management of upper urinary tract obstruction in resource-poor settings

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. 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 pevic 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. Twenty-nine open surgical procedures were carried out. They consisted of pyelolithotomy [n=12], pyeloplasty [n=6], ureteroureterostomy [n=4], ureteroneo-cystostomy [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 was encountered: two cases of migration of double-J ureteric stents and one case each of prolonged urine leakage and wound infection. 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

Posterior urethral valves in childhoos: experience in a center with scarce facilities

Posterior urethral valves [PUV] are the most common congenital causes of lower urinary tract obstruction in male children, but few cases have been reported from Nigeria. In this study we describe our 7-year experience of management of PUV in children in order to increase the awareness of this condition in our environment. This is a report of 41 consecutive children with PUV who were managed at the Jos University Teaching Hospitals [JUTH], Jos, Nigeria, from June 2000 to April 2006. Their age at presentation ranged from 2 days to 15 years [mean: 2.5 years]. The relevant clinical, laboratory and radiological data were entered into a database and analyzed. Twenty-eight patients presented with a condition highly suspicious of PUV, while 7 patients presented with other urological conditions. Six patients presented with non-urological symptoms which caused a delay in diagnosis and institution of treatment. Voiding cystourethrography was diagnostic in all cases. In the majority of patients [n=31], management consisted of transurethral balloon avulsion of the valves yielding a satisfactory outcome in over 80% of the patients. Urethral stricture was the main complication [which responded to serial dilatation] and occurred in 3 patients. The postoperative mortality rate was 2.6%. Although this study was restricted to one hospital, there appears to be a high incidence of PUV in children in North Central Nigeria. An increased awareness of varied clinical features, a high index of suspicion and simple conservative treatment by balloon avulsion of PUV would improve the outcome

Visual internal urethrotomy in the management of anterior urethral stricture

Urethral stricture disease is common in our environment. The aim of this study is to report our experience with visual internal urethrotomy [VIU] in the management of this disease. Seventy male patients with a mean age of 30.6 years were treated for anterior urethral stricture by VIU at the Jos University Teaching Hospital between May 2002 and April 2006. To evaluate the treatment results, we studied the following parameters: stricture etiology, outcome of urethrotomy and complications. All patients were treated as day cases. The main cause of urethral stricture found in 43 [61.4%] patients was infection followed by trauma which was found in 11 [15.7%] patients. Twenty five [35.7%] patients had been subjected to previous treatment, notably urethral dilatation. The strictures were bulbar in 62 [88.6%], non-obliterative in 66 [94.3%], single in 28 [40%] and < 1cm long in 10 [14.3%] patients. Fifty-six [80%] patients had a satisfactory outcome after a single or second urethrotomy, 10 [14.3%] showed an improvement of symptoms after a third urethrotomy, while in 4 [5.7%] patients urethrotomy failed after four sessions. There was a recurrence rate of 32.9% [n =23], including those who had a good outcome after repeated sessions. Other complications included bleeding in 5 [7.1%], and extravasarion in 6 [8.6%] patients. Six [8.6%] patients were admitted for observation because of cornplications No mortality was encountered. VIU is effective and relatively safe for the short-term management of selected patients with anterior urethral strictures. Patients who do not respond Favorably to this modality of treatment should be offered urethroplasty, the outcome of which is not affected by previous internal urethrotomy