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Journal of the West African College of Surgeons logoLink to Journal of the West African College of Surgeons
. 2016 Jul-Sep;6(3):138–163.

Peer-Reviewed Abstracts of Scientific Paper Presentation at The 56th Annual Conference of The West African College of the Surgeons at Yaounde, Cameroun 15th – 19th February 2016 Contd.

PMCID: PMC5555730  PMID: 28856129
J West Afr Coll Surg. 2016 Jul-Sep;6(3):138.

Prostate Cancer: Experience with 100 patients in a single center in Douala Cameroon.

C KAMADJOU 1,✉, J KAMGA 2, D EYONGETA 3, C TENKE 1, A KAMENI 1, B NJINOU 1

Purpose

Describe and evaluate how to manage patients with prostate cancer in a single center in Cameroon.

Materials and Methods

Between January and April 2015, 100 patients were diagnosed with a prostate cancer after prostate biopsy. A CT scan was performed in many cases to initiate the treatment.

Result

The mean age was 65 and the digital examination was pathologic in 65% of cases. Prostate cancer history was found in 7% of patients. 64% of the patients had low urinary tract symptoms and the mean PSA was 432,35 ng/ml. Prostate biopsy was performed in all patients by trans rectal ultrasonography and in 93% the histology was an adenocarcinoma. The Gleason score was superior to 7 in 53% of patients. Bone mets were discribed in 20 patients. Radical prostatectomy was performed in 24% of patients, 16 patients underwent orchiectomy, 27 a deprivation hormone therapy and we proposed an active surveillance in only one patient. A first line Chemotherapy was initiated in 5 patients. At least, 32 patients did not start a treatment and 2 deaths were observed before starting the treatment.

Conclusion

In our experience, prostate cancer is often diagnosed late in life when curative treatment is not an option. Patients do not accept radical prostatectomy due to urinary incontinence and impotence.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):138.

Epidemiological, clinical and therapeutic aspects of male circumcision complications at the Yaounde Central Hospital

AA Mbassi 1,3,✉, MJ Mekeme 1, L Mbouché 1, H Mobi 3, P Tchinda , PJ Fouda 1,2, FF Angwafo III 2, M Sow 1,2

Objectives

To determine the epidemiological, clinical and therapeutic aspects of circumcision at the Yaounde Central Hospital.

Materials and Methods

it is a retrospective study carried out on the medical records of 54 patients admitted at the Urology clinic of the Yaounde Central Hospital from 2000 to 2014. Outcome variables for analysis were described through their mean, maximum, minimum, number and percentage. p<0, 05.

Result

mean age at operation was 3.05 years. Circumcision was performed in a hospital setting in 48.10 cases and realized by paramedical personnel in 22 cases (40.70%). Mean period for consultation was 5.58 months. Dysuria was the main complaint (63%). Urethrocutaneous fistula was the major complication in 26 cases (48.10%). Meatotomy was the most practiced surgery (36.70%). Fistula closure was realized in 10 cases (20.40%).

Conclusion

circumcision is a surgery which can result in complications particularly on micturition and the sexual outcomes of the individual.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):139.

PENILE FRACTURE: EPIDEMIOLOGIC, CLINICAL, THERAPEUTIC AND PROGNOSTIC FEATURES. REPORT OF 15 CASES AT THE YAOUNDE CENTRAL HOSPITAL

A ESSOMBA 2, N SOW 2, PJ FOUDA 1,2, F ANGWAFO III 2, M SOW 1,2

Introduction

Penile fracture is a rare traumatic emergency generally occurring in a context of deviant sexual behaviors and requiring immediate management. The goal of this work is to outline the profile of these patients received at the emergency unit and to assess the prognosis after management in the urology service of the Yaounde Central Hospital.

Patients and Methods

This is a descriptive and retrospective study, from 2008 to 2014, concerning 15cases of penile fractures received in our setting.

Result

Extremes of age were 22 and 48 years, with a median of 35. The delay of consultation was few hours in all cases. Coitus injury was the main mechanism of trauma, following deviant sexual behaviors in almost all cases. Four cases had acute urinary retention associating a penile fracture and urethral rupture. The remaining eleven were sole fractures with 3 ruptures of both corpus cavernosum and 8 having one corpus cavernosum ruptured. The mean delay of surgery was an hour. The functional prognosis still remains to be assessed with all patients lost to follow-up.

Conclusion

The immediate management of penile fractures guarantees functional recovery.

Keywords

fracture, penile, epidemiologic, clinical, therapeutic, prognosis.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):139.

Obstetric fistula control campaigns in Cameroon: experiences and lessons

M J Mekeme 1,✉, A A Mbassi 1, H Moby 2, LF Mbouche 3, C Fouda 4, M Nwaha 4, PJ Fouda 1, M Sow 1, F Angwafo III 4, MA Sosso 4

introduction

Obstetrical fistula is an abnormal communication between bladder and vagina or between rectum and vagina following an obstructed labour. It is a public health problem particularly in poor regions.

Objectives

To give back the outcomes of obstetrical fistula treatment using a flap to improve pelvic continence

Materials and Methods

We conducted a prospective and retrospective study in several health facilities in Cameroon during 12 months. All patients with cervico-urethral fistula and who underwent surgery by using a flap were included.

Result

We performed surgery on 28 patients aged from 15 to 45 years old. Partial breakdown was observed in 5 patients. 18 % of patients presented with stress incontinence. 3 cases of total incontinence were registered. Success rate was 82.1%

Conclusion

The flap use to repair fistula respects the external urethra sphincter. This technique is easy to apply singularly for young surgeons.

Keywords

Obstetrical fistula, flap, Cameroon

J West Afr Coll Surg. 2016 Jul-Sep;6(3):140.

FOURNIER’S GANGRENE: EPIDEMIOLOGICAL AND CLINICAL ASPECTS AT THE YAOUNDE CENTRAL HOSPITAL

M J MEKEME 1,✉, A A MBASSI 1, L MBOUCHE 2, M KENMOE 1, M NWAHA 1, PJ FOUDA 3, M SOW 3

Background

Fournier’s gangrene is a necrosis of soft tissues of the perineum and external genitalia. Treatment combines resuscitation, antibiotic and necrosectomy

Objective

The purpose of this study was to highlight the epidemiological and clinical aspects of the Fournier’s gangrene at the Yaounde Central Hospital

Material and Method

We carried out a retrospective and descriptive study over a period of six years at the Yaounde Central Hospital. We enrolled all files of patients treated and followed-up for Fournier’s gangrene. Variables included were sociodemographic parameters, clinical findings, risk factors, prognosis, mortality.

Result

52 cases were enrolled. The median age of patients was 47. 42 ± 18.25 years. The most common risk factors were alcohol (25%), diabetes mellitus (19. 44%), HIV-AIDS (13.89%). The major complaint was scrotal swelling (71.20%) with an average period of 9.25 ± 6.84 days for consultation. Fever (100%), local pain and edema (96.20%) were almost present. 69.20% of patients were seen at the stage of necrosis. The most common clinical form was localized on external genitalia (40%). The mortality rate was 15.40%.

Conclusion

Fournier’s gangrene is no longer rare in our milieu. This medico-surgical emergency needs to be known by the majority of practitioners.

Keywords

Fournier’s gangrene, Yaounde Central Hospital

J West Afr Coll Surg. 2016 Jul-Sep;6(3):140–141.

CLINICAL, THERAPEUTIC AND EVOLUTIVE ASPECTS OF PROSTATE CANCER AT THE YAOUNDE CENTRAL HOSPITAL AND THE YAOUNDE GENERAL HOSPITAL

J Mekeme 1, H , Moby 2, A A Mbassi 1, L Mbouche 3, FL Ndgishe 4, PJ Fouda 1, Fru III Angwafo 5, M Sow 1, J Yomi 5, M A Sosso 5

Background

Prostate cancer is the most common cancer in men. The majority of patients in our environment are diagnosed late. Currently, treatment benefit from the progress in molecular diagnosis, technology and new target therapy.

