Surgical Advances in Treating Benign Prostatic Hyperplasia in Africa: What About the Endoscopic Approach?

OBJECTIVES

To assess the practices, trends, and challenges associated with the use of endoscopic techniques in Africa related to the surgical treatment of benign prostatic hyperplasia METHODS: The questionnaire, which was based on Google Forms, assessed several points related to the surgical management of benign prostatic hyperplasia.

RESULTS

In 67.4% of the centers, BPH was the primary pathology requiring surgical management.In all 43 centers, approximately 1/3 of the urologists (n = 41) are able to perform an endoscopic procedure for the management of prostatic hypertrophy. Of the 43 centers, 30 had a block equipped with endourology equipment, and 56.6% (n = 17) performed endourological surgery exclusively for the surgical management of BPH. TURP is the most widely used endoscopic technique. Open prostatectomy was the only surgical technique used in 14 centers (32.5 %).In the remaining centers, both procedures (endoscopy and open surgery) were used depending on the surgeon's skills.Twenty-six (60.5%) centers expressed the need for training in endoscopic management of BPH.

CONCLUSION

The main challenges encountered relate to the lack of competent personnel, the unavailability of equipment and materials, and the high cost to patients. It is essential to develop modern urology in Africa, particularly in terms of endourological practices.

Urethral Caruncle in Pediatrics: A Northern Tanzania Experience

Urethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in postmenopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present a case series of three pediatric patients with a urethral caruncle.

Place of urolithiasis in the spectrum of urological pathologies, practices and use of endourological procedures in the management of calculi of the upper urinary tract: results of a survey of referral centres in Africa

Our aim was to determine the current trend of endourology in the management of upper urinary tract calculi in Africa reference centres. We conducted an online multiple-choice questionnaire survey involving 46 centres from 27 countries using a structured well-designed Google Form (®) questionnaire. The questionnaires were distributed to the head of service through their emails. The questions collected demographic data about the centre, the epidemiology of urolithiasis, diagnostic means and management of upper urolithiasis, especially access to endourology procedures and their practices. Descriptive analyses were performed. The participation rate was 77.9%. Urinary lithiasis was one of the three main pathologies encountered in 42/46 centres. 33 centres had easy access to CT scanners and 34 had operating theatres equipped with endo-urological surgery equipment. Of these 34 centres, 30 perform endourology for the management of upper urinary tract stones. Rigid ureteroscopy is the main technique used by the centres. It is the only endourology technique used for stone management by 12 centres (40%). 7/30 (23.3%) have the option of performing rigid ureteroscopy, flexible ureteroscopy and percutaneous nephrolithotomy. The frequency of procedures varies widely, with 43.3% rarely performing endourological surgery. Seventeen centres have their operating theatre equipped with a fluoroscope and 6/42 centres have extracorporeal lithotripsy. Open surgery is still used in 29/42 centres (69.1%). Laparoscopy is available in 50% of centres, but none reported performing laparoscopic lithotomy. In Africa, urinary lithiasis plays an important role in the activities of referral centres. Modern management techniques are used to varying degrees (not all centres have them) and with very variable frequency. Open surgery is still widely performed as a management. Rigid ureteroscopy is the main endourological technique. It is essential to develop the practice of modern urology in Africa, mainly endourology.

Urologist Workforce and Services in Ethiopia

BACKGROUND

Urological conditions are a cause of diminishing quality of life, hence affecting productivity. Despite the need for urological treatment, it was excluded from receiving priority in both United Nation and Lancet commission. Most of the surgeries in sub-Saharan Africa are open surgeries. The lack of basic endourology equipment and a shortage of experts have limited Africans from receiving the privileges of minimally invasive surgeries, especially in urology. This study describes the socio demographics of the urologists in Ethiopia, the field of services they provide and their access to endourology equipment.

METHODS

This study presents data from a survey of urologists in Ethiopia who are members of Urology Society of Ethiopia (USE).

RESULTS

Thirty-three urologists of the 43 responded, making the response rate 76.5%. Qualification by urology residency in Ethiopia accounted for 66.7% of participants, followed by 21.2% by fellowship training abroad after general surgery training. All respondents practice open surgeries and 75.8% perform endourology. Video endoscope and cystoscopy sets were available to all those practicing endourology, with Direct Visual Internal Urethrotomy (DVIU) sets having the next highest availability and Flexible UreteroRenoScope(URS) and laser lithotripters the least accessible.

CONCLUSIONS

Urology in Ethiopia is in its infancy, where the lack of advanced medical equipment combined with a paucity of qualified urologists have created a huge challenge for the provision of these services.

Appendico ilial knotting: a rare cause of small bowel obstruction

Small bowel obstruction (SBO) is one of the most common acute surgical conditions that needs immediate innervation to prevent the morbidity and mortality associated with it. The common causes of SBO are different in developed and developing nations. Well-versed knowledge of the rare causes of SBO including its option of management is necessary. In this article, we present a case of an acute SBO secondary to Appendico-ileal knotting. The diagnostic difficulty and the options of management are discussed