Pelviureteric junction obstruction: A surgical experience

Objective: To describe the experience in the management of patients with intrinsic pelviureteric junction obstruction in the town of Mombasa, Kenya.Methods: This was an evaluation of the patients operated upon by the authors between 1995 and 2003. The thirteen patients subjected to surgery are presented.Results: Thirteen patients with pelviureteric junction obstruction aged 2 to 38 years, with a mean age of 20 years were studied. Male: female ratio was 10:3. The left side was more commonly affected in a ratio of 8:5. Six patients had Y-V pyeloplasty, five had dismembered pyeloplasty and two had nephrectomy. Seven patients had double ‘J’ stents inserted. Two patients had complications; one had prolonged urine leak of one month after unstented dismembered pyeloplasty, and the other had a broken stent. Two boys with a tentative diagnosis of pelviureteric junction obstruction turned out to have a right renal carcinoma, and a variant of polycystic kidney on the left. Both had nephrectomy, and excluded from the study.Conclusion: Pelviureteric junction obstruction is an uncommon condition. Results of reconstructive surgery are good with few complications. Despite clinical and radiological features suggesting intrinsic pelviureteric junction obstruction, the possibility of other pathology should always be borne in mind

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

Circumcision urethral injuries: Outcomes of surgical intervention

Background: Urethral injuries due to circumcision are rare. Coverage of the repairs with well vascularised tissue is associated with excellent outcomes.Objectives: To assess the outcomes of surgical intervention for urethral injuries of circumcision at two hospitals in the Coast Province of Kenya.Design: A retrospective study of patients managed for urethral injuries due to circumcision, spanning 8 years, between 2004 and 2011.Setting: Coast Province General Hospital, Mombasa (2004 -2008) and Moi District Hospital, Voi (2009 -2011).Patients and methods: Records of 15 patients were analysed for age, diagnosis, surgical procedures and outcome. Thirteen patients with coronal or subcoronal urethrocutaneous fi stula had repair and coverage of the reconstruction with dartos fascia. One patient with hypospadiac meatal stenosis with chronic urine retention after circumcision had meatoplasty and tubularised incised plate hypospadias repair with dartos fascia coverage. Urethral stricture at the level of the corona occurred in a 2.5 year old boy. He had suprapubic cystostomy to relieve urine retention. Augmented anastomotic urethroplasty with full thickness skin graft from the groin was done and the reconstruction covered with dartos layer.Results: There was no recurrence or occurrence of urethral fistula in any of the patients. The patient with meatal stenosis was noted to have mild torsion of the penis after surgery.Conclusion: Use of dartos fascia to cover repairs of urethral injuries of circumcision produced excellent results with no recurrence or occurrence of urethral fistula

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

Tubularised incised plate hypospadias urethroplasty in a regional setting

Objective: To prospectively evaluate an increasingly popular method of hypospadias repair.Patients and methods: Twelve patients with coronal, sub coronal and midpenile hypospadias were subjected to tubularised incised plate (TIP) urethroplasty as the primary procedure in Mombasa, Kenya. Their ages ranged fom two years to eight and a half years.Results: Three patients developed superficial skin necrosis of the ventrally transposed prepucial flaps. There was no breakdown, meatal stenosis, and stricture or fistula formation. The cosmetic results were good.Inclusion: The tubularised incised plate hypospadias repair produced good cosmetic results with no breakdown, stricture, meatal stenosis or fistula

Posterior urethral valves in the adult: report of two cases

Posterior urethral valves occur commonly in children. Occasionally, they present in adulthood. A report is made of two adult cases, aged nineteen and twenty one years with posterior urethral valves treated in Mombasa, Kenya. Presentation was with symptoms of bladder outflow obstruction. Urinaly tract ultrasound and micturating cystourethrograms were the radiological investigations done. Endoscopic electrosurgical ablation of the valves was undertaken, resulting in symptomatic and radiological resolution. The diagnosis of posterior urethral valves should be borne in mind in any man with symptoms of bladder outflow obstruction. East African Medical Journal Vol.81(8) 2004: 430-43