Surgical management of urinary tract stones in children:experience from Tikuranbessa hospital, Addis ababa, Ethiopia

Introduction: Urinary stone disease is a disorder with significant impact on quality of life. Moreover, children have a higher recurrence rate owing to associated metabolic and anatomic abnormalities. Management has changed with technological advances. Despite the current trend, open stone surgery is still widely practiced in developing countries. However, there have been no reports regarding treatment of this disease in children from Ethiopia so far. We aimed to determine the mode of management and outcomes of the différent approches for childhood urolithiasis which practiced in our institution. We also tried to assess factors leading to adverse outcomes.Methods: This is a retrospective descriptive study of pediatric patients who underwent surgical procedures for urolithias from September 2010 to August 2015. Medical records were reviewed for factors thought to affect outcome of management.Results: We investigated 50 children aged 0-15 years and the mean age for operation was 8.5 ± 3.2 years. The stones were found exclusively in upper urinary tract in 56%, lower urinary tract in 30% and a combination of sites in 14%. All lower urinary tract stones were managed with open surgery, of which cystolithotomy comprised 81%. Common procedures performed for upper urinary tract stones were open stone surgery (41 %) and ureteroscopic intervention in (34.5%). Success rate with ureteroscopy was 30%. Post-operative complications occurred in 24%; common ones being urinary tract infection (10%) and urinary leak (10%). The factors with significant correlation to post-operative complications were history of urinary tract infection and chronic kidney disease (p=0.02 and p=0.047 respectively). Recurrence occurred in 12%. Thirty percent of the children required a second surgical procedure.Conclusion: The practice in our institution is still evolving towards the standard approaches of stone treatment. Metabolic evaluation is lacking, post-operative complications are high and our experience with pediatric ureteroscopy was not satisfactory. Most of these issues were associated with our socioeconomic status, as facility was not adequately equipped and patients presented late with renal failure

Paediatric urologic pathologies at the national teaching hospital in Cotonou: an etiological and therapeutic aspects

BACKGROUND: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. PATIENTS AND METHODS: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. RESULTS: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, post-circumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%

Le kyste hydatique du rein fistulise dans les voies urinaires; prise en charge diagnostique et therapeutique a propos de 14 cas

Objectif l'hydatidose est une pathologie frequente au Maroc et constitue un probleme majeur de sante publique. La localisation renale de cette parasitose est rare. Les formes s'accompagnant de plus d'une fistulisation dans les voies excretrices presentent des particularites diagnostiques et therapeutiques qui seront decrites dans cet article. Patients et methodes 14 patients presentant un kyste hydatique du rein fistulise dans la voie excretrice urinaire ont ete inclus dans l'etude de 2002 a 2008. Les variables etudiees ont ete: l'age moyen; les antecedents; la symptomatologie clinique; l'imagerie; le traitement et l'evolution. Resultats L'age moyen etait de 38 ans (21-54). La douleur lombaire a ete retrouvee chez tous les patients et l'hydaturie chez 8 patients. L'echographie realisee chez tous les patients a montre 6 cas de kyste hydatique de type III et 8 cas de type IV selon la classification de GHARBI. L'uroscanner a confirme la nature hydatique de la masse et deux cas de rein non fonctionnel. L'hydaturie et la dilatation des cavites excretrices ont ete les principaux elements orientant vers le diagnostic. Le traitement a consiste en une resection du dome saillant et la fermeture de la fistule chez 12 patients; huit d'entre eux ont eu une nephrostomie per-operatoire apres cure de la fistule et deux patients une montee de sonde ureterale double crosse en pre-operatoire; les deux autres n'ont pas ete draines. Les deux patients restant ont eu une nephrectomie. Les suites ont ete marquees par une fistule stercorale colique chez un patient et deux cas d'infection de paroi. Conclusion Tout kyste hydatique du rein doit avoir un bilan d'imagerie comportant un uroscanner avec des cliches tardifs a la recherche d'une fistulisation dans la voie excretrice urinaire. Il est conseille de mettre en place une sonde ureterale en preoperatoire a visee diagnostique et therapeutique