Objective

To report the clinical, therapeutic and evolutive aspects of prostate cancer in two referral hospitals.

Materials and Methods

We carried out a retrospective and prospective study at the Yaounde Central Hospital and the Yaounde General Hospital during a period of 9 years (January 2005 to December 2014). We included 174 patients. The variables of interest included: age of patient, clinical and paraclinical parameters, treatment protocol.

Results

The median age of patients was 67.9 ± 8 years. Urinary symptoms were predominant (81.60%). Hypertension was associated in 45.9%. Digital rectal examination combined with transrectal ultrasound suspected a prostate cancer in 96.6%. The mean value of PSA was 1345,3 ± 3116,34 ng/ml. 54.5% of patients (n=95) were diagnosed at stage T4. Adenocarcinoma (97.70%) was the predominant histological pattern. Hormonal therapy was used in all patients. The median overall survival was 27 months.

Conclusion

Treatment of prostate cancer in our region demands standardization of diagnostic and therapeutic protocol so that all patients would benefit from various management options.

Keywords

prostate cancer, treatment, survival, Yaoundé

J West Afr Coll Surg. 2016 Jul-Sep;6(3):141.

RISK FACTORS FOR OBSTETRIC FISTULA IN EASTERN CAMEROON

J MEKEME 1,✉, A A MBASSI 1, H MOBY 2, L MBOUCHE 3, A G ESSOMBA 4, M A NWAHA 4, PJ FOUDA 1, M SOW 1, Fru III ANGWAFO 4, M A SOSSO 4

Background

Obstetric fistula usually occurs in women with a disadvantaged socio-economic status.

Objective

To identify and highlight the risk factors for obstetric fistula in Eastern Cameroon.

Methods

This was a convenient sample of 59 patients aged 15-65 years recruited consecutively from the Eastern region after sensitization via the local health and administrative authorities. The study was carried out at the Bertoua Regional Hospital from 02 to 30 June 2009.

Results

The average height of patients was 151.94 cm. The duration of fistula ranged between 2 months and 35 years with a median of 6 years. The fistula size varied from 0.5 cm to 6 cm with a median of 2 cm. The median age at 1st delivery was 16.5 years. The labor lasted about 48 hours for 22 % of patients with a median of 36 hours. Only 3.4 % of patients were salaried workers, 39% were housewives. 23.7 % had secondary education and none had university education. 10.17% delivered at home. 83.1 % attended at least one antenatal visit.

Conclusion

The risk factors for obstetric fistula in Eastern Cameroon are multiple; early (teenage) pregnancies as well as prolonged labor are by far the most common causes while low socioeconomic status and illiteracy are the key factors.

Keywords

Obstetric fistula, Risk factors, Eastern Cameroon.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):141–142.

CLINICAL AND THERAPEUTIC EPIDEMIOLOGICAL PROFILE OF ERECTILE DYSFUNCTION IN DOUALA

EH Moby 1,✉, BT Sala 1, A Mbassi 2, J Mekeme 2, S Youaga 3, F Angwafo III 4

Background

Erectile dysfunction is a disease that can have devastating effects on masculinity and the future of the family.

Purpose

The purpose of this study is to provide the clinical and therapeutic epidemiological profile of erectile dysfunction in three hospitals in Douala.

Methodology

The descriptive and prospective study was conducted over a period of six months in the urology departments of selected hospitals. A questionnaire containing socio-demographic, clinical, International Index of Erectile Function 5 score and therapeutic data was used to collect data. Data analysis was performed with the aid of the SPSS 20.0 software.

Results

205 patients were enrolled in the study. Erectile dysfunction prevalence was 27.2%, with a mean age of 50 years. 40% of patients were earlier treated by a general practitioner, and 31.2% by a specialist. Erectile dysfunction was present in 38% of patients aged below 40 and 72% aged above 40. 43.4% of patients had moderate erectile dysfunction while 36.6% did have severe erectile dysfunction. Advanced age was significantly associated with a severe form of erectile dysfunction (P<0.001). Glycemia was requested for 82% of cases and 98% of patients were treated.

Conclusion

Erectile dysfunction is present in Douala, with a prevalence of 27%. Management of such patients is important for marital and family stability.

Keywords

dysfunction, profile, Douala.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):142.

EPIDEMIOLOGIC, CLINICAL AND THERAPEUTIC PROFILE OF MALE URETHRAL STRICTURES IN DOUALA

EH Moby 1,✉, BT Sala 1, A Mbassi 2, J Mekeme 2, S Youaga 3, F Angwafo III 4

Background

Urethral stricture has diverse etiology: infectious, iatrogenic, post-traumatic and congenital. In developed countries, the infectious forms are declining while the post-traumatic and iatrogenic forms are rising. What is the situation in Cameroonian urban areas?

Purpose

To determine the clinical and therapeutic epidemiologic profile of male urethral strictures in Douala.

Methodology

We conducted a retrospective study over a period of 5 years in two hospitals in Douala. The study focused on male patients who fulfilled the selection criteria and were managed within the study period. Statistical analysis was performed using the SPSS 20.0. Software. Pearson’s correlation coefficient was used for comparing the associations between variables.

Results

144 patients were enrolled in the study and were of an average age of 38.38 years, with extremes of 1 year and 97 years. Urethral stricture prevalence stands at 7%. Dysuria is the main reason for consultation (44.4%). Strictures are infectious (48.6%), iatrogenic (26.4%), or traumatic (24.3%). They have spongy (40.3%), medullary (29.2%), and membranous (20.1%) seats. End to end urethroplasty (37.5%) and instrumental dilatation (32.6%) are the most used surgical techniques. Recurrences (44.4%) are the most postoperative course and appear on average 2.75 months after surgery.

Conclusion

Urethral stenosis or stricture is common among young adults in Douala and infectious etiologies are dominant. Choosing treatment for better long term results is a problem.

Keywords

Urethral stricture, epidemiology, diagnosis, treatment, Douala.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):143.

Transrectal prostate biopsy: indications, results and complications at the Brazzaville Teaching Hospital (CHU Brazzaville)

PA Bouya 1, AWS Odzébé 1,✉, AS OndzelOpara 1, M Ngalouo 1, AM OndongoAtipo 1, R B Banga Mouss 1

Purpose

Contribute to improving care for patients with prostate tumour.

Patients and Methods

This was a descriptive evaluative study which involved collecting restrospective data in the Andrology/Urology Department of CHU Brazzaville from 2009 to 2014. It concerned patients treated for prostate tumours and having undergone prostate biopsy using digital technology (2009-2012) and ultrasound (2012-2014).

Result

The average age of patients was 64.98 years. The largest age group was that of those over 55 years. The biopsy revealed adenocarcinoma in 36.1% of cases. The percentage of biopsies revealing a cancer was 13.88% (5/36) when the PSA was between 4 and 10ng/ml, this rate was 42.17% (70/166) when the PSA was > 10ng/ml. Out of 75 Gleason scores, 9.33% had a score between 2 and 4, 34.67% a score between 5 and 7 and 56% a score between 8 and 10. The overall complications rate was 19.71% with predominantly bleeding complications.

Conclusion

One out of three biopsies reveals a prostate cancer. Significant associations were found between age and cancer, biopsy results and DRE, and PSA levels and prostate cancer.

Keywords

prostate biopsy, prostate cancer, DRE, PSA, complications.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):143.

Priapism: epidemiological, diagnostic and therapeutic aspects

AWS Odzébé 1,✉, PA Bouya 1, R B Banga Mouss 1, Ngapoula 1, AS Ondzel Opara 1, M Ngalouo 1, AM Ondongo Atipo 1

Purpose

This study sought to: determine the frequency of priapism, determine the consultation period, and list the factors predisposing to priapism.

patients and Method

83 (eighty-three) patients were treated for priapism in the urology-andrology department of CHU Brazzaville, between 1 June 2005 and 1 June 2015. The study variables were: epidemiological (frequency, age, marital status, employment status, origin, place of living, history; diagnostic (circumstances occurred, consultation period, type of erection, haemoglobin electrophoresis, CBC results, aetiology); therapeutic (medical and surgical treatment); evolution (detumescence time, recurrence, complications).

