A catheterizable serous-lined urinary outlet associated with the ileal bladder augmentation Abol-Enein and Ghoneim procedure: a safe and reliable procedure in children

Purpose

This study aims to evaluate the long-term outcome of the serous-lined extramural continent catheterizable outlet procedure (SLECCOP) associated with ileal bladder augmentation in children.

Methods

This was a monocentric and retrospective study (2002-2021) that included children (<18 years) undergoing the SLECCOP associated with W-shaped ileocystoplasty with a catheterizable channel (Abol-Enein and Ghoneim procedure). Patients who received other types of bladder augmentation or W-shaped ileocystoplasty without a catheterizable channel were excluded. Patient records were reviewed for demographic information, surgical data, and long-term outcomes.

Results

This study included 52 children [33 boys, median age: 8.5 (0.8-18) years]. Pathological conditions included 28 children with the bladder exstrophy and epispadias complex (BEEC), 11 with neurogenic bladders, and 13 with other pathologies. Two patients underwent total bladder substitution. Thirty-four (65%) patients had bladder neck reconstruction (BNR), with 23 undergoing the SLECCOP and ileocystoplasty and 11 having prior BNR. All stomas, except for two, were umbilical, and were associated with omphaloplasty in 28 patients with the BEEC. A total of 40 stomas were created using the appendix (77%) and 12 with a Monti tube (23%). Stoma-related complications included cutaneous strictures (n = 2, 4%) and leaks (n = 10, 19%), all treated by dextranomer/hyaluronic acid copolymer injection (n = 10). A redo surgery was required in three patients: extraserosal wrapping was performed for persistent leakage (n = 2, 4%), and surgical revision was required for the Monti tube procedure (n = 1, 2%). Three patients (6%) underwent dilatation for transient stoma stenosis. Leakage occurred in 20% of appendix channels (n = 8/40) and 17% of Monti tubes (n = 2/12). Strictures were reported in 3% of appendix channels (n = 1/40) and 8% of Monti tubes (n = 1/12). Bladder stones developed in four patients (8%). Channel leakage persisted in one patient (2%) at a median follow-up of 4.4 years (IQR 1.4-9.7).

Conclusion

W-Ileal bladder augmentation with the SLECCOP is an efficient technique for treating children with incontinence caused by different etiologies. The rate of channel complication is very low, specifically for strictures, in this complex population of patients.

Hernie diaphragmatique post-traumatique de l’enfant: à propos d’un cas au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou

La hernie diaphragmatique post-traumatique est une urgence chirurgicale rare chez l’enfant mais pouvant mettre rapidement en jeu le pronostic vital. Les auteurs rapportent le cas d’un garçon de 04 ans admis aux urgences pour douleur abdominale suite à une contusion thoraco-abdominale par accident de la voie publique. Le bilan radiologique initial a consisté en une échographie abdominale qui a révélé un hémopéritoine de petite abondance sans lésion focale. Douze heures après son admission, le patient a présenté une détresse respiratoire avec tableau clinique de pneumothorax gauche qui a nécessité une exsufflation en urgence. Le diagnostic de hernie diaphragmatique gauche a été posé à la radiographie du thorax réalisée après la ponction. L’enfant a bénéficié d’une cure chirurgicale. L’évolution a été favorable. La hernie diaphragmatique post traumatique, bien que rare chez l’enfant, devrait être systématiquement recherchée par une radiographie thoracique ou un scanner thoraco-abdominal devant tout traumatisme abdominal avec hyper pression. Son traitement est chirurgical.

Hirschsprung's disease: management problem in a developing country

BACKGROUND

The management of Hirschsprung's disease remains a problem in developing countries. Our aim is to identify the main epidemiological, clinical, and therapeutic characteristics of Hirschsprung's disease at the University Child Hospital Charles De Gaulle of Ouagadougou (CHUP-CDG).

PATIENTS AND METHOD

It is a retrospective study carried out in the period from January 2001 to December 2007 in the Surgery Unit at CHUP-CDG, which is a reference centre for Paediatric Surgery in Burkina Faso.

