Objective:To explore the impact of the coronavirus disease 2019(COVID-19)pandemic on the training experiences of urology residents in Indonesia.Methods:A cross-sectional study using a web-based questionnaire(SurveyMon...Objective:To explore the impact of the coronavirus disease 2019(COVID-19)pandemic on the training experiences of urology residents in Indonesia.Methods:A cross-sectional study using a web-based questionnaire(SurveyMonkey)involved all registered urology residents in Indonesia.The questionnaire was structured in Bahasa Indonesia,composed of 28 questions,and divided into three sections:demographic characteristics,current daily activities,and opinions regarding training experiences during the COVID-19 outbreak.The survey was distributed to all respondents via chief of residents in each urology center from May 26,2020 to Jun 2,2020.Results:Of the total 247 registered urology residents,243 were eligible for the study.The response and completeness rate for this study were 243/243(100%).The median age of respondents was 30(range:24e38)years old,and 92.2%of them were male.Among them,6(2.5%)respondents were confirmed as COVID-19 positive.A decrease in residents’involvement in clinical and surgical activities was distinguishable in endourological and open procedures.Most educational activities were switched to web-based video conferences,while others opted for the in-person method.Smart learning methods,such as joining a national or international speaker webinar or watching a recorded video,were used by 93.8%and 80.7%of the respondents,respectively.The respondents thought that educational activities using web-based video conferences and smart learning methods were effective methods of learning.Overall,the respondents felt unsure whether training experiences during the COVID-19 pandemic were comparable to the respective period before.Conclusion:The COVID-19 pandemic negatively affected urology residents’training experiences.However,it also opened up new possibilities for incorporating new learning methodologies in the future.展开更多
Background: Endoscopic exploration and treatment of urinary tract disorders, whether by retrograde, percutaneous or endoscopic approach, defines endo urology. Objective: To report the results of endo urology practice ...Background: Endoscopic exploration and treatment of urinary tract disorders, whether by retrograde, percutaneous or endoscopic approach, defines endo urology. Objective: To report the results of endo urology practice in Bouaké during the two practice sessions. Patients and Methods: Cross-sectional and descriptive study of patients followed up and had benefited from exploration and/or endoscopic surgery in Bouaké. Our study was carried out in a facility in Bouaké, for two years, from January 2021 to December 2022. The parameters of interest were clinical, diagnostic, endoscopic procedure and results. Results: During the study period, 157 patients underwent endoscopic exploration and/or intervention. The mean age was 58.9 years (range 28 - 90 years). Males predominated with 95.5% (n = 150). Acute urinary retention was the most frequent reason for consultation (55.41%). Benign prostatic hyperplasia (BPH) was the most frequent pathology at 22.92% (n = 36). Urethrocystoscopy was performed in 52 cases (33.12%), Transurethral resection of the prostate (TURP) in 36 cases (22.92%), Endoscopic resection of secondary cervical sclerosis in 23 cases (14.64%), Endoscopic internal urethrotomy (EUI) in 15 cases (9.55%) and Transurethral resection of the bladder (TURB) in 10 cases (6.36%). Post-operative management was straightforward in 93.63% of cases (n = 147). Operative times of between 21 and 35 minutes were more frequent in 55.41% of cases (n = 87). Urinary tract infections accounted for 3.8% (n = 6) of surgical morbidity. The germ responsible for the infections was essentially Escherichia coli (E. coli). The mean duration of post-operative urinary drainage was 5.5 days (range: 4 - 6 days) for patients who underwent TURP, TURB and endoscopic resection of secondary sclerosis of the bladder neck. The mean duration of drainage after endoscopic internal ureterotomy was 21.6 days (range 14 - 30 days). Of the 157 endoscopies performed, 154 patients (98.08%) had a favourable outcome, with adenomyofibroma of the prostate being the most common histological type (52.17%, n = 36). Mortality was 1.27% (n = 2) in our series. Conclusion: Endo urology should be the urologist’s first choice for both exploration and surgery, given the satisfactory results.展开更多
Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure op...Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure operates with limited resources and more than half of the population lives below the poverty line. The objective of this study was to determine the frequency of post-operative mortality, to describe the main comorbidity factors responsible for this mortality and to identify the main cause of post-operative death in the urology department of the Ignace Deen National Hospital Material and Method: This was a retrospective descriptive study lasting 5 years from January 1, 2015 to December 31, 2019. It had focussed on all the files of patients operated on at the Urology Department of the Ignace Deen National Hospital, either in an emergency or planned and who died in per or post-operative immediately or 30 days later. Results: We recorded 63 cases of post-operative death, or a frequency of 1.84%. The average age was 61.92 ± 16.91 with the extremes of 12 and 91 years. Bladder (20.63%) and prostate tumours (60.3%) were the main admission diagnoses. High blood pressure was the main comorbidity factor found with 38.09% of cases followed by diabetes with 12.69%. Transurethral resection of the prostate, transurethral resection of the bladder and prostate adenocomectomy were the most performed surgical procedure with respective proportion of 19.04%, 20.63% and 38.09%. Probable cause of death were anemia in 25 cases (39.68%), septic in 20 cases (31.75%), heart failure in 6 cases (9.52%), pulmonary embolism in 5 cases (7.94%), obstructive renal failure 4 cases (6.35%) and stroke in 3 cases (4.76%). Conclusion: The majority of deaths occurred in patients over the age of fifty. Anaemia was the main cause of deaths. Difficulties in procuring blood products as well as the lack of modern therapeutic means are factors that make it difficult for patients to adequately manage.展开更多
Aim: To contribute to improving the management of urological emergencies at Labé Regional Hospital. Patients and Method: This was a dynamic, descriptive study lasting six months from July 1 to December 31, 2017. ...Aim: To contribute to improving the management of urological emergencies at Labé Regional Hospital. Patients and Method: This was a dynamic, descriptive study lasting six months from July 1 to December 31, 2017. Results: Urological emergencies represented 45.14% (n = 218) of all admissions to the urology unit. The mean age of our patients was 56.60 years with extremes of fifteen days and 93 years. The 71 - 80 age group was the most represented with 28.03% (n = 61) followed by 61 - 70 years with 24.31% (n = 53). Our patients’ activities were dominated by agriculture, with 35.77% (n = 88), and the city center was most affected by urological emergencies, with 39.44% of cases (n = 86). 70.18% (n = 153) of our patients had bladder retention on admission, and 53.21% (n = 116) underwent urethral catheterization, including 3 women. The etiology of bladder retention in these 3 women was dominated by two cases of bladder lithiasis and one case of neurological bladder. Conclusion: The management of urological emergencies requires specific material and human resources. Their knowledge will enable us to better understand this problem and could serve as a basis for a broad reflection on the organization of the management of urological emergencies in our region.展开更多
