Giant hydronephrosis in children: diagnosis and therapeutic aspects

To evaluate the clinical aspects, diagnostic and therapeutic problems of giant hydronephrosis in children managed at the Department of Urology of the University Hospital of Dakar, Senegal. In this retrospective -study all cases of giant hydronephrosis in children managed at the Department of Urology of Aristide Le Dantec Hospital, Dakar, between February 2000 and February 2007 were reviewed. The parameters studied were the epidemiological and clinical aspects, laboratory and imaging investigations and therapy, as well as the short, medium and long-term outcome. Our series included 7 patients with a mean age of 6.1 years [range 8 months - 12 years]. In 5 out of 7 cases, giant hydronephrosis was found on the left side. Ultrasonography was performed in all cases, and the giant hydronephrosis was first misdiagnosed as cystic renal disease in 6 cases. Intravenous urography revealed a non-functioning kidney in 4 cases. CT scan, performed in 6 cases, confirmed the diagnosis and provided further information about the remaining parenchyma. Nephrostomy was performed pre-operatively in 4 cases. Three patients underwent pyeloplasty, while nephrectomy was performed in 4 cases. At follow-up, a pelvi-ureteric stenosis associated with a colonic fistula was noted in one patient. Long-term follow up was uneventful in all patients. CT scan is the method of choice for the diagnosis of hydronephrosis. Nephrostomy allows an evaluation of the renal function and facilitates the extraperitoneal approach to the kidney

[Scrotal trauma: apropos of 14 cases]

To discuss the epidemiological, clinical and therapeutic aspects of scrotal trauma on the basis of a series of patients seen at the Department of Urology and Andrology, A. Le Dantec Hospital, Dakar. In this retrospective study the records of 14 patients treated for scrotal trauma at the Department of Urology and Andrology, A. Le Dantec Hospital, Dakar between July 1986 and July 2002 were analysed. The aptients' mean age was 28 years. The main etiology was road traffic accident. The most common presenting symptom was acute scrotum [n = 10]. Patients with penetrating trauma [n=4] presented within a mean time of 45 minutes following the injury. Blunt trauma was found in 10 patients. Treatment consisted of orchidectomy in 2, suturing of the lesions in 2, hematocele evacuation and repair of the lesions in 6 cases [testicular albuginea suture or epididymal lesion suture] and repair of hydrocele in 1 case. A favorable outcome could be achieved in 11 cases. Two cases of testicular atrophy and three cases of oligoasthenozoospermia were noted. Early consultation and routine scrotal ultrasonography in cases of blunt scrotal trauma without hematocele are necessary to improve the prognosis

[Priapism: clinical aspects and etiology]

Objective: To evaluate the clinical, etiological and therapeutical aspects of priapism

Patients and Methods: Sixty-three patients were retrospectively studied regarding their age, the time elapsed between onset of the condition and presentation at the hospital, their medical and surgical history, additional examinations such as blood count and hemoglobin electrophoresis, treatment modalities and outcome of treatment

Results: The mean age of the patients was 22, 4 years [range: 3-68 years]. The time elapsed between onset of the condition and presentation at the hospital ranged from 4 hours to 41 days. Two patients [3, 2%] presented about 6 hours after the onset of priapism, while 80, 9% presented more than 24 hours later. Hemoglobin electrophoresis revealed sickle-cell disease in 29 [46%] patients. In two patients, priapism occurred after intracavernous injection of vasoactive drugs. The patients were treated medically and/or surgically. Immediate penile flaccidity after treatment was obtained in 53 cases [84, 1%]. At a mean follow-up of 8 months 51 patients could be evaluated; 23 of them [45, 1%] reported a satisfactory erection. Fibrosis of the corpora cavernosa occurred in 24 [38.1%] patients

Conclusion: Priapism represents a urologic emergency which in Africa is commonly associated with sickle-cell disease. A timely and adequate treatment in our environment is rendered difficult due to the fact that most patients present very late. This situation can only be changed by an improvement of the socio-economic situation and a large-scale education of the population as well as the establishment of a larger number of specialized medical and health centers