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

Pattern of presentation and management of patients with undescended testis at Kilimanjaro Christian Medical Center, Tanzania

Objective: To assess the pattern or presentation, management and advice given to the parents or guardians of patients with undescended testes (UDT) at Kilimanjaro Christian Medical Center, Tanzania.Subjects and methods: From July 2010 to May 2011, 30 patients with UDT were prospectively evaluated regarding age at surgery, place of birth, information given to parents or guardians, side and site affected, results of ultrasonography, findings on surgical exploration, follow-up and surgical outcome.Results: The median age at surgery was 6 years (range 1–36 years), 4 patients (13.3%) had orchidopexy before 2 years of age, 6 (20%) before 5 years and 4 (13.3%) after 18 years of age. The UDT was on the right side in 56.7%, on the left side in 26.7%, bilateral in 16.7%, in the inguinal region in 70% and in the abdomen in 30%. An associated malformation was found in 53.5% of patients: a hernia sac in 13 (43.3%), hypospadias in 2 (6.7%) and a hydrocele in 1 (3.3%). The UDT was detected by the parents in 13 cases (43.3%), by the patient himself in 9 (30%) and by health care staff in 8 cases (26.7%). Only 10 parents (33.3%) received advice from health care staff: 6 were advised for surgery and 4 were advised to await spontaneous descent. Preoperative ultrasonography was false negative in 56% of cases. Orchidopexy was performed in 28 (93.3%) patients (the testis was secured in the scrotum in 23 and in the high inguino-scrotal position in 5), and 2 (6.7%) underwent orchidectomy. At 3-month follow-up the testes were situated in the scrotum (not retracted) in 25 patients (3 were lost to follow-up).Conclusions: The late presentation detected in this study is alarming, because the majority of patients were diagnosed and treated after 2 years of age. The role of ultrasound in diagnosis of UDT is limited. Health care workers should perform neonatal examination to detect UDT and inform parents that early correction of UDT will decrease the risk of infertility and facilitate future examination to detect the development of testicular malignancy

Blood Transfusion in Transurethral Resection of the Prostate (TURP): A Practice that Can be Avoided

Background: This study was aimed at establishing the determinants of blood transfusion in Transurethral Resection of the Prostate (TURP) at the Kilimanjaro Christian Medical Centre (KCMC) and explore prudent methods of blood use in this urological surgery Methods: This was a one year prospective, hospital based study done at The Kilimanjaro Christian Medical Centre, a 550 bed tertiary centre in the Kilimanjaro region of Tanzania. The study population consisted of 128 of 220 patients who underwent TURP in the year of study. The primary outcome measure was the factors that determine blood transfusion in TURP surgery in KCMC. The secondary outcome measure was the underlying causes leading to blood use and the likely modes that can lead to better use of blood in this urological surgery. Results: One hundred and twenty eight out of 220 patients were transfused, giving a blood transfusion rate of 58.2%. The mean amount of whole blood transfusion was 1.2 units with a range of 1-4 units. The main determinants of blood transfusion were prostate resection greater than 40grams, preoperative Hb less than 11g/dl and the experience of the surgeon. Underlying causes included lack of hospital transfusion protocol and routine autologous donation with a laboratory policy that fails to use the auto-donated blood for other patients who may need it. Conclusion: Inappropriate clinical decisions and lack of hospital blood transfusion protocol are responsible for improper use of available blood. Slightly more than three quarters of the transfusions were unnecessary and indicate that with a proper hospital transfusion protocol, blood transfusion after TURP can be minimized or, with modern approaches like intra-prostatic epinephrine, be done away with altogether. Recommendations: Clinical decisions based on prudent use of blood should be instituted to maximize on its benefits to deserving patients. A hospital policy with adequate laboratory support should be put in place to ensure adequate screening that allows availability of blood to patients in need irrespective of mode of donation