The robotic nurse plays an essential role in a successful robotic surgery.As part of the robotic surgical team,the robotic nurse must demonstrate a high level of professional knowledge,and be an expert in robotic tech...The robotic nurse plays an essential role in a successful robotic surgery.As part of the robotic surgical team,the robotic nurse must demonstrate a high level of professional knowledge,and be an expert in robotic technology and dealing with robotic malfunctions.Each one of the robotic nursing team“nurse coordinator,scrub-nurse and circulating-nurse”has a certain job description to ensure maximum patient’s safety and robotic surgical efficiency.Well-structured training programs should be offered to the robotic nurse to be well prepared,feel confident,and maintain high-quality of care.展开更多
While robotic surgery has shown clear utility and advantages in the adult population,its role in pediatrics remains controversial.Pediatric-sized robotic instruments and equipment are not readily available yet,so cert...While robotic surgery has shown clear utility and advantages in the adult population,its role in pediatrics remains controversial.Pediatric-sized robotic instruments and equipment are not readily available yet,so certain modifications can be made in order to make robotic surgery successful in children.While the cost of robotic surgery remains high compared to open procedures,patients experience greater satisfaction and quality of life with robotic surgery.Robotic pyeloplasty is a standard of care in older children,and has even been performed in infants and re-do surgery.Other robotic procedures performed in children include heminephroureterectomy,ureteroureterostomy,ureteral reimplantation,urachal cyst excision,bladder diverticulectomy,and bladder reconstructive procedures such as augmentation,appendicovesicostomy,antegrade continence enema,bladder neck reconstruction and sling,as well as other procedures.Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection.Future improvements in technology with production of pediatric-sized robotic instruments,along with increases in robotictrained pediatric urologists and surgeon experience along each’s learning curve,will help to further advance the field of robotic surgery in pediatric urology.展开更多
Objective:To describe the Chinese experience of natural orifice transluminal endoscopic surgery(NOTES)in urology.Methods:From December 2008 to May 2017,35 animal experiments and 305 clinical surgeries of NOTES or natu...Objective:To describe the Chinese experience of natural orifice transluminal endoscopic surgery(NOTES)in urology.Methods:From December 2008 to May 2017,35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions(NOSE)were performed in China.The animal experiments included five kidney biopsies,24 nephrectomies and six partial nephrectomies.The clinical surgeries included 12 transvaginal NOSE(TV-NOSE),266 hybrid transvaginal NOTES(TV-NOTES)and 27 pure TV-NOTES.The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site(U-LESS)nephrectomies,four suprapubic-assisted laparoendoscopic single-site surgery(SA-LESS)nephroureterectomies,and three laparoscopic radical cystectomies.The hybrid TV-NOTES procedure included 210 nephrectomies,31 adrenalectomies,eight nephroureterectomies,13 partial nephrectomies,and four heminephrectomies.The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies.Results:A total of 29 animal experiments were successfully performed.One partial nephrectomy was converted to standard laparoscopic surgery.Two kidney biopsies and two nephrectomies were unsuccessful.A total of 297 clinical surgeries were successfully performed.Six patients who underwent hybrid TV-NOTES were converted to open surgery.Two patients who underwent pure TV-NOTES were converted to SA-LESS.There were 22 major complications,16 occurred intraoperatively and six postoperatively.The mean visual analog score(VAS)of 48 h after the operation was 2.5 points in TV-NOSE,2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES.The mean follow-up of 50.6(3.0-87.0)months showed that all patients were in good condition.The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES.The vaginal incision healed well.Conclusions:TV-NOSE and TV-NOTES are feasible,safe,and effective with little injury,low pain,fast recovery,and good cosmetic outcomes in properly selected patients.They are worth consideration for urological clinical practice.展开更多
Prostatic hyperplasia and tumor are common diseases,and the minimally invasive surgery inserting the instruments through the urethra into the prostate is commonly conducted.Taking the robotic manipulator for such surg...Prostatic hyperplasia and tumor are common diseases,and the minimally invasive surgery inserting the instruments through the urethra into the prostate is commonly conducted.Taking the robotic manipulator for such surgery into consideration,this paper analyses the workspace of the end effector,and proposes the distribution error of the fixed point and the tracking error of manipulator end effector on the cone bottom surface of the workspace as the basis for control implementation of the manipulator.The D-H coordinate system of the manipulator is established and the trajectory planning of the end effector in the Cartesian space is carried out.The digital model was established,and dynamics simulation was performed in Solidworks and Matlab/Simulink environment to guide the manipulator design.Trajectory mapping and synchronization control between virtual model and the actual manipulator are realized based on digital twin technique.The virtual manipulator can reflect the real-time state of the manipulator with data interaction by comparing the dynamics simulation results with the motor current values obtained by experiment.Experiment was carried out with PD feedback control and Newton-Euler dynamics based feedforward control to get the trajectory tracking characteristic of each motor,errors of the fixed point and tracking performance of the end effector of the manipulator.The results show that compared with PD feedback control,feed forward control implementation can achieve a reduction of 30.0%in the average error of the fixed point of the manipulator and a reduction of 33.3%in the maximum error.展开更多
