Is the presence of blood in the urine.
Haemtinics- Drugs that improve blood haemoglobin.
Incontinence- Is involuntary loss of spinchteric function (in this case; involuntary loss of urine).
Lithotripsy- Fragmentation of stone without open surgery.
Micturition- The act of passing urine.
71
Neurogenic/neuropathic bladder- Is a term applied to a malfunctioning urinary Bladder due to neurologic dysfunction or insult emanating from internal or external trauma, or disease.
Obstructive nephropathy - Damage to renal parenchyma caused by obstruction along the urinary tract.
Obstructive uropathy - Is a structural impedance to the flow of urine anywhere along the urinary tract and the consequences thereof .
Optical urethrotomy - Cutting through urethral stricture under vision with the aim of re-establishing the lumen.
Palliation - To alleviate symptoms without curing underlying disease, hence, improving the quality of life.
Prostate specific antigen (PSA)- Is a protein produced by prostate cell.
Rising serum level is associated with cancer of the prostate.
Prostatectomy- Is a surgical removal of part or all of the prostate gland.
Prostatitis - Is inflammation of the prostate gland.
Pyelonephritis - Inflammation of the renal parenchyma.
Pyonephrosis - Is accumulation of pus in the kidney collecting system.
Radiotherapy - Is use of ionising radiation for treatment of diseases mostly cancers.
Saccules - Outpouching of the mucosa of a hollow organ
72
within the muscles of its wall
Septicaemia- Presence of actively dividing pathogenic micro- organism in the blood associated with systemic effects.
Stricture- Constriction or narrowing of a tubular structure in the human body (in this case; the urethra).
Urethritis - Inflammation of the urethra, usually caused by infection.
Urethrogram- Contrast X-ray film of the urethra that outlines it.
Urethroplasty- Surgical reconstruction of the urethra.
Urosepsis - Systemic inflammation resulting from infection of the urinary tract and/or male genital tract (e.g. prostate).
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81 APPENDIX I:
INFORMED CONSENT FOR PARTICIPATION IN THE STUDY
I, Dr. ABDULLAHI Muzzammil, a resident doctor in Aminu Kano Teaching Hospital, Kano is carrying out a study titled: “Urinary Retention in Adult Male Patients at Aminu Kano Teaching Hospital, Kano- Causes and Outcome of Management”. The aim of the study is to determine the causes of urinary retention in adult male patients at Aminu Kano Teaching Hospital, Kano and outcome of its management. This will provide an updated data for urinary retention in our environment and allow for recommendations to be made on the need to provide or improve the facilities and resources for proper management of the patients.
In the process of treatment some complications such as introduction of infection into the urinary tract, injury to the lower urinary tract and post obstructive diuresis are possible.
However measures will be taken to prevent them. In the event any of these complications develop further treatment will be offered to you.
Your participation is voluntary and you are allowed to withdraw at any stage of the study.
Confidentiality is ensured because all the data and information gathered will be kept confidential. In case the study is to be reported in scientific literature or gathering, your anonymity will be maintained.
……… ………..
Signature/thumbprint and date witness signature and date
82 APPENDIX II:
URINARY RETENTION AMONG ADULT MALE PATIENTS IN AMINU KANO TEACHING HOSPITAL, KANO- CAUSES AND OUTCOME OF MANAGEMENT.
QUESTIONNAIRE
Hospital No __________Serial No ___________ Contact Tel. No_________________
Age: yrs Marital Status S M Date_______________________
Duration of Urinary Retention Hrs Days Weeks Presentation Inability to Pass Urine Difficulty in Passing Urine If yes characterise
Suprapubic Pain Suprapubic Swelling Blood at external urethral meatus Feeling of incomplete bladder emptying overflow incontinence
Associated Clinical Features Haematuria Fever
Passage of Clots passage of necrotic materials vomiting Body Swelling Hiccup
Preceding Lower Urinary Tract Symptoms : Yes No
Predisposing factors for causes of urinary retention : pelvic trauma
Past history of urethral trauma/instrumentation Past history of urethritis past history of passage of stone Childhood terminal haematuria
exposure to industrial chemicals smoking
Drugs (specify) others (specify)
General examination findings: confusion/loss of consciousness Temperature (Toc) Pallor facial swelling pedal oedema uraemic frosts Urinary bladder: palpable percussable
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Blood at external urethral meatus urethral indurations Perinneal sinuses Meatal stenosis Scrotal or testicular swelling: yes No
if yes characterise
DRE Findings: Normal Lax sphincteric tone Enlarged prostate with benign features
Enlarged prostate with malignant features high riding prostate Bladder mass Rectal Tumour others (specify)
Neurologic Examinations:
Lower limbs power: Normal (grade 5) Reduced (specify grade 0-4) Vertebral region: Normal dimple Gibbus Tenderness Other swellings (specify)
Method of relieving retention: urethral catheterization Suprapubic cystostomy others (specify)
Volume of urine drained at catheterization: < 1000mls ≥1000mls Specify volume drained mls Mode of treatment: on admission out patient
Complications of treatment: none urethral injury haematuria Post obstructive diuresis others (specify)
Who relieves urinary retention: Nurse House officer Registrar in surgery At least senior registrar in urology
Commence on Drugs for Trial without catheterization: Yes No If yes specify drugs given
Investigations
Full blood count normal derange not done If derange specify
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Urea, electrolytes, and creatinine normal derange not done If derange specify
Urinalysis normal derange not done If derange specify
Urine m/c/s negative positive not done If positive specify
Abdominal ultrasound findings Not done
Abdominal x-ray findings Not done Cystoscopy findings Not done
PSA normal derange not done If derange specify
RUG+MCUG findings RUG only
MCUG only
Not done
Other investigations done (specify) 1- 2- 3-
Findings 1- 2- 3-