Role of vesicostomy in the management of posterior urethral valve in Sub-Saharan Africa.

OBJECTIVE: To review the role of vesicostomy in the management of posterior urethral valve (PUV), in neonates and infants, given the limitations for endoscopic treatment in this setting. METHODS: A review of 35 patients who presented with posterior urethral valve over a 10-year period. Demographic and clinical information were prospectively recorded on a structured pro forma, and the data extracted analysed using SPSS 11.0. RESULTS: The 35 boys were aged 3 days to 10 years (median 3 weeks). Twenty-three (65.7%) had a vesicostomy (age range 3 days-3 years, median 3 weeks). The mode of presentation was poor urinary stream 15 (65.2%), urinary retention 4 (17.4%), and renal failure 6 (26.1%). Main findings were palpable bladder 23 (100%), hydronephrosis 4 (17.4%). Abdominal ultrasound confirmed hydronephrosis and thickened bladder wall, and voiding/expressive cystourethrogram confirmed dilated posterior urethra and vesicoureteric reflux in all 23 patients. Complications following vesicostomy were stoma stenosis 1 (4.3%), bladder mucosal prolapse 1 (4.3%), perivesicostomy abscess 1 (4.3%); there was no mortality. Following vesicostomy, 10 (43.5%) patients had excision of the valves and vesicostomy closure at age 2-8 years (median 4 years). They are well, with normal renal ultrasonographic findings, bladder capacity range 115-280 ml, and normal urea, serum electrolytes, creatinine, at 3 years of follow up. Thirteen (56.5%) are still awaiting valvotomy but have remained well and with normal ultrasonographic renal findings. CONCLUSION: Vesicostomy is a useful temporising mode of urinary diversion in neonates and infants with posterior urethral valve (in the absence of unobstructed upper tracts) when facilities for endoscopic valve ablation are not readily available.

Management of anorectal malformation: Changing trend over two decades in Zaria, Nigeria.

BACKGROUND: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. MATERIALS AND METHODS: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. RESULTS: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5%) and 106 (65.8%) emergency operations in groups A and B, respectively. There were 61 (45.5%) and 55 (34.2%) elective operations in groups A and B, respectively. Regarding treatment, in group A, patients requiring colostomy had transverse loop colostomy, while in group B, sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5%), anal transplant 5 (8.2%), sacroabdominoperineal pull through (Stephen's operation) 6 (9.5%) and others 21 (34.4%). In group B, posterior sagittal anorectoplasty (PSARP) 46 (83.7%), anal transplant 1 (1.8%), posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6%) and anal dilatation 6 (10.9%) were done. Early colostomy-related complication rates were similar in the two groups (P > 0.05). The overall late complication rate was 65.5% in group A and 16.4% in group B (P < 0.05). The mortality was 25 (18.6%) in group A compared to 17 (10.6%) in group B (P < 0.05). CONCLUSION: There have been significant changes in the management of anorectal malformations in this centre in the last two decades, resulting in improved outcomes.

Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes

Morbidity of colostomy closure in children

The care of colostomy remains a burden to the family while complications associated with its construction and closure can be tasking to the surgeon. The aim of this study was to evaluate the outcome of colostomy closure in children in our setting. A prospective review of 31 consecutive children undergoing colostomy closure in a 6 year period. There were 18 (58.1%) boys and 13 (41.9%) girls, aged 5 months 13 years (median 3 years). The median duration of colostomy was 16 months [range, 5 days -8 years]. Indications for colostomy were anorectal malformations 16(51.6%), Hirschsprung/'s disease 10(32.3%) and others 5 (16.1%). The site of colostomy was sigmoid colon 21, transverse colon 9 and caecum one. The type of colostomy was divided 18(58.1%) and loop12 (38.7%). Intraperitoneal and extraperitoneal closure was performed in 27(87.1%) and 4(12.9%) patients, respectively. Thirteen (41.9%) patients had 16 postoperative complications; postoperative pyrexia 4 (12.9%), prolonged ileus 4 (12.9%), surgical site infection 2 (6.5%), septicaemia 2 (6.5%). Post operative complication rate was significantly associated with the status of the surgeon (p < 0.05) and duration of surgery (p < 0.05). The median duration of hospital stay was 8 days [range: 5-35 days]. There was no significant difference in hospital stay in patients with postoperative complication and thosewithout (p > 0.05). Morbidity following colostomy closure can be high, particularly when the procedure is performed by a junior trainee

A review of appendicectomy in Sokoto, North-western Nigeria.

BACKGROUND: Acute appendicitis is a common surgical emergency in developed countries. There is a strorng evidence of a rising trend in the developing world. METHODS: We present a retrospective review of appendicectomy as performed at Usmanu Danfodiyo University Teaching Hospital, Sokoto over a six year period (January 1997 to December, 2002) RESULTS: The diagnosis of appendicitis was made in 38.9% of surgical abdominal emergencies. The peak age group was 20 to 29 years with a male to female ratio of 1.4:1. The negative appendicectomy rate was 15.9% There was associated Schistosoma haematobium in 4.44% of cases. Appendicectomy had a morbidity rate of 13.3% and a mortality of 0.9%. CONCLUSIONS: Appendicitis was the commonest surgical emergency in Sokoto. The negative appendicectomy, morbidity and mortality rates were within the range widely quoted in the literature. The need to avoid negative exploration is imperative in this poor community.