Sani Ali Aji

Outcome and complications of permanent hemodialysis vascular access in Nigerians: A single centre experience

BACKGROUND It is widely accepted that autogenous arteriovenous fistula (AVF) carries less morbidity and mortality compared to all other forms of vascular accesses in maintenance hemodialysis patients. There is paucity of data on vascular access from sub-Saharan Africa. The aim of this study was to assess the outcome and complications of permanent vascular access in our center. MATERIALS AND METHODS The study is a prospective, hospital-based, longitudinal study. All consecutive patients on maintenance hemodialysis in Aminu Kano Teaching Hospital who were referred to the surgical unit of for creation of permanent hemodialysis vascular access were included in the study. The patients clinical and demographic data were documented. Data about vascular access types, outcomes, and complications were obtained over a 1-year period from the time of vascular access creation. RESULTS One hundred and seventy four patients were operated upon between January 2008 and December 2010 with a mean age of 46.4 years (range 18-76 years) and a male to female ratio of 1.5:1. Brescio--Cimino fistula was performed in 110 (63.2%) patients, brachiocephalic (Kauffmann) fistula in 51(29.3%), and synthetic graft in 1 (0.6%) patients respectively. Ten patients (5.7%) had brachio-brachial transposition arteriovenous fistula and 2 patients (1.1%) had transposition graft using harvested long saphenous vein. One-year patency rate was 63.2%. Complications encountered include AVF failure in 47(27.3%), steal syndrome in 2(1.1%), distal venous insufficiency in 2(1.1%), and false aneurysm in 6(3.5%) patients. CONCLUSION The outcome of permanent vascular access is favorable in our patient population with a one-year patency rate of 63.2%. The first choice of vascular access in our maintenance dialysis population should be AVF.

Catheterization Related Complications Among Adults Male Patients with Urinary Retention in a Teaching Hospital

Urethral catheterization is a common procedure in urologic practice. It is most commonly employed in relieving urinary retention. Various complications are associated with urethral catheterization and these depend on availability of expertise and strict observation of asepsis during the procedure. This study aimed at establishing the types and prevalence of complications associated with urethral catheterization among patients with urinary retention. It was a prospective study on 110 patients who presented in urinary retention and who were catheterize to relieve the retention. On presentation the patients were catheterize and urine was immediately taken for microscopy, culture and sensitivity. Patients with established UTI were excluded from subsequent investigation of catheter related UTI. Other complications of catheterization were also looked for and recorded. The patients age ranged from 17 to 100 years, with a mean age of 56±19.3 SD years. Up to 74.5% of the patients in this study did not develop any of the complications. The most common complication was introduction of UTI in 17.3%. This was followed by haematuria in 5.5% of the patients. Three patients (2.7%) had their urethra injured and none had post obstructive diuresis. Catheterization related urinary tract infection is common despite observing asepsis in relieving urinary retention but other complications are not common.

Solitary fibrous tumor mimicking prolapsed ureteral polyp.

Solitary fibrous tumor of the ureter is extremely rare. We describe a case where the polyp was prolapsing into the bladder mimicking a bladder tumor.

Giant Hydronephrosis Containing Eighteen Liters of Fluid in a Child: A Case Report

Giant hydronephrosis is defined as the accumulation of more than 1L of fluid in the collecting system of the kidney. We present a case of giant hydronephrosis containing 18 L of fluid in a 13 -year-old girlresulting from neglected PUJ obstruction. She had a single stage nephrectomy and did very well post -op.

Intravesical migration of gossypiboma following vaginal hysterectomy: An unusual cause of acute urinary retention

A gossypiboma also known as textiloma or cottonoid are terms used to describe a foreign object, such as a mass of cotton matrix or a sponge that is left behind in a body cavity during an operation. It is an uncommon surgical complication. The manifestations and complications of gossypiboma are so variable that diagnosis may be difficult and patient morbidity is significant. The incidence of retained surgical instruments is estimated at 1 in 100-3,000 of all surgical interventions and 1 in 1,000-1,500 for all intra-abdominal operations. We report a case of extrusion of forgotten gauze following vaginal hysterectomy in a 49-year-old woman. The gauze migrated into the bladder presenting with acute urinary retention. She had vesicostomy retrieval of the gossypiboma and repair of the defect on posterior wall of the bladder. She did well postoperatively with no complication. Any woman that had pelvic surgery and is presenting with recurrent pelvic pain, urinary tract infection (UTI) and lower urinary tract irritative, or obstructive symptoms gossypiboma should be suspected and investigated.

Calcinosis of the scrotum in children: Report of two cases and review of the literature

Scrotal calcinosis consisting of solitary or multiple deposits of calcium within or outside the dermis of the skin of scrotum are generally very rare and are considered to be idiopathic if it is not of metastatic or dystrophic types. Idiopathic calcinosis of the scrotum (ICS) in children under the age of 9 years is not documented in the literature. We are presenting a 6-month-old infant and a 5-year-old male patient with sub-dermal, intra-scrotal, extra-testicular ICS from children surgical unit of Murtala Muhammad Specialist Hospital, Kano in northern Nigeria. Each patient presented with a scrotal mass that was difficult to diagnose clinically. Following investigations including scrotal ultrasound, and serum calcium, scrotal exploration was carried out and the mass excised. Histological examination revealed features of scrotal calcinosis. The objective of this study was to present the clinical presentation, investigation, and treatment of these children. We shall also under-take a review of the literature.