Objective: To explore the application and effect of the enhanced recovery after surgery (ERAS) concept combined with psychological stress intervention in laparoscopic urological surgery nursing. Methods: 100 cases of ...Objective: To explore the application and effect of the enhanced recovery after surgery (ERAS) concept combined with psychological stress intervention in laparoscopic urological surgery nursing. Methods: 100 cases of urological surgical patients according to the nursing way, each 50 cases were divided into observation group and control group, and control group routine nursing, and the observation group implement rapid rehabilitation surgery concept in combination with psychological nursing, the comparison of two groups of patients with stress index, immune function, mental health, postoperative recovery index and the effect of complications. Results: There were statistically significant differences in stress index, immune function, mental health level, postoperative recovery index and complications between the observation group and the control group after psychological nursing (P Conclusion: The concept of rapid rehabilitation surgery combined with psychological nursing can help relieve psychological stress, restore immune function, reduce psychological pressure drop, speed up rehabilitation and reduce the incidence of postoperative complications in patients undergoing laparoscopic urologic surgery. Psychological nursing plays an adjunct role in laparoscopic urological surgery, so it is worth promoting.展开更多
Objective:A major role in the establishment of computer-assisted robotic surgery(CARS)can be traced to the work of Mani Menon at Vattikuti Urology Institute(VUI),and of many surgeons of Asian origin.The success of rob...Objective:A major role in the establishment of computer-assisted robotic surgery(CARS)can be traced to the work of Mani Menon at Vattikuti Urology Institute(VUI),and of many surgeons of Asian origin.The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines,improving patient comfort and disease outcomes and helping the industrial growth.The present paper gives an overview of the progress and development of robotic surgery,especially in the field of Urology;and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world.Methods:PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014,using algorithms based on keywords“robotic surgery”,“prostate”,“kidney”,“adrenal”,“bladder”,“reconstruction”,and“kidney transplant”.Inclusion criteria used were published full articles,book chapters,clinical trials,prospective and retrospective series,and systematic reviews/meta-analyses written in English language.Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion,and focused on techniques of robotic surgery,relevant patient outcomes and associated demographic trends.Results:A total of 58 articles selected for final review highlight the important strides made by robots in urology,from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014.In the hands of an experienced robotic surgeon,it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery,especially in urologic oncology and reconstructive urology.With increasing surgeon proficiency,the benefits of robotic surgery were consistently seen across different surgical disciplines,patient populations,and strata.展开更多
Introduction: Improvement in new patient access to urologic care is important and is increasingly measured as a reflection of practice quality. Two broad categories affect patient access: provider issues and patient p...Introduction: Improvement in new patient access to urologic care is important and is increasingly measured as a reflection of practice quality. Two broad categories affect patient access: provider issues and patient preferences. We chose to study the previously unreported patient choices that affect access delays between the time a urology appointment is requested and the urology appointment itself. Methods: A 3-week real time telephone survey was conducted with callers seeking a urology appointment. If the callers did not choose the first available appointment, they were questioned as to why they did not. This data was then compared to a 3-month access delay graph noting the number of new patients offered each day. Results: Adult and pediatric urologic clinics were evaluated separately. For adult clinics, 14% of patients chose not to accept the first available appointments and 5% sought urologic care elsewhere. For pediatric clinics, 44% delayed access beyond the first available appointment. Of these, 26% were asked by the physician to delay in order to time appointments with imaging studies on the same day, or were advised to wait longer because of the nature of the patient’s diagnosis. Parents’ choice delayed 18% of the appointments beyond the first available appointment. Discussion: These data reveal that about 85% of new patient access falls within the provider’s control. The other 15% of delays rest on the preferences of the patients. These decisions significantly skew the access delay data that is increasingly being used to measure the quality of a urology practice.展开更多
Urine examination is one of the important armamentarium in the practice of urology and it is a fundamental test that is usually carried out for urology patients, it can be as simple as dipstick analysis to a complex h...Urine examination is one of the important armamentarium in the practice of urology and it is a fundamental test that is usually carried out for urology patients, it can be as simple as dipstick analysis to a complex hormonal assays. Urine examination is done worldwide as an extension of physical examination which provides a lot of information about the pathology, and both physical and chemical analysis of urine are highly informative. There are several types of urine investigations, some of which include urinalysis, urine microscopy culture and sensitivity, urine microscopy for ova or cyst of parasites, urine cytology, urine tumour antigens assays, urine hormonal assays, urine toxicology, urine quantitative measurement and urine acid fast bacilli. Uses of urine examinations in urology could be diagnostic, such as renal function test, evaluation of heamaturia, stone diseases, urinary tract infections, urologic cancers and infertility or monitoring and for prognosis. Uses of urine investigations in practice of urology cannot be over emphasized as it has many revealing information of the physiology and pathology of urologic organs.展开更多
Laparoendoscopic single-site surgery(LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on...Laparoendoscopic single-site surgery(LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on the current status and future prospects for LESS in pediatric urology, with special emphasis on our experience with LESS in children. The clinical data available clearly demonstrate that LESS can safely and effectively be performed in a variety of pediatric urology settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low; mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains improved cosmetic outcome. Prospective randomized studies are awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technological advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics may be a driving force in the development of LESS.展开更多