Results

Priapism is the fourth urological emergency after acute urinary retention, renal colic, and hematuria, with a frequency of 1.37%. The average age of patients was 25.69 ± 13.5 years. Sickle cell disease was noted in 57.8% of cases. Twelve patients who consulted within 12 hours were successfully treated with oral and injectable etilefrine (IIC). 36 (thirty-six) consulted between 12 and 36 hours and were successfully treated with spongiocarvernous fistula using the WINTER technique. Of the 35 patients who consulted after 36 hours and were treated using the WINTER technique first line, there were 10 cases of failure which were then treated secondarily using the ALGHORAB method.

Conclusion

Priapism is not only a rare disease in urology but also a urological emergency. The Sickle cell aetiology is predominant, followed by idiopathic causes. Nearly half the patients are still admitted in urology after the 36th hour. Surgical treatment yields good results especially when patients are seen early.

Keywords

priapism, urological emergency, Sickle Cell

J West Afr Coll Surg. 2016 Jul-Sep;6(3):144.

THE EFFECT OF DIET ON URINARY NERVE GROWTH FACTOR ON UNOBSTRUCTED AND OBSTRUCTED MURINE BLADDERS

Temitope Adedeji 1, Ayodeji A Fasanmade 1, EOluwabunmi Olapade-Olaopa 1,✉

Introduction

Abnormal growth of afferent and efferent neurons stimulated by nerve growth factor (NGF) may contribute to detrusor dysfunction and also to lower urinary tract symptoms (LUTS). Different diets have been shown to have variable effects on LUTS. We therefore investigated the effects of diet on the expression of NGF, as a mechanism for dietary influence on bladder function in the obstructed and un-obstructed bladder.

Methods

We induced experimental BOO surgically in male wistar rats. Animals were prefed on various diets which were continued for 4 weeks after surgery. Rats were divided into sham-operated and BOO groups each with the following: control (normal rats’ feeds), high-carbohydrate (HCD), high-fat (HFD) and high-protein (HPD) dietary groups. ELISA for NGF was adapted from the methods of Westcamp and Otten (1987) and Hellweg (1989).

Result

In the unobstructed groups, NGF was significantly increased in animals fed on HFD and HPD (P<0.05) but was unchanged in HCD. In the BOO groups, NGF decreased only in the HCD-BOO group in comparison with the BOO control while the HFD and HPD remained unchanged. In individual comparisons of all dietary groups with their corresponding dietary-BOO groups, only the HFD exhibited a significant difference.

Conclusion

The results of this study show that diet has a variable effect on NGF expression in un-obstructed and obstructed murine bladders and that changes in NGF expression may contribute to the influence of diet on LUTS.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):144–145.

Epidemiology of bladder cancers in Ibadan, Nigeria

AO Takure 1,2,✉, MO Odubanjo 3, SA Adebayo 1,2, O Oluwasola 3, OB Shittu 1,2, LI Okeke 1,2, OA Fadimu 1,4, EO Olapade-Olaopa 1,2

Introduction

A previous study from the University College Hospital, Ibadan southwest, Nigeria on bladder cancers had described an increase in the frequency of urothelial carcinoma (UC) compared to the earlier reported preponderance of squamous-cell carcinoma (SCC). In this current study, we provide an update on the histopathologic pattern of this disease in our community.

Methods

We reviewed the records of the Ibadan Cancer Registry from January 1997 to December 2014 and analyzed the data available on the histologic subtypes of bladder carcinoma diagnosed in the hospital.

Result

Two hundred and sixteen bladder tumours were recorded during this period with a male to female ratio of 3.2:1. There were 181 bladder carcinomas. Of these, 68.5%, 19.9% and 11.6% were urothelial carcinomas (UC), squamous cell carcinomas (SCC), and adenocarcinomas (AC) respectively. UC was more common in all age groups and its peak age of occurrence was in the 51-60 year age group. The peak age for SCC was in the 41-50 year age group. Mean and median age of occurrence was significantly lower in females in all histotypes, and lowest in SCC [P = < 0.0001].

Conclusion

This population study has confirmed UC as the predominant histotype of bladder cancer in Ibadan, Southwest Nigeria currently and that both UC and SCC occur earlier in women. These findings have significant implications for health policies in the country.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):145.

Influence of diet on CXCL12 activity in un-obstructed and obstructed murine bladders

Temitope Adedeji 1, Ayodeji A Fasanmade 1, EOluwabunmi Olapade-Olaopa 1,✉

Introduction

CXCL12 is an inflammatory chemokine which is found in the normal urothelium but its expression is increased in interstitial cystitis/painful bladder syndrome (IC/PBS). Diet has been shown to influence inflammation and worsen lower urinary tract symptoms (LUTS). We investigated dietary influence on CXCL12 expression to determine possible mechanisms by which diet might affect LUTS in un-obstructed and obstructed murine bladders.

Methods

We induced experimental BOO surgically in male wistar rats. Animals were prefed on various diets which were continued for 4 weeks after surgery. Rats were divided into sham-operated and BOO groups each with the following: control (normal rats’ feeds), high-carbohydrate (HCD), high-fat (HFD) and high-protein (HPD) dietary groups. CXCL12 was assayed by ELISA using appropriate rat CXCL12 kits.

Result

In the unobstructed bladders, CXCL12 was significantly increased in animals fed on HFD and HPD (P<0.05) and significantly decreased in HCD. In the BOO groups, the HCD-BOO group exhibited a decrease in CXCL12 when compared to the BOO control, while CXCL12 increased in the HFD-BOO group. The HPD-BOO however remained unchanged. In individual comparisons of dietary groups with their corresponding dietary-BOO group, all dietary groups exhibited a significant difference.

Conclusion

The results of this study show that HFD and HCD elicit different reactions in CXCL12 activity in un-obstructed and obstructed murine bladders. These findings suggest that changes in CXCL12 activity may mediate the influence of diet on LUTS in humans.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):146.

Usefulness of Indigenous Language Patient Information Leaflets to Sample Affected and Non-affected Population of Ibadan, South West Nigeria

Funmilola Iranade 1, Duro Adeleke 1, EOluwabunmi Olapade-Olaopa 1,✉

Introduction

Patient Information Leaflets (PILs) provide information to patients (affecteds) and non-patients (non-afffecteds) alike to improve understanding of the disease and increase participation in the decision- making processes of their treatment. The aim of this study was to determine the usefulness of indigenous language PILs on urological diseases to both affecteds and non-affecteds.

Methods

Patient information leaflets developed for specific urological diseases and their treatment in English were translated into Yoruba the indigenous language of our locality. The leaflets were then translated to 50 randomly selected affecteds and 50 non-affected respondents. Questionnaires, in both languages, were then administered to assess their understanding of the leaflets and their usefulness. The responses were collated and analyzed.

Results

When the responses from affecteds and non-affecteds were combined, majority (78%) stated that they understood the leaflets and most (83%) described them as very helpful. All respondents (100%) found the translations useful, with most (84%) strongly agreeing that they broadened their knowledge of urological diseases and treatments, and majority (66%) stated they useful in choosing the appropriate treatments. Also, majority (64%) of the respondents believed they could advise others based on the knowledge they obtained from the indigenous language PILs. Most respondents (80%) agreed strongly that the PILs should be shared with other people as a source of information.

Conclusion

Majority of affected and non-affected population found indigenous language PILs useful in broadening their understanding of urological diseases and their treatments and would recommend them to others as veritable sources of information.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):146–147.

CLOSED BLADDER EXSTROPHY: A RARE CASE AT THE YAOUNDE GYNAECO-OBSTETRIC AND PEDIATRIC HOSPITAL

FF MouafoTambo 1,✉, IN KounaTsala 1, F Mantho 1, L Mbouche 1, D Bob 1, J Ditope 1, Malagal Fadi, 1, OG Andze 1

Background

Bladder exstrophy is a rare complex congenital malformation. Worldwide, the frequency reported is 10,000 to 50,000 births. Closed bladder exstrophy is even more exceptional and to the best of our knowledge, no case has been reported in Africa so far.

