Surgical Advances in Treating Benign Prostatic Hyperplasia in Africa: What About the Endoscopic Approach?

OBJECTIVE: To assess the practices, trends, and challenges associated with the use of endoscopic techniques in Africa related to the surgical treatment of benign prostatic hyperplasia METHODS: The questionnaire, which was based on Google Forms, assessed several points related to the surgical management of benign prostatic hyperplasia. RESULTS: In 67.4% of the centers, BPH was the primary pathology requiring surgical management. In all 43 centers, approximately 1/3 of the urologists (n = 41) are able to perform an endoscopic procedure for the management of prostatic hypertrophy. Of the 43 centers, 30 had a block equipped with endourology equipment, and 56.6% (n = 17) performed endourological surgery exclusively for the surgical management of BPH. TURP is the most widely used endoscopic technique. Open prostatectomy was the only surgical technique used in 14 centers (32.5%). In the remaining centers, both procedures (endoscopy and open surgery) were used depending on the surgeon's skills. Twenty-six (60.5%) centers expressed the need for training in endoscopic management of BPH. CONCLUSION: The main challenges encountered relate to the lack of competent personnel, the unavailability of equipment and materials, and the high cost to patients. It is essential to develop modern urology in Africa, particularly in terms of endourological practices.

Place of urolithiasis in the spectrum of urological pathologies, practices and use of endourological procedures in the management of calculi of the upper urinary tract: results of a survey of referral centres in Africa.

Our aim was to determine the current trend of endourology in the management of upper urinary tract calculi in Africa reference centres. We conducted an online multiple-choice questionnaire survey involving 46 centres from 27 countries using a structured well-designed Google Form (®) questionnaire. The questionnaires were distributed to the head of service through their emails. The questions collected demographic data about the centre, the epidemiology of urolithiasis, diagnostic means and management of upper urolithiasis, especially access to endourology procedures and their practices. Descriptive analyses were performed. The participation rate was 77.9%. Urinary lithiasis was one of the three main pathologies encountered in 42/46 centres. 33 centres had easy access to CT scanners and 34 had operating theatres equipped with endo-urological surgery equipment. Of these 34 centres, 30 perform endourology for the management of upper urinary tract stones. Rigid ureteroscopy is the main technique used by the centres. It is the only endourology technique used for stone management by 12 centres (40%). 7/30 (23.3%) have the option of performing rigid ureteroscopy, flexible ureteroscopy and percutaneous nephrolithotomy. The frequency of procedures varies widely, with 43.3% rarely performing endourological surgery. Seventeen centres have their operating theatre equipped with a fluoroscope and 6/42 centres have extracorporeal lithotripsy. Open surgery is still used in 29/42 centres (69.1%). Laparoscopy is available in 50% of centres, but none reported performing laparoscopic lithotomy. In Africa, urinary lithiasis plays an important role in the activities of referral centres. Modern management techniques are used to varying degrees (not all centres have them) and with very variable frequency. Open surgery is still widely performed as a management. Rigid ureteroscopy is the main endourological technique. It is essential to develop the practice of modern urology in Africa, mainly endourology.

Spectrum of urological cases in a West African Tertiary Hospital.

Context: Urological diseases vary from one geographical location to another worldwide. The knowledge of their distribution in each location could determine local workforce and facility needs and as well guide the areas of subspecialization. Aims: The aim of this study is to document the annual frequency and distribution of urological diseases at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Settings and Design: A cross-sectional retrospective study from January 2016 to December 2016 of all new patients seen at the urology outpatient clinic, emergency department as well as inpatient referrals from other departments of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Materials and Methods: The relevant records were extracted from the patient's case notes and entered into a semistructured questionnaire. Statistical Analysis Used: Data were analyzed using the SPSS software version 20. Results: A total of 607 new patients were seen over the study period. There were 576 (94.9%) males and 31 (5.1%) females, with a male-to-female ratio of 18.6:1. The median age was 45 years, with age range of 1-106 years. Urological emergencies were seen in 35.0% patients. Ninety-one percent of cases were acquired, whereas 8.2% were of congenital etiology. Overall, the most commonly diagnosed urologic diseases among new patients in order of decreasing frequency were benign prostatic enlargement (BPE) (18.6%), bladder tumor (11.8%), upper tract urinary calculi (10.3%), urethral stricture (8.9%), and prostate adenocarcinoma (7.4%). Conclusions: BPE, bladder tumor, upper tract urinary calculi, urethral stricture, and prostate adenocarcinoma are common in our environment. Knowledge of these diseases distribution may guide service expansion and workforce needs, inspire subspecialization as well as direct research and government policy in this community. Nongovernmental organizations wanting to have impact will be suitably directed.