The first issue of the World Journal of Clinical Urology(WJCU),whose preparatory work was initiated on December 6,2010,will be published on December 28,2011.The WJCU Editorial Board has now been established and consis...The first issue of the World Journal of Clinical Urology(WJCU),whose preparatory work was initiated on December 6,2010,will be published on December 28,2011.The WJCU Editorial Board has now been established and consists of 101 distinguished experts from 25 countries.Our purpose in launching the WJCU is to publish peer-reviewed,high-quality articles via an open-access online publishing model,thereby acting as a platform for communication between peers and the wider public,and maximizing the benefits to editorial board members,authors and readers.展开更多
Introduction: Telemedicine has been used as a tool for improving access to health services worldwide. The aim of the present study is thus to evaluate the effectiveness of urological consultation by videoconference, p...Introduction: Telemedicine has been used as a tool for improving access to health services worldwide. The aim of the present study is thus to evaluate the effectiveness of urological consultation by videoconference, perceptions regarding safety on the part of medical teams providing video consultation services and patient satisfaction after a urological appointment. Materials and Methods: A cross-sectional, observational, and analytical study was carried out with 50 volunteers referred from the basic health unit for a urology appointment. All patients were evaluated remotely by videoconference and in person by different urology teams. Results: The study revealed that effectiveness in terms of the degree of match between diagnoses performed by video consultation and those performed in person was 92%. The urology team’s perception regarding safety, measured using an in-house safety questionnaire, was high for both videoconferencing and in-person consultations and there was no statistical difference between the two (overall safety score for video consultation compared to in-person consultation was 9.7 ± 0.8 compared to 9.6 ± 0.8 and the p-value was 0.3 for Student’s t-test). Patient satisfaction with the appointment was similarly high for both groups, averaging 9.72 ± 0.4 among patients who attended a video consultation and 9.82 ± 0.4 among those whose consultation was conducted in person, with a p-value of 0.10478 for Student’s t-test. Conclusion: Video consultation in urology is an effective way to perform diagnoses, with high levels of perceived safety among urologists and high satisfaction rates among patients.展开更多
Objective:During the past three decades,laparoscopy has played a significant role in the management of urological disorders.This study aims to standardize the management of major vascular injury,which is a life-threat...Objective:During the past three decades,laparoscopy has played a significant role in the management of urological disorders.This study aims to standardize the management of major vascular injury,which is a life-threatening complication in the laparoscopic urological procedures.Methods:A total of 8210 patients with the urological disorder,who underwent laparoscopic surgery at Sir Run Run Shaw Hospital from January 2000 to December 2018,were included in this retrospective study.Patients’data of the laparoscopic major vascular injury were collected and analyzed,and the basic principles of the procedure were summarized.Results:A total of 15(0.18%)cases of major vascular injury were found among the 8210 patients,and 2 of them were converted to open surgery.Although the type of laparoscopic surgery,causes,and management of major vascular injury among the patients were diverse,the main management strategies of major vascular injury in laparoscopic surgery were to keep the vision clear,control bleeding rapidly by clamping and compression,make full preparation for possibly needed liquid resuscitation,and try best to repair under laparoscope.If necessary,converse to open surgery.Conclusion:Although the reported incidence of major vascular injury in laparoscopic urological surgery is extremely low,such injury can result in high morbidity and mortality.It is important to rapidly identify the cause and strictly follow the standardized management for better outcomes.展开更多
Objective To investigate the high risk factors of urinary tract infection among inpatients in department of urology. Methods A total of 880 cases of urological medical records were analysised retrospectively. Patients...Objective To investigate the high risk factors of urinary tract infection among inpatients in department of urology. Methods A total of 880 cases of urological medical records were analysised retrospectively. Patients with urinary tract infection were observed as a group,and the same number of urology patients without urinary展开更多
Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a ...Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a retrospective study of patients referred with urologic complications following obstetric and gynaecological surgeries. The study took place at the Teaching Clinic of Urology Andrology at CNHU of Cotonou between April 1, 2008 and March 31, 2013. Results: Forty-one patients were studied. They represented 3.5% of people hospitalized at CUUA throughout the study period. The average age was 41 years swith range of 20 and 57 years. Twenty-one (51.2%) of them were married. Thirty patients (73.2%) were referred from a non-academichospital, while 7 patients (17.1%) were referred from academic hospital. Caesarean section was the primary gynecological surgery in 22 cases (53.7%) and hysterectomy in 19 cases (46.3%). Clinically, the pre- dominant symptoms were leakage of urine throughout the vagina and obstructive anuria with or without back pain. We found 31 cases of VVF, 5 cases of bilateral ligation of the ureters, 3 cases of unilateral ligation of the ureter, 1 ureteralinjury and 1 uretero-vaginal fistula. These complications were diagnosed postoperatively in 95.1% of cases. Surgeries done included VVF repair in 31 cases (75.6%), unilateral ureteral reimplantation in 4 cases (9.8%), removal of ligation of the ureters in 3 cases (7.3%), bilateral ureteral reimplantation for 2 cases (4.9%) and end-to-end anastomosisin 1 case (2.4%). The postoperative period was uneventful in 29 cases and we observed 7 cases of surgical site infection. The overall success rate was 87.8%. Conclusion: Urological complications following gynecologic surgeries managed at the urologic department of teaching hospital of Coto-nou had an even higher incidence. Early diagnosis especially during the operative procedure would save the patients’ serious complications and open surgery due to the lack of endo-urological facilities. The most important factor in prevention is good knowledge of pelvicanatomy and good knowledge of the surgical techniques of caesarean operation section and trans-abdominal hysterectomy.展开更多
Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies com...Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.展开更多
Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabrie...Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.展开更多
基金This study was supported and financed by International Publication Research Grant Universitas Indonesia(Grant number:NKB-1535/UN2.RST/HKP.05.00/2020).
