Devenir des pathologies du canal péritonéo-vaginal et de la migration testiculaire chez l'enfant: prise en charge au centre hospitalier de Louga, Sénégal / Outcome of processus vaginalis and testicular migration related pathologies in children treated at Louga Hospital, Senegal

Contexte et objectifs. Le devenir des pathologies du canal péritonéo-vaginal (CPV) et de la migration testiculaire chez l'enfant est peu connu. L'objectif de ce travail était de décrire les aspects cliniques et le devenir de ces pathologies. Méthodes. Etude documentaire descriptive portant sur les hernies, hydrocèles, cryptorchidies et torsions du cordon spermatique opérées chez le garçon âgé de 0 à 16 ans, au Centre hospitalier de Louga, Sénégal, de janvier 2018 à décembre 2019. Résultats. 184 dossiers des patients ont été colligés, soit 32,5 % de patients opérés au cours de la période. Leur âge moyen était de 5,4 ± 4,3 ans. Ces pathologies englobaient : hernies inguinales (n=37 dont 3 étranglements), hydrocèles (n=113), cryptorchidies (n=27), testicules oscillants (n=2) et torsions du cordon spermatique (n=5). L'abord a été inguinal dans 96,1 %. Le traitement a consisté en : ligature du CPV, abaissement testiculaire, orchidopexie, orchidectomie. Aucune récidive, atrophie ou fonte testiculaire n'a été observée en trois mois de suivi. Conclusion. La prise en charge en urgence ou non des pathologies du CPV et de la migration testiculaire chez l'enfant est fréquente dans notre pratique, sans complication à courte terme. Le défi réside dans le suivi à long terme en raison des complications tardives

Context and objectives. Little is known about the outcome of patent processus vaginalis and testicular migration pathologies in children. The objectives of this study were to analyze clinical and therapeutic features of these pathologies. Methods. This was a descriptive retrospective study involving boys aged 0 to 16 years, operated for inguinal hernias, hydroceles, cryptorchidisms and testicular torsions, at the Louga Regional Hospital Center, Senegal, from January 2018 to December 2019. Results. 184 patients were recorded, which represented 32.5 % of all patients operated in the same period. Their average age was 5.4 ± 4.3 years. The managed pathologies were: inguinal hernias (n= 37 including 3 incarcerated hernias), hydroceles (n= 113), cryptorchidisms (n= 27), retractile testicles (n=2) and testicular torsions (n= 5). Inguinal approach was performed in 96,1 % of cases. Surgical managements were: ligature of the patent processus vaginalis, relocating the testicle within the scrotum, orchidopexy and orchidectomy. No recurrence, no purulent testicular discharge or testicular atrophy was encountered. Conclusion. Processus vaginalis and testicular migration pathologies are common in our practice. At 3 months of surgical operation, no complication was observed. However, the challenge is long-term follow-up due to late complications

Prune Belly syndrome au Centre Hospitalier National d'Enfants Albert Royer de Dakar, Sénéga

Introduction : Le Prune Belly Syndrome (PBS) (ou syndrome d'Eagle-Barrett) est une affection congénitale rare qui touche principalement les garçons. Il est caractérisé par la triade classique aplasie musculaire de la paroi abdominale antérieure, cryptorchidie bilatérale ou agénésie des testicules chez le garçon et malformation des voies urinaires.Observation : Il s'agissait d'un garçon de deux mois admis pour investigation d'une anomalie de la paroi abdominale antérieure constatée depuis la naissance. L'examen physique avait permis de retrouver une aplasie de la musculature abdominale avec un abdomen distendu flasque et étalé, une peau fripée faisant apparaitre l'empreinte des anses intestinales. Au niveau génital il y avait un hypospadias balano-prépucial avec un prépuce en chapeau de gendarme, une cryptorchidie bilatérale. L'échographie abdomino-pelvienne avait montré une mégavessie, une urétéro-hydronéphrose bilatérale et une absence de visibilité des testicules. L'urétro-cystographie rétrograde était normale. Le reste du bilan malformatif était normal.Conclusion : Le PBS reste une affection congénitale rare. Les formes avec absence de manifestations extra-urinaires sont de bon pronostic

