Upper Urinary Tract Calculi in Senegal: A Comparative Study between Open Surgery and Endoscopy, a Review of 89 Cases

Abstract

Objective: The aim was to assess the place of endourologic intervention in our practice and compare it to open surgery in the management of upper urinary tract calculi in Senegal. Patients and Methods: This was a retrospective study conducted at both the Principal and Grand Yoff Hospitals in which 89 patients with upper urinary tract calculi were mobilized. All patients with symptomatic upper urinary tract colic symptoms were included. Results: Eighty-nine were followed up during the study period, 63 men and 36 women (sex of ratio 1.2). The average age was 44 years with extremes 22 -75 years. Forty two patients, including 28 men and 14 women (sex ratio 1: 2) were treated with open surgery. The mean age was 42.75 years (4 -75 years). The average duration of hospitalization after open surgery was 8 days (4 -60 days). The mean stone size in open surgery was 23 mm (5 mm -45 mm). Complications noted were: 2 cases of urinomas (4.76%), 1 case of lower back fistula (2.38%), 1 case of renal pelvis fistula (2.38%) and 1 case (2.38%) of infection. Forty seven patients including 35 men (55.6%) and 12 women (46.2%) were treated by endourology. The average length of hospital stay was 2 days (2 d -3 d). The average stone size treated by endourology was 13 mm (5 mm -40 mm). No complications were observed in this group. The cost of open surgery was a third of that of endourology. Conclusion: Endoscopic surgery, as is observed from industrialized countries occupies a prominent place in the treatment of upper urinary tract calculi in Senegal; however, the only limiting factor encountered is the cost which remains out of reach for patients and burdening the * Corresponding author. R. Kane et al. 143 budgets of our hospitals with limited means.

<p>Urolithiasis: Presentation and Surgical Outcome at a Tertiary Care Hospital in Ethiopia</p>

“…The recent study identified a higher number of staghorn stones than studies done in Ethiopia (10%), Senegal (5.6%) and Iran (2.5%). 9 , 11 , 20 This might indicate the higher rate of underlying infectious causes in our patients. In contrary to other African studies, our review and a recent Ethiopian study reported that the left kidney was more commonly affected than the right one.…”

“…Unlike the well revolutionized surgical treatment of urolithiasis in the western world, open stone surgery still remains the mainstay of approach in most developing nations. 2 , 3 , 14 , 16 , 20 , 24 , 30 The recently available minimal invasive treatment options include extracorporeal shock wave lithotripsy (ESWL), URS, percutaneous nephrolithotomy (PCNL) and laparoscopic approaches 16 , 30 , 39 The rate of open surgery in the developed countries ranged from 0.47–5% and it is reserved for indications such as complex stone disease, concomitant anatomical abnormalities, failure of minimal invasive treatments, concurrent open surgery, severe limb contractures, and patient choice. 15 , 39 Authors from Africa reported the rate of endourologic procedures ranged from 30.5–52.8% which is encouraging and in line with our review (51.5%).…”

“…[17][18][19] Despite the advancement of minimally invasive and noninvasive management of stone disease, which has become the gold standard treatment, open stone surgery remains the technique of choice in most developing countries. 2,3,16,20,21 This reflects the lack of trained professionals and endourologic instruments. 16,[22][23][24] As Ethiopia is a fast-growing, sub-Saharan Africa country, located near to the Afro-Asian stone belt, the burden is expected to be rising and becoming a public health issue.…”

“…Despite the advancement of minimally invasive and noninvasive management of stone disease, which has become the gold standard treatment, open stone surgery remains the technique of choice in most developing countries. 2 , 3 , 16 , 20 , 21 This reflects the lack of trained professionals and endourologic instruments. 16 , 22–24 …”

Forgotten Ureteral Stents in a Tertiary Hospital in Accra and a Review of Endourological Management of Upper Urinary Tract Pathologies in the West Africa Sub-Region

“…A tabulation of our findings from a search of English publication on endourological procedures in the sub region ( Table 1) confirmed the paucity of endourological procedures for the treatment of upper urinary tract pathologies in the West African sub-region. This calls for efforts at training and increasing access to endourology equipment and services to improve the management of upper urinary pathologies including calculi as occurs in the cases of forgotten ureteral stents [31]- [34].…”