文摘Objective:To explore the impact of the coronavirus disease 2019(COVID-19)pandemic on the training experiences of urology residents in Indonesia.Methods:A cross-sectional study using a web-based questionnaire(SurveyMonkey)involved all registered urology residents in Indonesia.The questionnaire was structured in Bahasa Indonesia,composed of 28 questions,and divided into three sections:demographic characteristics,current daily activities,and opinions regarding training experiences during the COVID-19 outbreak.The survey was distributed to all respondents via chief of residents in each urology center from May 26,2020 to Jun 2,2020.Results:Of the total 247 registered urology residents,243 were eligible for the study.The response and completeness rate for this study were 243/243(100%).The median age of respondents was 30(range:24e38)years old,and 92.2%of them were male.Among them,6(2.5%)respondents were confirmed as COVID-19 positive.A decrease in residents’involvement in clinical and surgical activities was distinguishable in endourological and open procedures.Most educational activities were switched to web-based video conferences,while others opted for the in-person method.Smart learning methods,such as joining a national or international speaker webinar or watching a recorded video,were used by 93.8%and 80.7%of the respondents,respectively.The respondents thought that educational activities using web-based video conferences and smart learning methods were effective methods of learning.Overall,the respondents felt unsure whether training experiences during the COVID-19 pandemic were comparable to the respective period before.Conclusion:The COVID-19 pandemic negatively affected urology residents’training experiences.However,it also opened up new possibilities for incorporating new learning methodologies in the future.
文摘Background: Endoscopic exploration and treatment of urinary tract disorders, whether by retrograde, percutaneous or endoscopic approach, defines endo urology. Objective: To report the results of endo urology practice in Bouaké during the two practice sessions. Patients and Methods: Cross-sectional and descriptive study of patients followed up and had benefited from exploration and/or endoscopic surgery in Bouaké. Our study was carried out in a facility in Bouaké, for two years, from January 2021 to December 2022. The parameters of interest were clinical, diagnostic, endoscopic procedure and results. Results: During the study period, 157 patients underwent endoscopic exploration and/or intervention. The mean age was 58.9 years (range 28 - 90 years). Males predominated with 95.5% (n = 150). Acute urinary retention was the most frequent reason for consultation (55.41%). Benign prostatic hyperplasia (BPH) was the most frequent pathology at 22.92% (n = 36). Urethrocystoscopy was performed in 52 cases (33.12%), Transurethral resection of the prostate (TURP) in 36 cases (22.92%), Endoscopic resection of secondary cervical sclerosis in 23 cases (14.64%), Endoscopic internal urethrotomy (EUI) in 15 cases (9.55%) and Transurethral resection of the bladder (TURB) in 10 cases (6.36%). Post-operative management was straightforward in 93.63% of cases (n = 147). Operative times of between 21 and 35 minutes were more frequent in 55.41% of cases (n = 87). Urinary tract infections accounted for 3.8% (n = 6) of surgical morbidity. The germ responsible for the infections was essentially Escherichia coli (E. coli). The mean duration of post-operative urinary drainage was 5.5 days (range: 4 - 6 days) for patients who underwent TURP, TURB and endoscopic resection of secondary sclerosis of the bladder neck. The mean duration of drainage after endoscopic internal ureterotomy was 21.6 days (range 14 - 30 days). Of the 157 endoscopies performed, 154 patients (98.08%) had a favourable outcome, with adenomyofibroma of the prostate being the most common histological type (52.17%, n = 36). Mortality was 1.27% (n = 2) in our series. Conclusion: Endo urology should be the urologist’s first choice for both exploration and surgery, given the satisfactory results.
