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