Endoscopic Management of Ureteric Stones: Our Initial Experience

Urological Surgeries in a West African Teaching Hospital

Introduction

Urological surgeries are a significant part of surgical services. The need for these services varies regionally and globally. Knowledge of the local need is important for prioritisation of resources.

Objectives

To describe the urological procedures done in our hospital for effective utilisation of the already scarce resource in this region.

Patients and Methods

This was a retrospective one-year study of the urosurgical cases done in a Nigerian Teaching Hospital. The main theatre register was used to collate data. Data collected included age, sex, operation done and anaesthesia employed.

Results

One hundred and twenty-two male and three female patients were included with a male-to-female ratio of 41:1. The mean age of the patients was 56.6 ± 19.89 years. Elective cases accounted for 102 (81.6%) of surgeries. Regional anaesthesia was the most common form of anaesthesia accounting for 105 (84%) followed by local anaesthesia in 16 (12.8%). Day cases accounted for 77 (61.6%) of procedures. More than 80% of the study population was 50 years and older. Overall, the three most common performed surgeries were digital-guided prostate biopsy 47 (37.6%), suprapubic cystostomy 16 (12.8%) and open prostatectomy 9 (7.2%). In male patients, the three most common procedures were prostate biopsy 47 (38.5%), suprapubic cystostomy 16 (13.1 %), open prostatectomy 9 (7.4%) whereas nephrectomy, pyeloplasty and stent removal each accounted for 33.3% each of procedures in female patients. Endourological procedures accounted for 5 (4%) of cases.

Conclusion

Open surgeries accounted for the majority of these cases done with prostate-related procedures being the most common procedures. Few endourological procedures were performed.

Ureteroscopy and Holmium:YAG Laser Lithotripsy For Upper Tract Stones in a New Urology Centre: Our Initial Experience

Background

To demonstrate the outcome of our initial experience in the management of upper tract stones with ureteroscopy and Holmium: YAG laser lithotripsy.

Methodology

The data of thirty-two patients who had ureteroscopy and laser lithotripsy for upper urinary tract stones at a private urology centre in Awka, Anambra State Nigeria from September 2020 to June 2022 (20months) were retrospectively studied. Their sociodemographic data, clinical symptoms, the location and size of the stones, preoperative and postoperative stent use, hospital stay, complications, and stone-clearance rates were analyzed.

Results

A total of 32 procedures were performed on 32 patients. The mean age of the patients was 44.7 ± 12.2 years. The mean stone size was 15.4 ± 6.7mm with a range of 8.0-39mm, and Hounsfield unit ranging from 233-906. The stones were on the right tract, left tract, and bilateral in 46.9%, 43.7%, and 9.4% of the cases respectively. The patients had a mean length of hospital stay of 3.31 ± 1.45 days. The stone clearance rate was 90.3%. 53.1% of the patients had postoperative complications with 40.6% of these being post-operative fever which resolved with antibiotics. There was treatment failure in one patient due to the inability to scope the ureter on account of ureteral stricture.

Conclusion

Ureteroscopy and laser lithotripsy are safe and effective options in the management of upper tract stones with the advantages of being performed via a natural orifice, being less painful, with reduced risk of severe bleeding, irreversible loss of renal parenchyma, as well as a short hospital stay.

Urethral Stricture and Urethroplasty Practice in a Teaching Hospital in Anambra, South-Eastern Nigeria

Background

Management of urethral stricture disease remains a challenge in the field of urology. Though several options exist for its management, urethroplasty has proved to give the best outcome.

Methodology

This is a retrospective study of urethral strictures and urethroplasties for 5years spanning from January 2015 to December 2019 at a tertiary teaching hospital in Anambra, South East Nigeria. Data was retrieved from the case notes of all the urethral strictures cases which presented to our facility in these 5 years and analysed using Microsoft Excel.