文摘Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure operates with limited resources and more than half of the population lives below the poverty line. The objective of this study was to determine the frequency of post-operative mortality, to describe the main comorbidity factors responsible for this mortality and to identify the main cause of post-operative death in the urology department of the Ignace Deen National Hospital Material and Method: This was a retrospective descriptive study lasting 5 years from January 1, 2015 to December 31, 2019. It had focussed on all the files of patients operated on at the Urology Department of the Ignace Deen National Hospital, either in an emergency or planned and who died in per or post-operative immediately or 30 days later. Results: We recorded 63 cases of post-operative death, or a frequency of 1.84%. The average age was 61.92 ± 16.91 with the extremes of 12 and 91 years. Bladder (20.63%) and prostate tumours (60.3%) were the main admission diagnoses. High blood pressure was the main comorbidity factor found with 38.09% of cases followed by diabetes with 12.69%. Transurethral resection of the prostate, transurethral resection of the bladder and prostate adenocomectomy were the most performed surgical procedure with respective proportion of 19.04%, 20.63% and 38.09%. Probable cause of death were anemia in 25 cases (39.68%), septic in 20 cases (31.75%), heart failure in 6 cases (9.52%), pulmonary embolism in 5 cases (7.94%), obstructive renal failure 4 cases (6.35%) and stroke in 3 cases (4.76%). Conclusion: The majority of deaths occurred in patients over the age of fifty. Anaemia was the main cause of deaths. Difficulties in procuring blood products as well as the lack of modern therapeutic means are factors that make it difficult for patients to adequately manage.
文摘Aim: To contribute to improving the management of urological emergencies at Labé Regional Hospital. Patients and Method: This was a dynamic, descriptive study lasting six months from July 1 to December 31, 2017. Results: Urological emergencies represented 45.14% (n = 218) of all admissions to the urology unit. The mean age of our patients was 56.60 years with extremes of fifteen days and 93 years. The 71 - 80 age group was the most represented with 28.03% (n = 61) followed by 61 - 70 years with 24.31% (n = 53). Our patients’ activities were dominated by agriculture, with 35.77% (n = 88), and the city center was most affected by urological emergencies, with 39.44% of cases (n = 86). 70.18% (n = 153) of our patients had bladder retention on admission, and 53.21% (n = 116) underwent urethral catheterization, including 3 women. The etiology of bladder retention in these 3 women was dominated by two cases of bladder lithiasis and one case of neurological bladder. Conclusion: The management of urological emergencies requires specific material and human resources. Their knowledge will enable us to better understand this problem and could serve as a basis for a broad reflection on the organization of the management of urological emergencies in our region.
文摘The robotic nurse plays an essential role in a successful robotic surgery.As part of the robotic surgical team,the robotic nurse must demonstrate a high level of professional knowledge,and be an expert in robotic technology and dealing with robotic malfunctions.Each one of the robotic nursing team“nurse coordinator,scrub-nurse and circulating-nurse”has a certain job description to ensure maximum patient’s safety and robotic surgical efficiency.Well-structured training programs should be offered to the robotic nurse to be well prepared,feel confident,and maintain high-quality of care.
文摘While robotic surgery has shown clear utility and advantages in the adult population,its role in pediatrics remains controversial.Pediatric-sized robotic instruments and equipment are not readily available yet,so certain modifications can be made in order to make robotic surgery successful in children.While the cost of robotic surgery remains high compared to open procedures,patients experience greater satisfaction and quality of life with robotic surgery.Robotic pyeloplasty is a standard of care in older children,and has even been performed in infants and re-do surgery.Other robotic procedures performed in children include heminephroureterectomy,ureteroureterostomy,ureteral reimplantation,urachal cyst excision,bladder diverticulectomy,and bladder reconstructive procedures such as augmentation,appendicovesicostomy,antegrade continence enema,bladder neck reconstruction and sling,as well as other procedures.Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection.Future improvements in technology with production of pediatric-sized robotic instruments,along with increases in robotictrained pediatric urologists and surgeon experience along each’s learning curve,will help to further advance the field of robotic surgery in pediatric urology.
基金the National High Technology Research and Development Program(“863”Program)of China(2012AA021100)Ganpo 555 Talents Program of Jiangxi Province+2 种基金the Major Science and Technology Support Project from the Department of Science and Technology of Jiangxi Province(20132BAB205007)the Science and Technology Floor Project from the Department of Education of Jiangxi Province(KJLD12044)the Science and Technology Program from the Department of Health of Jiangxi Province(20121095).
文摘Objective:To describe the Chinese experience of natural orifice transluminal endoscopic surgery(NOTES)in urology.Methods:From December 2008 to May 2017,35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions(NOSE)were performed in China.The animal experiments included five kidney biopsies,24 nephrectomies and six partial nephrectomies.The clinical surgeries included 12 transvaginal NOSE(TV-NOSE),266 hybrid transvaginal NOTES(TV-NOTES)and 27 pure TV-NOTES.The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site(U-LESS)nephrectomies,four suprapubic-assisted laparoendoscopic single-site surgery(SA-LESS)nephroureterectomies,and three laparoscopic radical cystectomies.The hybrid TV-NOTES procedure included 210 nephrectomies,31 adrenalectomies,eight nephroureterectomies,13 partial nephrectomies,and four heminephrectomies.The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies.Results:A total of 29 animal experiments were successfully performed.One partial nephrectomy was converted to standard laparoscopic surgery.Two kidney biopsies and two nephrectomies were unsuccessful.A total of 297 clinical surgeries were successfully performed.Six patients who underwent hybrid TV-NOTES were converted to open surgery.Two patients who underwent pure TV-NOTES were converted to SA-LESS.There were 22 major complications,16 occurred intraoperatively and six postoperatively.The mean visual analog score(VAS)of 48 h after the operation was 2.5 points in TV-NOSE,2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES.The mean follow-up of 50.6(3.0-87.0)months showed that all patients were in good condition.The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES.The vaginal incision healed well.Conclusions:TV-NOSE and TV-NOTES are feasible,safe,and effective with little injury,low pain,fast recovery,and good cosmetic outcomes in properly selected patients.They are worth consideration for urological clinical practice.
