BMC Surgery最新文献

Introduction: The Mitrofanoff principal entails creating a continent catheterizable channel, traditionally the appendix. In patients with nonfunctioning kidney, the ureter of this kidney can be an alternative This study aims to compare outcomes of ureter versus appendiceal Mitrofanoff channels (MCs).

Patients and methods: We retrospectively reviewed patients who underwent MC creation between January 2020 and June 2024 for patients with neurogenic bladder, exstrophy-epispadias complex, prune belly syndrome, or posterior urethral valves. Group A included patients who had a ureter as MC (n = 11), while Group B included those with an appendiceal MC (n = 33). Data on demographics, operative details, complications, and continence outcomes were collected and analyzed.

Results: Forty-four patients (Male patients = 24) were included, with a median age of 13.0 years (IQR 9.0-15.0) in Group A and 10.0 years (IQR 7.0-12.0) in Group B (p = 0.002). Myelomeningocele was the most common diagnosis in both groups. Bladder augmentation was performed in 81.8% of patients in each group, predominantly with ileo-cystoplasty. Satisfactory clean intermittent catheterization (CIC) without complications was achieved in 54.4% of Group A and 57.5% of Group B. Stomal stenosis occurred more frequently in Group B (18.2% vs. 9.1%, p = 0.003), while meatal granuloma was more common in Group A (27.3% vs. 9.1%, p = 0.043). Other complications included urine leakage, painful catheterization, catheterization difficulty, and intestinal obstruction, with no significant intergroup differences.

Conclusion: Ureter as an MC offers a valid option for continent urinary diversion, demonstrating comparable continence outcomes as compared to appendiceal MC. The ureter represents a feasible and reliable alternative conduit in patients with a nonfunctioning kidney.

Background: Femoral shaft fractures (FSFs) are critical injuries that impose a substantial burden on patients and society, frequently resulting in catastrophic loss of employment and long-term disability in low- and middle-income countries (LMICs). While clinical management often focuses on reactionary surgical fixation, the high incidence of road traffic injuries and geriatric falls in Ethiopia necessitates a shift toward systemic preventative medicine. This study aimed to determine the prevalence and associated factors of FSFs among adult patients at Ethiopia's largest trauma center to provide a bimodal evidence base for public health advocacy and injury prevention strategies.

Methods: A hospital-based cross-sectional study was conducted at Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital between September 2023 and August 2024. The study included adult patients (≥ 18 years) admitted for the management of extremity fractures. A systematic random sampling technique was used to select 419 medical records, of which 388 were complete and included in the final analysis. Data were extracted using a structured checklist and analyzed using SPSS version 27. Logistic regression was employed to identify factors associated with femoral shaft fractures.

Results: Among 388 patients admitted with extremity fractures, 192 (49.5%) sustained femoral fractures. Of these, 56 had femoral shaft fractures, resulting in a prevalence of 14.4% (95% CI: 10.9-17.9) among all extremity admissions and 29.1% (95% CI: 22.7-35.6) among femoral fractures. Proximal femur fractures were the most common femoral sub-type (54.7%). Road traffic accidents (42.0%) and falls (40.7%) were the leading mechanisms. Multivariable analysis revealed that older age was a significant protective factor against shaft fractures compared to younger adults (19-45 years): age 46-65 (AOR = 0.23; 95% CI: 0.08-0.65; p = 0.006) and age > 66 (AOR = 0.05; 95% CI: 0.01-0.22; p < 0.001). Ground-level falls were significantly less likely to result in shaft fractures compared to falls from height (AOR = 0.07; 95% CI: 0.02-0.30; p < 0.001).

Conclusions: Femoral fractures constitute a major proportion of the traumatic workload in Ethiopia. Our findings suggest that clinical excellence in surgical fixation is insufficient to address this burden. We advocate for a firm transition toward preventative medicine led by trauma and orthopedic associations. This must include a bimodal strategy: aggressive public campaigns for seatbelt and helmet enforcement to protect the young workforce from high-energy trauma, and the implementation of osteoporosis screening and fall-prevention programs to mitigate fragility fractures in the aging population.

Background: Wrist ganglion cysts (GCs) are the most common soft-tissue masses of the hand and wrist. Although surgical excision is considered the most effective treatment, recurrence remains a clinical concern. Anatomical and demographic predictors of postoperative recurrence are not well established.

Methods: We included 347 patients who underwent surgical excision of wrist GCs between 2015 and 2023, with a minimum follow-up of 24 months. Clinical data (age, sex, side, hand dominance) and magnetic resonance imaging (MRI)-based topographic features (volume, surface area, wall thickness, location, longest and shortest diameters, aspect ratio, and distance to the adjacent joint) were recorded retrospectively. The primary outcome was cyst recurrence at a minimum follow-up of 24 months, defined as clinically or radiologically confirmed return of the cyst. Statistical analyses included chi-square tests, t-tests or Mann-Whitney U tests, and univariable and multivariable logistic regression analyses. All analyses were performed in the Python (Google Colab) environment using the pandas, NumPy, SciPy, and statsmodels libraries.

Results: The overall recurrence rate at a minimum follow-up of 24 months was 8.6% (30 of 347). Dominant-hand involvement was significantly associated with recurrence (χ² p = 0.006). In age-adjusted logistic regression, dominant-hand involvement increased the risk (OR = 6.51; 95% CI, 1.87-22.63; p = 0.003). Cyst distance to the adjacent joint was significantly shorter in recurrent cases (mean 7.6 mm vs. 8.1 mm; t-test p = 0.001, Mann-Whitney U p = 0.021). Based on age-adjusted logistic regression, each additional millimeter of cyst-to-joint distance conferred a 41% relative reduction in recurrence risk (OR = 0.59; 95% CI, 0.39-0.90; p = 0.013).

Conclusions: MRI-based evaluation of cyst-to-joint distance and consideration of dominant-hand involvement may help identify patients at increased risk of recurrence after surgical excision of wrist GCs. Incorporating these factors into preoperative planning may optimize surgical strategy, guide follow-up, and improve patient counseling.