Hypospadias repair in Jamaica: a two year review of the Bustamante Hospital for Children (BHC) experience

Hypospadias is the most common urological anomaly presenting at the BHC. The aim of this study was to assess the various anatomical anomalies and the results of the treatment. Over a two year period 50 boys presented with hypospadias. Meatal position, type of repair, duration of hospital stay and complications were recorded. There were 19 proximal and 31 distal hypospadias cases. Most patients presented during the first year of life but most operations were done between ages three and four years. Choice of surgery depended on the meatal position, and approximately equal numbers of patients received inpatient and outpatient care. Urethral fistula was the most common complication. Hypospadias repair requires meticulous surgical skills and careful postoperative care. Surgical techniques and results vary, but efforts must be made to reduce the incidence of postoperative fistula formation.(AU)

Plate urethroplasty (Snodgrass repair) versus traditional techniques for repair of distal hypospadias - abstract

The Mathieu technique and MAGPI repair have traditionally been the standard choices for distal hypospadias repair. Plate urethroplasty has recently been suggested as an alternative. Over a 2 year period, of 31 patients who presented with distal hypospadias 19 had the Mathieu repair and 12 had plate urethroplasty (Snodgrass repair). The results in the latter group were superior.(AU)

An epidemiological survey of bladder cancer in Jamaica - abstract

A retrospective analysis of 121 patients with bladder carcinoma seen at the University Hospital of the West Indies between 1979 and 1987 was done. The group was divided histologically into transitional cell (108, 89 per cent) and squamous cell (13, 11 percent). Transitional cell tumours were significantly commoner in males: squamous cell carcinoma was relatively more common in females. These findings could be related to the prevalence of lower urinary tract obstructive uropathy in the aging male and the higher incidence of chronic urinary tract infection in females. The age distribution was similar to most other malignancies peaking in the 7th decade although some transitional cell tumours were found in younger patients. A diet high in fats may be significant in the aetiology of both groups of tumours although this may be more important in the aetiology of the squamous cell type. Sixteen percent of the transitional cell group worked with or came into regular contact with petroleum products, fertilizers or paints. The incidence of both types of bladder tumours were significantly higher in city dwellers (AU)

Open prostatectomy versus endoscopic resection of the prostate a retrospective comparison - abstract

All patients who were subjected to prostatectomy at the University Hospital, Mona, from June 1972 to December 1984 were reviewed. Radical prostatectomy for carcinoma of the prostate was not included. A total of 713 patients were subjected to prostatectomy of whom 235 had either transvesical or retropubic prostatectomy and 478 patients had endoscopic resection of the prostate gland. One hundred and two patients (14 percent) developed complications, 47 (10 percent) after endoscopic resection and 55 (23 percent) after open prostatectomies. Haemmorrhage requiring blood transfusion of 2 or more units of blood occurred with 1 percent of endoscopic resections and 10.6 percent of open prostatectomies. Transient urgency incontinence occurred in 6.3 percent of endoscopic resections and 1.3 percent of open prostatectomies: the latter took a longer time to resolve. One point seven per cent of open prostatectomies had total incontinence which settled within one year. Regrowth of the prostate gland, as shown by the recurrence of irritative or obstructive symptoms and a palpably enlarged prostate on rectal examination, occurred in 10 percent of all patients (9 percent of endoscopic resection and 12 percent of open prostatectomy). One per cent of endoscopic resections and 2.4 percent of open prostatectomies developed fever, probably secondary to prostatic bed infection. There were 2 intraoperative deaths from myocardial infarction among the endoscopic resections. Endoscopic resection is as effective as open prostatectomy for the management of prostatomegaly and has fewer complications (AU)

Ectopia vesica at the Bustamante Children's Hospital - abstract

All cases of ectopia vesica treated at the Bustamante Children's Hospital from 1977 to 1984 were reviewed, to assess the effectiveness of treatment. During this period, eight cases were seen, one was lost to follow-up. Seven cases are therefore reported. There were no other associated congenital abnormalities. Three patients were not seen until after they were five months of age which is surprising because of the severity of this condition. Our policy has been to attempt staged reconstruction of the lower genito-urinary tract and to attain a funcitonally closed bladder. Cystectomy and urinary diversion (uretero-sigmoidostomy) were reserved for cases of failed bladder closure or an unacceptable level of incontinence. All patients had multiple surgical procedures. Three have undergone cystectomy and uretero-sigmoidostomy. Three have satisfactory bladder closure and are partially continent. One presently has a bladder neck fistula and is totally incontinent (AU)