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.

Impact of the first wave of the COVID-19 pandemic on emergency surgical activities at the National Reference University Hospital of N'Djamena.

AIM OF THE WORK: An evaluation of Covid-19 pandemic impact on emergency surgical activities at the CHU-RN in N'Djamena, Chad. METHOD: A retrospective study of patients admitted to the surgical emergency room during the first wave of the pandemic (April-June 2020). The data were compared to those of patients admitted during the same period in 2019 (control group).  Results: A total of 3248 patients were received: 2366 in 2019 and 882 in 2020. Respective reduction of 50% of admissions and 31% of emergency operations were observed. The average age (30 years) and male predominance remained unchanged. The average admission time went from 72 hours in 2019 to 7 days in 2020. We also noticed that digestive emergencies, such as acute generalized peritonitis (6.6% vs 14.4%, p < 0.1) and strangulated hernias (6.6% vs 15.2% p: 0.07) were more severe in 2020. CONCLUSION: COVID-19 had reduced admissions and urgent surgical interventions.