Ureteroscopy Outcome and Its Determinants in a Resource-Limited Setting

Ureteroscopy is a major diagnostic and therapeutic technique for lesions of the ureter and intrarenal collecting system. METHODS: A retrospective chart review was done at St. Paul's Hospital Millennium Medical College, Ethiopia to determine the outcome of ureteroscopy and factors affecting it. The study period was from January 2018 to April 2018. Multivariate analysis was done to determine factors affecting stone clearance and success rate. RESULT: One hundred six patients who underwent semirigid ureteroscopy were included in the study. The male-to-female ratio was 1.8:1. The mean age of the patients was 36.4 years (±12.6). Ninety-six (90.6%) patients were found to have ureteric stones, while 9(8.5%) patients had a ureteric stricture. Ureteroscopy therapeutic interventions for stones were successful in 89 (92.7%) patients. The mean procedure time and postoperative hospital stay were 44 minutes (±23.7) and 2.5 days (±2.5) respectively. Intraoperative complications (ureteric avulsion, hemorrhage, and ureteral perforations) occurred in 6(5.7%) patients. The stone clearance rate was 54.7% (52). The site of obstruction was passed in 93 patients making the success rate of the procedure 87.7%. The absence of intraoperative complications was significantly associated with success rate. Patients with intraoperative complications have low success rate (20%) compared to patients without complications (92.3%), p=0.42. CONCLUSION: Semirigid ureteroscopy had a good success rate, especially for stones in the distal ureter and if there is no flexible ureteroscope, it is an acceptable alternative

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

L'uretrorraphie termino-terminale tardive dans la rupture post-traumatique de l'uretre posterieur

"Objective: To analyse the long-term results of the treatment of post-traumatic posterior urethral rupture by delayed bulboprostatic anastomotic repair and to evaluate the efficacy and advantages of this technique. Patients and Methods: Between February 1989 and February 2004; 15 patients underwent delayed bulboprostatic anastomotic repair of post-traumatic posterior urethral ruptures. The results were evaluated taking into account the quality of micturition; continence and erectile function. Results: After an average follow-up period of 34 months (range: 12 - 72 months); all our 15 patients were continent and voided with a satisfactory flow. To achieve this result; 5 patients (33;3) had to undergo internal ureterotomy. Only 4 patients (26.7) reported erectile problems. Conclusion: Delayed bulboprostatic anastomotic repair remains the ""gold standard"" in the treatment of post-traumatic posterior urethral rupture. Compared to other methods of treatment of post-traumatic stenosis of the ureter; this technique allows for a long-term success with minimal complications."

Urologic day-care surgery : scope and problems in a developing country

Objective Due to the numerous economic and social benefits associated with the practice of day-care surgery; it is gaining widespread acceptance worldwide and across all specialties. We therefore determined the spectrum of procedures and the difficulties faced during implementation of day-care urologic surgery in a tertiary-care center in Nigeria. Patients and Methods This was a prospective study of all consecutive urologic day cases seen at the urology unit of Jos University Teaching Hospital; Nigeria; from January 2003 to December 2004. A total of 270 patients aged between 2 weeks and 100 years (median 55 years) with a male to female ratio of 14:1 were seen during the study period. The parameters studied were the presenting symptoms; diagnosis; treatment modalities; anesthesia; complications and whether or not the patients were converted to be in-patients or readmitted after discharge as well as the reasons for such conversion or readmission. The statistical analysis was done using the Epi-info 2004 system; version 3.2.2. Results The main conditions seen were urethral stricture in 89 (32.5) patients; benign prostatic hyperplasia in 86 (31.8); carcinoma of the prostate in 26 (9.6); carcinoma of bladder in 15 (5.6) and male infertility in 10 (3.7) patients. The procedures carried out were mainly urethroscopy/ urethrocystoscopy in 103 (38.2) patients; visual internal urethrotomy in 48 (17.8) and trucut prostatic biopsy in 33 (12.2) patients. Sedation was used in 142 (52.9); sedation and local anesthesia in 53 (19.7); local anesthesia alone in 9 (3.3); general anesthesia in 22 (8.1) and other combinations or omissions in entry in 41 (15.2) patients. Circumcision was performed on 3 neonates (1.1) without anesthesia. There was a cancellation rate of 15.6(n=42) mainly due to the inability of the patients to come (24 patients; 57.1); inadequate materials in the theatre (9 patients; 21.4); power failure (4 patients; 9.5); strike action (3 patients; 7.1) and financial difficulties (2 patients; 4.8). We had a conversion rate to in-patients of 1.9(n=5) for various reasons. No further complications or readmissions after discharge were encountered. Conclusion Urethrocystoscopy is the most frequently performed procedure and urethral stricture the most common diagnosis in our day practice. Cancellation of cases and conversion to in-patients remain our major challenges. The education of patients and physicians; as well as the provision of adequate material and infrastructure are recommended in order to provide the maximum benefit from urologic day-surgery practice