基金Supported by National Natural Science Foundation of China(Grant No.51675400).
文摘Prostatic hyperplasia and tumor are common diseases,and the minimally invasive surgery inserting the instruments through the urethra into the prostate is commonly conducted.Taking the robotic manipulator for such surgery into consideration,this paper analyses the workspace of the end effector,and proposes the distribution error of the fixed point and the tracking error of manipulator end effector on the cone bottom surface of the workspace as the basis for control implementation of the manipulator.The D-H coordinate system of the manipulator is established and the trajectory planning of the end effector in the Cartesian space is carried out.The digital model was established,and dynamics simulation was performed in Solidworks and Matlab/Simulink environment to guide the manipulator design.Trajectory mapping and synchronization control between virtual model and the actual manipulator are realized based on digital twin technique.The virtual manipulator can reflect the real-time state of the manipulator with data interaction by comparing the dynamics simulation results with the motor current values obtained by experiment.Experiment was carried out with PD feedback control and Newton-Euler dynamics based feedforward control to get the trajectory tracking characteristic of each motor,errors of the fixed point and tracking performance of the end effector of the manipulator.The results show that compared with PD feedback control,feed forward control implementation can achieve a reduction of 30.0%in the average error of the fixed point of the manipulator and a reduction of 33.3%in the maximum error.
文摘Objective: To explore the application and effect of the enhanced recovery after surgery (ERAS) concept combined with psychological stress intervention in laparoscopic urological surgery nursing. Methods: 100 cases of urological surgical patients according to the nursing way, each 50 cases were divided into observation group and control group, and control group routine nursing, and the observation group implement rapid rehabilitation surgery concept in combination with psychological nursing, the comparison of two groups of patients with stress index, immune function, mental health, postoperative recovery index and the effect of complications. Results: There were statistically significant differences in stress index, immune function, mental health level, postoperative recovery index and complications between the observation group and the control group after psychological nursing (P Conclusion: The concept of rapid rehabilitation surgery combined with psychological nursing can help relieve psychological stress, restore immune function, reduce psychological pressure drop, speed up rehabilitation and reduce the incidence of postoperative complications in patients undergoing laparoscopic urologic surgery. Psychological nursing plays an adjunct role in laparoscopic urological surgery, so it is worth promoting.
文摘Objective:A major role in the establishment of computer-assisted robotic surgery(CARS)can be traced to the work of Mani Menon at Vattikuti Urology Institute(VUI),and of many surgeons of Asian origin.The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines,improving patient comfort and disease outcomes and helping the industrial growth.The present paper gives an overview of the progress and development of robotic surgery,especially in the field of Urology;and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world.Methods:PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014,using algorithms based on keywords“robotic surgery”,“prostate”,“kidney”,“adrenal”,“bladder”,“reconstruction”,and“kidney transplant”.Inclusion criteria used were published full articles,book chapters,clinical trials,prospective and retrospective series,and systematic reviews/meta-analyses written in English language.Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion,and focused on techniques of robotic surgery,relevant patient outcomes and associated demographic trends.Results:A total of 58 articles selected for final review highlight the important strides made by robots in urology,from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014.In the hands of an experienced robotic surgeon,it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery,especially in urologic oncology and reconstructive urology.With increasing surgeon proficiency,the benefits of robotic surgery were consistently seen across different surgical disciplines,patient populations,and strata.
文摘Introduction: Improvement in new patient access to urologic care is important and is increasingly measured as a reflection of practice quality. Two broad categories affect patient access: provider issues and patient preferences. We chose to study the previously unreported patient choices that affect access delays between the time a urology appointment is requested and the urology appointment itself. Methods: A 3-week real time telephone survey was conducted with callers seeking a urology appointment. If the callers did not choose the first available appointment, they were questioned as to why they did not. This data was then compared to a 3-month access delay graph noting the number of new patients offered each day. Results: Adult and pediatric urologic clinics were evaluated separately. For adult clinics, 14% of patients chose not to accept the first available appointments and 5% sought urologic care elsewhere. For pediatric clinics, 44% delayed access beyond the first available appointment. Of these, 26% were asked by the physician to delay in order to time appointments with imaging studies on the same day, or were advised to wait longer because of the nature of the patient’s diagnosis. Parents’ choice delayed 18% of the appointments beyond the first available appointment. Discussion: These data reveal that about 85% of new patient access falls within the provider’s control. The other 15% of delays rest on the preferences of the patients. These decisions significantly skew the access delay data that is increasingly being used to measure the quality of a urology practice.
文摘Urine examination is one of the important armamentarium in the practice of urology and it is a fundamental test that is usually carried out for urology patients, it can be as simple as dipstick analysis to a complex hormonal assays. Urine examination is done worldwide as an extension of physical examination which provides a lot of information about the pathology, and both physical and chemical analysis of urine are highly informative. There are several types of urine investigations, some of which include urinalysis, urine microscopy culture and sensitivity, urine microscopy for ova or cyst of parasites, urine cytology, urine tumour antigens assays, urine hormonal assays, urine toxicology, urine quantitative measurement and urine acid fast bacilli. Uses of urine examinations in urology could be diagnostic, such as renal function test, evaluation of heamaturia, stone diseases, urinary tract infections, urologic cancers and infertility or monitoring and for prognosis. Uses of urine investigations in practice of urology cannot be over emphasized as it has many revealing information of the physiology and pathology of urologic organs.
