Surgery

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Functional outcome of Proximal Humerus Fracture Treated with Philos Plate at Tash Over Three Years
(Addis Ababa University, 2025-10-16) Adonias Ager; Natan Wondossen; Melese Gardie
Introduction: Proximal humerus fractures hold a significant portion of upper limb injuries, particularly among older adults and individuals exposed to high-energy trauma. Although the PHILOS (Proximal Humerus Interlocking System) plate has become a frequently accepted fixation method due to its angular stability and favorable functional outcomes, its practical use in Ethiopia remains held down by resource constraints, postoperative follow-up challenges, and variability in rehabilitation services. This study discovered the functional outcomes, union rates, and complication profile of proximal humerus fractures treated with PHILOS plates at Tikur Anbesa Specialized Hospital (TASH) over three years period. Methods: A retrospective cross sectional study was conducted on 48 adult patients who underwent PHILOS plate fixation for proximal humerus fractures at TASH between November 2021 and October 2024. Demographic, clinical, surgical, and radiographic data were extracted from medical records and described in descriptive analysis. Functional outcomes were assessed using the Constant-Murley score. Patients with at least 1year of followed-up were included in the functional outcome analysis. Results: The majority of patients were female (60%), with the 50–59-year age group most commonly affected. Falls (52.1%) were the leading cause of injury. Two-part fractures were the most common pattern (58.3%). Fracture union at one year was achieved in 91.7% of patients. Superficial infection (12.5%) and implant failure (10.4%) were the most frequent complications. The mean Constant-Murley score was 80 and 89.5% of patients demonstrated good to excellent outcomes. Conclusion: PHILOS plate fixation provides favorable functional outcomes and acceptable union rates for proximal humerus fractures in the Ethiopian context, despite systemic barriers. Fracture union rate and proportion of complications are comparable with regional and international studies. This study provides essential evidence to support improved fracture management with comparable functional outcome to other regional and international studies. This study provides essential evidence to support improved fracture management with comparable functional outcome to other regional and international studies.
Functional Outcomes of Anorectal malformation: A 5 years Retrospective Study at single institution, Ethiopia.
(Addis Ababa Uinverstiy, 2025) Gobena Mormata; Abay Gosaye
Anorectal malformation (ARM) is a wide spectrum of congenital malformation seen in pediatric patients. While the surgical techniques have advanced long term functional outcomes like voluntary bowel movement, soiling and constipations remain significant challenge for clinicians and patients especially in low income countries like Ethiopia. Objectives: To assess the functional outcomes of surgically reconstructed anorectal malformations and identifying factors affecting the outcomes at single tertiary institution in Ethiopia. Methodology: This is a retrospective cohort study which was conducted on 119 children treated for ARM over a 5-year period from September 2018 to September 2022. Functional outcomes was assessed using the Krickenbeck classification systems. Bivariate analysis was performed by using Chi-square, Fisher’s exact tests and Mann- Whitney U tests where they were appropriate according to the types of variables, then followed by multivariable logistic regression to identify independent affecting factors with Adjusted Odds Ratios [AOR] and 95% Confidence Intervals [CI]. Results: 84.9% of patients achieved VBM, while soiling and constipation were 47.1% and 24.4%, respectively. High ARM types were associated with higher soiling rates (77.8%; AOR 0.133, 95% CI: 0.031- 0.564, p=0.006). Conversely, low ARM type was associated with constipation (43.5%; AOR 8.4, 95% CI: 1.48-47.66, p=0.016). Redo anoplasty was associated with poor VBM (AOR 0.1, 95% CI: 0.02-0.49, p=0.005) and increased soiling (AOR 0.128, 95% CI: 0.028-0.582, p=0.008). While three-stage repairs showed higher soiling in bivariate analysis, multivariable analysis showed no independent effect. Early age at definitive surgery was associated with better voluntary bowel movement (AOR 0.97, 95% CI: 0.93-0.99, p=0.024). Conclusion and Recommendation: A functional outcome of ARM patients after surgical reconstruction at TASH is comparable to international studies. Types of ARM, redo anoplasty and age at definitive surgery were identified as independent affecting factors of the functional outcomes. However; neither stages of the surgery nor birth weight was independent affecting factor. So, the high rate of soiling need structured postoperative bowel management and follow-up. Early definitive surgery and decreasing of technical failures requiring reoperation are required for improving functional outcomes.
Patients Undergoing Transvesical Prostatectomy and Retropubic Prostatectomy
(Addis Ababa Uinverstiy, 2025) Abiy Tadele; Fitsum Solomon; Mezgebe Gedefe
Benign prostatic hyperplasia(BPH) has a wide range of management options, from watchful waiting to minimally invasive and open surgical procedures. Although open prostatectomy accounts for less than 5% of BPH surgeries globally, it remains a commonly practiced approach in developing countries such as Ethiopia due to limited resources and a shortage of trained personnel. Among open techniques, the transvesical approach is predominantly performed in our setting, despite better perioperative outcome of the retropubic approach. Objective: To compare the perioperative outcomes of open simple prostatectomy performed via the transvesical (suprapubic) approach and the retropubic approach for bladder outlet obstruction secondary(BOO) to BPH among patients undergoing surgery at Menelik II Hospital. Methods: This was an institution-based, multi-operator, prospective comparative cohort study employing a quasi-randomized allocation method. The study included patients with BOO due to BPH presenting to Menelik II Hospital beginning in October 2024 to October 2025. Data were collected using a structured questionnaire covering preoperative, intraoperative, postoperative (ward), and follow-up assessments, completed by resident and intern physicians. Statistical analysis was performed using SPSS. Perioperative outcomes and complications were compared. Results: A total of 35 patients were included in the final analysis. Baseline demographics and preoperative clinical characteristics were comparable between two groups. The RPP group showed significantly lower overall complication rates (11.2% vs 55.5%, p = 0.005) and reduced blood transfusion requirements (5.8% vs 11.1%, p = 0.016). Multivariate analysis adjusted for age and baseline hemoglobin (Hgb) showed that RPP was independently associated with a significantly lower postoperative Hgb drop (adjusted mean difference: 1.48 g/dL less; p = 0.006). Postoperative hospital stay was significantly shorter in the RPP group (adjusted mean difference: 1.62 days shorter; p = 0.016), and surgical drains were removed earlier (adjusted mean difference: 1.60 days earlier; p = 0.001). There was no significant difference in operative time (p = 0.449). Short-term patient-reported outcomes at 4–6 weeks, including patient satisfaction and LUTS improvement, were similar in both groups (p > 0.1). Conclusion: Retropubic prostatectomy appeared to be associated with more favorable perioperative outcomes. These findings support adopting RPP as the preferred open surgical technique for BPH in settings where open prostatectomy remains the primary option.