Injuries encountered during rigid ureteroscopy in training centers

Objective To analyze the peroperative injuries encountered during ureterorenoscopy (URS) in two training centers in Egypt over a four-month period. Patients and Methods A prospective computerized database of 88 patients (38 males and 50 females) who underwent URS at two urologic university training centers (Al-Azhar University Hospital; Cairo and Assiut University Hospital; Assiut; Egypt) between July and October 2003 was analyzed. The procedures were elective in all cases. The indication for URS; the state of the ureter; associated pathologies; intraoperative injuries encountered and their management were recorded for analysis. Results All but seven patients were operated for therapeutic indications; mainly stone disease and ureteric strictures. Peroperative injuries were encountered in 14 patients (15.9) with the commonest type being mucosal laceration (57) followed by minor ureteric perforations. Major injuries in the form of ureteric avulsion; laceration and extravasation were noted in 2of the cases. The procedure was associated with inadvertent bladder or urethral injury in three patients. In all cases the diagnosis of the ureteric injury was prompt and confirmed by intraoperative ureterography. Treatment was started immediately. Conclusion URS; although an important tool in the management of upper tract pathology; is an invasive procedure; especially for therapeutic indications. It may result in significant complications that may jeopardize the integrity of the concerned renal unit. Recent technology in the design of ureteroscopes and their accessories may minimize injuries; especially if applied in teaching hospitals where the learning curve of URS is a demanding task

Role of fexible ureterorenoscopy in the management of lateralizing essential haematuria

Objective: To evaluate the role of flexible ureterorenoscopy in diagnosis and treatment of lateralizing essential haematuria. Patients and Methods: Twenty-three patients suffering from unilateral haematuria were included in the study and underwent flexible ureterorenoscopy. Their age ranged from 17 to 68 years (mean age: 36 years). Unilateral gross haematuria was demonstrated cystoscopically. The patients were subjected to a careful history taking; full laboratory and radiological investigations. However; we failed to localize the cause of haematuria in the patients included in the study. This necessitated flexible ureterorenoscopy on the affected ureterorenal unit. Results: The collecting system was inspected in 21/23 patients. Discrete lesions were identified in 11 patients (haemangioma on a renal papilla in six; small vascular lesions in three; a small calculus in one and a small papillary growth in one). Non-specific abnormalities (erythema of the infundibulumor abnormal configuration in the renal papilla) were found in six patients. No lesion was detected in 4 patients. Patients with non-specific abnormalities were biopsied and coagulated. The remaining 11 patients with discrete lesions underwent laser fragmentation of the calculus; nephroureterectomy for the papillary transitional cell carcinoma (TCC) and 9 patients underwent fulguration with or without biopsies. The haematuria resolved in all patients with discrete lesions. Patients with non-specific abnormalities had a poor outcome in our series; since all had recurrent or persistent bleeding. Follow-up ranged from 6-18 months (mean 9 months). Conclusion: Flexible ureterorenoscopy can be of value in the diagnosis and treatment of lateralizing haematuria. Patients with discrete lesions respond well to endoscopic treatment (electrocoagulation)

Bilateral single session ureteroscopy for ureteral calculi : is it safe and effective

Objectives: To determine the feasibility; safety and success rate of bilateral single session rigid retrograde ureteroscopy (URS) for bilateral ureteral calculi. Patients and Methods: Thirty-five patients underwent bilateral single session ureteroscopic calculus removal. Results: Out of 70 renal units in 35 patients treated; clearance of the calculus was successful in the first session of ureteroscopy in 63 (90). A total of 28 patients (80) were completely rendered stone-free bilaterally in one operative session. Two patients needed a second session of URS; while five required ESWL for residual or migrated stone fragments. No major procedure-related complications were encountered in any of our patients. Conclusion: Bilateral single-session rigid URS for ureteral calculi is feasible; safe and effective. There is no significant increase in ureteroscopy-related complications. It spares the patients a second anaesthesia and a second procedure and; thus; reduces the total hospital stay; total expenditure and enables the patient to resume work earlier

Does tubularized incised plate urethroplasty fit primary and repeat shat hypospadias repair ?

Objective To evaluate prospectively our experience using tubularized incised plate (TIP) urethroplasty in primary and repeat penile shaft hypospadias. Patients and Methods Thirty-two boys with penile shaft hypospadias were selected to undergo TIP procedure. Their age ranged from 22 months to 9 years. Twenty-two cases were primary and 10 cases were repeat hypospadias repairs. To correct penile chordee; complete degloving of the penis and lateral dissection of tethering tissues was done in every case. This was followed by tunica albuginea plication in 7 cases; while ellipse excision was needed in 3 cases. Using the preserved urethral plate; single-layer urethroplasty was done in all cases. A vascularized subcutaneous flap (36 cases) or tunica vaginalis (4 cases) was always used to cover the neourethra. A postoperative stent was used for 8 - 12 days in all cases. Results The patients were followed up for a mean of 14.2 months. Postoperative clinical evaluation revealed success rates of 95.5and 90for primary and repeat cases; respectively. Among the primary cases; only one patient had urethro-cutaneous fistula concomitant with meatal stenosis; while among the repeat cases urethro-cutaneous fistula occurred in one patient. No case of urethral stricture or wound dehiscence was encountered. Our criteria for success were a single unimpeded forward-directed urine stream; a straight penis; good cosmesis and no need for further surgery. Conclusion We feel that TIP urethroplasty in primary and repeat cases of penile hypospadias is a reasonable option in cases with chordee not severe enough to necessitate excision of the urethral plate and when midline incision of the plate yields an adequate width amenable to tubularization