Inadvertent Stone Migration During Pneumatic Lithotripsy: Still a Conundrum in the 21st Century

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device\u27s operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management. Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device\u27s operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management

Testicular torsion induced by epididymo-orchitis: A case report

Introduction and importance: Acute scrotum is considered a urological emergency requiring early intervention depending on the cause. There are multiple causes of acute scrotum with testicular torsion being the most feared as delayed treatment leads to testicular loss. However, differentiating between epididymo-orchitis and torsion can be very difficult. Case presentation: We present a case of an 18-year old male patient with 2 separate episodes of acute scrotum. He had epididymo-orchitis as the first presentation followed by testicular torsion 5 days later. To our knowledge this is the first case of testicular torsion secondary to epididymo-orchitis. Clinical discussion: Differentiating between epididymo-orchitis and torsion is challenging but important due to risk of loss of testis with a wrong diagnosis. Once you establish epididymo-orchitis the suspicion for subsequent torsion should be high with close follow up and adequate counselling. Conclusion: He ultimately had orchiectomy, although a rare presentation, enlarged testis due to epididymo- orchitis can predispose an individual to developing testicular torsion thus adequate counselling on warning signs to patients with epididymo-orchitis is of particular importance so as to intervene early and ultimately save the testis

Overview of Antiretropulsion Devices for Prevention of Inadvertent Stone Migration during Pneumatic Lithotripsy for Ureteric Stone

The purpose of the present chapter is to provide an update about the use of preventive devices used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management. The aim to reduce the cost, ancillary procedure, reduce the operative time and improve the stone free rate. The hunt for ideal cadget to stop retrograde stone migration is still continue in 21 century

Validation of the Swahili version of the International Prostate Symptom Score at a private, nonprofit general hospital in Dar es Salaam, Tanzania

Background: Accuracy in translating the International Prostate Symptom Score (IPSS) into different languages is essential to ensure that it is comparable to the original version and acceptable to the target population. We aimed to develop and validate a Swahili version of the IPSS (sIPSS). Methods: We conducted a cross-sectional study involving 53 patients presenting with lower urinary tract symptoms to the Aga Khan Hospital in Dar es Salaam, Tanzania, from April through December 2018. We enrolled 53 patients with confirmed benign prostatic hypertrophy and 32 control patients with suspected or confirmed urolithiasis. We assessed the face validity and discriminative validity of the sIPSS using standard statistical constructs, including Cronbach’s alpha, intraclass correlation coefficients (ICC), the receiver operating characteristic curve, and Spearman’s rank correlation coefficient. Test–retest reliability was assessed by comparing baseline sIPSS scores with those obtained after 1 week for all participants, and sensitivity to change was assessed by comparing baseline scores to those at 4 to 6 weeks after treatment in the BPH group. Results: The sIPSS had excellent internal validity (Cronbach’s alpha, 0.86), comparable to that of the original IPSS. The test–retest reliability of the sIPSS was high (ICC, 0.84), and the mean improvement in sIPSS score 4 to 6 weeks after treatment was 9.7±6.4. Conclusions: For use in the Tanzanian population, the sIPSS is reliable, valid, and sensitive to change

Postoperative subcutaneous emphysema following percutaneous nephrolithotomy: A rare complication

Percutaneous Nephrolithotomy (PCNL) is a common urological procedure performed for complicated upper urinary tract stones. The advantages of PCNL include lower morbidity and mortality rates and quicker recovery compared to traditional open surgery. A number of complications have been reported which can be life threatening. Here we present a case of 71 years old lady, who developed subcutaneous emphysema following PCNL

A case report of minimally invasive percutaneous ultrasound guided tuberculous iliopsoas abscess drainage in an immunocompromised patient

Introduction and importance Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach. Case presentation 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment in a sub-Saharan Africa. Clinical discussion We concur with the recommendation to analyse fluid for tuberculosis in at risk individuals with minimally invasive procedures via interventional radiology as an adequate first line diagnostic and treatment option of psoas abscess. Ultrasound guided catheter placement and drainage successfully drained the abscess by day 10 similarly seen as the average duration in a case series from India. Conclusion The importance of the role of interventional radiology in treatment for complex abdominal pathologies in sub-Saharan Africa with its ability to diagnose and treat via minimally invasive procedures at highest precision and lowest risks and complications while maintaining a high level of suspicion for tuberculosis as the underlying etiology is highlighted