Retrospective Study on Surgical Outcome of Medulloblastoma among Operated Patients.
(Addis Ababa Uinverstiy, 2025) Alemu Gemeda; Yemisirach Buzuneh; Samuel Masresha
Medulloblastoma is a highly malignant primary central nervous system tumor and the most common solid brain tumor in children, contributing substantially to childhood cancer mortality. Pediatric cases often show more aggressive features, while adult tumors tend to have better outcomes. Given these differences and the lack of adequate local evidence, assessing surgical outcomes at Tikur Anbessa Specialized Hospital and MCM hospital is important to guide clinical practice in Ethiopia. Objective: To evaluate the surgical outcomes of patients with medulloblastoma who underwent operative management at TASH, and MCM hospital Addis Ababa, Ethiopia, between May 1, 2018 - September 30, 2025. Methodology: A two-hospital based retrospective cohort study was conducted on 47 patients with medulloblastoma who underwent operative management from May 1, 2018 to September 30, 2025. Data were obtained from medical records, operative notes, pathology reports, and pre- and postoperative imaging using a structured data extraction checklist. Descriptive statistics were used to summarize patient characteristics, while Kaplan–Meier survival analysis and Cox proportional hazards models were applied to assess progression-free and overall survival and to identify factors associated with poor surgical and functional outcomes. Statistical significance was set at a p-value < 0.05. Result: The survival declined markedly, being alive, 37 (78.7%), 95% CI (65.5–88.5) at 1 month, decreasing to 36 (76.6%), 95% CI (63.2–86.9) at 6 months, then 22 (46.8%), 95% CI (33.1–60.9) at 1 year, further to 11 (23.4%), 95% CI (13.1–36.8) at 2 years, and only 2 (4.3%), 95% CI (0.9–13.0) remaining alive at 3 years following surgery. No patient survived at 4 years follow up. The analysis indicates that more complete intraoperative resection is associated with better overall survival and longer progression-free survival. The patients with brainstem compression (AOR = 52.544; 95% CI: 1.754–1574.066) and immediate postoperative complications (AOR = 93.887; 95% CI: 1.985–4440.072), delayed initiation of radiotherapy and younger age were significantly associated with poor functional outcomes in medulloblastoma patients. vi vii Conclusion: In conclusion, survival among medulloblastoma patients declined progressively after surgery, with better outcomes linked to complete tumor resection and older age groups. Brainstem compression and immediate postoperative complications and luck of timely initiation of oncologic intervention were associated with poor functional and survival outcomes, underscoring the need for careful surgical management and postoperative care to improve survival and recovery.
The influence of work-life balance on surgical resident’s performance and satisfaction in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia, 2025
(Addis Ababa Uinverstiy, 2025) Bethlhem Denbel; Zelalem Assefa
Residency, especially in surgical specialties, is notorious for demanding schedules and high stress levels. Surgical trainees often work extended hours and face emotionally and physically taxing duties, which can encroach on personal and family life. Many Surgeons Worldwide reports imbalance between Work and their personal life. In a study done in Ethiopia. Physicians have poor life work balance which lead to poor patient care and increased medical erros. Which shows how negative WLB affects quality of care. Work-life balance is positively associated with well-being and job satisfaction and negatively associated with stress and mental health problems. Conversely, work-life conflict has been found to contribute to burnout, dissatisfaction, and intent to leave the profession Methods institutional based retrospective study done from January 1 2025- dec 31 2025 using online questioners. Results In this study we found that nearly two-thirds (65.5%) of surgical residents met the criteria for burnout. Which is defined as high emotional exhaustion and/or depersonalization. The result is comparable to reports from other surgical training programs, Specially in low- and middle-income countries like Ethiopia. In this resource limited counties prolonged working hours, frequent night duties, and limited institutional support are very common. Emotional exhaustion had the highest mean score among the burnout dimensions. Which shows workloads and long standing stress are major contributors to burnout in the study population. In contrast, personal accomplishment scores were moderate. This shows that despite high level of stress residents have professional fulfilment. Conclusion In conclusion burnout is highly prevalent among surgical residents at Tikur Anbessa Specialized Hospital. This burnout is strongly associated with workload, poor work–life balance, significantly reduce residents’ performance, and lower job satisfaction. In contrast positive work–life balance showed meaningful positive relationships with both performance and job satisfaction. Works targeting and addressing modifiable workplace factors are very important to improve resident well-being, improve job satisfaction and performance, and ensure high-quality patient care.
