One-Stage Urethroplasty for Strictures in Maiduguri, North Eastern Nigeria

Background. Urethral stricture is a frequent cause of lower urinary tract obstruction worldwide. The aim of this study is to present our experience with one-stage urethroplasty. Methods. All males that underwent one-stage urethroplasty between January 2001 and December 2010 were retrospectively reviewed. Details of their biodata, clinical presentation, diagnostic investigations, operative treatment, postoperative complications, and other outcome of surgery were extracted and analyzed. Results. Ninety-one patients aged 8–76 years, (mean; 45.6 ± 19.7) with urethral stricture were studied. Postinfective strictures accounted for 58.2% and postprostatectomy strictures for 3.3%. Twenty-six (27.9%) of the strictures were in the posterior urethra of which 18 (59.2%) were posttraumatic. Fifty-seven strictures (61.3%) were in the anterior urethra of which 51 (54.8%) were postinfective. Thirty-nine (42.9%) patients had end to end anastomosis, 29 (31.9%) flap augmentation and 17 (18.7%) tabularized flap substitution, and 6 (6.6%) dorsal onlay grafts (5 with buccal mucosa and 1 with penile skin). There were 18 (19.8%) cases of wound infection, 12 (13.2%) of restricture and 6 (6.6%) cases of urethrocutaneous fistula. Satisfactory urinary stream was found in 77 (84.6%) patients. There was no mortality. Conclusion. Infection is the commonest cause of urethral stricture followed by trauma, and one-stage urethroplasty give excellent results

Use of Mitrofanoff and Yang–Monti Techniques as Ureteric Substitution for Severe Schistosomal Bilateral Ureteric Stricture: A Case Report and Review of the Literature

Distal ureteric stricture is a common complication of urinary schistosomiasis which is a disease more prevalent in the tropics and subtropics. The surgical management of this complication is more challenging when it affects more than half of both ureters. We report the case of a 17-year-old Nigerian with a long standing recurrent painless terminal hematuria associated with bilateral colicky loin pains. Ultrasound scan showed bilateral hydro ureters and hydro nephrosis with deranged biochemical renal function. The patient had bilateral tube nephrostomy and antibiotic therapy. Definitive bilateral ureteric substitution was done using Mitrofanoff technique for the right ureter and Yang–Montie technique for the left ureter. The patient’s renal function became normal and he was discharged home without complication. The related literatures were reviewed. Surgical nonurothelial ureteral substitution is necessary for long, extensive, severe bilateral ureteric strictures so as to prevent progressive renal damage and end stage renal failure.Keywords: Appendix, intestine, schistosomiasis, stricture, ureter, ureteric substitutionNigerian Journal of Surgery, Jan-Jun 2012 | Volume 18 | Issue

Bleeding prostate: A 10-year experience in the University of Maiduguri Teaching Hospital (Umth), Nigeria

Background: Bleeding from an enlarged prostate gland is a major complication of benign prostatic enlargement (BPH). This review details our management over a 10-year period. Materials and Methods: A retrospective review of patients who presented with bleeding BPH between January 2001 and December 2010 was carried out to determine the outcome of management. Results: Forty-two patients with bleeding prostates treated by open prostatectomy were analyzed. The peak incidence was in the age group of 60-69 years. The main associated co-morbidities were hypertension in 17 (40.48%) and diabetes in seven (16.67) patients. Urine culture was positive in 24 (57.14%) patients, with E. coli in 13 (54.17%) and Pseudomonas in four (16.67%) patients as the main isolates. Most patients (37; 88.08%) received blood transfusions ranging from two to four units. Operative techniques were transvesical in 30 (76.92%) and retropubic in nine (23.08%) patients. Isolated median lobe enlargement of the prostate was seen in 18 (46.15%) and whole organ enlargement in 21 (53.85%) patients. The weight of the prostates ranged from 47 to 403 g (mean, 127 g). Incidental carcinoma was seen in one patient (2.56%). The mean hospital stay was 11 days (range 9-21), and the mean follow-up was 21 months (range 3-26). There was one (2.38%) mortality. Conclusion: BPH with massive hematuria invariably has an enlarged median lobe and is managed by open prostatectomy, without risk of re-bleeding