Results

A total of 186 patients were diagnosed with urethral stricture disease within the 5 years' period. However, only 28 (15.1%) of them had urethroplasty within the period, mostly due to lack of fund. Of those who had urethroplasty, their ages ranged from 4 - 64 years with a median of 29.50 years. Motor vehicular road traffic accident (RTA) was the most common (46.43%) aetiology. Excision and anastomosis was the most common type of urethroplasty performed (71.43%) and the most common complication was stricture recurrence (32.14%).

Conclusion

Though urethroplasty techniques have become more refined, accessibility of care continues to hamper treatment in Sub-Saharan Africa due to socioeconomic issues.

Donor Nephrectomy Through Mini-Flank Incision: A Single-Centre Experience Among Nigerian Patients

Background and objective

The field of kidney transplantation in sub-Saharan Africa is still in the rudimentary stages. The majority of patients with chronic kidney disease have no access to renal replacement therapy, leading to very high mortality rates. Donor nephrectomy (DN) is an important aspect of kidney transplantation. Over the last two decades, open DN (ODN) has given way to minimally invasive techniques like laparoscopic DN (LDN) and robotic-assisted DN. In this study, we aimed to describe our experience with mini-flank incision donor nephrectomy (MIDN) at a Nigerian renal transplant center.

Materials and methods

We conducted a retrospective review of all DN cases performed at a single Nigerian kidney transplantation center over a three-year period. Information obtained from these patients was classified into pre-, intra-, and postoperative. The data included sociodemographic characteristics, preoperative preparation, details of intraoperative techniques, and postoperative findings. These were entered into a proforma and analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY).

Results

A total of 230 patients underwent ODN during the study period. The majority of the donors were males (92.8%) with a mean age of 30.83 ±8.43 years. The body mass index (BMI) of most (76.1%) of the donors was within the normal range (18.5-24.9 kg/m²). The duration of DNs ranged from 72 to 154 minutes with a mean duration of 130 ±28 minutes. The length of flank incisions ranged from 7.8 to 12 cm with a mean incision length of 10.8 ±1.0 cm. Donors who had MIDN attained satisfactory postoperative pain control with about 90% of them having a BMI of <30 kg/m². Oral intake and ambulation were commenced on the first postoperative day, and the cosmetic outcomes were deemed acceptable in over 90% of kidney donors.

Conclusion

Mini-incision for DN through the flank approach is a suitable alternative to LDN in the developing world where facilities and skills for LDN or robotic nephrectomies are largely unavailable. It offers a short recovery time, early ambulation, and excellent allograft outcomes.

Comparison of mean operative time in patients undergoing Ho: YAG laser lithotripsy and pneumatic lithotripsy in ureterorenoscopy for ureteric calculus

Objective

To compare the mean operative time (MOT) in patients undergoing Ho: YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) for ureteric stones.

Methods

This randomized study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan from July 2016 to November 2018. Non probability consecutive sampling technique utilized to enroll 60 patients of both gender aged 18-60 years, having ureteric calculus ≤1.5cm. Randomization was done into group I (LL) and II (PL) via computer generated number tables. Six Consultant Urologists performed surgeries under spinal anesthesia utilizing Swiss Lithoclast^® Master (EMS⁺ S.A. Switzerland) in group II and holmium laser fiber (365μm, 8-10Hz, 9.6-16W, 2100nm wavelength) in group I respectively. MOT was noted from insertion of cystoscope till removal out of meatus. Data obtained was analyzed through IBM SPSS 24.0.

Results

Analysis involved 60 patients (30 each group) having similar baseline characteristics (age, gender, laterality, location). There was statistically significant different MOT between LL & PL (25.48±6.99 vs 34.83± 7.47 minutes, p < 0.001). Data stratification with respect to age, gender, laterality and stone location revealed similar trend. Lithotripsy technique significantly affected MOT (p < 0.001) on Multiple Linear Regression Analysis.

Conclusions

Ho: YAG LL is an efficient technique when compared with PL in terms of MOT for ureteric stones.