RESULTS

There were 52 patients (M: F=3.3:1). The annual incidence was seven cases. Age at presentation and diagnosis ranged from two days 10 years (median 20 months). Twenty five patients were from poor socio-economic conditions. Presentations were mainly intestinal obstruction, chronic constipation and enterocolitis. There were two cases of associated trisomy 21. Average age at operative intervention was 3.17 months. The rectosigmoidal form was the most frequently encountered. Over two-thirds (67.31%), with no complications at presentation, had benefited from nursing before their final treatment. A temporary colostomy was requested in case of complication. Swenson's technique was practiced for all the patients who underwent surgery operation. The assessment of functional results in eight patients after an average decrease of 3.5 years gave excellent results. Post-surgery complications were mainly enterocolitis in 12% of patients. Mortality rate was 16%.

CONCLUSION

Management of Hirschsprung's disease is a problem in Burkina Faso. It is characterised by its late presentation and difficult diagnosis due to inaccessibility and the non-availability of some investigation services (barium enema, histochemistry, and histology), resulting in high morbidity and mortality rates. Effective technical capacities, adequate staff training, and public education will be necessary to improve care quality.

[Features of hysterosalpingography performed in Burkina Faso]

PURPOSE

The goal of this study was to describe the distinctive hysterosalpingographic features of women with infertility in Burkina Faso.

MATERIALS AND METHODS

We performed a retrospective study of 1019 women who were referred for infertility between January 1996 to June 1997 at the National Hospital Centre of Ouagadougou. Clinical and radiological features were reviewed and statistical data analysed on the software EPI Info 5.0.

RESULTS

The mean age of the patients was 28+/-0,3 years. Primary infertility was found in 34.4% and secondary infertility in 65.6%. Abnormalities on plain film were present in 6.9% of the cases. Hysterosalpingography was abnormal in 62.1% of the cases. Tubal abnormalities were found in 62% and uterine lesions in 38.3%. The main hysterosalpingographic abnormalities were tubal obstructions, hydrosalpinx, uterine fibromas, and trauma sequelae in 25,9%, 25,3%, 16,5% and 10% of cases respectively. Seventy one percent of tubal and uterine lesions represent outcomes of chronic infections and underground abortions.

CONCLUSION

In Burkina Faso, hysterosalpingographic abnormalities are characterized by the predominance of infectious and traumatic sequelae. Such a frequency could be reduced by active politics against underground abortion and information about genital infections.

[Fetal weight gain curve for a cohort of 126 pregnant women at Ouagadougou, Burkino Faso]

We carried out a prospective study at Ouagadougou, from March 1 1997 to April 30 1998, in which we plotted curves of fetal weight gain, estimated by ultrasound biometry, with the aim of comparing our results to those of other authors and establishing a local chart. We established a growth curve from 936 fetal weights estimated during the follow up of 126 pregnant women. The mean age of the women included was 26 +/- 0,8 years and 52.4% were of the mean socioeconomic level. We identified significant differences between our weight gain curve and those of other authors. The factors involved in this difference are unclear but may be nutritive, ecological and ethnic in nature. Further work is required to produce local charts, to optimize the estimation of fetal weight.

[Ultrasound foetal biometry in the town of Ouagadougou, Burkina Faso. Report of a cohort of 126 pregnant women]

PURPOSE

This inquiry on the ultrasound fetal biometry in the town of Ouagadougou aimed to study the fetal growth through the ultrasound biometry in order to compare it with other authors's works and to lay down a local chart.

PATIENTS AND METHODS

This prospective study led from March 1997 to April 1998 The follow-up of 126 pregnant women allowed to lay down the graphs of following elements: biparietal diameter, cephalic circumference, transverse abdominal diameter, abdominal circumference and femur.

RESULTS

The average age of the subjects was 26 years old+/-0.8 and 52.4% of them belonged to an average socio-economic level. All the studied parameters were closely connected with the age of pregnancy. The DAT and the abdominal circumference presented the greatest correlation (0.998). The comparison of our growth graphs with those of others authors led to notice significant differences as well as with African, European and American graphs.

CONCLUSION

There is a need to lay down local charts in order to have a best estimation of the pregnancy age and the fetal growth.