CONGENITAL OBSTRUCTIVE UROPATHY IN NIGERIA, PAST, PRESENT AND FUTURE PROSPECTS By N. Eke Urology Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Definition:  Obstructive uropathy is any affection of the urinary tract  characterized by impairment of urine flow through the tract and which,  if left untreated, will cause progressive renal damage.  Obstruction may be mechanical or functional

Aim:  An update on congenital obstructive uropathy in children with emphasis on Nigeria.

Materials and methods:  Contemporary information on the management of obstructive uropathy from the Medline, etc.  Information from our experience in Port Harcourt.

Results: Congenital causes:  Pelvi-ureteric junction obstructions,  VUR and megaureter  Neuropathic bladder  Posterior urethral valves (PUV),  Phimosis  Meatal stenosis.

Acquired causes:  Calculi  Post-traumatic and post-inflammatory strictures  Schistosomiasis (ureteric)  Meatal stenosis (post circumcision)  Tumors e.g. Prostatic embryonal rhabdomyosarcoma

Early reports  Prof Eso in Niger Med J 1976, calculus disease  Odita, Omene. Afr J Med Med Sci 1980, neonatal ascites, PUV in 4 of 7 patients. All died

Current situation  Many centres have developed interest in paediatric renal diseases, especially OU  1994, Eke F &Eke N (UPTH)  1997, Airede A, et al (UMTH)  2003, Michael IO & Gabriel OE (UBTH)  2004, Anochie I & Eke F (UPTH)  2004, Olowu WA &Adelusola KA (OAUTH)  2005, Anochie I & Eke F (UPTH)  2006, Etuk I et al (UCTH)  2007, Eke N & Elenwo SN (UPTH)  Several other publications (AJOL)

Current contd  1990, Ojogwu LI (UBTH) on pathology of ESRD  1993, Bamgboye EL et al (LUTH) on haemodialysis

Management  History  Examination: Thorough; Assoctd anomalies   Anorectal, Vertebral malformations  Investigations RFTs; USS, CT, MCU, ?IVU  CLINICAL FEATURES  AgeBirth -16 years  Gender M:F = 2:1  Anuria  Abdominal distensionMichellin baby  Phimosis/meatal stenosis

Specific manifestations:  Prune belly syndrome  Urethral obstruction syndrome  Vesico-ureteric reflux  Hydronephrosis  Renal failure ARF, CRF

Diagnostic investigations:  Ultrasonography (antenatal and post-natal)   2nd trimester USS, 2-6 weeks post-natal  Intravenous urography  Cystography  Renography. (Follow up in hydronephrosis)   Chromosome studies in ambiguous genitalia

Palliative Treatments Palliative Treatments Fluid and electrolytes Peritoneal dialysis Haemodialysis - Maiduguri, Lagos, Port Harcourt, Ife, etc

Recent therapeutic advances :  In utero vesico-amniotic shunt.  Endoscopic valve ablation for PUV.  Minimally invasive techniques for urolithiasis.  Augmentation cystoplasty (prune belly)  Nephrectomy in a unilateral damaged kidney.  Renal transplantation where available. (Ife, Kano, Lagos)  Advances in cytotoxic drug therapy.

Therapeutic problems  Criteria to select patients for treatment require definition.  Multicentre collaboration  Causes of Treatment Failure:  Pretreatment irreversible renal damage  Bladder dysfunction and mal-development

Conclusion:  Advances in management previously unavailable in developing countries only now improving.  Compromise treatment options, therefore, still prevail.  Adequate treatment is essential to prevent end-stage renal impairment.

Acknowledgement  I am grateful for the opportunity to interact with you.  Happy New Year