Hinged Transpubic Approach to Delayed Repair of Posterior Urethral Distraction Defects Complicating Pelvic Fractures - Preliminary Experience

Objective: To present our experience with a transpubic approach to the management of one of the most challenging injuries of the lower urinary tract. Patients and Methods: Between January 2003 and December 2005; 7 patients presenting to our unit with complex urethral distraction defects due to type 2 or 3 posterior urethral disruption injuries complicating pelvic fracture were included in an ongoing evaluation of the transpubic approach to the repair of such defects. The patients had a mean age of 37.7 (range 22 - 56) years and were followed up for 1 - 4 years. Results: After the follow-up period 4 patients had a very successful outcome with trouble-free voiding. Three developed stric-tures; two of which were successfully managed with regular dilatation; while the third patient became catheter-dependent following dilatation and inadvertent creation of a false passage. This patient underwent a successful re-operation with full recovery. Conclusion: The transpubic approach to delayed repair of urethral distraction defects complicating pelvic fracture is feasible. It allows an effective dissection of the dense hematoma-fibrosis that commonly complicates these injuries at a later stage. The approach is particularly useful in complex long-standing defects where such dissection is made relatively easy by the ample working space provided. The successful outcome of treatment by this approach in 4 and ultimately 5 out of 7 patients offers a reasonable degree of salvage for patients with an otherwise poor prognosis. Further studies are warranted to confirm our positive results

Infertility among Nigerian Couples as seen in Calabar

Objective: This study was conducted to determine the infertility pattern among Nigerian couples in Calabar and to examine the outcome of our management strategies.Methods: A retrospective descriptive design study based on findings from the clinical files of infertile couples presenting at the gynaecology and the male fertility clinics of University of Calabar Teaching Hospital over a five-year period (2001-2005). Data were collected from all the documented clinical and laboratory findings.Results: The obvious causes of infertility constituted 58in females; 30in males and 12in both partners. Primary infertility was found in 69.7of males and 34.5of females and secondary infertility in 30.3of males and 65.5of females. Infection appears to be a strong predisposing factor to infertility in both male and female patients in our study population. Pregnancy was achieved in 24of our female patients who had tubal surgery; while 69of our males who had varicocelectomy had improvement in seminal fluid parameters.Conclusion: Prevention and prompt treatment of infection; particularly the sexually transmitted infections could be beneficial in the reduction of infertility among couples