Outcome and Associated Factors of Two-Step Tract Dilation in a Complete Radiation Free Percutaneous Nephrolithotomy at Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2025-12-07) Endale Demeke; Mesay Mekonen; Abeselom Lemma
Introduction: Percutaneous Nephrolithotomy is the Treatment of Choice for Complex Renal Stones. As Fluoroscopy Carries a Risk of Radiation Exposure, Ultrasound Guidance Has Emerged as an Alternative to Fluoroscopic Guidance. Objective: To Assess the Outcome, Safety and Efficacy of Ultrasound-Guided Percutaneous Nephrolithotomy (PCNL) Using A Two-Step Tract Dilation Method. Methods And Materials: A Cross-Sectional Study was done on 130 Cases That Underwent Ultrasound-Guided PCNL From January 1 to December 30, 2024. The Tract Was Dilated in a Two Step Fashion. In Step 1, after Puncturing The PCS, The Tract Was Dilated To 12 Fr. Then, A 9.5 Fr URS Was Introduced to Evaluate the Tract, Manipulate the Guide Wire, And Scan the Kidney. Finally, In Step 2, the Tract was Dilated to the Required Size. We Evaluated Patients' Demographic Features, Stone Complexity Using the S.T.O.N.E. Nephrolithometry Score, Complications Using the Clavien-Dindo Grading System, And Hospital Stay. On Postoperative day 1, A KUB Was Performed to Assess Stone-Free Status. Postoperatively, Patients were Followed up with Abdominal Ultrasound in the Outpatient Clinic. Results: of the 130 Cases, 84 (64.6%) were Male, And the Mean Age at Presentation Was 39.9 Years. About 35(26.9%) of Patients Had a Previous History of Open Renal Surgery. In 80% of Patients, The Stone Complexity Score Measured By S.T.O.N.E Score Was Between 6 and 8. In 86.9% of patients, only A Single Tract Was Used and the Mean total Duration of Surgery Was 100 Minutes. The Median Hospital Stay Was 2 days. Approximately 77.7% of patients had No Complications. The Mean Hemoglobin Drop Was 1.69 G/Dl, and there was no need for Transfusion. Prolonged urine leak was the most common complication (9.2%), and transient elevation of creatinine was seen at 35/77(45%). the Early Stone-Free Rate was 75.4%. Conclusion: Ultrasound-guided PCNL with two-step tract dilation is an effective and safe modality for performing PCNL and holds significant importance in resource-limited areas.
Short and Long-Term Renal Function Trajectories and Associated Factors Following Ultrasound Guided Percutaneous Nephrolithotomy (Pcnl) Assessed by Estimated Glomerular Filtration Rate
(Addis Ababa University, 2025-10-01) Samuel Fekadu; Abeselom Lemma; Fitsum Solomon
Background: Percutaneous Nephrolithotomy (PCNL) is the Treatment of choice for large and Complex Renal Stones. Information Regarding Stone Clearance Outcomes are Well Established. But, Data on Short- and Long-Term Renal Function Changes After PCNL Procedure, Particularly in Low Resource Settings Is Limited. Objective: Assess Short- and Long-Term Renal Function Pattern After A PCNL Procedure and Identify Factors Associated with Change in Estimated Glomerular Filtration Rate (Egfr) Among Patients Managed at Tikur Anbessa Specialized Hospital Between September 1, 2023 and October 30, 2024 Methods: A Retrospective Cohort Study Was Conducted. A Prospectively Collected Data from a Previous Research Was Supplemented by Electronic Medical Record Review and Analysis Was Done. Patient’s Aged ≥15 Years Were Included. Renal Function Was Assessed Using Egfr (CKD-EPI 2021) At Baseline, 72 Hours, 3 Months, 6 Months, And 12 Months. Longitudinal Egfr Changes Were Analyzed Using Linear Mixed-Effects Models with Multiple Imputation for Missing Predictor Data. Results: 100 Patients Were Included in the Study with Mean Age 41.2 ± 12.8 Years And 67% Male Were Male. Mean Egfr Showed a Transient, Non-Significant Decline At 72 Hours Followed by Progressive Recovery, Exceeding Baseline Values At 12 Months By +5.68 Ml/Min/1.73 M² (P = 0.034) Which Was Not Significant When It Was Adjusted for Other Factors. Old Age and Presence of Comorbidities Were Independently Associated with Lower Egfr at Baseline but Has No Significant Impact on the Patter of Egfr During Follow-Up. Significant Effect of Hydronephrosis and CKD Was Seen on the Pattern of Egfr. Presence of Moderate to Severe Hydronephrosis Showed Poor Recovery Whereas Patients with CKD Stages 3 And 4 Showed Significant Relative Improvement over time. Operative factors were Nnt Independently Associated with Long-Term Renal Function. Conclusion: PCNL Results in a Transient Early Postoperative Decline Followed by Recovery and Long-Term Preservation or Improvement in Most Patients, having no Net Effect on Renal Function. Baseline Renal Function and Hydronephrosis Severity Primarily Determine Postoperative Renal Function Pattern.
