12 research outputs found
Trans-scrotal single-incision orchidopexy compared with conventional orchidopexy in palpable undescended testis in a Nigerian Tertiary Hospital
Background The standard method of treatment of palpable undescended testes is through inguinal mobilization and a scrotal sub-dartos pouch. Trans-scrotal single-incision orchidopexy may be a suitable alternative.Aim The aim of this study was to assess as to how trans-scrotal orchidopexy compares with conventional orchidopexy in terms of the suitable placement of the testis in a dependent position in the scrotum and the surgical outcome.Patients and methods Forty children with 42 palpable undescended testes were randomly allotted into the conventional and the trans-scrotal orchidopexy groups over an 18-month period. The age, the testicular position, the side involved, the length of the vas gained after isolation and the division of the processus vaginalis, as well as the placement of the testes in the sub-dartos pouch without tension, were recorded. Postoperative complications and the subjective score of the cosmetic appearance of the scars during follow-up for at least 6 months. Success was defined as suitable placement of the testes in the sub-dartos pouch during operation, no conversion of patients in the single-orchidopexy group to the conventional inguinal approach, no complications and excellent cosmetic appearance of scars.Results The two study groups were well matched for age and testicular positions. About 22 (55%) patients had rightsided undescended testes and 16 (40%) had left-sided undescended testes, and in two (5%) patients, it was bilateral. All testes were satisfactorily placed in the subdartos pouch at surgery. Testicular retraction was observed in one patient in the conventional group, but in two patients in the trans-scrotal group. All wounds healed satisfactorily without infection. The overall wound complication rate in the trans-scrotal and the conventional groups were 2/21 and 3/21, respectively. In terms of the cosmetic appearance of the scar, patients in the trans-scrotal group had excellent cosmetic appearance as the scars were less visible and hidden in the rugal fold compared with the conventional method.Conclusion Trans-scrotal orchidopexy for palpable undescended testis is simple, safe and has a better cosmetic scar compared with the conventional approachKeywords: conventional, orchidopexy, testis, trans-scrota
Posterior urethral valves in fraternal twins: case report and review of the literature
We report a pair of dizygotic twins with type 1 posterior urethral valves. Concomitant and discordant presentation of posterior urethral valves in twins is rare, with a handful of cases in the literature. The occurrence of identical pathology in dizygotic twins probably suggests the possibility of an inherited trait as it does exist in monozygotic twins.Keywords: fraternal twins, identical pathology, inherited trait, posterior urethral valve
Management of pelviureteric junction obstruction at a tertiary teaching hospital in southwestern Nigeria: A retrospective analysis of case records
Background: Pelviureteric junction obstruction (PUJO) is an important cause of upper urinary tract obstruction. It can cause marked impairment of renal function, especially in bilateral cases, if not diagnosed and treated promptly. Surgical intervention is currently the mainstay of treatment. We aimed to review the pattern of presentation and management outcomes of patients diagnosed with PUJO. Methods: We conducted a retrospective study of patients aged 2–60 years who presented with PUJO between January 2005 and December 2014. Demographic characteristics, clinical presentation, investigations, and treatment modalities were extracted from case notes. Data were analysed using SPSS version 20. Results: The age range of the 32 included PUJO patients was 2–60 years, with a median age of 30 years. Children constituted 31% of patients. There were 15 males and a male-to-female ratio of 0.88:1. Most PUJO was unilateral and left-sided (n = 19; 59%). Loin pain was the commonest symptom (n = 26; 81%), while 25% of patients had a urinary tract infection at presentation. All patients had normal renal function at the time of surgery, and Anderson–Hynes pyeloplasty was the most common technique employed (72% of cases). Postoperatively, the majority of patients (n = 31; 97%) had complete symptom resolution. Surgical site infection (n = 3; 9%) was the commonest postoperative complication, and the median hospital stay was 11 days. There was no mortality. Conclusions: Most patients with PUJO presented late. Most of our patients underwent Anderson–Hynes pyeloplasty with satisfactory outcomes. Keywords: pelviureteric junction obstruction; PUJO; loin pain; Anderson–Hynes pyeloplasty; Foley Y-V plasty; Nigeria
Posterior urethral valves in children: Pattern of presentation and outcome of initial treatment in Ile-Ife, Nigeria
Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within thefirst 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors
Introduction of Suturing Skills Acquisition into Undergraduate Surgical Education: Early Experience from Ile-Ife, Nigeria
Background: Undergraduate medical students of the Obafemi Awolowo University, Ile-Ife, Nigeria, had over the years acquired various skills informally without structured training in basic skills in wound closure. The Department of Surgery introduced suturing skills acquisition workshop into the curriculum of the Final-Year Medical Students in 2016. This study describes the preliminary experience and the perception of the participants. Methods: All students undergoing the senior rotations in surgery and surgical specialties were taken through a day suturing skills workshop at the surgical skills laboratory. Skills were demonstrated using validated narrative videos followed by practical sessions supervised by senior registrars and consultant surgeons. All participants were requested to complete a feedback form after the workshop. Results: One hundred and eighty students were trained in six workshop sessions per year over two academic sessions. There were 128 (71.1%) male and 52 (28.9%) female students trained by 9 consultants and 13 senior registrars with 15–17 students in each session. Self-assessment feedback after the workshop revealed that all but 3 (1.7%) students felt very confident in handling basic instruments, 102 (56.7%) were confident of their proficiency in basic suturing, 68 (37.8) were less confident, whereas 10 (5.6%) were not confident looking ahead and 82 students (46.1%) wanted additional skills to attain proficiency in some common surgical procedures prior to graduation. Conclusion: The department achieved the aim of introducing suturing skills acquisition into undergraduate surgical education. In the future, other surgical skills acquisition workshops may be considered as desired by the students
Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria
Background: The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion. Patients and Methods: The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16. Results: Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123). Conclusion: DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated
Dicephalus dibrachius dipus conjoined twins in a triplet pregnancy
Conjoined twins occurring in a triplet pregnancy is a rare occurrence. We present a case of undiagnosed dicephalic conjoined twins occurring in a multigravida with triple pregnancy delivered by caesarian section. The anatomical and pathologic findings in these twins after their demise are described with a brief review of the literature. Keywords: twins, congenital anomalies, conjoined VTropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 87-8