Browsing by Author "Gepi-Attee, S."
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Item Delayed recognition of bilateral ureteral injury after gyneacological surgery(2008-12) Mensah, J.E.; Klufio, G.O.; Ahiaku, F.; Osafo, C.; Gepi-Attee, S.Background Iatrogenic bilateral ureteric injury is a rare complication of pelvic surgery, which if not recognised immediately results in significant morbidity and even mortality Objective To describe the presentation, aetiology and treatment of iatrogenic bilateral ureteric injuries recognised late following gynaecological surgery. Methods The case notes of 14 consecutive cases of bilateral ureteric injury managed between October 2000 and January 2007 were studied. Results Thirteen cases resulted from abdominal hysterectomy and one from vaginal repair of vesicovaginal fistula. Excessive bleeding with difficult haemostasis was the predominant predisposing factor. The indication for referral included oliguria, anuria, and urinary ascites or azotaemia. The time interval between the original surgery and the recognition of the injury ranged between 1 and 92 days. Patients in whom deterioration in renal function was ascribed to obstructive uropathy from bilateral ligation (postrenal renal failure) were referred much earlier than those in whom a diagnosis of prerenal renal failure was made (mean of 2 vs. 10 days). Five patients (36%) required dialyses before repair. All the repairs were done at open surgery. Thirteen survived with no loss of kidney. One patient died of overwhelming sepsis. Conclusions Late recognition and referral of bilateral ureteric injury was associated with serious complications. Post operative deterioration in a patient's renal function following pelvic surgery should be assumed to be due to ureteric obstruction until proven otherwise. Such patients should be promptly referred to centres with the facility for further investigation and management. Early open repair for these injuries is advocated.Item SURGICAL MANAGEMENT OF BPH IN GHANA: A NEED TO IMPROVE ACCESS TO TRANSURETHRAL RESECTION OF THE PROSTATE(East African medical journal, 2012-07) Kyei, M.Y.; Mensah, J.E.; Morton, B.; Gepi-Attee, S.; Klufio, G.O.; Yeboah, E.D.BACKGROUND: Open prostatectomy for benign prostate hyperplasia (BPH) is widely practiced in Ghana and Africa. Some of the reasons include lack of expertise and facilities for Transurethral Resection of the Prostate (TURP) and digital rectal examination assessment of prostates as greater than 50 grams.OBJECTIVES: To assess the prostate volumes of patients for surgical management of BPH by transrectal ultrasound (TRUS) and to determine, on the basis of prostatic volume, what percentage of those who had open prostatectomy could have been managed by TURP.DESIGN: Prospective cohort study.SETTING: The Korle Bu Teaching Hospital, Accra, Ghana.SUBJECTS: Patients for elective surgical management of BPH from March to September 2010 were studied.RESULTS: Fifty-eight. patients had surgical management of BPH. Forty-six of them (79.3%) had open prostatectomy whilst twelve (20.7%) had TURP with a mean age of 70.4 and 65.2 years respectively. The most common reason for the open prostatectomy was refractory retention of urine (76.0%) while that for TURP was lower urinary tract symptoms (58.3%). The mean prostate volume for the patients who had open prostatectomy was 64.2ml ± 28.7mls (range 23.0-121.0ml) while that of the TURP group was 40.1g ± 16.2mls (range 18.5-70.0mls). Of the open prostatectomy group, 67.4% of them had prostate volumes 75 mls or less. The blood transfusion and peri-operative complication rates for the open prostatectomy and TURP groups were 13% versus 8.3% and 8.7% versus 8.3% respectively. There was no mortality.CONCLUSION: Access to TURP in the surgical management of BPH in Ghana is low (20.7%). With improved facilities including routine use of TRUS for assessing prostate size and availability of expertise for TURP, 67.4% of patients offered open prostatectomy presently could benefit from TURP, using prostate volumes 75mls (75g) or less as indication for TURP.