Negative Appendectomy Rate in Urban Referral Hospitals in Tanzania: A Cross-sectional Analysis of Associated Factors

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negative appendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power. Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite a demonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males. Conclusion: The NAR is clinically significant as about two out of every five patients undergoing emergency appendectomy for suspected AA do not require the procedure. The AS is underutilized despite a demonstrated ability to decrease the NAR. We recommend that the AS be incorporated in the management of patients with suspected appendicitis

Perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital in Tanzania

Background: Surgical Site Infections are a major cause of morbidity and mortality among operated patients. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medication for a single patient. Few studies have shown qualitatively factors influencing this and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania. Objective: To describe the perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital. Methods: A qualitative study involving in-depth interviews with surgeons was conducted in English by the primary investigator. The interviews were audio-recorded and transcribed verbatim. Systematic text condensation by Malterud was used for data analysis. Findings: Fourteen surgeons and obstetrics and gynaecologists participated. Their perceptions were summarized into three main categories: Inadequate data to support practice; one who sees the patient decides the antibiotic prophylaxis; prolonged antibiotic use for fear of unknown. The participants perceived that choice of antibiotic should be based on local hospital data for bacterial resistance pattern, however the hospital guidelines and data for surgical site infection rates are unknown. Fear of getting infection and anticipating complications led to prolonged antibiotics use. Conclusion: The study provides an understanding of surgical antibiotic prophylaxis use and its implementation challenges. This was partly expressed by unavailability of local data and guidelines to enhance practice. To improve this, there is a need of guidelines that incorporates local resistance surveillance data and enhanced antibiotic stewardship programmes. A strong consideration should be placed into ways to combat the fears of surgeons for complications, as these significantly affect the current practise with use of surgical antibiotic prophylaxis

Primary leiomyoma — A rare tumour of ureter

A case of huge primary leiomyoma of the ureter in which nephroureterectomy was performed is presented. To the best of our knowledge, this case is a unique form of leiomyoma of the ureter due to its large size. There have been only twelve cases of primary leiomyoma of the ureter reported since 1955 and eleven of them were very small and one was big in size but smaller than the present case. Our case is considered to be the thirteenth

Diagnostic accuracy of computed tomography in adults with suspected acute appendicitis at the emergency department in a private tertiary hospital in Tanzania

Introduction. The increasing incidence of acute appendicitis in sub-Saharan Africa emphasizes the need for accurate and reliable diagnostic tools. However, the variability in the diagnostic performance of computed tomography for suspected acute appendicitis coupled with comparatively higher negative appendectomy rates in this setting highlight a possible concern regarding the diagnostic accuracy. This study evaluated the diagnostic accuracy of a computed tomography scan for suspected acute appendicitis at the emergency department in Tanzania. Methods.A retrospective diagnostic accuracy study was conducted from July to October 2020. All patients above 14 years of age who presented at the emergency department with right iliac fossa abdominal pain of fewer than ten days and underwent computed tomography for suspected acute appendicitis were evaluated, and the Alvarado score was computed. Histological diagnosis and clinical follow-up of 14 days were considered the reference standard. Ethical clearance was sought from the Aga Khan University Ethical review committee. Results 176 patients were included in this study. The sensitivity, specificity, and diagnostic accuracy were 100% (95% CI 91.8–100), 96.9% (95% CI 92.2–99.1), and 96.9% (95% CI 93.1–98.3), respectively. The mean Alvarado score in those without acute appendicitis was 4 (95% CI 3.7–4.3) compared to a mean score of 6.6 (95% CI 6.0–7.2) amongst those with acute appendicitis. The area under the receiver operator characteristics curve of computed tomography was 98.4%, and that of the Alvarado score was 84.1%. Conclusions The diagnostic performance of computed tomography in this study is similar to that established elsewhere. However, the Alvarado score is not routinely used for the initial screening of suspected acute appendicitis patients. A threshold of Alvarado score of 4 as a guide to conduct computed tomography for suspected acute appendicitis would have decreased computed tomography use by 50%, and missed 4 cases. Implementation studies that address Alvarado score use should be conducted