congenital obstructive uropathy in nigeria, past, present and future prospects by n. eke urology...

CONGENITAL OBSTRUCTIVE CONGENITAL OBSTRUCTIVE UROPATHY IN NIGERIA, UROPATHY IN NIGERIA,

PAST, PRESENT AND FUTURE PAST, PRESENT AND FUTURE PROSPECTSPROSPECTS

ByByN. EkeN. Eke

Urology Unit, Department of Surgery, Urology Unit, Department of Surgery, University of Port Harcourt Teaching University of Port Harcourt Teaching

Hospital, Port Harcourt, Nigeria.Hospital, Port Harcourt, Nigeria.

Definition:Definition: Obstructive uropathy is any affection of Obstructive uropathy is any affection of

the urinary tract the urinary tract characterized by impairment of urine flow characterized by impairment of urine flow

through the tract and which, through the tract and which, if left untreated, will cause progressive if left untreated, will cause progressive

renal damage.renal damage.

Obstruction may be mechanical or Obstruction may be mechanical or functionalfunctional

Aim:Aim:

An update on congenital obstructive An update on congenital obstructive uropathy in children with emphasis uropathy in children with emphasis on Nigeria.on Nigeria.

Materials and methods:Materials and methods: Contemporary information on the Contemporary information on the

management of obstructive uropathy management of obstructive uropathy from the Medline, etc.from the Medline, etc.

Information from our experience in Information from our experience in Port Harcourt.Port Harcourt.

Results: Results: Congenital causes: Congenital causes:

Pelvi-ureteric junction obstructions,Pelvi-ureteric junction obstructions, VUR and megaureterVUR and megaureter Neuropathic bladder Neuropathic bladder Posterior urethral valves (PUV), Posterior urethral valves (PUV), Phimosis Phimosis Meatal stenosis. Meatal stenosis.

Acquired causes:Acquired causes: Calculi Calculi Post-traumatic and post-inflammatory Post-traumatic and post-inflammatory

stricturesstrictures Schistosomiasis (ureteric)Schistosomiasis (ureteric) Meatal stenosis (post circumcision)Meatal stenosis (post circumcision) Tumors Tumors e.g. Prostatice.g. Prostatic embryonal embryonal

rhabdomyosarcomarhabdomyosarcoma

Early reportsEarly reports Prof Eso in Niger Med J 1976, calculus Prof Eso in Niger Med J 1976, calculus

diseasedisease

Odita, Omene. Afr J Med Med Sci 1980, Odita, Omene. Afr J Med Med Sci 1980, neonatal ascites, PUV in 4 of 7 patients. neonatal ascites, PUV in 4 of 7 patients. All diedAll died

Current situationCurrent situation Many centres have developed interest in Many centres have developed interest in

paediatric renal diseases, especially OUpaediatric renal diseases, especially OU 1994, Eke F &Eke N (UPTH)1994, Eke F &Eke N (UPTH) 1997, Airede A, et al (UMTH)1997, Airede A, et al (UMTH) 2003, Michael IO & Gabriel OE (UBTH) 2003, Michael IO & Gabriel OE (UBTH) 2004, Anochie I & Eke F (UPTH)2004, Anochie I & Eke F (UPTH) 2004, Olowu WA &Adelusola KA (OAUTH)2004, Olowu WA &Adelusola KA (OAUTH) 2005, Anochie I & Eke F (UPTH)2005, Anochie I & Eke F (UPTH) 2006, Etuk I 2006, Etuk I et alet al (UCTH) (UCTH) 2007, Eke N & Elenwo SN (UPTH)2007, Eke N & Elenwo SN (UPTH) Several other publications (AJOL)Several other publications (AJOL)

Current contdCurrent contd 1990, Ojogwu LI (UBTH) on pathology of 1990, Ojogwu LI (UBTH) on pathology of

ESRDESRD 1993, Bamgboye EL et al (LUTH) on 1993, Bamgboye EL et al (LUTH) on

haemodialysishaemodialysis

ManagementManagement HistoryHistory Examination: Thorough; Assoctd anomaliesExamination: Thorough; Assoctd anomalies Anorectal, Vertebral malformations Investigations RFTs; USS, CT, MCU, ?IVUInvestigations RFTs; USS, CT, MCU, ?IVU

CLINICAL FEATURESCLINICAL FEATURES AgeAge Birth -16 yearsBirth -16 years Gender M:F = 2:1Gender M:F = 2:1 AnuriaAnuria Abdominal distensionAbdominal distension Michellin babyMichellin baby Phimosis/meatal stenosisPhimosis/meatal stenosis

Specific manifestations:Specific manifestations: Prune belly syndromePrune belly syndrome

Urethral obstruction syndromeUrethral obstruction syndrome

Vesico-ureteric refluxVesico-ureteric reflux

Hydronephrosis Hydronephrosis

Renal failure ARF, CRFRenal failure ARF, CRF

Diagnostic investigations:Diagnostic investigations: Ultrasonography (antenatal and post-natal)Ultrasonography (antenatal and post-natal) 2nd trimester USS, 2-6 weeks post-natal Intravenous urography Intravenous urography Cystography Cystography Renography. (Follow up in hydronephrosis)Renography. (Follow up in hydronephrosis) Chromosome studies in ambiguous genitalia

Palliative TreatmentsPalliative Treatments

Fluid and electrolytes

Peritoneal dialysis

Haemodialysis-Maiduguri, Lagos, Port Harcourt, Ife, etc

Recent therapeutic advances Recent therapeutic advances ::

In uteroIn utero vesico-amniotic shunt. vesico-amniotic shunt. Endoscopic valve ablation for PUV.Endoscopic valve ablation for PUV. Minimally invasive techniques for urolithiasis.Minimally invasive techniques for urolithiasis. Augmentation cystoplasty (prune belly)Augmentation cystoplasty (prune belly) Nephrectomy in a unilateral damaged kidney. Nephrectomy in a unilateral damaged kidney. Renal transplantation where available.Renal transplantation where available.(Ife, Kano, (Ife, Kano,

Lagos)Lagos)

Advances in cytotoxic drug therapyAdvances in cytotoxic drug therapy..

Therapeutic problemsTherapeutic problems Criteria to select patients for treatment Criteria to select patients for treatment

require definition. require definition. Multicentre collaborationMulticentre collaboration Causes of Treatment Failure:Causes of Treatment Failure: Pretreatment irreversible renal damagePretreatment irreversible renal damage Bladder dysfunction and mal-developmentBladder dysfunction and mal-development

Conclusion:Conclusion: Advances in management previously Advances in management previously

unavailable in developing countries unavailable in developing countries only now improving. only now improving.

Compromise treatment options, Compromise treatment options, therefore, still prevail. therefore, still prevail.

Adequate treatment is essential to Adequate treatment is essential to prevent end-stage renal impairment.prevent end-stage renal impairment.

AcknowledgementAcknowledgement I am grateful for the opportunity to I am grateful for the opportunity to

interact with you.interact with you.

Happy New YearHappy New Year