Daycase urology at Ibadan, Nigeria: a ten year review

Daycase urology at Ibadan, Nigeria: a ten year review

Augustine Oghenewyin Takure^1,&, Olayiwola Babatunde Shittu¹, Linus Ikechukwu Okeke¹, Oluwabunmi Emiola Olapade-Olaopa¹, Sikiru Adekola Adebayo¹

¹Urology Division, University College Hospital (UCH), P.M.B.5116, Ibadan, Nigeria

^&Corresponding author

Augustine Oghenewyin Takure, Division of Urology, Department of Surgery, University College Hospital, P.M.B. 5116, Ibadan, Nigeria

Day case surgery (DCS) is the procedure carried out and the patient discharged on the same day. It was first documented by James Nicoll in Glasgow in 1909 and now well established in the United States of America, Europe, Australia, Asia and some part of Africa [1-3].

It is cost effective, significantly reduced waiting list and well tolerated by the patients 4. The increasing acceptability in both developed and developing world had led to its utilization by virtually all surgical specialties and more urologic patients are treated by DCS [4-8].

This retrospective study aimed to determine the extent of day case urology at the University College Hospital, Ibadan.

We reviewed the records of urologic day cases performed in the division of urology over a ten year period (January 2000 to December 2009). We analysed the following data both for paediatric and adult patients admitted for urologic procedures: age, sex, indications for treatment, procedures performed, type of anaesthesia administered and the rank of the performing surgeon. We excluded endoscopic procedures such as internal urethrotomy, cystoscopy, bladder neck incision and ureteric catheterization because these procedures are done in the endoscopy outpatient theatre. Likewise prostate biopsy is not included because it is carried out in the surgery outpatient clinic. The data were collected in a proforma and analysed using SPSS version 17 using simple statistics.

During the study period, a total of 789 major elective urological cases were managed and 1292 day-case urological procedures treated in the day-case theatre, of which 1002 (77.6%) were adults aged between 17 and 91 years and children 290 (22.4%) aged between 5 days and 15 years.

All the urology day cases were males. The indication for surgery was therapeutic in 1166 (90.2%) patients and diagnostic in 126 (9.8%) patients. Tables 1 and 2 show the indications, number and type of day case procedures performed in adults and children respectively.

The most common procedures carried out in adults were varicocelectomy (n=426, 42.5%), orchidectomy (n=332, 33.1%) and open testicular biopsy (n=120, 12.0%) and others include hydrocelectomy (n=35, 3.5%), orchidopexy (n=30, 3.0%) and Herniorrhaphy (n=23, 2.3%). While male circumcision (n=231, 79.7%) was the most common procedure performed in children and others include re-do-circumcision (n=14, 4.8%), orchidopexy (n=14, 4.8%), urethral dilatation (n=14, 4.8%) and herniotomy (n=10, 3.5%).

General anaesthesia (GA) was primarily used in children (158 children vs. 4 adults), while local anaesthesia (LA) was used only in adults. 131 (45.2%) children with intact prepuce had no anaesthesia for circumcision.

The majority of the procedures were performed by the surgery residents (1169 cases, 90.5%), while the consultants managed 123 (9.5%) cases. There was no hospital admission.

In Ibadan the day case urologic procedures (DCU) are carried out in the day case theatre attached to the main theatre where major elective procedures are performed simultaneously. The patients are observed in the recovery room and are discharged home from here or in the side room attached to the main wards for the appropriate gender and age. This is in contrast to what obtains at Ile- Ife and Jos both in Nigeria where there are dedicated day surgery units as practiced in the developed world [2-4].

In addition, the closeness of the day case theatre to the main operating theatre allowed close supervision of the trainee surgical residents who performed 1169 (90.5%) of the day case urologic procedures and this finding is similar to other study in Nigeria [3]. It was responsible for no re-admission of patients after these procedures.

DCU constituted 1292 (62%) of the total elective urologic procedures (1081) performed during our study period. However Sowande OA et al, found DCU as 51% comparable to UK and Australia while it was as low as 30.4% by Ojo E.O et al [3,4].

The scope of urologic procedures depends on the peculiarity of the environments as demonstrated in our study, where varicocelectomy, orchidopexy and testicular biopsy are the main procedures in adult. Male circumcision remained the most common procedure in children in Nigeria [3,4]. In previous studies diagnostic endoscopy and prostatic biopsy were more commonly carried out in the same theatre as open minor and major elective procedures. We excluded these procedures in our study because they were exclusively done at the surgery outpatient theatre [3-5,8]. Our findings becomes relevant because the volume of day cases done can encourage inter institution training of our trainee surgical residents so as to optimize their experiences in the training programme. We intend auditing our endoscopic day case procedures.

Unlike the previous studies in our environment, where all the circumcisions where performed without anaesthesia, our study, showed that 99 children had general and one caudal anaesthesia (16 weeks old child with intact prepuce) for circumcision. In the adults 990 (98.8%) tolerated local anaesthesia in form of 0.5% to 1% xylocaine with or without adrenaline [3,4].

We believe that the day case theatre is still suitable for day case urologic practice in our setting though a dedicated day care unit is preferred. In adults and children, open therapeutic procedures such as varicocelectomy, orchidectomy and circumcision were commonly performed while testicular biopsy was the main diagnostic procedure carried out in adults. There is the need for inter-institutional exchange programmes toward adequate surgical training.

The authors declare they have no competing interests.

Takure A.O: Concept and design, data collection and analysis, interpretation of data, initial draft, review of literature and final write up. Shittu O.B: Design, data analysis, interpretation of data, critical review of initial draft and final write up. Okeke LI: Critical review of draft and article and final write up. Olapade-Olaopa EO: Critical review of article and final write up. Adebayo SA:Review of article and final write up

Table 1: The indications and number of day case procedures - surgery in adults

Table 2: The indications and number of day case procedures - surgery in children

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