INTRODUCTION
Improvisation is the activity of making or doing something not planned
beforehand, using whatever can be found [1]. Materials which can be used for
lower urinary tract endoscopy include but not limited to drip stand, kitchen
sieve, feeding bottle. Surgeries which were carried out endoscopically were
TURP, DVIU, bladder neck incisions and clot evacuations. Endoscopic procedures
in urology entails the visualization of the urethra, prostate, bladder ureter
and the renal pelvis. The urinary tract is divided into upper and lower parts.
The renal pelvis down to the ureteric orifice make up the upper tract while
bladder down to the urethra make up the lower tract.
The regular practice of endourology in the developing countries is
gradually increasing however it is still on the decline compared to the western
or developed countries. Since the invention of the solid rod-lens system and
the fiber optic light source by H.H. Hopkins in 1959, the level of practice has
increased from simple diagnostic procedures to more complex therapeutic
applications [2]. This advancement in technology has enabled the urologist to
reach all corners of the urinary tract using the endoscopes [3]. Over the last
50 years endourology has revolutionized urological practices worldwide. This is
not so in many urological centers in West Africa [4].
AIM
This study was carried out with improvised materials and to demonstrate
that such materials could be safely used for endoscopic lower urinary tract
procedures. Study was carried out in Colworths medical center, a urologybased
hospital.
PATIENTS AND METHODS
Between November 2012 and June 2015, a prospective study of all
endourological procedures were performed at Colworths medical center. Both
informed and written consents were obtained from all the patients. The patients
were carefully chosen after confirmation of diagnosis following clinical,
radiological and labouratory evaluations.
Information obtained include age, gender, diagnosis, procedure, duration
of surgery, prostate size and complications were analyzed. The Improvised
materials included but not restricted to ordinary television set, drip stand,
kitchen sieve, water dispenser and feeding bottle. Endoscopic equipment
include all sizes of paediatric scopes, cystoscopes of all sizes, nephroscopes,
ureteroscopes, stone punches, urethrotomes. Some of the procedures were done
with the C arm fluoroscopic guidance. The choice of the anaesthesia was
subarachnoid block. Monitoring was done using automated patient monitor with
functions for ECG, SPO2, BP, HR, PR, and a well fitted alarm system. An
automated defibrillator was on hand for emergency and patient urine output was
monitored
Postoperative care was uneventful for most of
the patients but for few who needed close attention.
RESULTS
During the study, 206 endoscopic procedures were performed on 103 patients
with age range of 3 to 89 years with mean age of 66.99. There were 98 males and
5 females as seen in fiqures1 and 2. Initial cystoscopies were performed for
all the 103 patients. 53 transurethral resection of the prostate (TURP), 5
transurethral resection of the bladder tumour, 19 direct vision internal
urethrotomy (DVIU),15 channelization of the prostate, 2 bladder clot
evacuations, 1 double J stent insertions and 1 bladder neck incision were all
performed as seen in fiqures3 and 4.
One case of DVIU was abandoned due to bleeding and two cases of DVIU
stopped due to false passage. There was however no mortality.
Fig 1: Pie Chart showing proportions of male to Female
Study Participants
Fig 2: Bar chart showing the number of Male and female
patient participants
Fig 3: Pie chart showing
the ratio of different procedures carried out on the study participants
Fig 4:
Bar Chart showing the number of participants with the different procedures
carried out on them.
KEY:
TURP = transurethral resection of the
prostate
TURBT = transurethral resection of the
bladder tumour
DVIU = Direct vision internal urethrotomy
CP = Channelization of the prostate
BCE = Bladder clot evacuations
DJSI = Double J Stent insertions
BNI = Bladder neck incision
DISCUSSIONS: Philip Bazzini, a German army surgeon, invented the first instrument to
visualize the inside of a human body in 1806. He named this device the
Lichtieter. A candle and angled mirrors within the device would enable a
surgeon to see inside a body cavity. The device was originally intended to view
the pharynx, but it was quickly adapted to view the inside of the penis and
urethra [5]. This was the catalyst for further experimentation and innovation
of endoscopic instruments. Maximilian Carl-Friedrich Nitze and Joseph Leiter
developed the first true working cystoscope in 1878. From that point on, there
has been constant innovation and development that has led to the instruments
which urologists use today [6]. Materials improvised for the lower urinary
tract endoscopy include not restricted to ordinary television set, drip stand,
kitchen sieve, water dispenser and feeding bottle. Hysteroscopic
scissors was improvised in the treatment of PUV because of the cost of laser
machines, the after effect of diathermy cauterization and the avulsive effect
of foley catheter. The valves are neatly incised and excised at the 5 and 7
O’clock positions with satisfactory outcomes [7]. Endoscopic surgeries are
quite easy, fast, safe and cheap after the setup of equipment as the life span
can be prolonged with careful handling of instruments. Urethrocystoscopy is one
of the most precise diagnostic investigations in evaluation of lower urinary
tract symptoms and most of the procedure is done with the rigid cystoscopes in
our poor setting environment. Cystourethroscopy with a small calibre flexible
fiberscope under topical lignocaine poses less discomfort to the patient than
the rigid [8].The only challenge is the initial cost of setting a dedicated
endoscopy centre, training challenges can easily be surmountable with patience
dedication and setting priorities right [9].
REFERENCES:
1: IMPROVISATION. Definition in the Cambridge English Dictionary.
Dictionary.cambridge.org.2018
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pathophysiology and management. Indian Journal of Urology. 2001 Jan 1;17(2):97.
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Alioune Sarr. Diagnostic Rigid Urethrocystoscopy:
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