Urologic day-care surgery: scope and problems in a developing country L\'hospitalisation du jour en chirurgie urologique: objectifs et problèmes dans un pays en voie de développement

Objective : Due to the numerous economic and social benefits associated with the practice of day-care surgery, it is gaining widespread 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 urology 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%), 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 theatre (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. Resume Objectifs : L\'hospitalisation d\'un jour gagne l\'acceptation repandue dans le monde et dans toutes les specialites en raison de ses nombreux avantages economiques et sociaux. Nous avons determine la variete et les difficultes dont on a fait face pendant cette procedure dans un centre de soin tertiaire au Nigeria. Patients et methodes : Il s\'agit d\'une etude prospective de toutes les hospitalisations du jour consecutives en urologie vues a l\'unite d\'urologie de l\'Hopital Universitaire Jos, Nigeria, de janvier 2003 a decembre 2004. Un total de 270 patients d\'un âge de 2 semaines a 100 ans (mediane de 55 annees) avec un sexe ratio de 14/1 a ete vu pendant la periode de l\'etude. Les parametres etudies etaient les symptomes presentes, diagnostic, modalites du traitement, anesthesie, complications et si ou pas les patients ont ete convertis pour etre hospitalises ou ont ete readmis aussi bien que les raisons pour une telle conversion ou readmission. L\'analyse statistique a ete faite utilisant le systeme Epi-Info 2004, version 3.2. 2. Resultats : Les causes principales vues etaient la stenose de l\'urethre chez 89 patients (32.9%), hyperplasie benigne prostatique chez 86 (31.8%), carcinome de la prostate chez 26 (9.6%), carcinome de vessie chez 15 (5.6%) et sterilite masculine chez 10 (3.7%) patients. Les procedures pratiquees etaient principalement des urethroscopies / urethro-cystoscopies chez 103 (38.2%), uretrotomie interne endoscopique chez 48 (17.8%) et biopsie prostatique au trucut chez 33 (12.2%) patients. La sedation a ete utilisee dans 142 cas (52.9%), sedation et anesthesie locale chez 53 (19.7%), anesthesie locale seule chez 9 (3.3%), anesthesie generale chez 22 patients (8.1%) et d\'autres combinaisons d\'anesthesie ou manque de notes sur la forme d\'anesthesie chez 41 (15.2%) patients. Il y avait un taux d\'annulation de 15.6% (n=42) du a l\'incapacite des patients a venir (24 patients, 57.7%), materiel inadequat (9 patients, 21.4%), panne de courant (4 patients, 9.5%), greve (3 patients, 7.1%) et difficultes financieres (2 patients, 4.8%). Nous avions un taux de conversion de 1.9% (n=5) pour plusieurs raisons. Aucune complication supplementaires ou readmission apres sortie n\'ait ete rencontree. Conclusions : L\'uretrocystoscopie est la procedure frequemment realisee et la stenose de l\'uretre le diagnostic le plus commun dans notre hospitalisation du jour. L\'annulation de cas et la conversion restent nos defis majeurs. L\'education des patients et des medecins, aussi bien que les developpements infrastructurels est recommandee pour promouvoir cette procedure. African Journal of Urology Vol. 11(3) 2005: 203-207