Serigne Magueye Gueye

Global cancer surgery: delivering safe, affordable, and timely cancer surgery

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US

Les fistules péniennes après circoncision: A propos de 20 observations

6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.

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

RésuméLes complications de la circoncision, encore considérée comme un rite traditionnel, sont nombreuses, parfois graves, et toujours de traitement difficile.Nous présentons dans ce travail 20 cas de fistules péniennes post-circoncision.Il s’agissait de patients âgés en moyenne de 4 ans (2–12 ans), ayant consulté dans un délai moyen de 2 ans après l’acte chirurgical. Les signes fonctionnels étaient dominés par la miction par 2 orifices, et la fistule siégeait dans tous les cas dans le sillon balano-préputial. 14 patients ont eu une urétrorraphie avec suture bord à bord de leur fistule et 6 ont eu une fermeture de leur fistule par un lambeau cutané pénien pédiculé. On a obtenu 11 bons résultats d’emblée, 5 cas de fistulette résiduelle et 4 cas de dysurie post opératoire.Les difficultés du traitement chirurgical de ce type de lésion doivent inciter tout opérateur à accorder du temps et de l’attention à la libération des adhérences préputiales et à l’hémostase de l’artère du frein.AbstractComplications of traditional circumcision are very common. Their treatment is uneasy. We have performed a retrospective study including 20 cases of urethral fistula.Mean age was 4 years (ranged 2–12 years). They were referred to us in a mean time of 2 years. The main clinical outcome was penopreputial urethral fistula.14 patients underwent uretrorraphy with end to end suture while 6 had a one-stage penile cutaneous stand flap.The results were good in 11 cases. 5 patients had recurrence of the fistula and 4 were suffering from dysuria.Need for more attention during homeostasis and preputial dissection owing to the difficulties of surgical treatment of such lesions.

Fracture de verge: à propos de 12 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.

La cryptorchidie chez l'enfant sénégalais en âge scolaire

RésuméLa fracture de verge est un accident relativement rare. Nous rapportons 12 cas de fracture de verge colligés sur une période de 17 ans. Le traumatisme causal était le faux pas du coït (n=8) ou la manipulation intempestive de la verge en érection (n=4). La symptomatologie clinique a été marquée par la déformation de la verge (n=9) et la douleur lors du traumatisme (n=7). Dans 1 cas il existait une rupture urétrale associée. Tous les patients ont été traités chirurgicalement avec de bons résultats dans 11 cas sur le plan cosmétique et fonctionnel sans aucune dysérection. Les auteurs passent en revue les différents moyens diagnostiques et soulignent l’importance d’une réparation chirurgicale en urgence dans les fractures de verge.AbstractThe authors would like to report their management of 12 patients with penile fracture. Their protocol consisted of emergency surgical repair, which gave the patients the greatest chance of full recovery, i.e. normal erection and effective sexual intercourse. A review of the literature shows the relative rarity of this traumatic disease and emphasizes the value of cavernosography, MRI and sonography in the diagnosis.

Effective Project Management of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the Prostate (MADCaP)

ResumeLe but de cette enquête épidémiologique prospective a été de déterminer la prévalence et de préciser les particularités de la cryptorchidie chez le garçon sénégalais en âge scolaire.Sur 2830 garçons examinés, nous avons découvert 40 cas de testicule non descendu dont 19 à gauche, 17 à droite et 4 bilatéraux. La prévalence est de 1,41%. Par ailleurs, nous avons trouvé une corrélation entre la présence d’un testicule non descendu à l’âge scolaire et la catégorie socioprofessionnelle des parents. En effet, elle varie de 0,25% chez les enfants issus de milieu socialement favorisés à 2,5% chez les enfants défavorisés en particulier ceux d’ouvriers. Nous pouvons conclure que la prévalence de la cryptorchidie à l’âge scolaire est plus élevée dans notre étude que celles rapportées dans la littérature ’10, 28]. Le défaut d’information des parents issus de milieu socio-économique défavorisé, et la difficulté d’accès aux structures médicalisées semblent être les principaux facteurs de retard de dépistage et partant de traitement des testicules non descendus.AbstractThe aim of this prospective study was to determine the incidence and the particularities of cryptorchidism in senegalese schoolboys. In a serie of 2830 boys, 40 of them had a cryptorchid testes. The incidence was 1.41%. This rate is higher than those previously reported in the litterature.Correlating the incidence to the economic level of the boys, it appears that the incidence was very low in rich group (0.25%). In the opposite it was high in poor groups (2.5%).We conclude that the high incidence rate of cryptorchidism in boys is due to the lack of information of parents issued from poor social groups.

Incontinence urinaire de la femme : profil épidémiologique au sud du Sahara

Purpose Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostate cancer in Africa, focusing on building strategic and operational capacity. Methods Applying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical center-specific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics. Results The PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local center project managers. A specific evaluation was conducted 1 year after study initiation to obtain enrollment data, evaluate individual quality control management plans, and undertake risk log assessments and follow-up. Pilot data obtained identified areas in which centers required mentoring, strengthening, and capacity development. Strategies were implemented to improve project goals and operational capacity through local problem solving, conducting quality control checks and following compliancy with study aims. Moving forward, centers will perform quarterly evaluations and initiate strengthening measures as required. Conclusion The PMT has fostered the development of both strategic and operational capacity across project centers. Investment in project management resources is essential to ensuring high-quality, impactful health research in low- and middle-income countries.

