A. Thiam

Place de la pulpectomie bilatérale dans la suppression androgénique pour cancer de la prostate

PURPOSE To report the oncologic results and morbidity of bilateral pulpectomy and to identify factors that make this method of androgen suppression therapy the most used in our country. PATIENTS AND METHODS We conducted a prospective study in the urology department of Aristide Le-Dantec hospital (Dakar) between January 2008 and June 2010 (30 months). It included 84 cases of prostate cancer treated by bilateral pulpectomy under local anesthesia. RESULTS The mean age of patients was 72.17±12.48 years (53-91). The median PSA level was 101 ng/mL (12.18-9990). Metastasis have been detected in 75% of cases. The Gleason score was higher than 7 in 40 patients (47.6%). Three months after pulpectomy, an improvement of performance status was seen in 76 patients (90.4%). The back pain significantly decreased in intensity or disappeared in 65.3% (32/49) of cases. A complete recovery of lower limbs motor deficit was observed in 50% of cases (7/14). The PSA levels decreased in 57 of the 76 patients alive and the mean PSA level was then 72±11.7 ng/mL (3.8-2433). At six months, of the 53 patients in urinary retention, 18 had recovered spontaneous and complete urination. The PSA level was below 4 ng/mL in 33.8% (22/65) of cases and between 4 and 10 ng/mL in 52.3% (34/65) of cases. At 12 months, the median PSA nadir was 0.76 ng/mL (0,002-8,17) and 57.4% of the 54 patients alive had a PSA nadir less than 2 ng/mL. The mean follow-up was 11.08±10.34 months (1-30). A rising PSA occurred in 17 patients (20.2%) after an mean progression-free survival of 10.5 months (6-25). The overall survival at 6, 12 and 24 months were respectively 77.3, 64.3 and 52.3%. The overall cost of pulpectomy was 50 000 FCFA (76€). The specific morbidity of pulpectomy was two cases (2.4%) of infection of the operative site. CONCLUSION The bilateral pulpectomy was a method of androgen suppression immediately effective, efficacious with a low morbidity. Its very low cost is the main reason why it is still the most used method in our country.

La pathologie du canal péritonéo-vaginal en pratique urologique

PURPOSE To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams. PATIENTS AND METHODS We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment. RESULTS A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences. CONCLUSION Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams. LEVEL OF EVIDENCE 5.

Plastic Surgery of Male External Genitalia after a Trauma Caused by a Mill in Rural Area

The trauma of the external genital organs is a common urological emergency that can affect the patients functional and psychosocial prognosis as well as his family. We report a case of direct trauma of the external genitalia of a 27-year-old by a mill, requiring a recover plastic surgery in rural area. The examination at admission revealed a significant damage of penile and scrotal skin, denuding testes and cavernous bodies. A cover plastic surgery was performed. After a year of follow up, the outcome was good.

Penile and scrotal plasty for genital elephantiasis: A case report

Introduction: Filarial penoscrotal elephantiasis is a chronic lymphangitis with hypertrophy of the external genital organs (EGO) and still exists in countries with endemic filarial diseases. Case Report: We report a penile-scrotal elephantiasis case in a 20-year-old patient. He consulted for a scrotal mass reaching the knees with low urinary tract symptoms (LUTS) due to the burial of the penis. Excision followed by a scrotal skin plasty was performed. The aesthetic and the long-term functional results were satisfactory. Conclusion: The elephantiasis of external genital organs is becoming less and less frequent as a condition and surgery always occupies a place of choice in its management.

Fistules vésicovaginales posthystérectomie

OBJECTIVE Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF). PATIENTS AND METHODS We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure. RESULTS Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure. CONCLUSION In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.

Cancer du pénis au Sénégal : aspects cliniques et thérapeutiques

RésuméButsdécrire les aspects cliniques et thérapeutiques des cancers de la verge au Sénégal.Patients et méthodesnous avons effectué une étude rétrospective qui s’est intéressée aux dossiers des patients suivis pour cancer de la verge au service d’urologie du CHU Aristide Le Dantec entre janvier 2000 et décembre 2011.Résultatshuit patients d’âge moyen de 51,5 ans avec des extrêmes de 27 à 77 ans ont été répertoriés. Ils étaient tous circoncis dans l’enfance. L’examen clinique avait mis en évidence une tumeur ulcérobourgeonnante intéressant le gland et une partie du corps de la verge dans cinq cas; dans deux cas, elle intéressait la totalité de la verge alors que seul un cas était limité au gland. Les patients étaient ainsi classés selon le système TNM 2002 de l’UICC en cT2 (quatre cas), cT3 (trois cas) et cT1 (un cas). Le type histologique de la tumeur était le carcinome épidermoïde chez tous les patients. Il n’y avait pas de localisation secondaire au scanner thoracoabdomino-pelvien. Sur le plan thérapeutique, une pénectomie partielle a été réalisée dans cinq cas, une pénectomie totale avec curage ganglionnaire dans un cas. Deux patients ont refusé le traitement chirurgical. Aucune récidive n’était notée chez les cinq patients ayant subi une amputation partielle du pénis. La survie globale était donc de 83,3 % pour les patients opérés.Conclusionle cancer de la verge est rare au Sénégal. La prise en charge est délicate du fait du diagnostic tardif avec des lésions évoluées, d’où l’importance d’une sensibilisation des populations.AbstractObjectiveDescribe the clinical and therapeutic aspects of penile cancer in Senegal.Patients and methodsWe conducted a retrospective study that looked at records of patients followed for penile cancer in the urology service of the Aristide Le Dantec hospital between January 2000 and December 2011.ResultsEight patients of mean age of 51.5, with extremes of 27 and 77 have been identified. They were all circumcised in childhood. Clinical examination had highlighted ulcerated and burgeoning tumor affecting glans and a part of the penis in five cases; in two cases, it concerned the entire penis, while one case was limited to the glans. Patients were thus classified according cT3 (three cases) and cT1 (one case). The histological type of the tumour was, in all patients, squamous cell carcinoma. There was no secondary location in the thoracic-flow-pelvic scanner. Therapeutically, a partial penectomy was conducted in five cases, a total penectomy with ganglionic flushing in one case. Two patients refused surgical treatment. There was no recurrence in five patients who underwent a partial amputation of the penis. Overall survival was therefore of 83.3 for surgical patients.Conclusioncancer of the penis is rare in Senegal. The support is delicate because of late diagnosis associated with advanced lesions, hence the importance of awareness of the population.