Role of vesicostomy in the management of posterior urethral valve in Sub-Saharan Africa.

OBJECTIVE: To review the role of vesicostomy in the management of posterior urethral valve (PUV), in neonates and infants, given the limitations for endoscopic treatment in this setting. METHODS: A review of 35 patients who presented with posterior urethral valve over a 10-year period. Demographic and clinical information were prospectively recorded on a structured pro forma, and the data extracted analysed using SPSS 11.0. RESULTS: The 35 boys were aged 3 days to 10 years (median 3 weeks). Twenty-three (65.7%) had a vesicostomy (age range 3 days-3 years, median 3 weeks). The mode of presentation was poor urinary stream 15 (65.2%), urinary retention 4 (17.4%), and renal failure 6 (26.1%). Main findings were palpable bladder 23 (100%), hydronephrosis 4 (17.4%). Abdominal ultrasound confirmed hydronephrosis and thickened bladder wall, and voiding/expressive cystourethrogram confirmed dilated posterior urethra and vesicoureteric reflux in all 23 patients. Complications following vesicostomy were stoma stenosis 1 (4.3%), bladder mucosal prolapse 1 (4.3%), perivesicostomy abscess 1 (4.3%); there was no mortality. Following vesicostomy, 10 (43.5%) patients had excision of the valves and vesicostomy closure at age 2-8 years (median 4 years). They are well, with normal renal ultrasonographic findings, bladder capacity range 115-280 ml, and normal urea, serum electrolytes, creatinine, at 3 years of follow up. Thirteen (56.5%) are still awaiting valvotomy but have remained well and with normal ultrasonographic renal findings. CONCLUSION: Vesicostomy is a useful temporising mode of urinary diversion in neonates and infants with posterior urethral valve (in the absence of unobstructed upper tracts) when facilities for endoscopic valve ablation are not readily available.

Management of anorectal malformation: Changing trend over two decades in Zaria, Nigeria.

BACKGROUND: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. MATERIALS AND METHODS: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. RESULTS: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5%) and 106 (65.8%) emergency operations in groups A and B, respectively. There were 61 (45.5%) and 55 (34.2%) elective operations in groups A and B, respectively. Regarding treatment, in group A, patients requiring colostomy had transverse loop colostomy, while in group B, sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5%), anal transplant 5 (8.2%), sacroabdominoperineal pull through (Stephen's operation) 6 (9.5%) and others 21 (34.4%). In group B, posterior sagittal anorectoplasty (PSARP) 46 (83.7%), anal transplant 1 (1.8%), posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6%) and anal dilatation 6 (10.9%) were done. Early colostomy-related complication rates were similar in the two groups (P > 0.05). The overall late complication rate was 65.5% in group A and 16.4% in group B (P < 0.05). The mortality was 25 (18.6%) in group A compared to 17 (10.6%) in group B (P < 0.05). CONCLUSION: There have been significant changes in the management of anorectal malformations in this centre in the last two decades, resulting in improved outcomes.

Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes

Psychosocial effects of mastectomy on married African women in Northwestern Nigeria.

OBJECTIVES: Few studies have examined the psychosocial impact of breast cancer and its treatment on African women who come from a poverty-stricken, uneducated background in a developing country. The purpose of this study was to describe the specific psychosocial effects of breast cancer on married African women in order to help physicians educate and counsel future women and their families in Northwestern Nigeria. METHODS: Two semi-structured, self-report questionnaires were given to 81 consenting married African women treated with unilateral total mastectomy secondary to operable breast cancer at the Ahmadu Bello University Teaching Hospital. Questionnaires were answered at the time of the diagnosis and treatment consultation and at 6 months postmastectomy and included questions about demographics, frequency of conjugal relations and how the woman's sense of femininity was affected. Marital status was also tracked up to 3 years. RESULTS: Six months after surgery, the survey responses revealed that 67.9% of women felt inadequate as a woman because of the mastectomy and that 79.0% experienced a decrease in frequency of conjugal relations. Three years after primary breast cancer treatment, 61.7% of the participants were still married while 38.3% reported being divorced/separated from their husbands. CONCLUSIONS: These results indicated that married African women face significant physical, emotional and social changes and difficulties following primary breast cancer treatment. Culturally sensitive therapeutic groups and interventions should be established to help Nigerian women with breast cancer and their spouses and families understand and cope with the disease and its long-term health and quality-of-life implications.

Pseudoprune belly syndrome; its' associations and management challenge in a developing country: a case report.

BACKGROUND: Pseudo prune belly syndrome is an incomplete expression of the triad syndrome. Its incidence is poorly documented worldwide. We are not aware of any documented cases in Nigeria in recent times. Diagnosis is clinical; however, ultrasound scan plays key role in the overall assessment of the patient. METHOD: It is a report of an 8 day old boy who had pseudo prune belly syndrome with associated micro colon and rectal atresia managed at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, in October, 2005. CONCLUSION: Management of this patient was challenging due to lack of frozen section facility parenteral nutrition and finance. Awareness of the associated conditions and how to manage them is emphasized for good outcome.