B. Diao

Les urgences urologiques en milieu hospitalier universitaire à Dakar : aspects épidémiologiques, cliniques et thérapeutiques

OBJECTIVE To present the epidemiological, clinical and therapeutic features of the urological emergencies in Senegal, West Africa. MATERIAL AND METHODS The authors conducted a 20 months retrospective study that analyzed the epidemiological, clinical and therapeutic features of all urological emergencies admitted to the urology department of the university teaching hospital Aristide-Le-Dantec (Dakar). RESULTS There were 1237 urological emergencies. The mean age of the patients was 58.8 years (range one month-94 years). The sex ratio (M/F) was 20.32. These patients had an age equal to or higher than 60 years in 50.7% of the cases. The most frequent illness was urinary retention (53%) and genitor-urinary system infectious, which represented as a whole 16.4% of the cases. The gangrenes of male external genitalia (Fourniers gangrene) accounted for 4.1% of the cases and the priapism 1.3%. In emergency, 331 surgical operations were performed. The most performed procedures were the installation of a suprapubic catheter (59.8%) and debridement of a gangrene of male external genitalia (15.4%). CONCLUSION The most frequent urological emergency in our country was the acute urinary retention. Some serious illness like gangrene of male external genitalia (Fourniers gangrene) and priapism are not rare there.

Syndrome de Prune Belly : aspects épidémiologiques, cliniques et thérapeutiques

UNLABELLED Prune Belly syndrome (PBS) is a rare complex malformation with male predominance. His pathogeny is not yet completely elucidated. The goal of this work is to analyze the epidemiological, anatomoclinical and treatment aspects of a retrospective trial in Aristide-Le-Dantec Hospital. PATIENTS AND METHODS We carried out a retrospective study about 22 cases collected in the departments of urology-andrology and pediatric surgery in Aristide-Le-Dantec Hospital between April 1995 and November 2004. RESULTS The mean age of the patients was 15 months with extremes of one day and 10 years. The somatic examination revealed 20 cases of complete abdominal muscle aplasia, one right partial form and the last case had a left partial form. Nineteen patients were managed with conservative treatment and three patients benefited a surgical act for urinary abnormalities. The Montfort intervention was performed in two patients respectively aged eight and 10 years. The orchidopexy, stage 1, by Fowler-Stephens technique was performed in 13 cases. Five cases of death and nine cases of testicular atrophy after orchidopexy occurred. The followings were satisfactory in the three operated patients for urinary abnormalities. CONCLUSION The renal failure is the main cause of death. The management of the urinary tract abnormalities must be performed individually. The testis descending should be performed in newborn period to enhance the fertility chances. The abdominoplasty also should be done early for aesthetic reason and to improve pulmonary, defecation, and voiding functions.

Les cancers de vessie au Sénégal : particularités épidémiologiques, cliniques et histologiques ☆

OBJECTIVE To present the epidemiological, clinical and histological profile of the bladder cancer in Senegal. MATERIAL AND METHOD The authors conducted a retrospective study based on registries and clinical data of patients admitted for bladder cancer confirmed by the histology at the university hospital Aristide-Le-Dantec of Dakar. RESULTS Four hundred and twenty-eight bladder cancers were recorded. The incidence of the bladder cancer was 2.5% of the whole of cancers. The mean age of the patients was 45.5 years (range 12-86 years). The sex-ratio was 1.25. The majority of the patients consulted for low urinary tract symptoms (94.5%) and hematuria (88%). The prevalent histological type was squamous cell carcinoma (50.70%). CONCLUSION The bladder cancer in Senegal is a cancer of the young adult. The prevalent histological type is squamous cell carcinoma.

