Urologic Day-Care Surgery: Scope and Problems in a Developing Country

Abstract

OBJECTIVE-due to the numerous economic and social benefits associated with the practice of day-care surgery, it is gaining wide-spread acceptance worldwide and across all specialties. We therefore determined the spectrum of procedures and the difficulties faced during implementation of day-care urologic surgery in a tertiary-care center in Nigeria. PATIENTS AND METHODS- This was a prospective study of all consecutive urologic day cases seen at the urologic unit of Jos University Teaching Hospital, Nigeria, from January 2003 to December 2004. A total of 270 patients aged between 2 weeks and 100 years (median 55 years) with a male to female ratio of 14:1 were seen during the study period. The parameters studied were the presenting symptoms, diagnosis, treatment modalities, anesthesia, complications and whether or not the patients were converted to be in-patients or readmitted after discharge as well as the reasons for such conversion or readmission. the statistical analysis was done using the Epi-info 2004 system, version 3.2.2. RESULTS- The main conditions seen were urethral stricture in 89 (32.5%) patients, benign prostatic hyperplasia in 86 (31.8%), carcinoma of the prostate in 26 (9.6%), carcinoma of bladder in 15 (5.6%) and male infertility in 10 (3.7%) patients. The procedures carried out were mainly urethroscopy/urethrocystoscopy in 103 (38.2%) patients, visual internal urethrotomy in 48 (17.8%) and trucut prostatic biopsy in 33 (12.2%) patients. Sedation was used in 142 (52.9%), sedation and local anesthesia in 53 (19.7%) local anesthesia alone in 9 (3.3%0, general anesthesia in 22 (8.1%) and other combinations or omissions in entry in 41 (15.2%) patients. Circumcision was performed on 3 neonates (1.1%) without anesthesia. There was a cancellation rate of 15.6% (n=42) mainly due to the inability of the patients to come (24 patients, 57.1%), inadequate materials in the theater (9 patients, 21.4%), power failure (4 patients, 9.5%), strike action (3 patients, 7.1%) and financial difficulties (2 patients, 4.8%). We had a conversion rate to in-patients of 1.9% (n=5) for various reasons. No further complications or readmissions after discharge were encountered. CONCLUSION- Urethrocystoscopy is the most frequently performed procedure and urethral stricture the most common diagnosis in our day practice. Cancellation of cases and conversion to in-patients remain our major challenges. The education of patients and physicians, as well as the provision of adequate material and infrastructure are recommended in order to provide the maximum benefit from urologic day-surgery practice.