文摘Laparoendoscopic single-site surgery(LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on the current status and future prospects for LESS in pediatric urology, with special emphasis on our experience with LESS in children. The clinical data available clearly demonstrate that LESS can safely and effectively be performed in a variety of pediatric urology settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low; mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains improved cosmetic outcome. Prospective randomized studies are awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technological advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics may be a driving force in the development of LESS.
文摘The first issue of the World Journal of Clinical Urology(WJCU),whose preparatory work was initiated on December 6,2010,will be published on December 28,2011.The WJCU Editorial Board has now been established and consists of 101 distinguished experts from 25 countries.Our purpose in launching the WJCU is to publish peer-reviewed,high-quality articles via an open-access online publishing model,thereby acting as a platform for communication between peers and the wider public,and maximizing the benefits to editorial board members,authors and readers.
文摘Introduction: Telemedicine has been used as a tool for improving access to health services worldwide. The aim of the present study is thus to evaluate the effectiveness of urological consultation by videoconference, perceptions regarding safety on the part of medical teams providing video consultation services and patient satisfaction after a urological appointment. Materials and Methods: A cross-sectional, observational, and analytical study was carried out with 50 volunteers referred from the basic health unit for a urology appointment. All patients were evaluated remotely by videoconference and in person by different urology teams. Results: The study revealed that effectiveness in terms of the degree of match between diagnoses performed by video consultation and those performed in person was 92%. The urology team’s perception regarding safety, measured using an in-house safety questionnaire, was high for both videoconferencing and in-person consultations and there was no statistical difference between the two (overall safety score for video consultation compared to in-person consultation was 9.7 ± 0.8 compared to 9.6 ± 0.8 and the p-value was 0.3 for Student’s t-test). Patient satisfaction with the appointment was similarly high for both groups, averaging 9.72 ± 0.4 among patients who attended a video consultation and 9.82 ± 0.4 among those whose consultation was conducted in person, with a p-value of 0.10478 for Student’s t-test. Conclusion: Video consultation in urology is an effective way to perform diagnoses, with high levels of perceived safety among urologists and high satisfaction rates among patients.
文摘Objective:During the past three decades,laparoscopy has played a significant role in the management of urological disorders.This study aims to standardize the management of major vascular injury,which is a life-threatening complication in the laparoscopic urological procedures.Methods:A total of 8210 patients with the urological disorder,who underwent laparoscopic surgery at Sir Run Run Shaw Hospital from January 2000 to December 2018,were included in this retrospective study.Patients’data of the laparoscopic major vascular injury were collected and analyzed,and the basic principles of the procedure were summarized.Results:A total of 15(0.18%)cases of major vascular injury were found among the 8210 patients,and 2 of them were converted to open surgery.Although the type of laparoscopic surgery,causes,and management of major vascular injury among the patients were diverse,the main management strategies of major vascular injury in laparoscopic surgery were to keep the vision clear,control bleeding rapidly by clamping and compression,make full preparation for possibly needed liquid resuscitation,and try best to repair under laparoscope.If necessary,converse to open surgery.Conclusion:Although the reported incidence of major vascular injury in laparoscopic urological surgery is extremely low,such injury can result in high morbidity and mortality.It is important to rapidly identify the cause and strictly follow the standardized management for better outcomes.
文摘Objective To investigate the high risk factors of urinary tract infection among inpatients in department of urology. Methods A total of 880 cases of urological medical records were analysised retrospectively. Patients with urinary tract infection were observed as a group,and the same number of urology patients without urinary
文摘Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a retrospective study of patients referred with urologic complications following obstetric and gynaecological surgeries. The study took place at the Teaching Clinic of Urology Andrology at CNHU of Cotonou between April 1, 2008 and March 31, 2013. Results: Forty-one patients were studied. They represented 3.5% of people hospitalized at CUUA throughout the study period. The average age was 41 years swith range of 20 and 57 years. Twenty-one (51.2%) of them were married. Thirty patients (73.2%) were referred from a non-academichospital, while 7 patients (17.1%) were referred from academic hospital. Caesarean section was the primary gynecological surgery in 22 cases (53.7%) and hysterectomy in 19 cases (46.3%). Clinically, the pre- dominant symptoms were leakage of urine throughout the vagina and obstructive anuria with or without back pain. We found 31 cases of VVF, 5 cases of bilateral ligation of the ureters, 3 cases of unilateral ligation of the ureter, 1 ureteralinjury and 1 uretero-vaginal fistula. These complications were diagnosed postoperatively in 95.1% of cases. Surgeries done included VVF repair in 31 cases (75.6%), unilateral ureteral reimplantation in 4 cases (9.8%), removal of ligation of the ureters in 3 cases (7.3%), bilateral ureteral reimplantation for 2 cases (4.9%) and end-to-end anastomosisin 1 case (2.4%). The postoperative period was uneventful in 29 cases and we observed 7 cases of surgical site infection. The overall success rate was 87.8%. Conclusion: Urological complications following gynecologic surgeries managed at the urologic department of teaching hospital of Coto-nou had an even higher incidence. Early diagnosis especially during the operative procedure would save the patients’ serious complications and open surgery due to the lack of endo-urological facilities. The most important factor in prevention is good knowledge of pelvicanatomy and good knowledge of the surgical techniques of caesarean operation section and trans-abdominal hysterectomy.
文摘Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.
文摘Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.
