The management of upper urinary tract obstruction in resource-poort settings

Objective: The management of upper urinary tract obstruction in the absence of modern facilities presents a major challenge to Urologic practice in developing countries. The aim of this study was to describe the etiology, presentation and treatment of upper urinary tract obstruction at the Jos University Teaching Hospital, Nigeria. Patients and Methods: This is a prospective analysis of 37 consecutive patients (18 males, 19 females) with a mean age of 35.5 years (range 3-55) who were managed for upper urinary tract obstruction at our department between January 2001 and December 2005. Two of them presented with a second pathology, so that we treated 39 pathologies in total. Flank pain was the most common clinical feature, being present in 35 patients (94.6%). Other clinical features were gross hematuria in 12 (32.4%), an enlarged kidney in 5 (13.5%), renal impairment in 4 (10.8%) and hypertension in 3 (8.1%) patients. Diagnostic work-up consisted of plain radiography, abdominal ultrasound scan, intravenous urography and retrograde pyelography. Renal pelvic stones were the leading cause of obstruction (13 patients; 35.1%), while congenital pelvi-ureteric junction (PUJ) obstruction was found in 7 (18.9%) and ureteric stricture and vesical schistosomiasis in 4 (10.8%) and 3 (8.1%) patients, respectively. Two patients had bilateral obstruction from two different causes. Results: Twenty-nine open surgical procedures were carried out. They consisted of pyelolithotomy (n=12), pyeloplasty (n=6), ureteroureterostomy (n=4), ureteroneocystostomy (n=3), nephrectomy (n=2) and ureterolithotomy (n=2). Eight patients were treated non-surgically. Two patients are awaiting definitive surgical treatment. A total of 4 (13.8%) complications following 29 operative procedures was encountered: two cases of migration of double-J ureteric stents and one case each of prolonged urine leakage and wound infection. Conclusion: Upper urinary tract obstruction is not uncommon in our environment. In the absence of modern facilities, open surgery remains our main option of treatment; and it is relatively safe. Objectif: La prise en charge de l'obstruction du haut appareil urinaire en l'absence des équipements modernes présente un défi important de la pratique urologique dans les pays en voie de développement. Le but de cette étude était de décrire l'étiologie, la présentation clinique et le traitement de l'obstruction du haut appareil urinaire à l'h pital universitaire de Jos, Nigéria. Patients et méthodes: C'est une analyse prospective de 37 patients consécutifs (18 males, 19 femelles) présentant un age moyen de 35.5 ans (3-55 ans) qui ont été contr lés pour obstruction du haut appareil urinaire à notre service entre janvier 2001 et décembre 2005. Deux ont présenté une deuxième obstruction après qu'ils aient été traités pour la première, de sorte qu'en fait nous avons traité 39 cas. La douleur du flanc était la présentation clinique la plus commune, étant présente chez 35 patients