Management of Complex Urogenital Fistulae in the Female

Objective: To present our experience in the management of complex genitourinary fistulae in the female. Patients and Methods: Between 1995 and 2004; 12 female patients with a mean age of 30 (range 6 - 40) years were managed in our department for various types of complex genitourinary fistulae caused by difficult labor in 6 cases; abdominal hysterectomy in 5 cases and car accident in one case. All patients were subjected to clinical; radiological and endoscopic examination. The fistulae were managed by open surgery. The procedures were individualized according to the existing pathology and included bladder augmentation and construction of a bladder tube. Results: The fistulae were repaired successfully and socially acceptable continence was achieved in all patients. Conclusion: Through urological evaluation of complex urinary fistulae is recommen- ded. The treatment should be individualized based on the existing pathology and may include bladder augmentation and construction of a bladder tube

The Traid of Idiopathic Normal-Pressure Hydrocephalus : a Clinical Pratice Case Report

"An 89-year-old white male presented with memory impairment; slowness in responsiveness; and frequent falls over a two-year duration. Six months earlier; the patient was believed to have had a ""dementia with parkinsonian features;"" but showed no response to incrementing doses of both donepezil and carbidopa-levodopa. Urinary urgency was believed to have been due to prostate hypertrophy. A head CT with contrast revealed moderate ventriculomegaly in the setting of mild diffuse cortical atrophy. A diagnosis of idiopathic normal-pressure hydrocephalus (INPH) was made."

Resistance Pattern of Urinary Tract Infection Bacterial Isolates to Selected Quinolones

The Quinolones inhibit bacteria by interacting with DNA topoisomerases (gyrases) of which four subunits (two A and B monomers) have been identified thus; inhibiting bacterial DNA gyrase. High level resistance to quinolones can be produced by serial exposure of bacteria to subinhibitory concentration. A Total of 408 suspected UTI and high vagina swab (HVS) samples were examined for bacteria and the isolates obtained tested against the newer quinolones. Prevalence of Bacterial isolates revealed Escherichia coli 10(92) as the most isolated organism from urine; while Staphylococcus aureus 31(32) was the most isolated species from HVS samples. Bacterial species such as coliforms 55(70) and Klebsiella spp 42(84); equally had high prevalence rate in urine samples. Pseudomonas aeroginosa 19(66) was next to Staphylococcus aureus in terms of prevalence of isolated strains from HVS samples. The resistance pattern observed for these isolates; showed that the strains were least resistant to Ciprofloxacin; followed by Ofloxacin and Perfloxacin; while they were most resistant to Nalidixic acid. There was however no statistical significance P0.001) between the use of Ofloxacin and Perfloxacin; however; ANOVA showed a significant difference (P0.05) between the pattern of Klebsiella spp resistance against Perfloxacin when compared to Proteus vulgaris

The Management of Upper Urinary Tract Obstruction in Resource-Poor Settings

Objective: The management of upper urinary tract obstruction in the absence of modern facilities presents a major challenge to Urologic practice in developing countries. The aim of this study was to describe the etiology; presentation and treatment of upper urinary tract obstruction at the Jos University Teaching Hospital; Nigeria. Patients and Methods : This is a prospective analysis of 37 consecutive patients (18 males; 19 females) with a mean age of 35.5 years (range 3-55) who were managed for upper urinary tract obstruction at our department between January 2001 and December 2005. Two of them presented with a second pathology; so that we treated 39 pathologies in total. Flank pain was the most common clinical feature; being present in 35 patients (94.6). Other clinical features were gross hematuria in 12 (32.4); an enlarged kidney in 5 (13.5); renal impairment in 4 (10.8) and hypertension in 3 (8.1) patients. Diagnostic work-up consisted of plain radiography; abdominal ultrasound scan; intravenous urography and retrograde pyelography. Renal pelvic stones were the leading cause of obstruction (13 patients; 35.1); while congenital pelvi-ureteric junction (PUJ) obstruction was found in 7 (18.9) and ureteric stricture and vesical schistosomiasis in 4 (10.8) and 3 (8.1) patients; respectively. Two patients had bilateral obstruction from two different causes.Results: Twenty-nine open surgical procedures were carried out. They consisted of pyelolithotomy (n=12); pyeloplasty (n=6); ureteroureterostomy (n=4); ureteroneocystostomy (n=3); nephrectomy (n=2) and ureterolithotomy (n=2). Eight patients were treated non-surgically. Two patients are awaiting definitive surgical treatment. A total of 4 (13.8) complications following 29 operative procedures were encountered: two cases of migration of double-J ureteric stents ; one case of prolonged urine leakage and another case of wound infection. Conclusion : Upper urinary tract obstruction is not uncommon in our environment. In the absence of modern facilities; open surgery remains our main option of treatment; and it is relatively safe

