Forgotten Ureteral Stents in a Tertiary Hospital in Accra and a Review of Endourological Management of Upper Urinary Tract Pathologies in the West Africa Sub-Region

Background: Forgotten ureteral stent is defined as prolong indwelling ureteral stent whose function is no longer desired. Ureteral stents are used in the management of upper urinary tract pathologies. Prolonged indwelling ureteral stents may be complicated by urosepsis or renal failure, encrustation, stone formation, spontaneous fracture which may either be retained or voided in the urine (stenturia). Hitherto, these complications were managed by open procedures alone in our center. We report our recent experience in endourology with the management of three cases of forgotten ureteral stents with durations of ten years and two years (two cases) and review endourological practice in West Africa. Conclusion: Although encrusted stents can be managed successfully by minimally invasive approaches in the majority of cases, the best treatment is prevention. Urology units should have preferably an electronic stent register such that when the time for removal is due, the patient's name and details are flagged red. If electronic register is not available, then a hard paper/book register should be made to prevent situations of forgotten stents. Also, efforts must be made to improve endourological services in the West Africa subregion to allow patients to have the benefit of endourology in the management of upper urinary tract pathologies including that of stones originating from an encrusted or fractured forgotten ureteral stent.

Day of Surgery Cancellation in Urology at a Public Tertiary Hospital and a Private Specialist Hospital

Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.