Experience With Ventral Penile Skin Island Flap urethroplasty

Background:Island flap techniques currently used in urethroplasty utilize the prepuce and the dorsal penile skin. Our experience with a one-stage island flap urethroplasty for urethral strictures utilizing the ventral penile skin is described.Patients and Method: This is a longitudinal study of seventy six consecutive patients with impassable and complicated urethral strictures treated using this technique over a seven-year period. Sixty were bulbous while sixteen were bulbomembranous urethral strictures. Following operation the patients were assessed using urine flow rates, urethrograms and some urethroscopy. Restrictures were successfully reoperated.Results: Sixty-eight patients (89.5%) had satisfactory voiding with good urine stream without complication at one year after operation. Five patients (6.6%) had restricture and three (3.9%) others had urethral bagginess and postmicturition dribbling. The overall complication rate was 10.5%. At three years after initial operation and reoperation seventy-five patients (98.7%) were voiding satisfactorily. There was one complete failure, no death.Conclusion: This technique has produced satisfactory results compared with other similar techniques in current use. Further work is required to make valid conclusions about the value of this procedure

An audit of nephrectomy by general surgeons

Objectve: To analyse all nephrectomies performed by general surgeons at Usmanu Danfodiyo University Teaching Hospital, Sokoto (UDUTH) over a ten-year period. The setting provided an opportunity to critically examine the process and outcome of nephrectomies done by general surgeons. Method: A retrospectively study of nephrectomies performed by general surgeons in UDUTH in the 10 year period (January 1993 to December 2002). Results: A total of 25 nephrectomies were performed by the general surgeons during the study period. The male to female ratio was 4:1. The indications were renal malignancy in 39.0% of cases others were non-functioning symptomatic hydronephrotic kidneys. Renal function was not assessed in two patients with renal trauma before surgery. In some patients with polycystic renal disease and pelvic- ureteric junction obstruction indication for nephrectomy was not properly described. The disease staging and extent of surgery in patients with kidney cancer were not often stated. In 20% of patients there was significant morbidity and a threat to life and the overall mortality was 13.0%. Conclusion: In the dearth of the urological surgeons in our environment the had to supplement in the occasional care of some urological patients. The best result is outcome is from patients having nephrectomy for non functioning hydronephrotic kidneys. The outcome in the treatment of the congenital renal anomalies, malignant and trauma to the kidney was not satisfactory suggesting the trained urologist will be better equipped to sort things out. Keywords: audit, nephrectomy, general surgeons Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 256-25

Cystoscopic removal of an intravesical gossypiboma mimicking a bladder mass: a case report

<p>Abstract</p> <p>Background</p> <p>Intravesical retained surgical sponges are very rare and only a few cases have been removed by minimally invasive techniques.</p> <p>Case presentation</p> <p>We report a case of an intravesical gossypiboma in a 71-year-old man from western Nepal, who presented with urinary retention and persistent lower urinary tract symptoms one year after open cystolithotomy. He was diagnosed with an intravesical mass using ultrasonography. The retained surgical sponge was found during cystoscopy and removed through endoscopy.</p> <p>Conclusion</p> <p>Intravesical gossypibomas are rare and can mimic a bladder mass. This is one of the few reported cases of cystoscopic removal.</p

Schistosomiasis and Urinary Bladder Cancer in North Western Tanzania: A Retrospective Review of 185 Patients.

Worldwide, cancers of the urinary bladder are well known to be associated with environmental chemical carcinogens such as smoking and occupational exposure to polycyclic aromatic hydrocarbons. These cancers are typically transitional cell carcinoma (urothelial carcinoma). In areas where schistosomiasis is endemic there is a high incidence of squamous cell carcinoma of the urinary bladder. Schistosomiasis causes chronic granulomatous cystitis leading to squamous metaplasia of transitional epithelium, and subsequently development of squamous cell carcinoma. The western part of Tanzania on the shores of Lake Victoria is such an endemic area. This study was done to document the burden of urinary bladder cancer associated with schistosomiasis in this region. This was a descriptive retrospective study of histologically confirmed cases of urinary bladder cancer seen at the Department of Pathology Bugando Medical Centre (BMC) over a period of 10 years. Data were retrieved from the records of the Departments of Pathology, Medical Records and Surgery. Data were analyzed by the use of contingency tables. A total of 185 patients were diagnosed with cancer of the urinary bladder during the study period, where as 90 (48.6%) were males and 95 (51.4) were females. The mean age at diagnosis was 54.3 years. Squamous cell carcinoma was the most frequent histological type (55.1%), followed by conventional transitional cell carcinoma (40.5%). Eighty three of all cancer cases (44.9%) were found to have schistosomal eggs. Schistosomiasis was commonly associated with squamous cancers compared to non squamous cancers. Most of the cancers associated with schistosomiasis had invaded the muscularis propria of the urinary bladder at the time of diagnosis (p<0.001) and such cancers were frequent below 50 years of age with a significant statistical difference (p<0.001). Poorly differentiated tumors were more frequent in females than males with a significant statistical difference (p=0.006). The majority of urinary bladder cancers seen in the Lake Region were squamous cell carcinoma associated with schistosomiasis. These cancers showed an aggressive behavior and were commonly seen in the younger age groups. Effective control of schistosomiasis in this region should significantly reduce the burden of urinary bladder cancer

Oral mucosa grafts for urethral reconstruction

Background: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are flexible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution

Bioengineering tissue for organ repair, regeneration, and renewal

No Abstract

Childhood Fall from Heights in Sokoto, Nigeria.