Infant Feeding Tube as Urinary Tract Stent

Background: The infant feeding tube is a cheap and readily available device with many uses in the urinary tract. Many types of stents are available in the market but among other factors; cost and affordability limit their use in developing countries and remote areas. Aim: To document experience with infant feeding tubes as stents in the urinary tract. Methods: Data from the hospital records of patients who required stents at the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria were obtained from their case notes from May 2003 to May 2006. Information extracted from these case notes included: age and sex of patient; indications for stenting; stent-related complications and outcome of surgery. The data were analysed using Microsoft Excel Software. Results: Thirty-three patients who required stents within the period were included in the study. In nineteen patients (57.6) feeding tubes were used as urethral stents while in 14 (42.4) as ureteric stents. Operations requiring stents include: dismembered pyeloplasty 9.1 (3); ureteric re-implantation 24.3 (8); ureterolithotomy 9.1 (3); and urethroplasty 57.6 (19). The stents were left in situ for 2-3 weeks depending on the indication. Ureteric stents were left for 3 weeks while urethral stents were usually left for 2 weeks. However; where a significant complication was noted; the stent was removed. Complications noted in 4 patients (12.1) which were probably stent-related include: bladder spasm; infection and wound dehiscence. Conclusion: Infant feeding tubes can be used as suitable urinary tract stents where expensive stents are not available

Obstructive uropathy in childhood : a Review

Background: Obstructive uropathy is any affection of the urinary tract characterized by impairment of urine flow through the tract and which; if left untreated; will cause progressive renal damage.Aim: To present an update on obstructive uropathy in children with emphasis on the situation in Nigeria.Methods: Contemporary information on the management of obstructive uropathy was obtained by searching the Medline and adding information from the authors' experience.Results: Obstructive uropathy causes renal impairment in all age groups. The causes in children may be congenital or acquired. The congenital causes include pelvi-ureteric junction obstructions; posterior urethral valves (PUV); urethral atresia; phimosis and meatal stenosis. Associated anomalies include imperforate anus and ver tebral malformations. Acquired causes include calculi; post-traumatic and post-inflammatory strictures and meatal stenosis. Some specific manifestationsare prune-belly syndrome; hydronephrosis and renal failure. Diagnostic investigations include ultrasonog raphy; intravenous urog raphy; cystography and renography. Recent technological advances have impacted on the treatment of the different lesions. These include in utero vesico- amniotic shunt and endoscopic valve ablation for PUV and minimally invasive techniques for urolithiasis. Nephrectomy may be indicated in a unilateral damaged kidney. Not all lesions require treatment. Criteria to select patients for treatment require definition. Occasionally treatment fails because of pretreatment irreversible renal damage. The resulting end-stage renal failure is an indication for renal transplantation.Conclusion: Obstructive uropathy is an important cause of renal impairment. Contemporary advances in the management are yet to become available in developing countries. Compromise treatment options therefore prevail. Adequate treatment is essential to prevent end-stage renal failure

Evaluation des helminthiases intestinales et urinaires et impact du traitement chez les enfanst d'age scolaire de la ville d'Arrah

Les helminthiases intestinales et urinaires sont tres frequentes en zone tropicale ou elles constituent un veritable probleme de sante publique; les enfants etant la cible privilegiee. Ce travail est une etude epidemiologique prospective realisee dans la ville d'Arrah de Decembre 2003 a Juin 2004 dans les differentes ecoles primaires. Elle a porte sur 400 eleves ages de 4 a 16 ans dont 240 garcons et 160 filles. Elle avait pour but d'etablir la prevalence des helminthiases intestinales et urinaires; etablir la relation entre certains facteurs et la survenue de ces affections et enfin evaluer l'impact du traitement. Il ressort que 21;25pour cent des enfants sont porteurs d'au moins un helminthe. Les helminthes rencontres sont par ordre de frequence decroissante Strongyloides stercoralis (8;75 pour cent); Necator americanus et Schistososnia haematobium (6pour cent); Ascaris lumbricoides (2;5pour cent); Trichuris trichiura (1pour cent) et Hymenolepis diminuta (0;5 pour cent).Par ailleurs; nous avons constate une absence de Schistosoma mansoni. Le polyparasitisme a ete retrouve chez 16;16 pour cent des enfants parasites. Le portage parasitaire est influence par le sexe; la profession de la personne en charge; le revenu mensuel de la personne en charge; le nombre de personnes par logement; le type de logement; le mode d'approvisionnement en Eau et les antecedents de deparasitage. Au controle post-therapeutique effectue apres un mois; nous avons obtenu un taux de guerison de 95;3pour cent. Au 3 eme mois ce taux est passe a 87;1pour cent avec un taux de re infestation de 12;9pour cent