Assessment Of Quality of Life of Patients on long term diversion (Percutaneous Nephrostomy Versus Ureteral Stent) Cross-Sectional Comparative Study
(Addis Ababa University, 2025-12-01) Getu Andarge; Abeselom Lemma; Habtamu Aderaw
Background: Obstructive uropathy from Ureteral Obstruction often requires urinary diversion When Definitive treatment Cannot Be Performed Promptly or is not planned at all when patient is a terminal. Two Common Long-Term Diversion options are Percutaneous nephrostomy (PCN) and Ureteric Stenting (Double-J Stent). Understanding how These Modalities affect Patients’ quality of life (Qol) and Clinical Profile is Essential for Informed, Patient-Centered Decision-Making. This Study Attempted to Fill That Gap by Evaluating Qol and Patient Reported Symptoms in adults Managed with PCN versus Ureteric Stents for Prolonged Ureteral obstruction. Methods: This Cross-Sectional Comparative Study Was Conducted at AAU TASH Hospital. Eligible Participants Are Adults Who Have Undergone Urinary Diversion for Ureteral Obstruction and Have Maintained Their Device (PCN Or Ureteric Stent) for at least 90 days. Data Collection Includes Combined In-Person Interviews and Medical Records Review. Qol Was Assessed Using Validated Instruments (Including Euroqol EQ-5D-5L) and a Tube-Related Symptom Questionnaire. Demographic and Clinical were Recorded. Descriptive Statistics Was Used to Summarize Groups, And Inferential Analyses (E.G. Bivariate and Multivariable Regression) Were Used to Identify Factors Associated with Qol Differences Between PCN And Stent Groups, Controlling for Potential Confounders. Ethical Approval was Obtained, and Oral Informed Consent Was Secured from All Participants The PCN Group Mainly included patients with advanced malignancy while the stent group includes patient with benign diseases and prophylactic before major complication. Analysis showed the stent group had a significantly higher overall health state (VAS Mean 59.7 Vs. 43.0, P <0.001) and better overall quality of life in most dominas of euro ol 5D 5L : the Bivariate analysis Demonstrated that mode of diversion, Malignancy Status, Duration And Purpose of Diversion Were Both Highly Significant Predictors of Quality of Life (QOL), and The Subsequent Multiple Regression Confirmed That These only Mode of Diversion And Purpose of Diversion Factors Were The Strongest Independent Variables, Together Explaining 22.2% of The QOL Variance, while Other Clinical Variables Were Not Significant Conclusion-for long-Term Diversion in This Cohort, The Double-J Ureteral Stent is Associated with A Superior quality of life Compared to the Percutaneous nephrostomy. The External Nature of the PCN Tube Imposes an Overwhelming, Independent Burden on Patient Self-Care and Mobility. Clinical Decision-Making Must Prioritize Internal Drainage Whenever Clinically Feasible.
Patternsand Outcome of Pediatrics Mediastinal masses operated at Tikur Anbessa Specialized Teaching Hospital: Five years’ Experience
(Addis Ababa Uinverstiy, 2025) Abebe Tsegaye; Belachew Dejene
Introduction: Mediastinal mass represent congenital anomalies, infectious, Pseudo masses, benign and malignant neoplasms. Over one-half of children with mediastinal mass are symptomatic. Mediastinal mass represents wide varieties of histologic morphology and require many different forms of surgical and non-surgical treatment. Principle involved in the treatment of mediastinal mass are protection of airway from compression, accurate diagnosis and complete resection with minimal morbidity. Material and Method: - Institution based retrospective cross-sectional study was conducted at TASH, Addis Ababa Ethiopia among children who were operated with the diagnosis of primary Mediastinal mass. Patient demographic, Clinical radiological histological and perioperative information collected. Data entered and cleaned using Microsoft excel and was analyzed using the SPSS(IBM)version 26. Result: Primary mediastinal mass was found in 15(55.6 %) of male with Male to female Ratio 1.25:1. Mean age at presentation was 3.53 years with a median size of the mass 6.7 cm. The most common location of tumor was posterior mediastinum 14(51.9 %) followed by Middle mediastinum 9(33.3 %). Bronchogenic cyst (37 %) were the commonest histologic type followed by Duplication enteric cyst (29.6 %), Neurogenic tumor (11.1%), Germ cell tumor (11.1%) lymphatic malformation (7.4 %) and other (3.7) %. Perioperative complication rate was 44.4 % and mortality rate accounts 14.8 %. Most common complication accounts for pulmonary complication 25.9%.%. Injury to the mediastinal structure including major vessels, esophagus and thoracic duct accounts 11.1 %. Conclusion and Recommendation: - Perioperative complications is common after resection of mediastinal mass in children including pulmonary complication, mediastinal structure injury, Drug related complication, SSI and Death. Minimal invasive surgery is possible alternative to open mediastinal mass resection and it has shorter hospital stay with minimal morbidity so our institution can apply this different technique of intervention.
Measurement of Spinopelvic parameters in healthy Ethiopian Adults: a cross-sectional study.
(Addis Ababa University, 2025) Fentahun Bantigegn; Eskinder Kebede; Biruk Lambisso; Alazar Menbere
Background: Spinopelvic alignment plays an important role in understanding spinal biomechanics and planning for surgical interventions to achieve best outcome and avoid complications. Restoration of spinopelvic balance during spinal surgery is very important to ensure a good outcome. Many studies have been conducted on normal range of spinopelvic parameters globally and are found to be population specific. Despite these values known to be different across populations, there was no established normal values for Ethiopian adults. This Study defined normal range of spinopelvic parameters in healthy Ethiopian Adults. Objectives: This study aimed to determine the normal range of key spinopelvic parameters in healthy Ethiopian adults and to analyze the correlations between these parameters and demographic factors such as age and sex. Methods: An observational cross-sectional study was conducted on healthy Ethiopian adult volunteers who visited TASH for various reasons other than hip and spine pathologist. It was conducted at TASH from August 2025 to December 2025. Standing single lateral lumbosacral radiography was obtained under standard conditions after informed consent taken. Two spine surgeons independently measured pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis. Result: in this study, a total of 102 volunteers participated, of whom 55 males and 47 females with median age of 38. The mean values of PI, SS, PT and LL were 52.8 ± 9.5°, 39.3 ± 7.8°,13.3 ± 7.3° and 42.4 ± 10.4° respectively. Females show higher values in all parameters.PT and PI-LL show correlations with age. Strongest association was noted between LL and SS. Conclusions: this is the first study that determine normal range of spinopelvic parameters in healthy Ethiopian adults. All parameters were higher in females. PT and PI-LL increase with age. Our spinopelvic parameters values differ across different studies due to ethnic variations as determined by various studies.