Cancer sur testicule non descendu intra-abdominal. A propos de 5 cas

Resume Le cancer du testicule est une pathologie rare chez le noir africain. Nous rapportons une serie de 5 observations de cancer de testicule sur testicule cryptorchide. Patients et methodes Nous avons realise une etude retrospective de 5 cas de cancer du testicule sur testicule cryptochide. Nous avons recueillis l’âge des patients au moment du diagnostic, les circonstances de diagnostic, les taux des marqueurs tumoraux et les resultats anatomo-pathologiques apres exerese de la tumeur. Les patients ont fait l’objet d’une description basee sur le resume de leur observation. Resultats L’âge moyen etait de 30,6 ans (27 ; 34). Un seul patient etait pere d’un enfant au moment du diagnostic. Tous les patients ont consulte pour mauvais etat general associe a une masse abdominale palpable. L’elevation des marqueurs tumoraux etait inconstante. Une effraction capsulaire a ete notee chez trois patients avec un cas de rupture dans la cavite peritoneale. Sur le plan ana-path, nous avons trouve 3 carcinomes embryonnaires et 2 seminomes. Il existait des metastases ganglionnaires chez trois patients. Conclusion La rarete des cancers des testicules intra-abdominaux ne doit pas les faire meconnaitre. Le diagnostic precoce de ces tumeurs passe par l’abaissement des testicules cryptorchides car meme si cet abaissement ne previent pas ces tumeurs, il permet une meilleure surveillance.

Auto-amputation récidivante du pénis sur terrain schizophrène: à propos d’un cas

ResumeTraumatismes rares, les amputations du pénis sont le fait de patients psychotiques dans la grande majorité des cas. La schizophrénie est le trouble psychotique le plus fréquemment retrouvé.La prise en charge des automutilateurs génitaux est avant tout psychiatrique; cette prise en charge psychiatrique permettant d’assurer une acceptation de l’acte chirurgical par ces patients.AbstractPenile amputation is a rare form trauma, usually occurring in psychotic patients, mostly with a diagnosis of schizophrenia.The management of self-mutilation of the genitalia is primarily psychiatric, designed to ensure acceptance of surgical repair by the patient.

La dysfonction éréctile au Sénégal: Profil épidemiologique

RésuméEn Afrique, le vécu du patient présentant une dysfonction érectile (DE) est rendu particulier par la polygamie, et il existe peu de données sur cette pathologie. L’objectif de notre étude était de rapporter le profil épidémiologique des DE dans la population générale sénégalaise en adoptant un protocole standardisé basé sur l’Indice International de la Fonction Erectile (I.I.E.F.5) version française.MéthodologieII s’agit d’une enquête prospective transversale randomisée, qui s’est intéressée aux sujets âgés de 18 ans et plus. Un questionnaire auto administré totalement anonyme comportant deux parties, était utilisé : une première partie donnant des renseignements sur l’état civil, le terrain, l’existence d’une dysfonction ’rectile, les troubles sexuels associés, les pathologies associées, et une deuxième partie basée sur l’I.I.E.F.5. Deux groupes ont été identifiés : Groupe DE (sujets présentant une dysfonction ’rectile) et Groupe non DE (sujets ne présentant pas de dysfonction ’rectile). Au plan statistique, la différence entre les deux groupes concernant l’étude d’un caractère était considérée comme significative pour p ≤ 0,05 au test duKhi 2. Résultats La prévalence globale de DE était de 26%. La prévalence par tranche d’âge a révélé une augmentation progressive du taux de dysfonction érectile avec l’âge, passant de 11% entre 20 et 30 ans, à 76% entre 70 et 80 ans. Le nombre de polygames était significativement plus important chez les patients présentant une DE (29,2%) par rapport au groupe non DE (6,6%) (p < 0,0001), et la sévérité des DE augmentait avec le nombre d’épouses. Le nombre d’éthyliques chroniques était significativement plus important dans le groupe DE (p=0,023).Le taux de DE augmentait avec la durée de l’intoxication tabagique, passant de 11,9% pour une durée inférieure à 5 ans, à 16,9% de 5 à 10 ans, pour atteindre 71,2% lorsque la durée de l’intoxication est supérieure à 10 ans. Certaines affections (diabète, hypertension artérielle et dépression nerveuse) étaient significativement plus fréquentes dans le groupe DE. L’analyse du type de la DE avait permis de révéler que le taux des DE secondaires (95,6%) était plus important que celui des DE primaires (4,4%). Les troubles sexuels associés étaient plus importants dans le groupe DE avec une différence significative.AbstractThe life of patients in Africa with Erectile Dysfunction (ED) is made particularly difficult in men married to many wives and few data are available on this disorder. The purpose of this study was to report the epidemiological profile of ED in the Senegalese general population using a standard protocol based on the simplified version of the International Index of Erectile Function (IIEF5) translated into French and validated.MethodologyThis was a transverse randomized survey of subjects over the age of 18 years. Subjects completed a self-administered questionnaire composed of two parts. The first part contained information on demographic characteristics, associated diseases, erectile dysfunction and associated sexual disorders and the second part was based on IIEF5. Two groups were identified: a group with erectile dysfunction (ED group) and another group without erectile dysfunction (No ED group). Differences between the two groups were considered to be statistically significant for p ≤ 0.05 on the Chi-square test.ResultsThe global prevalence of erectile dysfunction was 26%. The prevalence by age-group revealed a progressive increase of ED with age from 11% between 20 and 30 years to 76% between 70 and 80 years. The rate of polygamous men was significantly higher in the group with ED (29.2%) compared to the group without ED (6.6%) (p < 0.0001) and the severity of ED increased in relation to the number of wives. Chronic alcoholism was significantly more frequent in the group with ED (p = 0.023). The frequency of ED increased with the duration of cigarette smoking from 11.9% for less than 5 years, 16.9% between 5 years and 10 years and 71.2% for more than 10 years. Some diseases (diabetes, hypertension and depression) were significantly more frequent in the group with ED. Analysis of the type of ED revealed that secondary erectile dysfunction was more frequent (95.6%) than primary erectile dysfunction (4.4%). Associated sexual disorders were significantly more frequent in the group with ED.