Complex therapy for hepatic trauma

Background:Hepatic trauma is a major cause of death in abdominal injury patients.. This study was aimed at investigating the outcome of management of 197 patients presenting with hepatic injuries.Methods:This was a rgtrospective study of all patients treated for hepatic injuries at Oilu Hospital from January 1980 to January 1999 and at Dodoma Regional Hospital from January 1990 to January 2001.Seven patients were treated non-surgically while 188 had surgery. Conservative treatment included absolute bed rest, replacement and stabilization of the blood capacity, anti-inflammation drugs and styptic. Surgical procedures for patients with grade I11 and IV hepatic trauma included packing with omentum and repair of liver lacerations, debridment or irregular hepatectomy under Pringle's maneuver, perihepatic tamponade with or without selective ligation of hepatic artery and post hepatic vein repair together with T-tube and perihepatic drainage.Results: There were 30 deaths (15.3% mortality rate). All the seven patients treated conservatively survived. The main cause of death was exsanguination with or without coagulopathy, multiple organ failure (MOSF) and associated injuries. Conclusion:The basic operative principles for liver injuries are thorough debridment and haemostasis, elimination of bile leakage and unobstructed drainage.Key words: Abdominal injury, hepatic injury, therapeutics, and surgery

Iatrogenic ureteric and bladder injuries in obstetric and gynaecologic surgeries

No Abstract. East African Medical Journal Vol. 83(2) 2006: 79-8

The urinary diversion in children with bladder exstrophy and epispadias: alternative to primary bladder closure

No Abstract

Late presentation of Wilms’ tumour to a tertiary hospital

No Abstract

Management of Posterior Urethral Valves at Kilimanjaro Christian Medical Centre: A 10 Years Experience

Background: Posterior urethral valve (PUV) disorder is an obstructive developmental anomaly in the urethra and genitourinary system of male newborns. A posterior urethral valve is an obstructing membrane in the posterior male urethra as a result of abnormal in utero development. This study was aimed at reviewing the management and outcome of treatment of PUV at KCMC among children presented for treatment during the period from January 1998 to December 2007.Methods: This was retrospective hospital based review of 56 patients treated for posterior urethral valves. The study was conducted in the Institute of Urology at Kilimanjaro Christian Medical Center, which is a tertiary referral hospital located in northern part of Tanzania. The study population was consisted of all children diagnosed to have posterior urethral valves in the study period. All the children clinically suspected to have posterior urethra valves had the diagnosis confirmed by micturating cystourethrogram and depending on their age, underwent initial vesicostomy and finally posterior urethral valve fulguration as the definitive treatment. Data regarding age at presentation, types of valves seen, clinical presentation, initial treatment given, definitive treatment and complications of definitive treatment of PUV was extracted. Information on outcome of definitive treatment of PUV was also extracted. The information was transferred to a data sheet for analysis.Results: At presentation 57.1% of patients were aged below two years while 16.1% were above six years of age. Hydronephrosis occurred in 94.6% of patients. A dribbling urinary stream was found in 82.1% of patients. Urinary tract infection was also common, being present in 58.9% of patients. Fifty percent of patients presented with urine retention while vesicoureteral reflux was found in 23.2%. Of the valves seen 96.9% were type I. Initial treatment comprised of vesicostomy (42.9%), initial valve ablation (51.8%) and urethral catheterization 5.3%. Electrofulguration was the mainstay of definitive treatment of PUV and was instituted in all of the definitively treated patients. Urethral stricture as a complication was seen in 8.9% of the patients. Residual valves were seen in 20% of patients. A treatment success rate of 86.7% was observed. A mortality rate of 5.4% was found.Conclusion: The clinical presentation of PUV and the age at presentation is similar to that seen in Europe and America. Type I valves form the majority of posterior urethral valves. Electrofulguration is the mainstay definitive treatment of PUV at KCMC. The success rate of treatment of PUV is good and compares with that seen in Europe and America