<p>Surgical Management of Urolithiasis of the Upper Tract – Current Trend of Endourology in Africa</p>

Abstract

Urolithiasis is a global pathology with increasing prevalence rate. The lifetime recurrence of urolithiasis ranges from 10–75% creating a public health crisis in affected regions. The epidemiology of urolithiasis in most parts of Africa and Asia remains poorly documented as incidence and prevalence rates in these settings are extrapolated from hospital admissions. The surgical management of kidney and ureteral stones is based on the stone location, size, the patient’s preference and the institutional capacity. To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy. However, regarding the lack of endourological equipment and expertise in most parts of Sub-Saharan Africa (SSA), most urological centers in these regions still consider open surgery for kidney and ureteral stones. This review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines.

<p>Urolithiasis: Presentation and Surgical Outcome at a Tertiary Care Hospital in Ethiopia</p>

“…2,3,14 Even if ultrasound has low sensitivity to identify urinary stones, it is the initial choice of imaging for reasons such as accessibility, affordability and safety. 3,12,16,36 In our study NCCT was utilized in 19.8% of the patients which is very low as compared with a study from Kenya (81%) and Nigeria (57.9%). 4,12 The high burden of patients from other disciplines and frequent malfunction maybe the reason for the low use of NCCT in our patient's diagnosis.…”

“…This holds true in reports from our country and elsewhere. 2,5,9,11,13,16,25,29 In contrast to this, studies from USA, Japan and Nigeria found out that calculi are frequent in the 5th and 6th decade of life. 1,12,32 This variation may be explained by a difference in study subjects and geographic location.…”

“…6,7,9 The treatment options include watchful waiting, stone dissolution, medical expulsive therapy, extracorporeal treatment, uroendoscopic interventions and open stone surgery. 12,16 Overall, the specific treatment relies on stone composition, site, size, number, patients' general condition and preference, and institutional capacity. [17][18][19] Despite the advancement of minimally invasive and noninvasive management of stone disease, which has become the gold standard treatment, open stone surgery remains the technique of choice in most developing countries.…”

“…[17][18][19] Despite the advancement of minimally invasive and noninvasive management of stone disease, which has become the gold standard treatment, open stone surgery remains the technique of choice in most developing countries. 2,3,16,20,21 This reflects the lack of trained professionals and endourologic instruments. 16,[22][23][24] As Ethiopia is a fast-growing, sub-Saharan Africa country, located near to the Afro-Asian stone belt, the burden is expected to be rising and becoming a public health issue.…”

“…2,3,16,20,21 This reflects the lack of trained professionals and endourologic instruments. 16,[22][23][24] As Ethiopia is a fast-growing, sub-Saharan Africa country, located near to the Afro-Asian stone belt, the burden is expected to be rising and becoming a public health issue. 5 However, data are scarce and the treatment options are limited.…”