Objective

The aim of this report was to add this case to those currently existing in the medical literature worldwide and present the therapeutic difficulties in an African setting.

Case presentation

The authors report a case of a 5-year-old girl seen at the paediatric surgery service of the Yaounde Gynaeco-Obstetric and Pediatric Hospital. The patient presented with a low set umbilicus, wide pubic diastasis and a hypoplasic urethra that could not admit a size 10 foley catheter. However, the bladder neck was functional, as the patient was continent. The clitoris was bifid but of normal size. Endoscopic evaluation showed a dilated bladder probably resulting from chronic bladder outlet obstruction. The vagina was horizontalised but normal in size (6 cm) and the cervix appeared normal. The kidneys were well differentiated and no dilatation of the calices was seen at the adbominal ulstrasound. The use of intermittent catheterisation as decribed by Mitrofanoff deserves to be discussed in our setting.

Conclusion

The management of closed bladder exstrophy specifically in the African milieu is paved with difficulties and the outcome is uncertain.

Keywords

closed bladder exstrophy, Yaounde, Cameroon.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):147.

FOLLOW UP OF CHIDREN WITH POSTERIOR URETHRAL VALVES OPERATED AT THE YGOPH

G Guemkam 1, FF Mouafo Tambo 2,✉, L Mbouche 2, C Kamadoju 2, PY Mure 3, FFF Angwafo 2, AG Ondobo 2

Background

Posterior urethral valves (PUV) account for up to 50% of the obstructive causes of chronic kidney disease in the pediatric age group. Antenal diagnosis is possible in 80% of cases. The incidence of PUV is approximately 1 for 5000-8000 male live births.

Objective

This study aimed at evaluating the outcome of children operated for PUV at the YGOPH.

Methodology

This was a retrospective study including all cases of PUV managed in the pediatric surgery service of the YGOPH over a period of 8 years (october 2007-march 2015). Patients with a vesicostomy were excluded. Data was analysed for growth, survival and kidney function.

Result

Fourteen patients were managed during the study period. Age at the time of diagnosis ranged from 2 days to 8 years. Antenatal diagnosis was made in 4 patients but no details on the quantity of amniotic were precised. With a minimal follow-up of 11 months, growth rate was satisfactory, the blood pressure was within normal range for height. Seven patients developed chronic kidney disease (stage 2 and 3), one patient is undergoing dialysis in Milan and one died.

Conclusion

The outcome of PUV depends on the progression to end stage renal disease that requires kidney transplant. Nephroprotection is the only means to slowdown or prevent this poor evolution.

Keywords

valves, follow-up, chronic kidney disease.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):148.

CHALLENGES IN THE DIAGNOSIS AND MANAGEMENT OF NON TRAUMATIC URETHRAL STRICTURES BOYS AT YGOPH

FF Mouafo Tambo 1,✉, G Fossi 1, C Kamadjou 1, L Mbouche 1, AS NwahaMakon 1, J Birraux 2, OG Andze 1, FF Angwafo 1, PY Mure 2

Background

Non-traumatic urethral strictures in male children are not uncommon, especially in an African setting.

Objective

Highlight the diagnostic and therapeutic difficulties in the management of non-traumatic urethral strictures in boys at the YGOPH.

Methodology

The authors report five cases of non-traumatic urethral strictures managed at the paediatric surgery department of the YGOPH over a two-year period (November 2012-November 2014).

Result

In order to confirm the diagnosis of urethral stricture, all patients were assessed both with cystuoretrography and urethrocystoscopy. The findings were; either an inflammatory urethra (n=2), either a single or multiple stenosis. The actions were performed included: internal urethrotomy (N = 1), urethral dilatation (n = 1), vesicostomy (n = 2) and urethral catheterization (n = 3). With a median follow-up of 8.2 months all patients remained symptoms free.

Conclusion

The authors report the difficulties encountered in the diagnosis and management of non-traumatic urethral strictures in boys at the HGOPY. The existence of an inflammatory aetiology of urethral strictures in boys deserves to be considered.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):148–149.

COMPLICATIONS OF CIRCUMCISION AT THE GYNAECO-OBSTETRIC AND PEDIATRIC HOSPITAL OF YAOUNDE (YGOPH): A REPORT OF 15 CASES

FF Mouafo Tambo 1,✉, S Fadi 1, JJ Ditope 1, D Nyanit Bob 1, L Mbouche 1, OG Andze 1

Background

Complications arising from the practice of circumcision in our environment are numerous and pose major therapeutic difficulties involving the functional prognosis, aesthetic and sometimes potential vital risks.

Objective

This study aimed at describing the anatomic, clinical and therapeutic aspects of circumcision accidents at the Gynaeco-Obstetric and Pediatric Hospital of Yaoundé.

Methodology

Our study was retrospective and descriptive; over a period of 10 years, we recorded cases of complications related to circumcision occurring in patients less than 15 years and managed at the pediatric surgical unit of the Gynaeco-Obstetrics and Pediatric Hospital of Yaoundé.

Result

Overall 15 patients were managed in our unit during the study period, representing 1.5cases/year. The average age of the patients was 5.57 years (7months-14 years). The mean time before consultation was 10 months (3hrs - 2 years). The circumcision was carried out as a ritual in all cases. Clinical patterns encountered were dominated by urethrocutaneous fistulae (53.3%), followed by glanular and/or penile amputation (6.7%). Therapeutic procedures performed varied with respect to the indication: closure of urethral fistula (46.7%), meatoplasty (13.3%), wet dressing + antibiotics (6.7%), buccal mucosa graft urethroplasty (6.7%), correction of chordee (6,7%), vesicostomy (6.7%) and control of haemorrhage and suturing(6.7%).

Conclusion

Adverse events related to the ritual practice circumcision as a routine in our setting are quite high. Some of these complications require major surgical procedures are sometimes required for their management.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):149.

OUR EXPERIENCE IN THE MANAGEMENT OF POSTERIOR URETHRAL VALVES AT A TERTIARY HOSPITAL IN YAOUNDE

FF Mouafo Tambo 1,✉, L Mbouché 1, D Nyanit 1, J Ditopè 1, S Fadi 1, R Malagal 1, FF Angwafo III 1, OG Andzé 1

Background

Posterior urethral valves (PUV) are the most common cause of bladder out let obstruction in boys.

Objective

The authors share their experience in the management of PUV in a resource-poor country.

Methodology

This was a retrospective and descriptive study of all patients aged 0-15 years managed for PUV at the pediatric surgery service of the YGOPH, over a period of 5 years. The data collected from patients’ medical records was analyzed for age, duration of symptoms before presentation, presenting features, findings on the cystourethrogram and at endoscopy, surgical procedure performed, follow-up, morbidity and mortality.

Result

Fifteen patients including 8 infants and 6 newborns were managed during the study period. Average duration of symptoms was 12 months (1day-96months). Majority of patients presented with symptoms of urethral obstruction, mainly difficulty in urinating. The diagnosis of urethral valves was made on the basis of voiding cystourethrogram (n=11) and /or urethrocytoscopy (n=4). Endoscopic ablation of the urethral valves and cutaneous vesicostomy were performed in 13 and 7 patients respectively. After a median follow-up of 2 years (4-64months), 2 patients presented with urethral strictures and 2 others died of chronic renal failure.

Conclusion

The authors put forth a plea for early diagnosis in their context and highlight the need for a constant nephrological out-patient follow-up of patients who undergo initial urethral valve resection.

Keywords

urethral valves, endoscopic ablation, YGOPH

J West Afr Coll Surg. 2016 Jul-Sep;6(3):150.