Prosthetic Limb Use, Barriers, and Associated Factors among Lower Limb Amputees at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A cross-sectional Study (2020 - 2025)
(Addis Ababa University, 2025) Nebiyu Elias; Alpha Seifu
Abstract Introduction: Lower limb amputation (LLA) is a global health issue affecting millions of people worldwide. Globally, an estimated 1.5 million people undergo amputations every year and needs access to prosthetic services. This surgical intervention leads to a significant change of an individual’s life that has a very intricate relationship with psychosocial, social, economic, and physical adjustments. Restoring functional mobility and independence through prosthetic limb rehabilitation is therefore a cornerstone of post-amputation care. Methods: An institution-based cross-sectional study was conducted at Tikur Anbesa Hospital, Ethiopia. Data collection was carried out through Reviewing medical charts & telephone calls with participants to complete self-structured questionnaires. Descriptive and binary Regression analysis were performed to analyse data using Statistical Package for Social Science (SPSS)26. Results: A total of 106 patients were included in the study.86 (81.1%) were male with Median age of respondents 50.50 (IQR) of 32.75 - 64 years. 86.8% of the amputations were unilateral, with Below knee(39.6%) and Above knee (56.6%). 55(51.9%) of the participants get a prosthesis. The average time between amputation and fitting of a definitive prosthesis was 7.79 months (SD +/- 5.32 months). The three most reported barriers for not receiving a prosthesis were long waiting time, unsuitable amputation stump and lack of awareness about available prosthetic options. On Regression analysis only, level of amputation found to be associated with prosthetic fitting. Conclusions: While progress is evident, persistent barriers and disparities in prosthetic rehabilitation demand urgent action. By addressing these, Ethiopia can enhance mobility, independence, and quality of life for amputees, fostering social reintegration and reducing the broader socioeconomic burden of limb loss. This study serves as a foundation for evidence-based reforms, ultimately advancing equitable assistive technology access in resource-limited settings.
Outcomes of open vs closed reduction with percutaneous pinning of completely displaced pediatric supracondylar fracture of humerus at Tikur Anbessa Specialized Hospital, a four-year retrospective study
(Addis Ababa Uinverstiy, 2025) Tefera Belay; Birhanu Ayana; Bahiru Bezabih; Samrawit Esayas
Background: Displaced supracondylar humerus fractures (SCHF) are common pediatric injuries. While Closed Reduction and Percutaneous Pinning (CRPP) is the first line treatment, Open Reduction and Percutaneous Pinning (ORPP) is required when closed reduction fails, and when intraoperative fluoroscopic imaging is not available. The comparative functional and cosmetic outcomes of these techniques within our context is not known, leading to variation in perception of surgical practice. Objective: To compare functional and cosmetic outcomes between CRPP and ORPP for displaced SCHF (Gartland types III and IV) in children at TASH. Methods: A retrospective cohort study will be conducted, reviewing medical records of all eligible children (<16 years) treated with CRPP or ORPP for displaced SCHF at TASH between May 1, 2021, and April 30, 2025. Data on patient demographics, fracture characteristics, and operative details will be collected. Functional and cosmetic outcomes will be assessed using Flynn criteria. Complications including nerve palsy, infection, and malunion will be recorded. Statistical analysis using SPSS version 27 (t-tests, chi-square, regression) will be performed to compare outcomes between the two groups. Expected Outcomes: the study will provide crucial, localized evidence on the functional and cosmetic outcomes, and specific complications associated with CRPP and ORPP. The finding is expected to inform the development of an evidence based treatment protocol for displaced pediatric SCHF at TASH, aiming to optimize surgical decision making, improve patient outcomes and guide resource allocation.
Knowledge, Attitude, and Practice of Nurses on the Use of Glutaraldehyde in Urology Departments at Three Hospitals, Addis Ababa, Ethiopia
(Addis Ababa University, 2025-12-08) Tsiyon Nigusie; Messay Mekonnen; Habtamu Aderaw
Background: Glutaraldehyde is a widely used high-level disinfectant for reprocessing heat-sensitive urological instruments such as endoscopes. Although effective when used properly, improper handling or inadequate knowledge of reprocessing protocols can expose patients to healthcare-associated infections and staff to chemical hazards. Despite its widespread use in Ethiopian hospitals, there is limited data on nurses’ knowledge, attitude, and practice regarding glutaraldehyde use in urology departments. Objective: To assess the knowledge, attitude, and practice of nurses on the safe and effective use of glutaraldehyde for urological instrument reprocessing in three tertiary hospitals in Addis Ababa—Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital Medical College, and Minilik II Comprehensive Specialized Hospital. Methods: A cross-sectional study conducted from September 1–30, 2025, by including all nurses working in the urology departments of the three hospitals. Data collected using a structured, self-administered questionnaire covering sociodemographic information, knowledge, attitude, and practice components. A descriptive analysis was used to report the percentages and frequencies. The mean knowledge, attitude, and practice scores were analyzed using an Independent t-test, ANOVA, and Pearson’s correlation tests. Results: A total of 42 urology department nurses participated in the survey. Half of the nurses exhibited average knowledge and only a minority (14.3%) had adequate knowledge.78.6% of nurses demonstrated a strong Positive Attitude toward safety. However, this attitude did not translate into safe practice, as 46.3% of participants demonstrated Inadequate Practice, and only 2.4% achieved an Adequate Practice score. A significant finding was the perceived lack of institutional support: 58.5% strongly disagreed that their workplace provides sufficient Personal Protective Equipment (PPE) and training. Significant difference in the mean overall kAP score is found across the nurses highest professional qualification (p=0.036) and status of nurses on receiving formal training on glutaraldehyde use (p=0.007). Additionally, a significant positive correlation between knowledge-attitude (r=0.238, p0.05), and attitude-practice (r=0.02, p>0.05) was observed. Conclusion: Despite a generally positive attitude and a portion of nurses achieving adequate knowledge, the concerning finding of inadequate practice and the strong perception of lack of resource, adequate training and written, facility-specific standard operating procedures brings a critical challenge. Urgent, interventions are needed to prevent patient infection risk and bring occupational health.