Early experience with laparoscopic management of nonpalpable undescended testes

Background: Nonpalpable undescended testes (NPT) constitute 20%­30% of undescended testes, and its management has been a challenge both in diagnosis and treatment. Worldwide, laparoscopy is the current gold standard of management. In Nigeria, the management of NPT has largely been by open surgery with consequent high morbidity. In Nigeria, the trend is changing from a largely open management with its attendant high morbidity, to laparoscopic management which is the current worldwide gold standard of care. Aim: This study aims to classify the laparoscopic features of NPT and determine the outcome of managed cases in our center. Methodology: Prospective data were collected from consecutive patients who had laparoscopy for NPT at the Paediatric Surgical Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from June 2014 to July 2016. Results: A total of 15 patients with 23 testes were treated. There were eight patients with bilateral NPT; four had left and the remaining three right NPT. The age ranged from 1.2 to 29 years with a median of 5 years. Eleven out of the 22 internal inguinal rings were open. The position of the testes was canalicular (2), peeping (2), low abdominal (6), high abdominal (6), blind-ended vas (1), absent vas and vessels (5). No further intervention was needed for the six agenetic/atrophic testes. Standard open orchiopexy was done for the two canalicular testes. Eight testes were brought down by one stage laparoscopic orchiopexy while four were brought down by staged laparoscopic Fowler-Stephens procedure. Laparoscopic orchiectomy was done in two patients (a grossly dysmorphic testes [nubbin] and a high abdominal testis in a 29-year-old). Orchiopexy was successful in 11 out of 15 fixed testes. Of the unsuccessful ones, three testes were atrophic (volume less than what it was initially) while two were high scrotal (one testes has both complications). There was no conversion to open abdominal surgery. All patients were discharged within 24 h of surgery.Conclusion: Laparoscopy provides for a better management of NPT by combining diagnosis and intervention in the same sitting with a good success rate and minimal postoperative morbidity

La prise en charge de l'ectopie testiculaire a l'hopital central de Yaounde : a propos de 171 cas

INTRODUCTION:L'ectopie testiculaire est frequente. Le diagnostic et la prise en charge precoces sont necessaires a cause des risques d'atrophie; de cancerisation; de subfertilite; et les consequences psychologiques en rapport avec l'absence d'un testicule dans une bourse. Cette prise en charge est tardive dans notre milieu. Le but de ce travail etait d'etudier les facteurs interferant avec cette prise en charge. MeTHODOLOGIE Nous avons revu 172 dossiers des patients operes d'ectopie testiculaire de 1999 a 2012. Nous avons etudie l'age au moment de l'operation; la qualification de la personne ayant assure l'accouchement; les facteurs interferant avec la prise en charge et les resultats de cette prise en charge. ReSULTATS L'age des patients au moment de la chirurgie variait de 1 a 48 ans; avec une moyenne de 8 ans. Seuls 21 patients avaient ete operes dans les delais recommandes. L'information medicale avait ete erronee ou insuffisante dans 93 cas. L'on retrouvait la peur de l'operation dans 42 cas; les problemes financiers dans 14 cas; l'ignorance des parents dans 7 cas. CONCLUSION Le manque d'information des soignants ou des parents; la peur de l'operation et le manque de moyens financiers sont les principales causes de delai dans la prise en charge de l'ectopie testiculaire. Ce travail fait ressortir la responsabilite du personnel de sante dans le la prise en charge precoce de l'ectopie testiculaire

Diagnostic value of high resolution ultrasound in localisation of the undescended testis in children

Background: The use of ultrasonography in the pre-operative localisation of undescended testes has become controversial due to fears about its accuracy. This study was designed to ascertain the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in the localisation of the undescended testes in children. Patients and Methods: A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching Hospital, Idi-Araba, Lagos, over a 12 month period was performed. The pre-operative clinical and ultrasound findings were compared with the findings on surgical exploration. Results: Forty boys with 52 undescended testes were studied. The mean age of the boys at the time of surgery was 4.0 ± 0 years (range 1-11 years). Forty-six (88.5%) testes were localised pre-operatively by ultrasound- 20 of 22 (90.9%) palpable testes and 26 of 30 (86.7%) non-palpable testes. Intra-operatively, 49 (94.2%) of the undescended testes were found while 3 (5.8%) were absent/vanishing testes. Ultrasound evaluation had an accuracy of 86.5%, sensitivity of 89.8%, and specificity of 33.3%, PPV of 95.7% and a NPV of 16.7%. Conclusion: Ultrasound assessment is beneficial in pre-operative evaluation of children with undescended testes