OUR EXPERIENCE IN THE MANAGEMENT OF DISORDERS OF SEX DEVELOPMENT: A REPORT OF 400 CASES

FF Mouafo Tambo 1,✉, J Birraux 2, A Wonkam 1, S Boubakary 1, WY Joko 1, JJ Ditope 1, BD Nyanit 1, G Fossi 1, NS Lyhmi 1, AS Salihou 1, S Fadi 1, M Ngowe Ngowe 1, OG Andze 1, MA Sosso 2, S Dahoun 2, P Chatelain 3, V Tardy 3, Y Morel 3, C Le Coultre 2, PY Mure 3

Background

The prevalence of disorders of sex development (DSDs) is not known in our African milieu where late diagnosis is common. The management of DSDs is in full expansion in our country through the support from an ongoing partnership with the North.

Objective

The aim of this study was to assess the importance of the local need and assert the feasibility of providing optimal care for children with DSDs in the context of a developing country.

Methodology

From November 2009 to November 2015, 12 surgical team trips concerning DSDs were carried out at the YGOPH. All patients aged less than 18 years presenting with malformations of the external genitalia in whom a precise diagnosis had been made were included in the study.

Result

Overall 1000 patients were seen during the study period of which 179 had a precise diagnosis. The mean age of the patients was 7.2 years. During this same period, 200 surgeries were carried out at YGOPH of which 130 hypospadias reconstructions and 15 feminizing genitoplasties. After a median follow-up of 3 years (7months -6 years) no infectious nor serious metabolic complications was recorded. Six patients had a total breakdown of the urethroplasty and 5 others had a urethocutaneous fistula.

Conclusion

The authors stress on the need for a high index of suspicion and immediate referral of any abnormality of the external genitalia and immediate referral to HGOPY, they affirm the feasibility of confirm the optimal management of these disorders.

Keywords

disorders of sex development, management, YGOPH.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):151.

ENDOSCOPIC INCISION AND URETEROSCOPY FOR THE TREATMENT OF URETEROCELE AND PELVIC URETERAL CALCULI: EXPERIENCE WITH 6 PATIENTS AT A SINGLE CENTER

C KAMADJOU 1,✉, A KAMENI 1, C TENKE 1, B **NJINOU NGNINKEU 1

Purpose

To retrospectively evaluate the safety and effectiveness of endoscopic incision and ureteroscopic lithotripsy in adults with orthotopic ureterocele and associated calculi.

Methods

From January 2011 to December 2014 at our center, 6 adults underwent transurethral incision of an ureterocele and pelvic ureteroscopic lithotripsy for associated calculi. The perioperative data of these patients were retrospectively analyzed. The literature was reviewed to identify all the reported options for management of this relatively rare condition.

Result

Ureterocele was associated with a single system in all patients. 3 patients had associated pelvic ureteral stones. Endoscopic ureterocele incision and ureteroscopy were used for complete stone clearance. The procedure was uneventful in all patients. The average postoperative hospital stay was 1, 5 days. All patients were stone free after the procedure. 5 patients were available for follow-up at 3 and 6 months. None of these patients had any evidence of residual ureterocele and/or hydronephrosis when evaluated at 3 months. Micturating cystourethrography (MCU) at 3 months revealed low-grade vesicoureteral reflux (VUR) in 3 patients; no reflux was found with MCU at 6 months.

Conclusion

Endoscopic management of adult orthotopic ureterocele and associated calculi effectively decompressed ureterocele and removed stones in all patients without any significant postoperative morbidity. Low-grade VUR that may occur postoperatively resolved at 6 months. A literature review suggests that the management of both ureterocele and calculi simultaneously should make endoscopicaly.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):152.

TRANSURETHRAL LITHOTRIPSY WITH RIGID URETEROSCOPY FOR PROXIMAL AND DISTAL URETERAL STONES: RESULTS OF A SINGLE CENTER IN CAMEROON

C** KAMADJOU 1,✉, A KAMENI 1, C TENKE 1, B NJINOU NGNINKEU 1

Purpose

To evaluate the efficacy and safety of intracorporeal lithotriptors, Lithoclast (EMS, Switzerland) in retrograde rigid ureteroscopy of proximal and distal ureteric calculi.

Methods

Out of 20 patients with ureteral calculi underwent Lithoclast lithotripsy using a 8/9.8F rigid ureteroscope. We reviewed the medical records from January 2010 to December 2014. Of the stones treated 14 were lower ureteric, 1 were middle ureteric and 9 were upper ureteric stones. The mean diameter of the stones was 8 mm (4-15). Two senior consultants performed the procedure.

Result

Of the 24 stones, 100% were successfully fragmented: 35% of the lower, 5%of the middle and 45% of the upper ureteric stones. Median operative time was 45 minutes (range, 25-65 minutes). The average number of procedures was 1 with 18 patients requiring one, and 2 patients requiring two because of bilateral ureteral calculi. Postoperative stenting was done in all patients for 2 weeks. The post-operative hospitalization was 1 days. Significant complications include 2 case of ureteric perforation who needed prolonged internal ureteral stenting.

Conclusion

In sub-saharian Africa, Rigid ureteroscopy was associated with shorter operation time and postoperative hospitalization period. These data also suggest that it was safe and more effective than open surgery in the aspect of high stone-free rate with low complication rates. We believe that it is an excellent treatment modality for managing ureteral calculi.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):152–153.

Laparoscopic radical prostatectomy using an extraperitoneal approach:initial experience in 20 cases in a single center in Douala, Cameroun.

C KAMADJOU 1, C TENKE 1, JP SANDJON 2, J KAMGA 3, A KAMENI 1, B NJINOU NGNINKEU 1,✉

Purpose

To evaluate the operative, oncologic, and functional results oflaparoscopic radical prostatectomy based on an initial series of 20 patients. We developed a pure extraperitoneal approach with pelviclymph-node dissection. This approach seems more comparable to the open technique and avoid potential risks. We evaluated the perioperative parameters (blood loss, operating time, transfusion rate) and postoperativeresults (oncological results, continence and potency) after our first 20 cases.

Material and Method

Between January 2011 and April 2014, we performed 20 laparoscopic radicalprostatectomy. On average, patients were 62 years old (range 53-73), hadpreoperative mean PSA values of 20.44 ng/ml (3.2-44,30). The clinical stagewas T1 in 90%, T2 and T3 in 10%. In large majority of cases (17 patients), Gleason score was less than 7. We used a pure extraperitoneal approach and we performed a descending technique starting with the dissection at the bladder neck. The seminal vesicles dissection is comparable to the openapproach.

Result

No deaths were observed in this series. No Conversion was required. Themean operating time was 198 minutes (120-300), including the lymphadenectomyphase that was considered necessary in 75% of patients. The meanpostoperative bladder catheterization time was 10 days. The mean hospitalstay was 3 postoperative days. Pathological stage was less than pT2 in 16patients (80%).

Positive nodes were found in 15% of patients (3/20). At a mean follow-up of6 months, 65% of patients were free of biochemical recurrence. Detectablepostoperative PSA at 3 month was observed in 6 patients. The continencerate (no pad) was 45% at 3 months. After a nerve-sparing procedure in 13patients, the total potency rate at 6 months was 30%.

Conclusion

This study confirms the value, in our experience, of the laparoscopicapproach to radical prostatectomy, which allows satisfactory cancer controlassociated with low perioperative morbidity and encouraging functionalresults in terms both of continence and erectile function.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):153–154.
C KAMADJOU 1, C TENKE 1, JP SANDJON 2, J KAMGA 3, A KAMENI 1, B NJINOU NGNINKEU 1,✉

Purpose

Laparoscopy can be an alternative modality in the management of renal and ureteral stones. We present our experience with laparoscopic renal and ureteral stone surgery. Although most ureteral and renal stones are managed using endourologic techniques, open surgery or shockwave lithotripsy.

Method

31 patients (20 renal units and eleven urétéral unit) underwent transperitoneal laparoscopic pyelolithotomy and ureterolithotomy at our institution. Twenty males, 11 females with mean age of 42 years (range 25-70 years) underwent 30 laparoscopic procedures. The mean stone number and size, were 3 (range 1-5) and 2 cm (range 1-4.5 cm), respectively. Five patients had staghorn calculus.

