A five-year review of nephrectomies at the Lagos State University Teaching Hospital (Lasuth) Ikeja Lagos

Background: Nephrectomies are performed for various reasons ranging from benign to malignant renal diseases. The surgical approach for a nephrectomy also varies with location. In Nigeria and many other developing countries, the major technique of performing a nephrectomy is an open approach.Objective: The objective of the study was to evaluate the cases of nephrectomies performed over a 5-year period at the Lagos State University Teaching Hospital, Ikeja and compare the findings with those from other institutions in our region.Materials and Methods: This was a retrospective study. The clinical records of consecutive patients who had nephrectomies done over a 5-year period between January 2009 and December 2014 were reviewed. The data extracted from their record included age, sex, indication for  nephrectomy, laterality (whether right or left), surgical approach, duration of surgery, the incidence of blood transfusion, histological findings and treatment outcome.Results: The records of a total of 40 patients were available. There were 16 males (40%) and 24 females (60%) with a M:F ratio of 1:1.5. The mean age was 44.75 ± 17.16 years (range: 3-70 years). The indication in the majority of the patients was renal malignancy (n = 30, 75%) while the remaining 10 (25%) were benign cases ranging from non-functioning hydronephrotic kidneys from pelviureteric junction obstruction to staghorn calculi. A total of 25 cases (62.5%) were on the right, while 15 (37.5%) were on the left. The imaging study done for diagnosis was majorly an abdominopelvic CT scan in 32 patients (80%). Twenty-one patients (52.5%) had a flank approach, while 19 patients (47.5%) had an anterior approach for their surgery. The mean duration of surgery was 140 ± 53.2 minutes (range 60-270 minutes). 27 patients (67.5%) were transfused perioperatively. The majority (n = 14, 46.7%) of the patients with renal malignancy had a histological diagnosis of the papillary variant of renal cell carcinoma. 32 patients (80%) were followed up for at least 3 years, while the rest were lost to follow up. The quantity of blood transfused correlated with the duration of the surgery.There was no perioperative mortality.Conclusion: Renal malignancies are the most common indication for nephrectomy in our centre. Though associated with a high transfusion rate, open nephrectomy (even when performed for a malignant condition) remains a safe procedure with a good outcome. Keywords: Nephrectomy, Renal malignancies, Blood transfusio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Outcome of Mainz II pouch urinary diversion after radical cystectomy in patients with muscle-invasive bladder cancer: our experience

Introduction: Mainz II pouch urinary diversion in patients with muscle‑invasive bladder cancer is one of the options of continent urinary diversion following radical cystectomy (RC). We aim to report our experience and the outcome of our patients who had this procedure.Patients and Methods: Patients who had RC and Mainz II pouch urinary diversion for muscle‑invasive bladder cancer in our institution from 2007 to 2016 were evaluated. Variables analyzed included age, gender, stage of the disease, pathological grade and tumor types, complications, and survival status.Results: There were 11 patients who had Mainz II pouch urinary diversion after RC for bladder cancer over a 10‑year period. Four (36%) were male and 7 (64%) were female. The mean age of the patients was 58.6 (range, 52–65) years. The diseases were pT2, pT3, and pT4 in 2 (18%), 7 (64%), and 2 (18%) patients, respectively. Four (36%) had pelvic nodal metastasis. Nine (82%) had a histological diagnosis of transitional cell carcinoma, and two (18%) were squamous cell carcinoma (SCC). Ten (91%) patients had high‑grade disease, whereas only 1 (9%) patient had low‑grade disease. Short‑term morbidities were electrolytes derangement, hypokalemia, and acidosis in 2 (18%) patients and pyelonephritis in 2 (18%) patient. The two patients with invasive SCC had recurrence and death within 12 months of surgery. At present, four of the patients are alive, and seven are dead. Survival till date ranged from 8 to 120 months (mean survival time was 48 months). All patients achieved day and night time continence, and there was no significant long‑term morbidity from the method of urinary diversion.Conclusion: Mainz II pouch urinary diversion is safe and acceptable to most of our patients with good long‑term results.Keywords: Bladder cancer, Lagos, Mainz II pouch urinary diversion, Nigeria, outcom

Outcome of Mainz II Pouch Urinary Diversion after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer: Our Experience

Introduction: Mainz II pouch urinary diversion in patients with muscle-invasive bladder cancer is one of the options of continent urinary diversion following radical cystectomy (RC). We aim to report our experience and the outcome of our patients who had this procedure. Patients and Methods: Patients who had RC and Mainz II pouch urinary diversion for muscle-invasive bladder cancer in our institution from 2007 to 2016 were evaluated. Variables analyzed included age, gender, stage of the disease, pathological grade and tumor types, complications, and survival status. Results: There were 11 patients who had Mainz II pouch urinary diversion after RC for bladder cancer over a 10-year period. Four (36%) were male and 7 (64%) were female. The mean age of the patients was 58.6 (range, 52–65) years. The diseases were pT2, pT3, and pT4 in 2 (18%), 7 (64%), and 2 (18%) patients, respectively. Four (36%) had pelvic nodal metastasis. Nine (82%) had a histological diagnosis of transitional cell carcinoma, and two (18%) were squamous cell carcinoma (SCC). Ten (91%) patients had high-grade disease, whereas only 1 (9%) patient had low-grade disease. Short-term morbidities were electrolytes derangement, hypokalemia, and acidosis in 2 (18%) patients and pyelonephritis in 2 (18%) patient. The two patients with invasive SCC had recurrence and death within 12 months of surgery. At present, four of the patients are alive, and seven are dead. Survival till date ranged from 8 to 120 months (mean survival time was 48 months). All patients achieved day and night time continence, and there was no significant long-term morbidity from the method of urinary diversion. Conclusion: Mainz II pouch urinary diversion is safe and acceptable to most of our patients with good long-term results