La cryptorchidie : aspects epidemio-clinique et therapeutique au service de chirurgie pediatrique du CHU Gabriel Toure

Objectifs : Decrire les aspects epidemio-cliniques et analyser les resultats de la prise en charge des cryptorchidies. Materiels et methode : Il s'agissait d'une etude retro et prospective qui s'est deroulee du 1er Janvier 2005 a 31 Decembre 2009 et qui a porte sur tous les enfants de 1 a 15 ans traites pour cryptorchidie dans le service de chirurgie pediatrique du CHU Gabriel Toure. Resultats : En 5 ans nous avons collige 42 cas de cryptorchidie (8;4 cas/an). L'age moyen de nos patients a ete 6;48 ans. Trente et huit (90;5) patients ont ete recus pour vacuite scrotale et 4 patients (9;5) pour tumefaction inguinale. La cryptorchidie etait droite chez 24 malades (57;2); gauche chez 15 malades (35;7) et bilaterale chez 3 malades (7;1). L'orchidopexie conventionnelle a ete realisee chez 36 patients et la technique de Fowler- Stephens chez 6 autres. Apres 6 mois une retraction testiculaire a ete notee chez 2 malades (4;7). Apres 1 an elle a ete notee chez 6 malades (14;3) et une atrophie testiculaire chez 2 malades (4;7). La decouverte de la cryptorchidie est tardive dans nos pays. Un diagnostic et un traitement precoces assureraient un avenir fonctionnel et esthetique du testicule

Adult Patients Presenting with Undescended Testis in Awareness-Poor Region

Objectives The majority of patients with undescended testis present during childhood with minimal complications owing to straightforward treatment with excellent postoperative outcome. This paper reports the mode of presentation; challenges and outcome of management of adult patients with undescended testis. Methods. This prospective study included consecutive cases of adult patients managed with undescended testis from January 2004 to December 2008 in Evbuomore; Nigeria. Results Eighteen adults with a mean age of 38.3 years (range 19-61) were managed during the period. Ten (55.5) had bilateral; 5 (27.8) right and 3 (16.7) left lesions. Awareness was poor as they presented due to infertility in 8 (44.4); associated hernia 5 (27.8); wife/self discovery 4 (22.2) and accidental discovery by a health worker 1 (5.6); with 9 men (50) presenting between 30 and 40 years of age. On inguinal exploration; only 3 (10.7) patients had viable but significantly reduced testicular volume; 17 (60.7) were atrophic/fibrotic while in 8 (28.6) the vas deferens ended blindly in the inguinal canal with no viable testicular tissue. Apart from three patients who had children before presentation; infertility persisted even after treatment despite adequate hormone profiles and satisfactory sexual performance. Counseling of spouses was a major challenge; with 8 couples adopting children and three marriages ending in separation. conclusion: Management of adults with undescended testis was challenging due to irreversible complications; psychological effects and poor outcome of treatment which shows the importance of awareness programs that will result in childhood presentation