RésuméLe contexte: Les maladies urologiques varient d'une zone géographique à une autre dans le monde. La connaissance de leur répartition dans chaque site pourrait déterminer les besoins locaux en main-d'œuvre et en installations et guider les domaines de sous-spécialisation. Objectifs: Documenter la fréquence annuelle et la distribution des maladies urologiques à l'hôpital universitaire de Usmanu Danfodiyo, Sokoto. Paramètres et Conception: Une étude rétrospective transversale de janvier 2016 à décembre 2016 de tous les nouveaux patients vus à la clinique externe d'urologie, au service des urgences ainsi que les références hospitalières d'autres départements de l'hôpital universitaire Usmanu Danfodiyo (UDUTH), Sokoto, Nigéria. Méthodes et Matériel: Les dossiers pertinents ont été extraits des notes de cas des patients et entrés dans un questionnaire semi-structuré. Analyse Statistique Utilisée: Les données ont été analysées à l'aide de SPSS version 20. Résultats: Au total, 607 nouveaux patients ont été vus au cours de la période d'étude. Il y avait 576 hommes (94,9%) et 31 femmes (5,1%) avec un ratio hommes/femmes de 18,6: 1. L'âge médian était de 45 ans avec une tranche d'âge de 1 à 106 ans. Des urgences urologiques ont été observées chez 35,0% des patients. Quatre-vingt-onze pour cent des cas ont été acquis tandis que 8,2% étaient d'étiologie congénitale. Dans l'ensemble, les maladies urologiques les plus fréquemment diagnostiquées chez les nouveaux patients par ordre décroissant de fréquence étaient une hypertrophie bénigne de la prostate (EPB) 18,6%, une tumeur de la vessie (11,8%), des calculs urinaires des voies supérieures (10,3%), une sténose urétrale (8,9%) et une prostate adénocarcinome (7,4%). Conclusions: Une hypertrophie bénigne de la prostate, une tumeur de la vessie, des calculs urinaires des voies supérieures, une sténose urétrale et un adénocarcinome de la prostate sont courants dans notre environnement. La connaissance de la répartition de ces maladies peut guider l'expansion des services et les besoins en main-d'œuvre, inspirer la sous-spécialisation ainsi que la recherche directe et la politique gouvernementale dans cette communauté. Les organisations non gouvernementales souhaitant avoir un impact seront convenablement dirigées.

Post-operative Vesicoenterocutaneous Fistula with Multiple Intestinal Knotting: A Case Report.

Herein is a case of a 51-year-old farmer who presented to our facility with initial leakage of urine but later urine mixed with faeces from the lower abdomen after two previous abdominal surgeries. He had an open transvesical prostatectomy due to benign prostate enlargement complicated by leakage of urine from lower abdominal wall scar. A repeat surgical intervention to correct the urine leakage was followed by recurrence of urine leakage and later by leakage of feculent urine from the lower anterior abdominal wall. At our facility, he had exploratory laparotomy with manual unknotting of ileal loops, fistula tracts excision, resection, and end-to-end ileoileal anastomosis. The bladder wall was repaired with suprapubic cystostomy. Although the finding of asymptomatic multiple small bowel knotting was incidental in the index case, its timely management averted a sitting timed bomb that may lead to a diagnostic dilemma with catastrophic consequences.