Dr. KIPTOON DAN KIPKEMBOI

Urolithiasis is an emerging problem in Kenya previously thought to be very rare and in which the use of modern methods of treatment has not been widely practiced OBJECTIVE: To review the presentation and management of patients presenting with urolithiasis in Nairobi, Kenya DESIGN: A retrospective study SETTING: The Nairobi hospital and Upper Hill Medical Centre a day care facility next to the Nairobi hospital SUBJECTS: One hundred and twenty five males and fifty three females aged 9 to 75 years RESULTS: One hundred and seventy eight patients were treated for urolithiasis over a five-and- half year period. Their mean age was 44.8 years, and the median was 45 years The 178 patients required 262 procedures to achieve stone clearance. One hundred and two patients had ESWL, with an overall stone clearance rate of 95%. Twenty-three patients had PCNL; 18 as the first procedure and 5 after failed ESWL. Fifty-one patients had ureteroscopic management. Forty seven had laser or pneumatic lithotripsy while four had stone removal by Dormia basket. Seven patients had bladder calculi managed by either cystolitholapaxy or forceps retrieval. CONCLUSIONS: This study demonstrates a higher annual incidence of urolithiasis in Nairobi than earlier literature. Study demonstrates that ESWL and ureteroscopic methods are highly effective in the treatment of renal and ureteral calculi as day care procedures.

Two patients with penile carcinoma are presented after management at a district hospital in Kenya. Both had undergone ritual circumcision as teenagers and presented late. HR was a 73 year old who presented with a fungating penile mass for which a partial penectomy was performed after wedge biopsy confirmed malignancy. He thereafter declined to have the surgical specimen sent for histology and took the amputated stump for burial in his compound to avoid bad omen. GK was 25 years old and presented with a fungating mass and underwent partial penectomy after a histological diagnosis was made. He absconded from follow-up after being informed of the need for further surgery due to tumour infiltration of the surgical margins. The history and clinical images are presented and we discuss the difficulties of cancer management at a rural district hospital

Acute acalculous cholecystitis (AAC) typically affects hospitalized patients with critical illness. Outpatient AAC is reported to occur in elderly males with cardiovascular comorbidities. We report the presentation of acute acalculous cholecystitis in two young African men admitted for the first time within days of each other. They reported short histories of right upper abdominal pain and had tender gallbladders. Sonography revealed gallbladder wall thickening. Open cholecystectomy and histology confirmed AAC.The postoperative outcome was excellent. Recognition of AAC in a subset of young male patients presenting de novo with right upper quadrant pain is stressed. Cholecystectomy has good prognosis in these cases.

Objective: To describe the common postoperative complications of prostatectomy as
seen at Kenyatta National Hospital.
Materials and Methods: This is a prospective study of patients who underwent
prostatectomy for benign prostatic hyperplasia at Kenyatta National Hospital between
6th October 2003 and 21 st June 2004.
Main outcome measures: Age, co-morbidity, type of surgery, complications, reoperation,
mortality, postoperative catheterisation, and duration of postoperative
hospital stay.
Results: A total of eighty five patients participated in the study, and their average age
was 66 years. Open prostatectomy was the more common type of prostatectomy
accounting for 81 % of cases while transurethral resection accounted for 19 % of
cases.
The most common intra-operative complication during prostatectomy was
haemorrhage which occurred in ten patients (11.8 %).
The most common postoperative complication following prostatectomy was wound
sepsis occurring in 24 patients (35 %, n=69). Other postoperative complications
observed were urinary tract infection (15 %), clot retention (10 %), pyrexia (10 %),
and pneumonia (8.2 %).
Three patients (4.4 %) required re-operation due to complications of postoperative
wound sepsis.
One patient had perforation of the bladder during transurethral resection and required
a laparotomy to repair the bladder.
Twenty six patients (30 %) had co- existing medical conditions. There was a
significant association between wound sepsis and diabetes mellitus (p< 0.05).
The mean duration of postoperative catheterisation was 6.66 days. There was a
significant difference in the duration of postoperative catheterisation between open
prostatectomy and transurethral resection (p= 0.001).
The mean duration of postoperative hospital stay was 8.16 days.
There was a significant difference in the duration of postoperative hospital stay
between open prostatectomy and transurethral resection (p= 0.001).
Conclusions: The duration of postoperative catheterisation and hospital stay are
mainly determined by type of prostatectomy, and the presence of diabetes mellitus
significantly increased the risk of developing postoperative wound sepsis.