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Cassell A 3rd. et al., 2020: Surgical Management of Urolithiasis of the Upper Tract - Current Trend of Endourology in Africa

Cassell A 3rd, Jalloh M, Ndoye M, Mbodji M, Gaye O, Thiam NM, Diallo A, Labou I, Niang L, Gueye S.
Department of Urology and Andrology, Hospital General De Grand Yoff, Dakar, Senegal.
2Department of Surgery, Liberia College of Physicians and Surgeons, Monrovia, Liberia.

Abstract

Urolithiasis is a global pathology with increasing prevalence rate. The lifetime recurrence of urolithiasis ranges from 10-75% creating a public health crisis in affected regions. The epidemiology of urolithiasis in most parts of Africa and Asia remains poorly documented as incidence and prevalence rates in these settings are extrapolated from hospital admissions. The surgical management of kidney and ureteral stones is based on the stone location, size, the patient's preference and the institutional capacity. To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy. However, regarding the lack of endourological equipment and expertise in most parts of Sub-Saharan Africa (SSA), most urological centers in these regions still consider open surgery for kidney and ureteral stones. This review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines.
Res Rep Urol. 2020 Jul 6;12:225-238. doi: 10.2147/RRU.S257669. eCollection 2020. PMID: 32754452 Review. FREE ARTICLE

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Commenti 1

Hans-Göran Tiselius il Mercoledì, 30 Dicembre 2020 08:30

In most parts this article is a summary of current principles of stone removal. Different principles are presented in all aspects of the management of stone patients
.
It is discussed how the management of patients with stones in the kidneys and ureters significantly differ between the countries in Sub-Saharan Africa. Principles for stone removal are dictated by the socioeconomic conditions. Although endourology is developing in some countries such as Senegal and Kenya, such methods are not available in others. It is of note that open surgery still was the standard method for almost 70% of the patients.

Interestingly, stone composition was very similar to what we find in other parts of the world.

Calcium stones 80%
Infection stones 10-15%
Uric acid stones ≤ 3%
Cystine stones 2%
Drug induced stones 1%
With an efficient low-cost SWL device the situation would be completely different despite the high frequency of calcium oxalate stones. Without the need of anesthesia and without the need of expensive endourological equipment it would be possible to achieve good results also in countries with low resource settings!

Hans-Göran Tiselius

In most parts this article is a summary of current principles of stone removal. Different principles are presented in all aspects of the management of stone patients . It is discussed how the management of patients with stones in the kidneys and ureters significantly differ between the countries in Sub-Saharan Africa. Principles for stone removal are dictated by the socioeconomic conditions. Although endourology is developing in some countries such as Senegal and Kenya, such methods are not available in others. It is of note that open surgery still was the standard method for almost 70% of the patients. Interestingly, stone composition was very similar to what we find in other parts of the world. Calcium stones 80% Infection stones 10-15% Uric acid stones ≤ 3% Cystine stones 2% Drug induced stones 1% With an efficient low-cost SWL device the situation would be completely different despite the high frequency of calcium oxalate stones. Without the need of anesthesia and without the need of expensive endourological equipment it would be possible to achieve good results also in countries with low resource settings! Hans-Göran Tiselius
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Giovedì, 22 Aprile 2021

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