After insertion of abdominal trocart, pneumoperitoneum was achieved, and the kidney or ureter was exposed. The renal pelvis and ureter was identified, dissected, and opened. The stones were extracted using laparoscopic forceps. This rigid forceps was used to extract any caliceal stones. The renal pelvis and ureter was sutured after placement of antégrade ureteral DJ stent, and the stones were removed from the peritoneal cavity. The procedure was concluded after placement of an intraperitoneal drain.

Result

All procedures were completed laparoscopically. The mean operative time was 140 min. The estimated blood loss was less than 20 mL, and none of the patients received a blood transfusion.There were no major intraopertive or postoperative complications. The stone-free rate was 100%. The mean hospital stay was 3 days (range 1-5 days). All patients needed D J stent placement. One patient with infected staghorn calculus had prolonged urinary leak, which stopped with conservative management. DJ stent was removed after 40 days. Within a mean follow-up period of 3 months, no stone recurrence occurred.

Conclusion

Laparoscopic removal of renal and ureteral calculi plays a role in special cases of urolithiasis. In experienced hands, it can be performed safely and efficiently and may therefore replace open stone surgery in most indications. The benefits of laparoscopy are lower postoperative morbidity, shorter hospitalization, shorter convalescence time, and better cosmetic results.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):154.

Extracorporeal shock wave lithotripsy in the treatment of urinary calculi: A single center experience in Douala, Cameroun

C KAMADJOU 1,✉, C TENKE 1, A KAMENI 1, B NJINOU 1

Purpose

The aim of this prospective study was to assess the efficiency of extracorporeal shockwave lithotripsy (SWL) in a single center in Douala-Cameroun.

Materials and Methods

Between Febuary and may 2015, a total of 30 ( 18 male and 12 female) consecutive adult patients with the mean age of 42,46 years (range 19-59) presenting with stones located in renal pelvis (56,6%), Urétéral JPU (23,3%), and upper ureter (20%) were treated using the DIREX Integra lithotripter. 3 patients underwent SWL after double-J ureteral catheter insertion. Treatments was performed without anesthesia and delivered in outpatients setting.

Result

19 patients (63.3%) had their calculi completely fragmented after 2 sessions and 10 (33,3%) patients had residual fragments calculi. Of these ten patients, 2 (20%) patients need retrograde ureteroscopy with double J stent placement. In one patient fragmentation was uncessful even after 4 sessions.

Only one patients (12.5%) were admitted to hospital because of fever, and 8 ( 26,6%) patients presented colics, and of these 3 (37,5%) patients underwent double J stent placement.

Conclusion

The management of urinary calculi in adults using SWL was proved to be safe, suitable and efficient, particularly for ureteral stones <15 mm, renal pelvic stones <20 mm. SWL delivered in an outpatient setting as an anaesthesia-free treatment is still considered the first option for the majority of stones with a minimal number of complications.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):155.

LAPAROSCOPIC PYELOTOMY WITH COMBINED PYELOPLASTY FOR A SEVEN YEAR OLD BOY: REPORT OF ONE CASE

C TENKE 1,✉, C KAMADJOU 1, J KUITCHE 1, A KAMENI 1, B NJINOU NGNINKEU 1,✉

Purpose

We present a case of a child who was referred, with a diagnosed right renal calculi and a left uretero-hydronephrosis without obstacle associated with both right inguinal and umbilical hernias. An indication of laparoscopic pyelolithotomy with combined pyeloplasty and umbilical and inguinal hernia repair as an alternative to standard open surgery.

Case presentation

A seven year-old boy, 31kg, 146cm was referred to us for a shock-wave extracorporeal lithotripsy treatment of a 1,5 cm right renal calculi, associated with a left hydronephrosis Stage: I and normal renal function.

The medical history revealed several urinary tract infections since the age of 9 months, with episodes of right abdominal pains without fever or hematuria. At the age of two years, a posthectomy was performed, with a urethral calibration and a bladder catheter was left in place for 2 days. At the age of four, IVP (IntraVenous Pyelogram) and Cystography showed a mild amount of post-micturition residual urine. From five to six years old, he was recommended abundant hydration. The abdominal pain was persisting, associated with fever and an antibacterial therapy with co-amoxiclav was instituted three months before the transfer to our center.

Physical examination demonstrated umbilical and right inguinal hernia. The biological data were in the range of normal. The abdominal X-ray and ultrasonography revealed the presence of a renal stone of 15mm. If we had to do shock wave lithotripsy for the renal calculi treatment, the boy would need sedation; for the double J stent and inguinal hernia repair surgery, he would require general anesthesia. We have therefore decided to do a right-sited laparoscopic pyelolithotomy with pyeloplasty plus double J stent and open inguinal hernia repair surgery.

The patient did not need any special pre operative preparation. General anesthesia with endotracheal intubation plus controlled ventilation and maintenance with Sevoflurane, was performed. Intermittent bolus of Sufentanil and Atracurium was given. We monitored throughout the procedures the ECG, pulse oxymetry, NIBP, capnography, temperature and a nasogastric tube was placed before the surgery. In the first operative time, pyelothomy, pyeloplasty and placement of the double J were realized, drain placement and stone extraction. Then the patient was placed in the supine position. The second operative time consist of right inguinal repair.

Result

Complete stone clearance was achieved. Operative time was 124 minutes. Estimated blood loss was <50 mL. No notable complications were encountered. Intravenous analgesics drugs were administered for the post operative pain management during 48 hours. The intraperitoneal drain was removed on day 2, and the patient was discharged 72 hours after surgery. The double J stent was removed 2 weeks after surgery under general anesthesia as we performed open umbilical hernia repair.

Conclusion

Laparoscopic surgery can be safely and effectively performed in the pediatric population. The procedure promotes lesser pain and complications, early rehabilitation, short hospital stay. It also minimizes the cosmetic impacts. Requiring open surgery is the last resort, because of anatomical abnormalities, or failed MIS.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):156.

URO040 Prostate Cancer: Experience with 100 patients in a single center in Douala, Cameroon

C KAMADJOU 1,✉, J KAMGA 2, D EYONGETA 3, C TENKE 1, A KAMENI 1, B NJINOU 1

Purpose

Describe and evaluate how to manage patients with prostate cancer in a single center in Cameroon.

Materials and Methods

Between January and April 2015, 100 patients were diagnosed with a prostate cancer after prostate biopsy. A CT scan was performed in many cases to initiate the treatment.

Result

The mean age was 65 and the digital examination was pathologic in 65% of cases. Prostate cancer history was found in 7% of patients. 64% of the patients had low urinary tract symptoms and the mean PSA was 432,35 ng/ml. Prostate biopsy was performed in all patients by trans rectal ultrasonography and in 93% the histology was an adenocarcinoma. The Gleason score was superior to 7 in 53% of patients. Bone mets were discribed in 20 patients. Radical prostatectomy was performed in 24% of patients, 16 patients underwent orchiectomy, 27 a deprivation hormone therapy and we proposed an active surveillance in only one patient. A first line Chemotherapy was initiated in 5 patients. At least, 32 patients did not start a treatment and 2 deaths were observed before starting the treatment.

Conclusion

In our experience, prostate cancer is often diagnosed late in life when curative treatment is not an option. Patients do not accept radical prostatectomy due to urinary incontinence and impotence.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):157.

LAPAROSCOPIC PROMONTO-FIXATION FOR GENITAL PROLAPSE: EXPERIENCE OF 300 CASES

Bertin NJINOU NGNINKEU 1,✉

Introduction

We describe the series of our initial 300 patients treated with laparoscopic promonto-fixation (LPF).

