Magnitude of post-urethroplasty urinary tract infections in children with hypospadias at a tertiary hospital in Kenya.

INTRODUCTION: Children who have undergone urethroplasty procedure for hypospadias are at a higher risk of getting urinary tract infections (UTI). This may be due to urethral scarring following urethroplasty that acts as a nidus for UTI. The risk is also attributed to urine stasis due to complications of urethroplasty such as urethral diverticulum, urethral stricture, meatal stenosis or breakdown of urethroplasty. Hypospadias is associated with mullerian duct remnants such as mullerian duct cysts and enlarged prostatic duct utricle which may lead to recurrent UTI. OBJECTIVE: To determine the magnitude of urinary tract infections after urethroplasty for hypospadias in children at Kenyatta National Hospital (KNH), a tertiary hospital in Kenya. DESIGN: This was a prospective descriptive cross-sectional study of male children with hypospadias who had undergone urethroplasty between January 2014 to December 2018 (5years) at KNH with age range from 6 months to 18 years. Appropriate urine collection method was used to obtain the urine specimen for microscopy, culture and sensitivity tests. Data collected was analyzed using STATA 15. Significance of the results was considered at 95% confidence interval. RESULTS: The total number of patients seen and urine samples collected was 83 boys. The prevalence of UTI following urethroplasty for children with hypospadias was 6% (5/83). They all had UTI symptoms. Of the patients who had UTI, 60% was due to Enterobacter coli, 20% Pseudomonas aeruginosa and 20% Enterobacter cloaca complex. E.coli was 100% sensitive to nitrofurantoin, amoxicillin/clavulanic acid and cefazolin while 33% resistant to ciprofloxacin and Trimethoprim/sulfamethoxazole. Majority of the patients with UTI (80%) had penoscrotal hypospadias and 60% of them developed complications post-operatively. CONCLUSION: Urinary tract infections is not a common finding in children who have undergone urethroplasty for hypospadias at KNH. Patients with penoscrotal hypospadias appears to be at a higher risk of developing UTI in our institution with E. Coli being the commonest bacteria implicated. Antibiotic protocol should be based on local culture and sensitivity pattern.

Wilms tumor survival in Kenya.

PURPOSE: Survival from Wilms Tumor (WT) exceeds 90% at 5 years in developed nations, whereas at last report, 2-year event-free survival (EFS) in Kenya reached only 35%. To clarify factors linked to these poor outcomes in Kenya, we established a comprehensive web-based WT registry, comprised of patients from the four primary hospitals treating childhood cancers. MATERIALS AND METHODS: WT patients diagnosed between January 2008 and January 2012 were identified. Files were abstracted for demographic characteristics, treatment regimens, and enrollment in the Kenyan National Hospital Insurance Fund (NHIF). Children under 15 years of age having both a primary kidney tumor on imaging and concordant histology consistent with WT were included. RESULTS: Two-year event-free survival (EFS) was 52.7% for all patients (n=133), although loss to follow up (LTFU) was 50%. For the 33 patients who completed all scheduled standard therapy, 2-year EFS was 94%. Patients enrolled in NHIF tended to complete more standard therapy and had a lower hazard of death (Cox 0.192, p < 0.001). CONCLUSION: Survival of Kenyan WT patients has increased slightly since last report. Notably, WT patients completing all phases of standard therapy experienced 2-year survival approaching the benchmarks of developed nations. Efforts in Kenya should be made to enhance compliance with WT treatment through NHIF enrollment.