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.

Varicocèle et infertilité masculine

RésuméIntroductionLa responsabilité de l’homme dans l’infertilité du couple est établie par plusieurs travaux. Le but de ce travail est de rapporter les aspects cliniques, spermiologiques de la varicocèle et d’évaluer les résultats de la varicocélectomie rétropéritonéale à ciel ouvert.Patients et méthodesIl s’agit d’une étude rétrospective évaluant les résultats de la varicocélectomie rétropéritonéale à ciel ouvert, dans le service d’urologie-andrologie du centre hospitalier et universitaire Aristide-Le-Dantec de Dakar, Sénégal. Nous nous sommes intéressés aux patients suivis pour infertilité du couple, porteurs de varicocèle et chez la (les) partenaire(s) de qui aucune autre cause d’infertilité n’a été décelée. Pour l’évaluation des résultats, nous avons comparé les moyennes des paramètres spermatiques pré-et postopératoires en utilisant le test Z (test de comparaison de deux moyennes sur deux séries appariées). Une différence était considérée comme significative si p inférieur ou égal à 0,05.RésultatsCinq cent quatorze dossiers ont été retenus au cours de l’exploitation sur une période de six ans (janvier 2005–décembre 2010). L’âge moyen de nos patients était de 36,5 ± 7,3 ans. L’infertilité était primaire dans 62,4 %. L’exploitation des spermogrammes préopératoires a permis de noter que l’oligozoospermie sévère (33,7 %) était associée à des degrés divers à une asthénozoospermie et à une thératozoospermie. Ces patients étaient suivis avec un recul moyen de 22 mois (6–48 mois). L’amélioration des paramètres spermatiques était significative, concernant la concentration et la mobilité des spermatozoïdes. Le taux de grossesses naturelles obtenu dans la série était de 20,8 %. Aucun cas de grossesse naturelle n’a été noté dans le groupe des patients présentant une azoospermie, mais une induction de la spermatogenèse a été notée dans 20,5 % des cas. Près de deux grossesses sur trois (64 %) ont été notées durant les 12 premiers mois postopératoires.ConclusionLe traitement chirurgical de la varicocèle permet d’améliorer les paramètres spermatiques, ce qui non seulement permet l’obtention de grossesses naturelles mais également de simplifier les techniques d’Assistance Médicale à la Procréation (AMP) prévues grâce aux nouveaux paramètres.AbstractIntroductionMale responsibility in couple infertility has been established in several studies. The purpose of this research was to report varicocele clinical and spermatic aspects and assess the outcomes of open retroperitoneal varicocelectomy.Patients and methodsOur study is a retrospective assessment of the outcomes of open retroperitoneal varicocelectomy at the urology department of Aristide Le Dantec teaching hospital (Senegal). Our focus is on patients with varicocelectomy facing couple infertility (inability for sexually active couples who are not using contraceptive methods to obtain a pregnancy over a year), patients among which no other infertility cause was revealed in their partner or partners in polygamist households. To assess the results, we compared the averages of preoperative and postoperative spermatic parameters by using the Z test (comparison test of two averages on two mated series). A difference was regarded as significant if P ≤ 0.05.ResultsFive hundred and fourteen cases were examined over 6 years (January 2005–December 2010). The average age of the patients was 36.5 ± 7.3 years. The infertility was primary in 62.4%. The analysis of the preoperative spermograms revealed that severe oligozoospermia (33.7%) was the most common abnormalities in the sperm cells concentrations. The abnormalities in the sperm cells concentrations were variously connected with an asthenozoospermia and to a theratozoospermia. The patients were monitored with an average hindsight of 22 months (6–48 months). The improvement of the parameters was more significant on the concentration and the mobility of sperm cells. The natural pregnancy rate obtained in our study was 20.8%. The registered pregnancies were more important in the group IV (48%). No case of natural pregnancy was noted in the group I but an induction of the spermatogenesis was noted in 20.5% of the cases. About two thirds of natural pregnancies (64%) were noted during the first 12 post-operative months.ConclusionThe surgical treatment of varicocele allows improving the spermatic parameters. Not only do these improvements help obtain natural pregnancies but also simplify the techniques of ART planned with the preoperative spermatic parameters.

