Genito-urinary reconstruction in southern Nigeria.
BACKGROUND
Urologic cases constitute about 25% of a busy surgical practice in Nigeria with up to 50% of these cases being genito-urinary abnormalities in adults and children. As most urologic surgery in Nigeria is done by general surgeons, a knowledge of the disease pattern and effective techniques in management would be helpful in surgical training.


OBJECTIVE
To describe the disease pattern and surgical outcomes in patients undergoing genito-urinary reconstruction in southern Nigeria


METHODS
We retrospectively reviewed the medical records of patients who underwent genito-urinary reconstructive procedures by two urologists and one paediatric surgeon over a 7-year (1991-1998) period at two tertiary referral centres in southern Nigeria. We extracted data such as age, sex, nature of pathology, surgical therapy and outcomes. Patients with a follow up of 12 months were excluded. The pattern of genito-urinary disease, type and outcome of surgical therapy, and complications were determined.


RESULTS
Two hundred and twenty seven patients (121 men, 39 women, and 67 children) underwent genito-urinary reconstruction during the seven years spanning 1991-1998. The study population consisted of 160 adults and 67 children (< 15 years old). Mean patient age was 43 years with a range of 18-87 years for adults and three years (range 18 months-13 years) for children. Mean follow up duration was 15 months, (range--13 months-seven years). Urethral abnormalities comprised 69% (98/ 227) of the lesions. The most common abnormality was urethral stricture in 98 (43%) patients. Urethral strictures were reconstructed as follows; primary anastomosis 83 (84.6%), pedicled penile skin island 6 (6.1%), Blandy 2 stage, 4 (4%), meatoplasty three (3%) and meatotomy, two (2%). The overall complication rate for repair of urethral strictures was 4.08%. There were 79 (35%) congenital lesions, including hypospadias 62 (27%), pelvi-ureteric junction obstruction 13 (6%), bladder exstrophy 2 (0.8%), chordee without hypospadias, 2 (0.9%), and concealed penis 1 (0.4%). These were managed using the following techniques; MAGPI, 30 (48.3%), urethroplasty, 22 (10%) single stage 10 (45%), two-stage 12 (55%), and urethral mobilization 10 (16%). Vesico-vaginal fistula complicating obstructed labour and pelvic surgery was the main cause of urinary fistulae. Ten patients underwent microsurgical epididymo-vasostomy for obstructive azoospermia resulting in three pregnancies.


CONCLUSIONS
Lower urinary tract reconstruction represents a major proportion of urologic surgery in southern Nigeria. Management by urologic specialists results in good outcomes, therefore urologic training in this area should include a large component of lower urinary tract reconstruction.
Akporiaye
L E
LE
Baptist Medical Centre, Eku, Delta State, Nigeria. lesakporiaye@hotmail.com
Oguike
T C
TC
Evbuomwan
I
I
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D005832:Genital Diseases, Male / Q000601:surgery; D006801:Humans; D007021:Hypospadias / Q000601:surgery; D007223:Infant; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000601:surgery; D014551:Urinary Tract / Q000002:abnormalities* / Q000601:surgery*; D014570:Urologic Diseases / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000706:statistics & numerical data*; D055815:Young Adult