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Ureteroscopy in a Resource Limited Setting: The Tikur Anbessa General Specialized Hospital Experience in Addis Ababa, Ethiopia

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Abstract:

Background: Ureteroscopy (URS) is defined as retrograde instrumentation performed with an endoscope passed through the lower urinary tract directly into the ureter and calyceal system. However, ureteroscopy has gradually become a major diagnostic and therapeutic technique for lesions of both the ureter and intrarenal collecting system. Complications of URS range from minor complications such as colic, fever and haematuria to major complications like ureteric perforation and avulsion Methods: This was a cross sectional study of patients who underwent URS at TAGSH from 11th September 2010 to 10th September 2011. Medical records of patients were reviewed and data retrieved by a preset questionnaire. The clinical notes and imaging studies were examined. After the data was collected, it was analyzed using the statistical software SPSS version 16. Results: The main indications for ureteroscopy in our study were ureteric stones (64.3%), ureteric stricture (7.1%), ureteric obstruction of unknown cause (11.9%) and others such as pelviureteric junction (PUJ) obstruction and non-excreting kidney (16.7%). At ureteroscopy, 38 (45.3%) patients had stone disease confirmed during ureteroscopy, 20 (23.9%) were diagnosed normal and 16 (19.1%) had ureteric stricture. Most patients 56 (66.7%) had no post-operative complications. The overall complication rate of the procedure was 33.3% (n=28). Fourteen (16.7%) patients had abdominal colic, 7 (8.3%) reported haematuria, 3 (3.6%) had post-operative fever while 4 (4.8%) patients had both colic and haematuria. Only a single (1.2%) patient had ureteric perforation. Conclusion: Ureteroscopy is an indispensible diagnostic and interventional procedure. Our study shows we have a long ways to go to improve our therapeutic ureteroscopic ureteric stone lithotripsy. We can also conclude that ureteroscopy is a very safe procedure.

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