Transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defects: The outcomes of surgical management.

BACKGROUND: Currently, transperineal anastomotic urethroplasty approach is the reference standard in the surgical reconstruction of pelvic fracture urethral distraction defects. The approach is suitable for all but the most complex cases which might require abdominoperineal approach. AIMS: We reviewed our recent experience with transperineal anastomotic urethroplasty with respect to success rate and complications. PATIENTS AND METHODS: This was a retrospective descriptive study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defects within the study period were retrieved. Patients' demographics, cause and nature of pelvic fracture urethral distraction defects, the success rate, and complications were collected and subjected to statistical analysis using SPSS® version 22. RESULTS: Sixteen men with mean age of 29.6 ± 7.8 years had transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defect (PFUDD) during the study period. The mean defect gap length was 4.5 cm (range, 2-7 cm). Out of the 16 patients, 6 (37.5%) had simple transperineal urethroplasty, while 10 (62.5%) underwent a more extensive transperineal urethroplasty. Four patients (25%) had inferior pubectomy. A total of 7 (43.8%) patients had erectile dysfunction (ED) before and after the urethroplasty. Five (31.3%) patients had ED before the urethroplasty 2 (12.5%) patients developed ED after the surgery. After mean follow-up duration of 2 years (range, 1-4 years), 12 (75%) patients had satisfactory urinary stream. The mean Qmax for the 16 patients was 16 ml/s (range, 0-35 ml/s). The 12 (75%) patients that had no complaints of LUTS, had Qmax ≥ 15 ml/s at mean follow-up duration of 2 years. CONCLUSION: Transperineal anastomotic urethroplasty for PFUDD is considered suitable technique for treatment of PFUDD with good surgical outcome.

Laparoscopic surgery in a Nigerian teaching hospital for 1 year: challenges and effect on outcomes.

BACKGROUND: Laparoscopic surgery has developed rapidly in developed nations within a relatively short time to become a major method of treating surgical diseases, with increasing application across specialties. However this is not the situation in developing countries like Nigeria. This may be as a result of local challenges to the performance of laparoscopic procedures. It is important to identify what these challenges are. METHODOLOGY: We prospectively studied problems encountered during the performance of laparoscopic procedures, and their effects on the procedure in a Nigerian teaching hospital for a year. Demographic information, laparoscopic procedure, problems encountered and effect on procedure, and outcomes were analyzed using descriptive statistics. RESULTS: Our sample consisted of 21 patients who had laparoscopic procedures performed by the authors; 12 (57%) were therapeutic procedures. Average age was 34.1 years (range 18-50 years) and majority (61.9%) were female. Problems encountered included non functioning/malfunctioning equipment (76.2%), power outages (33.3%), and dead light source bulbs (14.3%). There were 5 (23.8%) conversions to open surgery as a result of problems encountered; another conversion (4.8%) was to tackle an ascending colon tumour discovered at laparoscopy. CONCLUSION: The performance of laparoscopic procedures in a Nigerian public hospital is affected largely by inadequate and often malfunctioning equipment, and attention to these may reduce rates of conversion to open surgery.