Patterns of Associated Cardiac and Renal anomalies in Anorectal Malformation/ARM/ Patients seen at Black Line Hospital, Addis Ababa Ethiopia, November 2024 - October 2025.
(Addia Ababa University, 2025-10-12) Yidnekachew Getachew; Miliard Derbew
Background: Anorectal malformations (ARM) encompass a broad spectrum of congenital anomalies affecting the distal gastrointestinal tracts like anus and rectum as well as urinary tract, and genital tract in both boys and girls. These anomalies range from minor, easily managed cases with excellent functional outcomes to complex cases that are challenging to treat, often associated with other anomalies, and have poor functional prognoses. Approximately 50% of ARM cases present with additional defects or are part of a syndrome. Methods: This study was employed as an institution-based prospective cohort design. It involves direct physical examination and by reviewing medical records of cases seen or managed at Black Lion Specialized Hospital between November 2024 and October 2025. The source population was included all children admitted during this period. The study population consist of children diagnosed with ARM. Result A total of 59 children diagnosed with anorectal malformation (ARM) were admitted to Black Lion Specialized Hospital during the study period. Of these, 35 (59.3%) were male and 24 (40.7%) were female. The age at presentation varied: 21 children (35.6%) presented within the first 24 hours of life, while the oldest patient was a 10-year-old boy with ARM and rectoperineal fistula. Regarding the types of ARM, the most common in males were rectoperineal fistula (n=12, 34.3%) and ARM without fistula (n=11, 31.4%). In females, rectovaginal fistula was the most frequent (n=13, 54.2%), followed by persistent cloaca (n=5, 20.8%). Associated congenital anomalies were common. Cardiac anomalies were present in 29 patients (49.2%), with atrial septal defect (ASD) and patent ductus arteriosus (PDA) being the most common structural heart defects. Renal anomalies were detected in 12 patients (20.3%), predominantly hydronephrosis and renal ectopia. Conclusion and recommendation: A substantial proportion of children with anorectal malformation (ARM) presented to the hospital beyond 72 hours of life, underscoring the persistent need for enhanced awareness, clear communication, training, and logistical support to primary healthcare facilities and community health workers to promote early detection, prompt referral, and timely definitive management. Additionally, this study revealed that a significant number of patients, particularly males, had ARM without an overt fistula to the urinary tract (no visible fistulous communication). Consequently, a distal colostogram should be routinely performed in all cases as a fundamental diagnostic tool to precisely define the distal rectal anatomy, confirm the level of rectal atresia, identify possible occult fistulas, and guide the optimal surgical approach during definitive corrective surgery. Also MRI can be used in selected cases to see the exact location of the rectum, identify fistulas, visualize pelvic muscles and sacral bone structures, and find associated anomalies guiding precise surgical repair for better functional outcomes.
Prevalence of Musculoskeletal Complications among Hemophilia Patients as Seen inTikur Anbessa Specialized Hospital.
(Addis Ababa Uinverstiy, 2025) Bizuayehu Amanu; Binyam Dagmaw
Background: Hemophilia is an X‑linked bleeding disorder caused by deficiency of factor VIII (Hemophilia A) or factor IX (Hemophilia B). Repeated bleeding into joints and muscles leads to musculoskeletal complications, accounting for 70–80% of hemorrhagic episodes. There is no local data showing musculoskeletal complications in Ethiopia. Methods: A descriptive cross‑sectional study was conducted among 149 male hemophilia patients attending Tikur Anbessa Specialized Hospital. Data were collected through structured interviews, physical examination, and review of hematology clinic records and recorded using Cobo toolbox. Statistical analysis was performed using Statisty application, with p < 0.05 considered significant. Results: Musculoskeletal complications were identified in 83.9% of patients, including hematomas (91.3%), pseudotumor (9.4%), muscle atrophy (36.2%), joint swelling (65.1%), loss of range of motion (57.0%) and joint instability (16.8%). Pain was reported by 79.9%, most commonly in the knees (80.7%), followed by elbows (34.5%) and ankles (22.7%). Statistical analysis revealed significant associations between factor level ( p< 0 .01) and treatment modality ( p<0.001) with musculoskeletal complications, while age of the patient, age at diagnosis of hemophilia, and hemophilia type were not statistically significant. Conclusion: Most of patients (83.9%) have musculoskeletal complications among hemophilia patients in Tikur Anbessa Specialized Hospital, with knees disproportionately affected. The treatment modality (p < 0.001) and factor level(p < 0.01) are significantly associated with musculoskeletal complications among hemophilia patients.
Enhanced Recovery After Surgery Protocol as Innovative Solution for Improving Surgical Patients’ Outcome in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.
