Treatment of upper urinary tract calculi at the University Hospital of Conakry: retrospective analysis of 54 cases

To study the diagnostic and therapeutic aspects of upper urinary tract calculi at a hospital in Guinea taking into consideration the local working conditions. This retrospective study included 52 patients with a total of 54 urinary tract calculi treated between January 1, 1994 and December 31, 2003. The parameters studied included the presenting symptoms, the findings on clinical and laboratory investigations and the methods of treatment. The patients' mean age was 37.5 [range 13 - 76] years with a preponderance of the age group of 21 - 30 years, representing 26.9% [n = 14] of the cases. The male-to-female ratio was 10:3. The socio-economic groups most affected by upper urinary tract calculi were farmers and housewives. Pain was the most frequent presenting symptom seen in 92.3% of the patients. The average time between onset of symptoms and presentation was 35 months. Urine microscopy and culture revealed infection in 46 patients [88.5%]; organisms were isolated in 42 cases [80.8%], the majority were Proteus mirabilis, E. coli and Streptococci in 45.2%, 33.3% and 21.4% of the cases, respectively. Intravenous urography [IVU] helped in the diagnosis in 81.5% cases [n = 44]. Treatment consisted of surgery in 96.2% [n=50] of the patients, while 3.8% [n=2] were treated conservatively. After a mean follow-up of 34 months, the results are satisfactory with a pain- and stone-free rate of 82.7% [n=43]. The diagnosis of upper urinary tract calculi is easy. However, we have noted a considerable delay in treatment due to the lack of equipment in our technical environment leading to considerable morbidity and prolonged hospitalization of the patients

[Bilharzial prostatitis: a case report and review of the literature]

Male genital lesions due to Schistosoma haematobium are rare in our environment. However, they were already reported by Chaker in 1889 and by Lortet and Vialleton who described the first lesions in seminal vesicles. We herein describe one case of schistosomal prostatitis discovered accidently in a 65-year-old patient after transurethral resection

[Traumatic rupture of the posterior urethra. Analysis of 87 cases at the Conakry University Hospital]

To report on our experience in the management of traumatic rupture of the posterior urethra. Eighty-seven patients with traumatic rupture of the posterior urethra were treated at the Department of Urology and Andrology of the Conakry University Hospital between January 1988 and December 2004. Trauma was caused by a car accident in 68 [78.2%] and by 72 hours after the accident. The others presented at a stage where urethral structure had already developed. Pelvic fracture was observed in 56 [64.4%] patients. The predominant presenting symptom was urinary retention in 62 [71.3%] patients, followed by bleeding per urethram in 59 [67.8%] and perineal hematoma in 23 [26.4%] patients. Treatment consisted of immediate realignment with a guiding catheter, deferred urethroplasty between the 8th and 10th day, or delayed urethroplasty, depending on the time elapsed after the injury. Good results were achieved in 32 [36.8%] and satisfactory results in 29 [44.8%] cases. Erectile dysfunction was noted in 19 [21.8%] patients. Treatment of ruptures of the posterior urethra remains controversial. Due to the fact that in our environment endoscopic realignment is not possible, deferred emergency end-toend urethrorraphy remains the method of choice for ruptures not associated with other serious lesions. In case of associated serious injuries, these are given priority as a life-saving measure before urethral repair

[Squamous cell carcinoma of the penis. Report of two cases in CHU of Conakry]

Based on two cases, the authors review the literature and discuss the difficulties of treatment of advanced-stage penile cancer. Two male circumcised patients [age:32 and 46 years] presented with invasive penile carcinoma. In both patients, clinical examination revealed large, infected penile tumors with a healthy stump of less than 5 cm. Superficial inguinal adenopathy and HIV-positivity were found in one of the patients. Both patients were subjected to total penectomy with perineal urethrostomy and antibiotic treatment

[Endoscopic surgery of the lower urinary tract at the Ignace Deen University Hospital. Report on 550 cases]

Objective: This study was carried out to analyze the frequency, feasibility and morbidity of endoscopic surgery of the lower urinary tract in our department

Patients and Methods: In a retrospective study covering a period of six years [January 1, 1996 to December 31, 2001], 550 patient files were analyzed with respect to the results of endoscopic surgery of the lower urinary tract

Results: Out of 550 endoscopic interventions, transurethral resection was performed in 272 [49.4%], endoscopic internal urethrotomy in 236 [42.9%], bladder neck incision in 40 [7.3%] and ablation of posterior urethral valves in 2 [0.37%] patients. Complications of transurethral resection were found in two patients only [0.74%] in the form of reabsorption syndrome in one and capsular perforation in the other. The complication rate of endoscopic internal urethrotomy was 9.32%, most commonly extravasation of irrigation fluid into the scrotum

Conclusion: Endoscopic surgery of the lower urinary tract is a technique yet to be mastered in our country as it is a valuable and important addition to the armamentarium of the urologist