Primary bladder neck obstruction (PBNO) in children in a resource-limited setting.

PBNO although rare when missed may have the debilitating effect of obstructive uropathy in children. The gold standard for its diagnosis requires videourodynamics and electromyography (EMG) studies which are not available in nearly all hospitals in developing countries. We present a case demonstrating the usefulness of readily available imaging in diagnosis of PBNO as well as demonstrate effectiveness of alpha blockade in children. MCUG and cystoscopy should suffice in cases of suspected PBNO in neurologically normal children to inform trial of therapy in resource limited settings.

The safety profile and acceptability of a disposable male circumcision device in Kenyan men undergoing voluntary medical male circumcision.

PURPOSE: We established the safety and effectiveness as well as the acceptability of the Alisklamp® device for male circumcision among Kenyan men. MATERIALS AND METHODS: To qualify for this hospital based, prospective, interventional cohort study one needed to be an uncircumcised adult male who was HIV negative with no comorbid factors or genitourinary anomalies precluding circumcision. A total of 58 men were recruited from a population of 90. Outcome measures were the safety profile of Alisklamp and its efficiency and acceptability by participants. RESULTS: All 58 procedures were completed without device malfunction, hemorrhage or undesirable preputial excision. Mean ± SD procedure time was 2.43 ± 1.36 minutes and mean device removal time was 15.8 ± 7.4 seconds. There were 2 adverse events, including mild edema and superficial wound infection related to poor hygiene in 1 case each. All men resumed routine activity immediately after circumcision. Of the 58 participants 25.9% experienced mild nocturnal erectile pains that required no medication. During 6-week followup all men were satisfied with the procedure, tolerated the device well and would recommend it to a friend. CONCLUSIONS: Alisklamp has an excellent safety profile and excellent acceptability among men who undergo circumcision using the device. This technique is easy to teach and it would prove to be a handy device to scale up the rate of male circumcision. Based on these findings the device merits a comparative clinical trial.