(Addis Ababa University, 2025-04-19) Peniel Kenna; Girmay Medhin; Abebaw Fekadu; Tihitena Negussie
Introduction: Close to a third of the global disease burden is accounted for by surgical conditions. The 76th World Health Assembly Agenda item 13.1 highlighted urgent actions needed to enhance surgical care. With 18-25% postoperative complication rate, application of the Enhanced Recovery After Surgery (ERAS) protocol is advised. The aim of this study was to assess the effectiveness of the ERAS protocol in improving short-term and intermediate surgical patient outcomes in Low- and Middle- Income Countries (LMICs). Methodology: We conducted systematic review and meta-analysis and the protocol was registered in the PROSPERO database (CRD42024524807). A systematic search for observational studies and clinical trials was conducted in PubMed, Scopus, Cochrane, and Web of Sciences along with online trial registries and Google Scholar. Search strategy includes keywords related to “Enhanced Recovery After Surgery”, “ERAS”, “Fast-Track Surgery”, “LMICs”, and names of LMICs. Reference sections of the included studies were manually searched. Risk of bias of included studies were assessed using Cochrane risk of bias and Newcastle-Ottawa scale. Results: A total of 1332 studies were initially identified and after removing duplicates, 1243 studies remained, with 56 papers eligible for full-text review. Eight studies were identified from reference section and were added to evidence synthesis. Thirty-five studies, 23 clinical trials and 12 observational studies were included for review and 33 studies were included for meta-analysis. Eighty-four percent of the publications were from south and southeast Asia. Comparable number of participants were distributed in the intervention (3,163) and control (3,243) groups. The studies comprised mostly abdominal surgeries (n=17). Each study compared ERAS protocols with routine perioperative care. Meta-analysis indicated significant reduction of postoperative morbidity following the implementation of the ERAS protocol [(RR=0.73; 95%CI, 0.55 to 0.76) with (I^2) of 1.1% (P-value of 0.44)]. Also, significant reduction in postoperative length of hospital stay was observed when ERAS protocol was implemented [(SMD= -0.67 [95%CI -0.54 to -0.82]) with I^2 = 76.8]. There was no significant difference in postoperative mortality and readmission rate. Conclusion: Improved patient outcomes related to reduced postoperative complication rate and length of hospital stay were observed with ERAS application. The ERAS protocol appears promising in LMICs for enhancing surgical patient outcomes; Hence, we recommend its application. Although there could be ERAS implementation cost, its role in expediting patient recovery could reduce costs related to hospitalization.
Thirty Days Posoperative Outcome After Radical Cystectomy and Associated Factors at TASH, Ethiopia.
(Addis Ababa University, 2025-07) Woretaw, Anmut; Bekele, Seyefe (Ass.Prof.); Melaku, Admasu (Ass.Prof.)
Background: radical cystectomy is one of the complex and technically demanding urologic surgeries. It is done usually for non-metastatic muscle invasive bladder cancer. Globally the morbidity and mortality rate is significantly high, even the advancement of operative techniques doesn’t change the outcome significantly. And, the outcome of RC is not well studied in Ethiopia including in the study area. Objectives: The objective of this study was to assess the thirty days postoperative outcome of open radical cystectomy and associated factors among patients who were operated at Tikur Anbesa Specialized Hospital. Method: Institution based cross sectional retrospective study was conducted on consequently selected patients who were operated in Tikur Anbesa Specialized Hospital from September 2020 to May 2025. Data was collected using Kobotoolbox from the patients’ medical records. Then exported to Excel and exported to SPSS version 25 after cleaned. Subsequently descriptive analysis and binary logistic regression was done. Association between independent and outcome variables studied using multivariable logistic regression. Variable with p –value <0.05 was used to declare the level of significance. Result: A total of 35 cases were analyzed the average age was 55.54 years. Male sex accounts for 74.3%. ONB was done in 25.7% whereas the rest was IC. 45.7% of the operated patients were with smooth post-operative course others developed minor and major complications. Pre and post-operative biopsy showed 32 cases were urothelial cancer whereas 3 cases were non-urothelial cancer.in 22 cases post-operative biopsy was found and marginal status define. Of these 22 cases 68.2% was margin positive. There were about 4 deaths early post operatively due to surgical causes. Multivariable regression analysis showed serum albumin level <3g/dl was associated with post-operative complication with p-value of 0.019 and adjusted odds ratio of 14.54. Conclusion: The 30 day mortality and morbidity rate were 11.4% and 54.3% respectively. Serum albumin <3g/dl was associated with post-operative complication.
Analysis of clinical presentation of prostatic cancer patients at TASH: Two-year retrospective cross-sectional study
(Addis Ababa University, 2025-07) Muluneh,Sewunet; Melaku,Admassu(Ass.Prof.)
INTRODUCTION: Prostate cancer is second most diagnosed cancer exceeded by lung cancer only across globe and it is fifth leading cause of cancer associated mortality. It is number one cause of cancer death in men in 48 countries which includes many countries in sub-Saharan Africa. In Ethiopia, it was the third most diagnosed cancer and eighth cause of cancer death in 2013 in both sexes. In Ethiopia, in 2019 and 2020, it was second leading cancer in incidence in males with reported new cases of 2,570 & 2,720 respectively. OBJECTIVE: The study describes clinical presentation of prostatic cancer patients seen at outpatient department of Urology unit of TASH from 31st December,2023 to 1st January ,2025 GC. METHODS: The study was two-year cross-sectional descriptive study on prostatic cancer patients seen at Urology unit of TASH, Addis Ababa, Ethiopia from 31st December, 2023 to 1st January, 2025 GC. The questionnaires were used extract data of study population from patients’ chart by data collectors to collect the necessary information and phone call was used to get additional information from patients. Data collected with kobo toolbox, entered to spreadsheet and analysed by SPSS version 26. The findings of the study were summarized with Descriptive statistics and results presented in the form of text, table, and chart. Pearson chi-square test, Bi variable and multi variable logistic regression analysis used to explore association between different variables. Significant associations were declared at P-value <0.05 on multi variable logistic regression analysis. Results: 98.4% of the patients were symptomatic at time of diagnosis with 97.7% having LUTS and 33. 9% having metastatic symptoms. 24.4% have locally advanced cancer and 34.2% have metastatic prostate cancer. The ISUP grade group 4 and 5 account for 97% of cases, PIRADS 4 and 5 account for 67.5% of cases and mean PSA at time of diagnosis was 285ng/ml. Conclusion: 98.4% of the patients were symptomatic at time of diagnosis. Majority of patients were diagnosed with advanced of stage prostate cancer with higher Gleason's score, higher PIRADS score and high PSA at time of diagnosis. On multimodal regression analysis, Gleason’s score has significant association with PIRADS score and digital rectal examination finding. TNM staging has significant association with residential area, educational status, presence of symptoms at presentation, PIRADS score and digital rectal examination in the study. Work plan and budget: The study was conducted from March, 2025 GC to May, 2025GC with total budget of 47,491.4 Ethiopian birr.
