Management of urinary tract stones in Ghana: a national review and practice audit

Abstract

Background: Urinary stone disease (USD), defined as the formation of hard mineral and salt deposits (stones) within the urinary tract, remains a growing concern in Ghana, reflecting both traditional risk factors and emerging lifestyle changes. In response, the Ghana Association of Urological Surgeons (GAUS) conducted a national review of practice patterns to assess the progress in adopting modern treatment modalities and identify persistent challenges.

Methods: A retrospective survey was carried out across urological centres in Ghana from January to December 2023. Data were collected using a standardised template that captured patient demographics, stone location, and treatment modalities. The findings were analysed and compared with global trends, particularly regarding economic and infrastructural contexts.

Results: A total of 268 cases were reported from five of the six teaching hospitals and four private hospitals in the country (66.4% male, mean age 46.3 years). Upper urinary tract stones (kidney, ureter, renal pelvis) accounted for 232 cases, 99.6% of which were treated using endoscopic or non-invasive methods. These included ureteroscopy (URS) with laser fragmentation (91 cases), percutaneous nephrolithotomy (PCNL, 61 cases), extracorporeal shock wave lithotripsy (ESWL, 30 cases), double J (DJ) stenting (seven cases), and medical expulsive therapy (MET, 42 cases). Only one open pyelolithotomy was recorded. Conversely, 77.8% of lower urinary tract stones (32 bladder, four urethral) were managed by open surgery, reflecting the frequent need to simultaneously address underlying pathologies, such as benign prostatic hyperplasia (BPH) or strictures.

Discussion: Ghana’s endourological capability for upper urinary tract stone management has reached global standards, with the absence of open ureteric procedures highlighting effective skill distribution and inter-facility referrals. However, lower tract stone management remains surgically invasive due to anatomical, logistical, and economic realities. Key systemic challenges include equipment maintenance costs, reliance on external vendors, and limitations in biomedical engineering support.

Conclusion: Ghana has achieved significant milestones in modern urological care for USD, especially in the upper urinary tract. Addressing the remaining gaps, particularly in equipment sustainability and minimally invasive access for lower tract stones, requires a coordinated policy and investment framework.