Methods

Since November 2002 and January 2015, Three hundred patients were scheduled for LPF alone for genital prolapse or combined to TVT or TOT for urinary stress incontinence. Eight had previous cure of prolapse, 50 hysterectomy and 31 vaginal vault prolapse. 30 had cystocele grade 4, 180 grade 3, 70 grade 2 and 20 grade 1. Five had rectocele grade 4, 55 grade 3, 220 grade 2 and 20 grade 1. Four presented uterine prolapse grade 4 and 6 grade 3. 120 were incontinent and 30 presented occult incontinence. No patient had overactive bladder. The procedure consists by correction of rectocele and cystocele by using 2 meshes, which are fixed, to the promontory. A TVT or TOT was placed if warranted.

Result

Mean follow-up (FU) was 130 months (6-720). Patients were evaluated postoperatively at 6 and 12 months FU. LPF alone was performed to 15 patients and combined to 135 patients. Operating time<2 hours, blood loss<80 cc and mean hospital stay were 4 days. Ten patients presented recurrent cystocele grade 1, 5 rectocele grade 2, 20 de novo urgency, and 4-urge incontinence. Six urinary retention requires TVT section. Complications consist to 1 ureteral and 4 anterovaginal wounds.

Conclusion

Laparoscopic promonto-fixation is feasible with good results in the cure of genital prolapse. Laparoscopy is performing the same procedure as the open technique with the advantages of the minimal invasive surgery.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):157–158.

POST-TRAUMATIC EMERGENCY TREATMENT WITH EMDR

Phil Samuel Som 1,✉

EMDR means (Eye Movement Desensitization and Reprocessing). It is a psychotherapy treatment discovered by Francine Shapiro in 1987, which was originally designed to alleviate the distress associated with traumatic memories Francine Shapiro, 1989a, 1989b). Shapiro’s (2001) Adaptive Information Processing model posits that EMDR facilitates the accessing and processing of traumatic memories and other adverse life experience to bring these to an adaptive resolution. After successful treatment with EMDR, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. During EMDR therapy the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist directed lateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and audio stimulation are often used (Shapiro, 1991). Shapiro (1995, 2001) hypothesizes that EMDR facilitates the accessing of the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights. EMDR therapy uses a three pronged protocol:

1) the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;

(2) the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized;

(3) imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptiv

Twenty positive controlled outcome studies have been done on EMDR. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):158.

LAPAROSCOPIC DEROOFING/EXCISION OF SYMPTOMATIC RENAL CYSTS IN IBADAN: INITIAL EXPERIENCE

AO Takure 1,2,✉, O Afuwape 1,3, SA Adebayo 1,2, IN Chibuzo 2, EO Olaopa-Olapade 1,2, LI Okeke 1,2, OB Shittu 1,2

Background

The routine use of abdominal ultrasound scan and computed tomographic (CT) scan in the investigation of abdominal symptoms has increased the detection of asymptomatic renal cysts. Symptomatic renal cysts are eminently suitable for treatment through laparoscopic approach. We report our initial experience with the laparoscopic treatment of symptomatic renal cysts in Ibadan.

Result

A total of 4 patients were treated between June and October, 2015. There were2 males and 2 female. The mean age was 61.25 (age range, 40-75) years. Three of them presented with recurrent left loin pain and one had cough and fever. The comorbid conditions in the patients were hypertension in 3 and peptic ulcer disease in one patient. The complete blood count, electrolyte, urea and creatinine were all within normal limits. Abdominal ultrasound and CT scan showed thin-walled cortical cysts with sizes varing from 3.5cmx4cmx5cm to 9.8cmx8.1cmx7.4cm. All the cysts were in the left kidney, with two each located in the upper pole and middle pole respectively. The mean operating time was 200 minutes (range 180-225). The estimated blood loss was 20-80mls. All four patients had laparoscopic transperitoneal deroofing and excision of the renal cortical cysts. The postoperative period was uneventful and all were discharged on the second day after surgery.

Conclusion

laparoscopic deroofing/ excision of simple renal cystsis feasible and safe in our environment. Period of hospital stay for the treatment of symptomatic simple renal cysts after surgery is short.

Keywords

symptomatic renal cyst, laparoscopic deroofing/excision, Ibadan

J West Afr Coll Surg. 2016 Jul-Sep;6(3):159.

PROFILE OF MAJOR LIMB AMPUTATIONS IN ZARIA, NORTH-WEST NIGERIA

KE Amaefule 1,✉, IL Dahiru 1, MI Maitama 1, FS Ejagwulu 1

Background

Amputation is one of the oldest surgical procedures in history. Till date, it remains one of the commonest surgical procedures. The indications cut across almost all pathologies, and the predominant ones in any region depend on certain predisposing factors in that region. Over the past six years, the northern Nigeria has witnessed increasing wave of insurgency attacks; and the Nigerian economy has grown to be the largest in Africa with the attendant change in citizens’ lifestyle expected of such economy.

Objective

To determine if there has been a change in the profile of major amputations in Zaria, north-west Nigeria.

Methodology

A retrospective descriptive study of patients who had major amputations in Ahmadu Bello University teaching hospital from January 2009 to May 2015.

Results

Two hundred and two major amputations in 199 patients were studied. There were 47 children (0 -16 years) and 152 adults. The commonest indication for amputation in children was traditional bone setters’ post-splintage gangrene (48.9%); while diabetic foot disease was the commonest indication in adults (37.5%). Non-diabetes related peripheral vascular disease accounted for 19 amputations (12.3%). Amongst adults, the commonest indication for upper limb amputations was trauma, followed by electric burns; while diabetic foot disease was the commonest indication for lower limb amputations.

Conclusion

There has been a change in the pattern of amputations amongst our adult populations with emerging disease conditions which can be attributed to a change towards a western type of lifestyle with the growth in the Nigerian economy; while that of children remains unchanged. More needs to be done on checkmating the traditional bone setters’ indelible mark on this vulnerable group.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):159–160.

BILATERAL SHOULDER DISLOCATION PRESENTING AS A THORACIC TRAUMA: CASE REPORT

AG Nguene Nyemb 1,✉, JR Minyem 1

Background

Unilateral anterior shoulder dislocations account for 95% of all shoulder dislocations. Bilateral shoulder dislocations are rare, and if they occurred, posterior type of dislocations is common. Bilateral anterior shoulder dislocations are very rare

Objectives

We report a case of simultaneous bilateral anterior dislocations of shoulder with associated greater tuberosity fracture.

Case Report

A forty-year-old man presented to our center with thoracic pain following a backward fall by extending both arms behind his back. On examination there was loss of round contour of shoulder with restricted range of movements of arms. Radiographs revealed that the shoulders were dislocated with associated greater tuberosity fracture on one side. The dislocations were reduced with closed method followed by immobilization in arm sling and subsequent rehabilitation.

Discussion

Shoulder dislocations typically present unilaterally and are anterior in nature. Bilateral simultaneous posterior shoulder dislocations are typically associated with seizure or electrocution and are more common than bilateral simultaneous anterior dislocations. This lesion affects mainly men with a mean age of 33.5 years. The most common cause is trauma, followed by muscle contractions due to seizures or electrocution. In 15.7% of the cases, the diagnosis of bilateral anterior dislocation was not acute (<3 weeks), and in virtually all of these cases it was not traumatic.

Conclusion

All orthopedic surgeons and emergency physicians should be aware of such unusual possibilities to have an early diagnosis and treatment. An early reduction and appropriate rehabilitation can provide satisfactory functional outcome.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):160.

EPIDEMIOLOGICAL AND LESIONAL ASPECTS OF FRACTURES IN THE ELDERLY IN COTONOU, BENIN

Pascal CHIGBLO 1,✉, Gipsy AGAVOEDO 1, Oswald GOUKODADJA 1, Fiacre TIDJANI 1, Eric LAWSON 1, Soumaïla MADOUGOU 1, Aristote HANS - MOEVI 1

Introduction

Trauma of osteoporotic elderly are common and pose management problems.

Objective

The aim of this study was to describe the epidemiological and lesional aspects of fractures in the elderly.

Methodology

This is a retrospective study over a period of 3 years (2011-2013) on patients aged at least 60 years, with a fracture of the locomotor apparatus after trauma. Pathological fractures were excluded.