Continent Cutaneous Urinary Conversion

Objectives: After ileal or colon conduit diversion some patients; in particular in adolescence; desire a conversion into a continent form of diversion thus removing external devices and improving the quality of life. We report our long-term results of conversion from conduits into a continent cutaneous diversion. Methods: Between July 1986 and February 2001; a total of 32 patients (mean age: 18 years; range 6 to 49 years) underwent conversion of a colon (n=19) or ileal conduit (n=13) into an ileo-caecal pouch with a mean follow-up of 97 months (range 11-185 months). Conversion was performed using a simplified technique incorporating the preexisting colon/ileal conduit into ileocaecal Mainz pouch I. The morphology of the upper urinary tract; renal function; con-tinence and metabolic changes were analyzed. Results: A total of 17 patients (53) showed complications requiring surgical intervention; these included stoma stenosis (13); pouch calculi (28) as well as ureteric stenosis in 4/61 RU (7). Continence was achieved in 97of patients. Faecal frequency was unchanged in 75of patients without treatment while the rest required medical therapy (cholestyramine; loperamide). During follow-up; early substitution of alkalizing agents was performed at a base excess of -2.0 mmol/l for 15 patients (47); thus preventing acidosis. The renal function remained stable during follow-up. All patients are completely satisfied; in particular as compared to the previous situation. Conclusion: The inclusion of the preexisting colon or ileal conduit facilitates continent cutaneous conversion and decreases bowel requirements. An acceptable complication rate; a stable renal function and the patient's comfort support the conversion of a conduit into Mainz Pouch I as a safe and viable option on the long run

Urodynamic evaluation of voiding function in females with stress urinary incontinence

Objective The evaluation of voiding function in females with lower urinary tract symptoms (LUTS) with a special emphasis on the evaluation of storage function and the state of continence. Patients and Methods 176 patients were investigated for urinary incontinence-related problems at the Unit for Neuro-Urology and Urodynamics of the Department of Urology; University Medical Center Nijmegen (The Netherlands). The patients were classified into two groups according to their symptoms and urodynamic studies. Group I consisted of 103 patients with stress urinary incontinence (SUI); while Group 2 included 73 patients with other forms of urinary incontinence or no urodynamic abnormalities at all. All patients were subjected to urodynamic investigations including uroflowmetry; static and dynamic urethral pressure profiles; filling cystometry and pressure-flow studies. Results It was noted that the bladder capacity as well as the average and maximum flow rates tended to be higher among patients with SUI. Some insignificant increase in outlet obstruction; as assessed by the Lin PURR nomogram was noticed. Detrusor contractility was only found to be significantly reduced in patients with SUI when the total Watts factor was compared in both groups. Conclusion When comparing both groups; significant differences were found in the filling cystometry as well as in the urethral pressure profile variables. Some differences were also detected with regard to pressure-flow studies and detrusor contractility during voiding

Effect of clean intermittent catherization on lower urinary tract : an experimental study

