Background: Forgotten ureteral stent is defined as prolong indwelling ureteral stent whose function is no longer desired. Ureteral stents are used in the management of upper urinary tract pathologies. Prolonged indwelling ureteral stents may be complicated by urosepsis or renal failure, encrustation, stone formation, spontaneous fracture which may either be retained or voided in the urine (stenturia). Hitherto, these complications were managed by open procedures alone in our center. We report our recent experience in endourology with the management of three cases of forgotten ureteral stents with durations of ten years and two years (two cases) and review endourological practice in West Africa. Conclusion: Although encrusted stents can be managed successfully by minimally invasive approaches in the majority of cases, the best treatment is prevention. Urology units should have preferably an electronic stent register such that when the time for removal is due, the patient's name and details are flagged red. If electronic register is not available, then a hard paper/book register should be made to prevent situations of forgotten stents. Also, efforts must be made to improve endourological services in the West Africa sub-region to allow patients to have the benefit of endourology in the management of upper urinary tract pathologies including that of stones originating from an encrusted or fractured forgotten ureteral stent.
BackgroundThe objective of this study was to determine the factors responsible for peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia and thus offer a guide for blood product management for the procedure.MethodsThis was a prospective study of 200 consecutive patients who underwent open prostatectomy for BPH from January 2010 to September 2013 at the Korle Bu Teaching Hospital, Accra. The data analyzed included the pre-operative blood haemoglobin level (Hb), presence of co-morbidities, the case type, indication for the surgery, ASA score, anaesthetic method used, systolic blood pressure, status of the operating surgeon, duration of surgery and the operative prostate weight. The transfusion of blood peri-operatively was also documented.ResultsThe mean age of the patients was 69.1 years. Elective cases formed 83.5 % with refractory retention of urine being the commonest indication for surgery (68.0 %). The mean pre-operative Hb was 12.1 g/dl. Consultants performed 56.0 % of the prostatectomies. Transvesical approach was used in 90.0 % of the cases. The mean operative time was 101.3mins (range 35.0–240.0) with a mean operative prostate weight of 110.8 g (range 15–550 g). Most of the patients (82.0 %) had spinal anaesthesia. The blood transfusion rate was 23.5 %. The transfusion rate was significantly higher in patients with anaemia (p = .000), emergency cases (p = .000), the use of general anaesthesia (p = .002), a resident as the operating surgeons (p = .034), prostate weight >100 g (p = .000) and duration of surgery (p = .011). In a multivariable logistic regression analysis however only the pre-operative Hb (p = .000. OR 0.95, 95 % CI [0.035–0.257]) and the duration of surgery (p = .025, OR 1.021, 95 % CI [1.003–1.039]) could predict blood transfusion in open prostatectomy for BPH in this series.ConclusionsA ‘group and save’ policy should be the preferred blood ordering procedure for patients with Hb ≥ 13.0 g/dl scheduled for an elective open prostatectomy for BPH under spinal anaesthesia. A long operative time however may increase the need for blood transfusion.
Uretero-vesical anastomosis is the connection of the ureter to the urinary bladder at a new site to achieve unimpeded flow of urine from the ureters into the urinary bladder. A rare complication of this procedure is the development of stricture at the anastomotic site. This report is on a 62-yr. old female with one year history of left flank pain and a prior left uretero-vesical anastomosis done 14 years earlier. She had been managed for recurrent urinary tract infections, but the left flank pain was persistent. Abdominal and pelvic CT scan with intravenous urogram helped establish the diagnosis of uretero-vesical anastomotic stricture. This was successfully managed with endoscopic dilatation after retrograde placement of guide wire under fluoroscopy followed by serial dilation. In a patient presenting with flank pains after a previous uretero-vesical anastomosis, stricture at the anastomotic site is an important differential diagnosis. Endoscopic management is the preferred initial management which produces successful outcomes
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