Results

We identified 95 cases. The mean age was 70.52 years. There were 44 women and 51 men. Most patients (81%) had at least one comorbidity dominated by high blood pressure and diabetes. The mean preoperative Parker score was 8.61 and the patients were ASA 1 or 2 in 78.94% of cases. The etiologies were dominated by falls (50.53%) and traffic road accidents (46.32%). The trauma was severe in 51.58% of cases. The average admission time was 12 days. There were 119 fractures dominated by fractures of the proximal femur (39 cases). Morbidity was 53.68%. Anemia was common and 20% of patients were transfused. The average hospital stay was 36.74 days with extremes between 15 months and two days. Mortality was 5.26%.

Conclusion

fractures in the elderly are relatively common and unfortunately associated with a high morbidity and mortality.

Keywords

Elderly, Falls, Fractures

J West Afr Coll Surg. 2016 Jul-Sep;6(3):160–161.

TRAUMATIC HIP DISLOCATION IN COTONOU, BENIN

Pascal CHIGBLO 1,✉, Gipsy AGAVOEDO 1, Oswald GOUKODADJA 1, Fiacre TIDJANI 1, Eric LAWSON 1, Soumaïla MADOUGOU 1, Aristote HANS - MOEVI 1

Introduction

Hip dislocations are a trauma emergencies.

Objective

We studied their epidemiological, clinical and therapeutic aspects at the CNHU HKM.

Methodology

This was a retrospective study of patients treated for traumatic hip dislocation between 2006 and 2014 and with a minimum follow up of one year.

Results

we selected 23 cases out of 40. The male predominance was with a sex ratio of 4,7. Patients had a mean age of 39.6 years (18-70 years). The workers were the most affected. We noted 19 (82.6%) including 18 regular posterior dislocations. This was mainly fracture dislocation (17 of 23 cases) .The average of the dislocation reduction was 41.0 hours (2h-20 days). The final treatment was 16 times (69.6%).Orthopaedic and 7 times (30.4%) surgical including a total hip replacement. We noted few complications, 2 cases of hip osteoarthritis, and one death. The average of total weight bearing was 125 days (90-180 days).

The average follow-up was 53.5 months (12-108 months). The functional results were excellent, very good and good respectively in 8 (36.4%), 4 (18.2%), and 8 patients (36.4%) by the score of Merle d'Aubigné and Postel.

Conclusion

Traumatic hip dislocations are an absolute emergency that can initiate the functional prognosis of the pelvic limb. They must be reduced as soon as possible in order to avoid complications.

Keywords

Traumatic dislocation; hip; reduction, evolution.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):161.

CHALLENGES OF SETTING UP AN ARTHROPLASTY: EXPERIENCE OF A TERTIARY HEALTH CARE FACILITY IN A POOR RESOURCE SETTING.

I L Dahiru 1,✉, K E Amaefule 1, Y Z Lawal 1, M I Maitama 1, F S Ejagwulu 1, M O Ogirima 1

Background

The evolution of Total joint replacement operations have revolutionize the management of irreversible painful joint disorders and has also found usefulness by being extended to other pathological conditions. The present decade has and is still witnessing a rise in the number of cases being performed in different centres with variable outcomes. The sustenance of these high tech operations are not without their challenges. Ahmadu Bello University Teaching Hospital, a tertiary health care facility in Nigeria, has in the last three years established an arthroplasty unit offering mainly Total hip and Knee replacement operations. The challenges we faced sustaining this important aspect of Orthopaedic Surgery prompted us to report our experience.

Method

This is a prospective study carried out over a period of three years, March 2012 to march 2015, involving 52 consecutive patients with clear indications for either THR or TKR. They were adequately councelled after diagnosis and encouraged to get funds for the operations. 7 patients out rightly rejected the procedures after councelling and opted out.

Result

52 patients with clear indications for THR or TKR were seen during the study period. There were 31 females and 21 males. The age range is 16 – 60years. 12 and 8 patients require bilateral THR and TKR respectively. 22 patients require unilateral THR 10 patients require unilateral TKR.17 total joint replacements were carried out on 13 patients with 4 knees and 13 hips replaced. Procedures were done periodically after pooling patients.5 patient were operated in the first year, 6 patients in the second year, and 6 patients in the third year. 12 patients require 6 – 12 months period to be financially ready while only one was financially ready at the time of diagnosis. 3 patients were declared unsuitable for the procedure despite being financially ready. 15 patients gave up because of prohibitive cost of operation. 7 patients rejected the offer of joint replacement and 14 patients are still at various stages of getting funds. Implants used in the first 2 years were those of Johnson and Johnson while for the third year implants were those of Smith and nephew.

Conclusion

Total joint replacement operations are important advances recorded in the field of Orthopaedics with patients requiring the procedures available globally. Setting up of Arthroplasty units in poor resource settings are however not without challenges. Strenghtening the National Health Insurance policy in Nigeria can go a long way in making this important aspect of Orthopaedic Surgery well grounded.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):162.

LOWER EXTREMITY RECONSTRUCTION: THE PRESENT AND FUTURE - OUR EXPERIENCE

C M Isiguzo 1,✉, K Opara 2

Background

Lower extremity reconstruction can be challenging. Management has evolved in the last two decades. Multidisciplinary approach involving the Plastic surgeons, Orthopaedic surgeons and vascular surgeons has produced the best result. A plastic surgeon with microvascular surgery expertise is a great advantage. The study presents our current experience. It demonstrates our challenges and determined our future plans.

Objective

To highlight common and complex presentations of lower extremity injuries in our environment along with the challenges

Methodology

A case series involving a total of 4 cases

Results

The cases were managed successfully using various pedicled flap techniques

Conclusion

There is need to for us to work closely with Orthopaedic surgeons in our centres to facilitate early presentation of the patients. Importantly there is a mandatory need for plastic surgeons to develop microsurgical skills in our region now more than any area of plastic surgery.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):163.
C M Isiguzo 1,✉, K Opara 2

Background

Perforator flaps are among the recent inclusions to the armamentarium of the plastic surgeon which is almost becoming mainstream. This new inclusion makes it possible for any skin flaps to be harvested as long as the perforator vessels can be dissected.

Objective

To present our experience and challenges in the use of perforator flaps in reconstructive surgery

Methodology

Case reports

Result

Good results were achieved with the use of perforator flaps in reconstruction of left elbow joint defect and post burn axillary reconstruction

Conclusion

All plastic surgeons should be encouraged to explore the use of the perforator flaps in their practice as it removes most of the impediments to use of traditional pedicled flaps.

J West Afr Coll Surg. 2016 Jul-Sep;6(3):163.
Kabir Abubakar Mohammed 1,✉, Mamuda Abdurrahman 1, Musa Adamu Kabiru 1, Mohammed Shamsudeen 1, Ibrahim Mustapha 1

Background

80% of adult will experience low back pain at one point in their life. While most will resolve with or without medication, some may experience persistence of symptoms. Some patient may develop back pain by virtue of their work which predisposes them to mechanical back due to wrong posture. The varied nature of activities of hospital workers may predispose them to mechanical low back pain.

Objective

To determine the prevalence of low back pain among hospital workers. To identify risk of low back pain among hospital workers.

Methodology

The study was a cross sectional study. Two hundred health workers from the biggest Four Public Hospitals within the Kano metropolis were interviewed using questionnaire. A total of 32 stem questions were asked. Data gotten was analysed using the SPSS software.

Result

88(44%) of respondents were females while 122 (56%) were males. The mean age was 34.3years. 146(73%) of respondents have had low back pain within the last two years. Of this, 46% had their work activity affected by the low back pain. 6 patients (36%) were given excuse because of the back pain. 15.15% 0f all respondent have family history of low back pain. Equal numbers of respondents think that low back pain is preventable.

Conclusion

Health workers may be at special risk due to the nature of their activities. Though it is common it may be prevented by increasing awareness among health workers on the posture and activities that reduce risk.

Articles from Journal of the West African College of Surgeons are provided here courtesy of Wolters Kluwer -- Medknow Publications

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