Challenges of Surgical Repair of Hypospadias in Ile-Ife; Nigeria

Objective: To document the presentation; outcome and challenges of management of hypospadias in a resource-limited setting. Patients and Methods: For this retrospective study we analyzed the files of all patients with hypospadias managed at the Obafemi Awolowo University Teaching Hospital; Ile-Ife; Nigeria between 1996 and 2006. The parameters studied were the patients' bio-data; clinical presentation; treatment and outcome. Results: During the 10-year period under review 51 cases of hypospadias were managed. The majority of the patients (n=39; 76.5) presented within the first year of life with a mean age at presentation of 1 year and 8 months; though most of the repairs were done in the 2nd; 3rd and 4th years of life. Of the 51 patients 46 (90.2) came from rural and semi-urban areas and 18 (35.3) had been circumcised before presentation. Surgical repair consisted of preputial island flap in 22 patients (43.1) followed by a peri-meatal based flap (Mathieu procedure) in 16 patients (31.4). The MAGPI procedure was used in 5 patients (9.8) and the Snodgrass procedure in 1 (2). Staged repair was necessary in 7 patients (13.7). Post-operative complications were encountered in 15 patients with urethrocutaneous fistula being the commonest one (11 patients; 21.6). Conclusion: Our results show that hypospadias can be successfully managed in a low- resource setting

Undescended testes in a developing country: a study of the management of 71 patients

BACKGROUND: A testis located outside the scrotum is prone to a lot of complications but early detection and correction give good result. The purpose of this study was to determine the pattern of presentation, complications recorded, the surgical treatment offered and outcome in a developing country. PATIENTS AND METHODS: A retrospective study of patients that presented with undescended testes at the University of Benin Teaching Hospital between January, 1997 and December, 2006. RESULTS: A total of 76 orchidopexies and 10 orchidectomies were done on 71 patients with undescended testes during the period. They were aged 9 months and 47 years (mean 8.3 +/- 7.9 years) at surgery. Only 31 (43.7%) patients presented at age 5 years and below while 40 (56.3%) presented after 5 years. Seventy-two (83.7%) testes were palpable, ultrasound scan was used to locate 10 (11.6%), while 4 (4.7%) could only be located during groin exploration. Intraoperative assessment of the testes were 54 (62.8%) normal testicular volume, 22 (25.6%) reduced volume and 10 (11.6%) atretic. All those aged 5 years and below had normal/reduced testicular volume and all had orchidopexy whereas those above 5 years with normal/reduced testicular volume had orchidopexy and those with atretic testis had orchidectomy. Post operatively, testicular growth was recorded only among the pre/pubertile boys, the testes retracted in two patients, scrotal skin infection in one, and intra scrotal haematoma in two. CONCLUSION: Delayed presentation resulted in morphological changes, increased complications, number of orchidectomy and reduced chance of testicular growth post orchidopexy

Undescended testis at Nnamdi Azikiwe Teaching Hospital; Nnewi; Nigeria : a ten year audit

Introduction: Undescended testis is a global problem; and late diagnosis and treatment can lead to disastrous consequences. We undertook this study to evaluate our management protocol and see how it fits into changing trends in management and compare our results with those obtained in other centers. Material and Methods: A retrospective study of all patients with undescended testes seen and operated at Nnamdi Azikiwe Teaching Hospital; Nnewi; Nigeria during a 10-year period (1993-2003) was carried out. Results: Twenty-seven patients were analysed. 66.7of them were above 2 years of age. Eighteen patients had unilateral crypt-orchidism and 12 patients (44.4) had associated inguinal hernia. The undescended testis was found predominantly in the inguinal region (17 patients) and orchidopexy was done in 16. Half of our patients (51.7) were lost to follow up immediately after the intervention. Conclusion: The late presentation and inability to follow up these patients make the monitoring of such patients very difficult. We suggest that thorough examination of the external genitalia should form part of the normal post-natal check up and that a mass education campaign be undertaken

Testicules impalpables : approche diagnostique et therapeutique; apport de la coelioscopie

Sans resume

Prevalence of hypospadias abdominal and peno-scrotal abnormalities among primary school boys in a Nigeria community