Azoospermias au Sénégal: quelle prise en charge à l’heure de l’ICSI?

UNLABELLED The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries. MATERIAL AND METHODS A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence. RESULTS Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases. CONCLUSION Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

Lésions des organes génitaux externes par arme a feu: a propos de six observations

ResumeObjectifIl s’agit de déterminer la place de l’azoospermie parmi les étiologies de l’infertilité au Sénégal.Matériel et méthodesNous avons répertoriés, parmi 492 dossiers de patients hypofertiles 141 cas d’azoospermie. Nous avons étudié le profil clinique, paraclinique et évolutif après prise en charge.RésultatsL’âge moyen était de 40,6 ans. Une atrophie testiculaire était retrouvée dans 35% des cas. A la biopsie testiculaire 72% de cas d’azoospermie sécrétrice étaient confirmés. Une varicoc#x00E8;le était associée dans 56% des cas. La cure de varicoc#x00E8;le effectuée dans 32,6% des cas a permis d’obtenir une amélioration des paramètres du spermogramme dans 28% des cas.AbstractAzoospermia is one of the most serious causes of couple infertility, has a very high prevalence among all causes of infertility and is due to multiple aetiologies.Objectiveto determine the place of azoospermia among the various causes of infertility in Senegal.Material and methods141 cases of azoospermia were identified from a series of 492 infertile patients. The clinical profile, laboratory results and outcome after management were studied.ResultsThe mean age was 40.6 years. Testicular atrophy was detected in 34.75% of cases. Azoospermia was secretory in 71.69% of cases. A varicocele was associated in 56% of cases. Varicocele repair was performed in 32.62% and allowed an improvement of sperm parameters in 28.3% of cases. Testicular biopsy, performed in 53 cases, demonstrated 2 cases of Sertoli cell syndrome, 3 cases of arrested maturation, 8 cases of hypo spermatogenesis, and 25 cases of seminiferous tubules. Forty nine cases of azoospermia were associated with normal FSH levels. Only one patient was treated by assisted reproductive technologies (ART).

La tumeur adénomatoïde de l'épididyme : A propos d'un cas

RésuméL’usage fréquent des armes à feu fait que tout médecin doit avoir des notions de balistique lésionnelle.Butsinsister sur les aspects épidémiologiques, balistiques lésionnels et thérapeutiques.Patients et Méthodesil s’agit d’une étude rétrospective qui s’est intéressée aux dossiers de patients admis pour lésions des organes génitaux externes par armes à feu dans services d’urologie de l’Hôpital Aristide Le Dantec, de l’Hôpital Général de Grand Yoff et de L’Hôpital Principal de Dakar durant la période allant du mois de Janvier 1998 au mois de Janvier 2003.RésultatsLes patients étaient tous de sexe masculin avec un âge moyen de 37,7 ans (22 ans à 52 ans). Dans cinq cas les lésions étaient survenues dans un cadre accidentel. Les lésions étaient: deux cas d’amputation du testicule, deux cas de plaies des corps caverneux, deux cas de lésion urétrale, un cas de plaies périnéoscrotales. Après parage des lésions, les gestes complémentaires ont été une orchidectomie (deux cas), une suture albuginéale (deux cas) et une urétrorraphie termino-terminale (deux cas). Tous les patients ont bénéficié d’une antibiothérapie et d’une sérothérapie antitétanique. Aucun cas de décès n’a été observé dans les suites immédiates. Avec un recul moyen de plus de 18 mois aucun cas de sténose urétrale ou de dysfonctionnement érectile n’était noté. Le spermogramme était normal dans les cas d’amputation du testicule.AbstractGunshot injuries to the external genital organs are rare. In this study, the authors report six cases and describe the epidemiological, terminal ballistic and therapeutic aspects.Patients and MethodsThis is a retrospective study of patients admitted with gunshot injuries to the external genital organs to the urology departments of Aristide Le Dantec Hospital, Grand Yoff General Hospital and Dakar Principal Hospital, between January 1998 and January 2003. The following parameters were studied: patients’ age and gender, interval between accident and admission, clinical features, complementary investigations and treatment, and early and late outcomes.ResultsOnly males were observed and the mean age of these patients was 37.7 years (range: 22–52 years). Lesions were accidental in five cases. Two cases of testicular wounds, two cases of corpus cavernosum injuries, two cases of urethral injury, and one case of perineal wound were observed. After excision of the lesions, complementary procedures consisted of: orchidectomy in two cases, corpus cavernosum — albuginea suture in two cases and end-to-end urethral suture in one case. Perineoscrotal wounds were sutured three days after debridement. All patients received antibiotics and antitetanus serum. No death was observed during the immediate follow-up. No case of urethral stricture or erectile dysfunction was observed with a follow-up of 18 months. Semen analysis was normal in the two cases of orchidectomy.