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

Delai de reveil anesthesique apres chirurgie uretero-renale chez des insuffisants renaux chroniques au CHU d'Antananarivo

Objectif: Evaluer la variation du delai de reveil apres chirurgie uretero-renale chez des insuffisants renaux chroniques. Methodes: Les auteurs ont realise une etude retrospective; descriptive et analytique sur une periode de trois ans entre janvier 2006 et decembre 2008; des dossiers des patients insuffisants renaux chroniques ayant beneficie d'une chirurgie renale ou ureterale sous anesthesie generale avec intubation oro-tracheale; au CHU JRA Antananarivo Madagascar. Resultats: Cinquante deux dossiers ont ete colliges. Le type de chirurgie influencait significativement le delai d'extubation; en l'occurrence l'uretero- nephrectomie qui le prolongeait et la nephrectomie qui l'ecourtait. Aucune variation significative de ce delai n'a ete retrouve quel que soit la duree d'anesthesie; le stade de l'insuffisance renale; le type d'agents anesthesiques hypnotiques ou morphinomimetiques (fentanyl) ou l'utilisation de medicaments a longue demi-vie (diazepam et pancuronium). Conclusion: Il ne faut pas se contenter de tenir compte de la pharmacocinetique et de la duree d'action des medicaments; mais aussi et surtout du type d'intervention; a fortiori si la fonction renale est prealablement alteree. Prioriser les agents hypnotiques volatils et les agents anesthesiques a elimination plasmatique seraient benefiques pour ces patients

Non-Tensile Tunica Albuginea Plication for the Correction of Penile Curvature

Objective: To evaluate the efficacy of non-tensile tunica albuginea plication (NTTAP) using nonabsorbable sutures for the correction of congenital and acquired penile curvature and to determine the key points for a successful outcome of this procedure. Patients and Methods: From June 2004 to July 2007; 43 patients with penile curvature (35 congenital and 8 secondary to Peyronie's disease) underwent surgical correction by NTTAP. The indications were difficult or impossible vaginal penetration; and a cosmetically unacceptable penis. For tunica albuginea plication (TAP) we applied the 16 dot procedure using non-absorbable sutures (Tycronr 2/0 polyester fiber). Results: After a mean follow-up period of 18 months; successful results with respect to penile straightening; normal erection; penetration and sensation; confirmed both subjectively and objectively; were achieved in all patients. Post-operative penile shortening of less than 1.5 cm was present in 50of the cases; but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100(35/43 very satisfied and 8/43 satisfied). Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful appropriate expectations; and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle; which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea; which may prevent postoperative erectile dysfunction; is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity

Urological Injuries during Pelvic Surgery in Women; Gezira; Central Sudan

Injuries to the ureter and bladder are common in female pelvic surgery; sometimes extremely common to be considered as traditional. This is a retrospective study conducted in Gezira Hospital for Renal Disease and Surgery; Medani Teaching Hospital and Medani Maternity Hospital; #ad Medani; Sudan. #e included $paetents 'ith urological injuries follo'ing obstetrical gynecology interveneton in the previous ( years. The interaoperaetve injuries consettuted; -.; 'hile the remote injuries 'ere 6+7(.6 -.. #e conclude that the urological injuries are common complications during pelvic surgery; associated mainly 'ith abdominal hysterectomies and Cesarean section

Evaluation du dispositif transdermique d'administration de fentanyl (Ionsisr) dans l'analgesie apres chirurgie urologique

La voie intraveineuse a ete longtemps privilegiee pour l'administration d'analgesiques en post operatoire; du fait de son caractere non invasif; la voie transdermique semble etre une alternative interessante. Objectif: Le but de ce travail est d'evaluer l'analgesie procure par le dispositif transdermique d'administration de fentanyl Ionsisr apres une chirurgie urologique; ainsi que la satisfaction des patients et des paramedicaux par rapport au produit. Methode: Il s'agit d'une etude prospective realisee sur une periode de deux mois concernant des patients adultes ayant beneficie d'une intervention urologique sous coelioscopie ou a ciel ouvert. Resultats et conclusion: Ionsysr seul a suffit a assurer l'analgesie pour 67de nos malades. Pour les 33restants se pose l'indication d'une prise en charge multimodale de la douleur. Ionsysr est en general bien accepte par les patients et le personnel paramedical en termes de facilite d'utilisation pour les patients et pour le peu de contrainte qu'il engendre pour le personnel paramedical

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

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