A prospective study of childhood fall from heights at Usmanu Danfodiyo University Teaching Hospital, Sokoto from January 1999 to December 2000 is presented. A total of 59 children aged 14 years and below were seen. Thirty five (59.3%) were males and twenty four (40.6%) were females. Fall from multistory buildings was the commonest cause of accident (35.6%) followed by fall from trees (27.1%). The commonest trauma was head injury seen in 36 patients (55.4%) and was responsible for the overall mortality of 6.8% (4 cases). Extremity fractures occurred in 18 patients (27.7%) and limb lost was recorded in 5 patients (8.5%). The biomechanics of fall, the peculiarities of fall from height in this environment and preventive measures are discussed. Sahel Med. J. Vol.6(1) 2003: 26-2

Techniques of Male Circumcision

Male circumcision is a controversial subject in surgical practice. There are, however, clear surgical indications of this procedure. The American Academy of Pediatrics (AAP) recommends newborn male circumcision for its preventive and public health benefits that has been shown to outweigh the risks of newborn male circumcision. Many surgical techniques have been reported. The present review discusses some of these techniques with their merits and drawbacks. This is an attempt to inform the reader on surgical aspects of male circumcision aiding in making appropriate choice of a technique to offer patients. Pubmed search was done with the keywords: Circumcision, technique, complications, and history. Relevant articles on techniques of circumcision were selected for the review. Various methods of circumcision including several devices are in use for male circumcision. These methods can be grouped into three: Shield and clamp, dorsal slit, and excision. The device methods appear favored in the pediatric circumcision while the risk of complications increases with increasing age of the patient at surgery.Key words: Complication, dorsal slit, device, excision, male circumcision, public health benefit, techniqu

Pattern of Paediatric Trauma in North Western Nigeria

There is scanty literature on paediatric trauma from the developing countries. This study is aimed at contributing information on childhood injuries in North Western Nigeria. We prospectively studied childhood admission for accidental trauma at Usmanu Danfodiyo University Teaching Hospital, Sokoto over a two year period ( January 1999 to December 2000). A total of 403 children 15 years and below, were seen during the period. The male to female ratio was 1.8:1. The commonest cause of trauma was road traffic accident (RTA); 35.5% of cases followed by burns; 26.8% and fall; 16.6% of cases. Foreign bodies were responsible for 5.5%, grinding machines for 3.0% and collapsing mud buildings for 1.7% of cases. Pedestrian injuries accounted for 45.5% of RTA victims. The overall mortality was 6.2%. RTA, with an expressive pedestrian constituent, ranked as the commonest cause of trauma. Socio-economic emancipation, intra-city traffic considerations, abrogation of child labour and provision of adequate water supply should reduce these accidents. Trauma prevention and care programme in developing countries should always address paediatric injuries. KEY Words: Paediatric, Trauma, North Western, Nigeria Sahel Medical Journal Vol.7(1) 2004: 32-3

Current concepts in the management of anterior urethral strictures

Objectives: This review paper presents the current trends in the evaluation and treatment of anterior urethral strictures. Stricture disease is recorded as one of the oldest afflictions of mankind and even in the millennium; it is the one disease associated with rapid turn over in treatment options and continuous evolution of new options. The stricture is still a significant burden on the urologist workload right from initiation of treatment and follows up. It may be associated with significant morbidity and deteriorating quality of life and may be frustrating to treat. Current trends are to discover a long lasting satisfactory treatment suitable in most cases ‘the gold standard’.Methods A review of current concepts in anatomy and the patho-physiologic mechanisms of the anterior stricture has been done. A structured literature search through a MEDLINE search was performed. New urethral substitutes have been compared to other techniques of urethroplasty as seen over the. last decade. Expert surgical consensus and opinion have been reviewed.Results The anterior urethral stricture is a consequence of major peri-urethral fibrosis and may be very complex if the inflammation is complicated or prolonged. It can be satisfactorily assessed by routine retrograde urethrography and endoscopic assessment for type and complexity. The urethral ultrasound appears to provide more information about the extent of fibrosis and the length of strictures. In review of recent experience, it has proven to be accurate convenient and a cheap complement to already established studies. Oral mucosa, rectal mucosa, bladder mucosa , dermal grafts, tunica vaginalis, tissue culture and synthetic polymers have all been applied over the last decade in the search for the suitable urethral substitute.The bucccal mucosa is outstanding among several options in the repair of the diseased anterior urethra as popularized by Barbagli. It appears to provide the solution for most situations in the anterior urethral stricture..Conclusions: The Bucccal mucosal graft(BMG) may as well be the new ‘gold standard' in the management of anterior urethral stricture