Modified ureterosigmoidostomy for management of malignant and non-malignant conditions

Objective: To investigate the outcome of Mainz Pouch II urinary diversion for both malignant and non-malignant diseases. Design: A retrospective analysis. Setting: Kilimanjaro Christian Medical Centre, Institute of Urology, Moshi, Tanzania from April 1995 to May 2007. Patients: Mainz Pouch II was created in 83 patients of which, 38 were females and 45 were males (M:F 1.2:1). Results: Early complications were seen in 11 (13.2%) patients, as follows: one (1.2%) prolonged ileus, 1(1.2%) wound dehiscence, two (2.4%) perioperative deaths among the malignant group, seven (8.4%) superficial wound sepsis. Long term complications were seen in 14 (16.9%) patients, as follows: one (1.2%) patient developed an incision hernia, one (1.2%) patient developed unilateral pyelonephritis, one (1.2%) patient developed unilateral ureteral stenosis, two (2.4%) patients had deterioration of renal function, three (3.6%) patients developed mild to moderate unilateral hydronephrosis, three (3.6%) patients developed mucoceles. Among the 83 patients in this series, three (3.6%) patients developed metabolic acidosis, two (2.4%) of which, required oral bicarbonate supplementation. All (100%) patients had daytime continence while three (3.6%) patients had occasional night time incontinence. Overall total continence was achieved in 80 (96.4%) of the patients. Conclusion: The Mainz Pouch II is a safe and reproducible method of urinary diversion and serves as a satisfying method of continent urinary diversion in all age groups. This reconstructive surgery enabled the afflicted to achieve personal goals, hopes and aspirations, positively influencing their quality of life. The follow up show low complication rate with good results in terms of continence and quality of life, however, long term results remain to be evaluated. East African Medical Journal Vol. 85 (7) 2008: pp. 334-34

Surgery for ureteral complications of bilharziasis

OBJECTIVE: To review our experience with reconstructions of ureteral complications of Schistosoma haematobium, in a centre situated in an endemic zone. PATIENTS: Fifty one patients operated for bilharzial complications of the ureters. METHODS: A retrospective analysis of patients operated upon, at the Coast Province General Hospital, Mombasa, Kenya between 1996 and 2008. All patients had obstructive ureteral complications. Data abstracted included demographics, level and nature of complication, surgical options utilized and follow-up. RESULTS: Endoscopic visual internal ureterotomy (VIU) was performed in 21 (41%) patients, resection and ureteroneocystostomy in 27 (49% of 55 procedures done), resection and ureteroureterostomy in one, nephrectomy in two and ileal replacements in two. Nephrostomy was performed in two patients who presented with anuria. Two patients restenosed after VIU and were offered resection and ureteroneocystostomy. One patient restenosed after ureteroneocystostomy and underwent a revision with psoas hitch. One patient with nephrostomy had bilateral ureteric replacement with ileum to skin. The two patients with anuria who had nephrostomy done eventually died of progressive renal failure. CONCLUSION: Schistosoma haematobium is associated with severe complications of the upper urinary tracts. Once established these complications are amenable to surgical correction, by both open and endoscopic techniques as long as renal function is not irretrievably impaired

Dismal salvage of testicular torsion: A call to action!

Background: Testicular ischaemia and infarction in cases of torsion depend on the duration and degree of twisting. Early evaluation and treatment are associated with high salvage reports.Objective: To determine the salvage rates of testicular torsion in selected hospitals at the Coast Province of KenyaDesign: A retrospective study of patients managed for testicular torsion and related conditions between 1999 and 2011.Setting: Coast Province General Hospital, Mombasa (1999 - 2008) and Moi District Hospital, Voi (2009 - 2011).Patients and Methods: Case records of 44 patients were reviewed. Forty two underwent scrotal explorations while two patients with bilateral  testicular loss due to torsion had no surgery. Patients were reviewed for age, operative diagnoses, testicular salvage, surgical procedures  performed and recurrence of symptoms.Results: Of 29 patients operated for acute testicular torsion, four had viable testes (salvage rate of 14%). Seven patients had bilateral orchidopexyfor intermittent testicular torsion. Three patients who had missed torsions with resultant total testicular atrophy, had orchidopexy of the contralateral testes. At scrotal exploration 2 patients with epididymorchitis and one patient with a torsion of appendix testis that was excised, were not subjected to orchidopexy. There was no occurrence of torsion after orchidopexy.Conclusion: Testicular torsions were associated with low salvage rates. Increased public awareness coupled with clinician, parental, teacher,  teenage and adult male education with respect to the consequences of acute scrotal pain is warranted