Prevalence and Associated Risk Factors of Early Local Complications After Total Laryngectomy in Laryngeal Carcinoma Patients at Tikur Anbessa Hospital and Yekatit 12 Hospital Medical College: a Retrospective Study Over 5 Years.
(Addis Ababa University, 2025-02) Zelalem, Welelew; Bogale, Mesele (Ass. Prof); Arusi, Mohammedsefa (Ass. Prof)
Background: Laryngeal carcinoma is the most common site of malignancy in the head and neck worldwide. Total laryngectomy is the standard surgical treatment for management of locally advanced laryngeal and hypopharyngeal cancers. Complications after total laryngectomy have significant impact on morbidity and health care cost, leading to prolonged hospitalization, further operations, permanent sequelae, and sometimes a fatal outcome. Studies from various countries report that the prevalence of early postoperative complications after laryngectomy ranges from 9% to 25%. In Ethiopia, the prevalence and risk factors of early local complications in total laryngetomy patients is not yet studied. Objective: To determine the prevalence and associated factors of early local complications in laryngeal cancer patient who had total laryngectomy at Tikur Anbesa Hospital and Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2025. Methods: A retrospective study design was conducted to determine the magnitude of early local complication and associated risk factors in laryngeal cancer patients for whom total laryngectomy was done at Tikur Anbesa Hospital and Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia from January 1 to 30 2025. All patients with a diagnosis of laryngeal cancer for who total laryngectomy was done at Tikur Anbesa Hospital and Yekatit 12 Hospital Medical College from January 2019 to December 2024 were included. Data were collected using a structured checklist questionnaire by using Kobo tool box was imported to SPSS for analysis and interpretation. Descriptive statistics was used to describe baseline patient characteristics. To identify the independent effects of the factors logistic regression analysis was employed and those variables with a p value <0.05 was considered as a significant predictor factor for early local laryngectomy complications. Result: A total of 43 patients met the inclusion criteria and were enrolled in the study. The mean age 58.52 years (SD = 12.21, range: 30–82 years). There were 41 males and 2 females with a ratio of 21 to 1. All patients 100% presented with voice change. A large majority of patients 93.0% reported shortness of breath while throat pain/discomfort and stridor present in 88.4% percent of patients each and the least was neck swelling in 16.3 %. The majority of patients 83.7 % were diagnosed at TNM Stage IV with smaller proportion 16.3 % were at Stage III disease. Nodal stage of the disease shows 74.42% N0, 13.95%, N1 and 11.63 % N2. Only smaller proportion (4.7%) had partial pharyngectomy. Preoperative tracheostomy was done in 79.1% of patients. The most commonly used neopharynx maturation was the vertical method (41.9%). Pharyngocutaneous fistula was observed in 20.9% of cases. Wound infection, bleeding and hematoma, mortality rate, chyle leak reported in 34.9%, 11.6%, 4.7%and 2.3% of cases respectively. Conclusion: This study highlights that wound infection is the most prevalent postoperative complication following total laryngectomy, affecting nearly one-third of patients. Given the high prevalence of wound infections and pharyngocutaneous fistulas, enhanced perioperative care, strict infection control measures, and optimized surgical techniques are essential to improve patient outcomes. Further prospective studies are recommended to better understand the risk factors and develop targeted interventions to reduce postoperative complications in laryngeal cancer patients undergoing total laryngectomy in Ethiopia.
Research done on patient and/or parent satisfaction among patients underwent hypospadias surgery at TASH and DMCSH; Three years cross sectional, prospective study; Ethiopia, 2022
(Addis Ababa University, 2023) Misgea,Abdureuf; Temesgen,Fisseha(MD)
Introduction Hypospadias is one of the most common congenital anomalies in boys, occurring in 1 in 150 to 300 live births (Elliott et al., 2011; Springer et al., 2015) followed by Down’s Syndrome, Cleft Lip and Spinal bifida. Surgeon perspective of outcome assessment is vital; but it will not be complete without patient input. In spite of what surgeons may determine a successful repair, parental and patient perception of their outcomes may differ (Lorenzo et al., 2014; Mureau et al., 1996). Longitudinal studies following hypospadias repair are still rare and the real impact in adolescence and adult life remains uncertain. This may be due to lack of condition specific validated patient-related outcome (PRO) measures and objective tools to evaluate young people and families The study was done determine the Parent reported outcome of hypospadias repair in our institution and to identify the effects of factors on post-operative PRO. Objective The objective of study was to assess patient and/or parent satisfaction among patients underwent hypospadias surgery for three years in TASH and DMCSH; 2022 Methodology The study was conducted in TASH and DMCSH for children with hypospadias operated during January, 2019 – December, 2021. Data was collected in four major stages as chart retrieval, address identification, phone communication and data analysis. The study design was hospital based cross sectional descriptive. Result and Discussion Potential variables identified for confound of association for post hypospadias surgery satisfaction includes age, location, type of hypospadias, type of first procedure, and total number of procedure. Bivariate and multinomial logistic regression was done with above variables showed that there is strong association of satisfaction level with localities from Addis Abeba (P=0.02, 95% CI) Our study revealed that locality or address, type of hypospadias, and repeated procedures all shares major contribution in reducing our patients and parents level of satisfaction after hypospadias surgery. We are also showed that it is possible to assess post-operative PRO and post-operative follow up by the use of mobile phones with consistency of operating team and strong network connection. Conclusion and Recommendation Parental and /or patient related outcome assessment and satisfaction level has paramount importance than surgeon oriented outcome assessment. We can use phone calls for post hypospadias surgery satisfaction assessment without much difficulty.

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