Objective To investigate the effect of clean intermittent catheterization (CIC) on the lower urinary tract in experimental animals. Patients and Methods: Eight male spinalized cats were subjected to CIC for a period of 6 - 9 weeks. A urine specimen for culture was obtained weekly. A pathological examination of the proximal and distal urethra and the bladder was performed. Results Urinary tract infection was detected in all cats starting from the second week. It responded to antibiotics but recurrence occurred after discontinuing the treatment. One animal died in the 4th week from fibrinopurulent peritonitis caused by necrotizeng ulcerative cystitis. False passage occurred in another cat at the end of the 6th week. It was managed by fixation of a urethral catheter for a week; and CIC was then continued for another two weeks. Pathological examination showed a thickening of the urethral wall that progressed with the duration of CIC. Microscopic examination of the urethra showed epithelial hyperaemia; ulceration and an inflammatory reaction with oedema as well as an inflammatory reaction of the lamina propria. The muscular layer showed progressive hypertrophy with continuing CIC. The bladder wall showed epithelial ulceration; Brunn nests and squamous metaplasia with islands of degenerated cells. Conclusion Recurrent urinary tract infection; local traumatic reactions of the urethral and bladder wall; especially epithelial damage of the mucosa; and false passages are common complications occurring with CIC in the experimental animal. Although the situation in the experimental animal has no relevance in humans; yet; it may throw light on some aspects of possible complications of long-term CIC

Complications of orthortopic ileal reservoirs

Objectives To evaluate the early and late postoperative complications; upper urinary tract morphology and function and metabolic alterations which may occur after ileal continent orthotopic urinary diversion. Patients and Methods Between July 1999 and January 2001; 42 male patients were subjected to radical cystoprostatectomy for bladder cancer and orthotopic urinary diversion at the urology departments of Cairo University and Suez Canal University Hospitals. All cases were evaluated clinically; bacteriologically; urodynamically and radiologically during the early and late postoperative periods (at 3 - 6 months and 6 - 18 months; respectively). The patients were divided into three groups: in Group I (22 cases) a W neobladder was fashioned with the uretero-ileal anastomosis done by creating extramural serosally lined tunnels. In Group II (12 cases) a Camey II pouch was done with ureteroileal anastomosis by direct end-to-end anastomosis in four and by Le Duc technique in eight pouches. In Group III (8 cases) a Kock's pouch was done with the ureters being directly implanted in the afferent loop above the constructed intussusception ileal nipple valve. In all types of reservoirs we used 45 cm of the ileum. Preoperatively all but four ureters were normal. These four ureters were dilated and uretero-ileal anastomosis was done by extramural serosally lined tunnels. Results In the early follow-up period total diurnal continence was achieved in 72; 75and 75of the patients of Groups I; II and III; respectively; versus 91; 83and 88in the late postoperative period. Nocturnal continence was achieved in 64; 67and 63during the early postoperative period compared to 73; 75and 75in the postoperative period for the three groups; respectively. In the early postoperative period complications occurred in 33of the patients including ureteroileal leakage (9.5); a prolonged pouchourethral anastomotic leakage (11.9); wound dehiscence (4.7); deep venous thrombosis (2.3); bronchopneumonia (2.3) and a prolonged ileus (2.3). Late complications occurred in 26.2of the patients including urethral recurrence; pelvic recurrence and urethroileal anastomotic stricture in 4.8; 14.2; 4.8; respectively and urethral stricture at the bulbomembranous junction in 2.4. A higher incidence of renal deterioration was detected in cases where the ureters were implanted directly (60) or in cases where the ureters were implanted by Le Duc technique (30). Deterioration was noted in 12.5of the cases where the ureters were implanted in an intussusception nipple valve and in 4.5of the renal units where the ureters were implanted in an extramural serosally lined tunnel. At 9 months postoperatively metabolic acidosis occurred in one patient with a Camey II neobladder. Conclusion A number of early and late postoperative complications were encountered after orthotopic neobladder. Metabolic complications were found in the form of metabolic acidosis in one patient. The lowest incidence of renal deterioration was reported in cases with extramural serosally lined ureteroileal anastomosis

Prune belly syndrome a rare case report

A case of a rare congenital anomaly of Prune Belly Syndrome (PBS) predominant in males is presented. 1 Incidence is 1 in 40;000 lives births. The complete syndrome is characterized by ; dilatation of the upper urinary tract; lateral deviation of the dilated ureters large bladder with urachal anomalies; vesicoureteral reflux; dilatation of the prostatic utricle; undescended testis and patchy agenesis of the anterior 2 abdominal wall. All the above features may not necessarily be present in one single case. The major anomaly is due to failure of proper development of both the urinary tract and anterior abdominal wall. Respiratory; cardiac; skeletal and anorectal malformations may be present as well