Reasons for Elective Surgery Cancellations in a Senegalese Pediatric Surgery Department

Introduction: Cancellation of elective surgery is common in developing countries. This decision is difficult to make as it generates economic and organizational consequences for the healthcare facility and an additional source of stress for patients and their caregivers. This study aimed to analyze the various aspects of this medical problem. Patients and Methods: We conducted a prospective and descriptive study over six months (from January 1st, 2017, to June 30th, 2017) at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Senegal. Results: Ninety-one cases were collected. The cancellation rate was 20.8%. Infants were affected in 36.3% of cases. Among anesthesiologists, 83.5% were residents, and 16.5% were specialists. Cancellation in nephroblastoma children with an indication for extended nephrectomy represented 15.4% of cases. Concerning reasons for cancellation, comorbidities, dominated by respiratory infections, accounted for 28.5% of cases, patient absences for 24.2%, and issues related to the anesthesiologist for 17.6%. Cancellations were avoidable in 33% of cases. Patients were responsible for cancellation in 37.4% of cases, the healthcare system in 33%, and medical reasons in 29.7%. Conclusion: Our findings suggest that one-third of cancellations could have been avoided with improvements in the healthcare system. Actions should be taken to reduce the cancellation rate in our context.

Persistent Congenital Paraurethral Cyst, a Rare Cause of Dysuria in a Girl

Congenital paraurethral cyst rarely occurs. Its natural history is spontaneous regression, leading to conservative management adoption. We report an exceptional case of a 13-year-old female with a persistent congenital paraurethral cyst, leading to dysuria. We surgically excised the cyst, and the outcomes were unremarkable 20 months postoperatively.

Delayed Management of High-Grade Renal Trauma in a Child with Bilateral Lower Polar Artery: A Case Report

High-grade renal trauma rarely occurs due to low-velocity mechanisms. With its clinical presentation, delayed diagnosis rarely happens. We report the case of a 12-year-old girl diagnosed seven days post-trauma with grade IV renal trauma complicated with infected urinoma and bilateral lower polar vessels. She was non-operatively managed with ultrasound-guided percutaneous drainage of the urinoma, which resolved, and had unremarkable six months follow-up. We discuss the role of preexistent hydronephrosis in low-velocity impact, pitfalls of diagnosis in resource-constrained settings, and management of high-grade trauma.

Management and Outcome of Ureteropelvic Junction Obstruction in Senegalese Children

Introduction: The ureteropelvic junction obstruction is a rare congenital malformation of the upper urinary tract. We report its management and outcome at Senegal’s main pediatric surgical department. Patients and Methods: We conducted a descriptive review of all patients managed in our pediatric surgical department at Albert Royer National Children’s Hospital Centre from January 1st, 2013 to December 31st, 2017. Results: Thirty patients were included in our study. The mean age was three years. Males were more affected (sex ratio of 2.75). The prenatal diagnosis was made in 23% of cases using prenatal ultrasonography. An abdominal mass was the circumstance of discovery in 36% of cases, and lumbar contact and renal sloshing were found in 66% of cases. There was no renal function impairment in 93% of cases. Urinary tract infection occurred in 50% of cases. Ultrasonography (100%) and urinary computed tomography (56%) were used to diagnose. A temporary nephrostomy was performed in 23% of cases, and as definitive treatment, an open Anderson-Hynes procedure was performed in 96% as a nephrectomy was made in a patient. Early postoperative complications were encountered in 56% of cases: urinary tract infection (36%), surgical site infection and anastomotic stenosis (6% both), and urinoma and textiloma (both in 3%). A patient died from sepsis. After a mean follow-up of 12 months, no additional complication was reported. Conclusion: Ureteropelvic junction obstruction was frequently diagnosed late, and its management carried unneglectable morbidity in our environment. A laparoscopic approach would be a solution to improve its outcome.