La calcinose scrotale : aspects cliniques et thérapeutiques à propos de 5 cas

Scrotal calcinosis is a rare pathology and etiology still discussed. We report five cases in patients without particular history of another disease. Clinical examination revealed scrotal wall with painless nodules of various sizes producing a whitish substance, pasty. The phosphate levels were normal in all patients. They all had a resection of the lesions associated with scholarships plasty recovery. Histopathological study revealed calcified epidermoid cysts in 4 cases.MOTS CLÉS Calcinose scrotale ; Kyste épidermoïde ; Traitement chirurgical Résumé La calcinose scrotale est une affection rare et d’étiologie encore très discutée. Nous rapportons cinq cas chez des patients sans antécédent pathologique particulier. Cliniquement, les bourses étaient parsemées de nodules indolores de taille variable produisant une substance blanchâtre, pâteuse. Le bilan phosphocalcique était normal chez tous les patients. Ils ont tous eu une exérèse des lésions associée à une plastie de recouvrement des bourses. L’étude histopathologique a mis en évidence des kystes épidermoïdes calcifiés dans 4 cas.

Distribution extraparenchymateuse et accessibilité au clampage sélectif des artères rénales segmentaires au cours de la néphrectomie partielle : à propos de la dissection de 30 reins de cadavres frais non formolés

OBJECTIVE To assess the feasibility of selective clamping of segmental renal arteries during partial nephrectomy, in order to limit renal infarction to the pathological area to be resected. MATERIALS AND METHODS A dissection of renal artery and its extraparenchymal branches was realised. The study included 30 kidneys from recent nonformolised corpses. The size, distribution, and accessibility of the arteries were considered. All the corpses underwent a lombotomy with or without rib resection. RESULTS The majority of dissected kidneys had a unique artery (96.66% of cases). The number of segmental arteries was zero in five cases (16.66%), one in four cases (13.33%), two in four cases (13.33%), three in one case (3%), four in 15 cases (50%) and five in five cases (16.66%). The posterior and inferior segmental arteries were more accessible to isolate with a respective ratio of 94 and 100% at segmental level. Apical and middle segmental arteries were least accessible with a respective ratio of 73 and 80%. The majority of accidents during dissection occurred with the middle segmental artery (62.5% of vascular lesions). CONCLUSION This anatomic dissection on corpses showed that selective renal segmental arteries is possible in the majority of cases. This dissection is better indicated in partial nephrectomies for renal tumours located posteriorly or in the lower pole.