Objectives To determine the prevalence of hypospadias; patent processus vaginalis; umbilical hernia; splenomegaly and cryptorchidism in primary school boys of a Nigerian community. Patients and Methods A community-based observational study using the cluster-sampling method was done. One thousand and ninety-six primary school boys aged between 5 and 13 years from five randomly selected schools in the administrative district of the Ogbaru Local Government Area (LGA) of Eastern Nigeria participated in this study; while in only 1080 boys some specific information on umbilical hernia was available. Each participant underwent a general; abdominal; groin and peno-scrotal physical examination. Results The prevalence of hypospadias was 1.1and this was equivalent to the incidence. The prevalence of a patent processus vaginalis was 1.0with an estimated incidence of 1.3. Cryptorchidism was present in 0.8and retractile testis in 3.2. The prevalence of umbilical hernia was 26and the splenomegaly rate was 7. Conclusion The incidence and prevalence of simple hypospadias was higher than previously suggested by a tertiary hospital-based report from Western Nigeria. Umbilical hernia was very common but apparently only few patients needed treatment. The incidence of a patent processus vaginalis was similar to that reported in other parts of the world; although surgical correction was delayed. Splenomegaly was common; not only due to endemic malaria; but also due to sickle-cell disease; with implications for the management of childhood trauma in this part of the world

Evaluation of staged fowler-stephens orchiopexy for the high abdominal testis

Objective: To evaluate staged Fowler - Stephens orchiopexy for the high intra-abdominal testis. Patients and Methods: The study included 78 patients with laparoscopically diagnosed high intra-abdominal testes. Their age ranged from 2 -16 years. All cases underwent staged Fowler - Stephens orchiopexy. The first stage was done during diagnostic laparoscopy by clipping the internal spermatic artery and vein 2-3 cm superior to the intra-abdominal testis. Six months later the second stage of the procedure in the form of open (67 cases) or laparoscopic orchiopexy (11 cases) was performed. Only 65 patients were available for follow up at 6 and 18 months following the second stage. At each follow-up visit; the testicular position; size and viability were assessed by Technetium 99 (Tc99m) testicular scintigraphy. Results: Out of 78 cases; 10 had bilateral high intra-abdominal testes. Second stage open orchiopexy was done in 67 cases while the remaining 11 cases were subjected to laporoscopic orchiopexy. No operative or postoperative complications were detected apart from a prolonged ileus after the second stage in 6 patients. On follow up; 49 testes were scrotal and of good size while 6 testes were scrotal and atrophic. In the remaining 10 cases the testes were at the neck of the scrotum and of good size. Tc99m testicular scintigraphy was done in 65 cases. A good perfusion was detected in the majority of them (59 cases) while no radiotracer accumulation was detected in the remaining 6 cases. Conclusion: Laparoscopic clipping of the gonadal vessels is safe in patients with high abdominal testes. The staged approach with preservation of the testicular collateral vascular supply provides an adequate viability of the high abdominal testis with a high success rate. Tc99m testicular scintigraphy allows a proper assessment of the testicular viability as compared to measurement of the testicular size only

Interet du traitement chirurgical de la cryptorchidie a Yaounde

Une etude retrospective visant a evaluer l'interet du traitement chirurgical de la cryptorchidie a porte sur 123 patients operes a Yaounde pendant une periode de 10 ans allant de 1984 a 1994. L'analyse a revele que 93 patients (75;6 pour cent) avaient ete operes apres l'age de trois ans; au moment ou des alterations histologiques avaient deja compris le pronostic fonctionnel du testicule et augmente le risque de cancerisation. Des resultats comparables dans la litterature montrent l'insuffisance de l'information medicale sur l'age optimal de l'abaissement des testicules cryptorchides. L'etude fait des propositions pour un changement de comportement

Les problemes poses par les testicules non descendus

L'auteur; qui donne d'abord le sens de testicule non descendu; expose ensuite les raisons de cette malformation. A 5 ans d'age; avec une cryptorichidie unilaterale droite non palpable; l'auteur pense qu'il n'y a pas de la place pour un traitement hormonal; seul un traitement chirurgical se justifie et devra etre realise sans delai

Incidence of undescended testis in a population of children at Benin City

One thousand; eight hundred and ninety-six children aged 6 to 12 years were examined for undescended testis. The incidence was found to be 0.8in the 6 year olds; and also in the 7 and 8 years groups. The overall incidence was 0.4. A differential intrascrotal descent rate was also discovered between the right and left testes; by observations of position of testis in scrotum in each age group: thus while at the age of 6 years 9.4of the left testes and 6of the right testes had touched the base of the scrotum; at the age of 12 years 88.3of the left testes but 95.7of the right testes lay in the base of the scrotum