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BACKGROUND: Over the years, the prevalence of prostate cancer (PCa) has been on the increase. Poor prognosis has been a reflection of increased advance-staged diagnosis and inadequate financial assistance. The prioritization of resources cannot be effective enough to factor in the unexpected economic burden resulting from ill health unless health economic approaches are utilized to estimate the cost of diseases including PCa. With the absence of data on the cost of PCa in Ghana, and the evidence of the benefits of PCa cost-of-illness studies on cancer financing, it has become imperative to investigate the direct health cost of PCa on patients and careers. Hence, we investigate the cost of PCa diagnosis and management, the availability and prices of PCa medications, and the affordability of PCa care in Ghana. METHODS: The prevalence approach to cost-of-illness studies was adopted in this study through a random selection of two (2) hospitals, four (4) private laboratories, and ten (10) private community pharmacies in the Ashanti Region of Ghana. The diagnostic and management cost of PCa was investigated through the application of validated data collection instruments to representatives of the selected hospitals and laboratories. The availability and prices of PCa medications were studied with the administration of a validated tool to representatives of the selected pharmacies. The data were analyzed with Microsoft Excel Spreadsheet and the affordability of care was assessed considering the 2021 Ghana National Daily Minimum Wage (GNDMW). RESULTS: The cost of diagnosing non-metastatic and metastatic PCa were respectively estimated at GHC 1686.00 ($ 290.58) and GHC 6876.00 ($ 1185.09). Radical prostatectomy, as a management option, was estimated at GHC 2150.00 ($ 370.56) higher than Extended Beam Radiotherapy (GHC 2150.00: $ 370.56). The mean PCa drug availability for the sampled pharmacies around the public hospital, all the sampled pharmacies, and around the private hospital were respectively 61.54, 51.54, and 41.54%. None of the sampled drugs at the stated strengths had a 100% availability. A 6-month androgen deprivation therapy employing goserelin was GHC 3000.00 ($ 517.05). The median drug price ratio (MDPR) was 0.72 - 15.38, with generic bicalutamide 150 mg tablets as the cheapest and generic flutamide 250 mg tablets as the most expensive. CONCLUSION: The diagnostic and management cost of PCa currently overwhelms the average Ghanaian because the minimum daily wage in 2021 is GHC 12.53 ($ 0.46). A higher economic burden was associated with metastatic PCa and hence, the need for strategies to improve early detection. Also, the inclusion of PCa management in the National Health Insurance Scheme would lessen the financial burden of the disease on patients and careers, and improve management outcomes.

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The use of buccal mucosa grafts in urethral reconstruction for complex anterior urethral strictures has gained popularity over the years with very good outcomes reported in literature. We report on the successful repair of a complex anterior urethral stricture in a 14-year-old boy following catheterization using this method at the Komfo Anokye Teaching Hospital. The aim is to describe the method of dorsal onlay oral mucosa graft urethroplasty and to review the literature.

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BACKGROUND: Circumcision is a common minor surgical procedure and it is performed to a varying extent across countries and religions. Despite being a minor surgical procedure, major complications may result from it. In Ghana, although commonly practiced, circumcision-related injuries have not been well documented. This study is to describe the scope of circumcision-related injuries seen at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. METHODS: The study was conducted at the Urology Unit of the Komfo Anokye Teaching Hospital in Kumasi. Consecutive cases of circumcision-related injuries seen at the unit over an 18 month period were identified and included in the study. Data was collected using a structured questionnaire. Data was entered and analysed using SPSS version 16. Charts and tables were generated using Microsoft Excel. RESULTS: A total of 72 cases of circumcision-related injuries were recorded during the 18 month period. Urethrocutaneous fistula was the commonest injury recorded, accounting for 77.8 % of cases. Other injuries recorded were glans amputations (6.9 %); iatrogenic hypospadias (5.6 %), and epidermal inclusion cysts (2.8 %). The majority of children were circumcised in health facilities (75 %) and nurses were the leading providers (77.8 %). The majority of circumcisions were conducted in the neonatal period (94.7 %). CONCLUSION: Circumcision-related injuries commonly occurred in the neonatal period. Most of the injuries happened in health facilities. The most common injury recorded was urethrocutaneous fistula but the most tragic was penile amputation. There is the need for education and training of providers to minimise circumcision-related injuries in Ghana.

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BACKGROUND: Intrauterine contraceptive device is the most common method of reversible contraception in women. The intrauterine contraceptive device can perforate the uterus and can also migrate into pelvic or abdominal organs. Perforation of the urinary bladder by an intrauterine contraceptive device is not common. In West Africa, intravesical migration of an intrauterine contraceptive device has been rarely reported. In this report, we present a case of an intrauterine contraceptive device migration into the urinary bladder of a 33 year old African woman at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. CASE REPORT: A 33 year old African woman presented with persistent urinary tract infection of 7 months duration despite appropriate antibiotic treatments. An abdominal ultrasonography revealed a urinary bladder calculus which was found to be an intrauterine contraceptive device on removal at cystoscopy. She got pregnant whilst having the intrauterine contraceptive device in place and delivered at term. CONCLUSION: The presence of recurrent or persistent urinary tract infection in any woman with an intrauterine contraceptive device should raise the suspicion of intravesical migration of the intrauterine contraceptive device.

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