[Primary varicocele and fertility: postoperative evaluation of spermiogram and pregnancy parameters]

There is no general consensus as to the ability of varicocelectomy to improve fertility. The objective of this retrospective study was to evaluate the post-operative improvement in male fertility [based on sperm parameters] and the pregnancy rate. This is a retrospective study of 50 patients with palpable varicocele who were subjected to varicocelectomy by the Palomo technique at the Urological Department of Grand Yoff Hospital, Dakar, Senegal. The examined parameters were the spermiogram characteristics [concentration, total motility after 1 hour, vitality] and the spermiocytogram [percentage of normal morphology]. These were tested once before and twice after the operation [between 3 and 9 months postoperatively and then again after 9 months]; the postoperative pregnancy rate was evaluate in 35 patients. In all patients the spermiogram revealed an improvement in the average values of all parameters, without actual normalization, except for morphology [spermiocytogram]. The post-operative results were statistically significant only for the sperm concentration. The majority of patients [76% to 92%] showed pre-operative spermiogram values below normal, except for morphology [28%] [spermiocytogram]. In 48% to 64% of patients the spermiogram characteristics improved, depending on the parameter taken into consideration. Improvement was particularly more evident in those patients who had presented with low average values. Prognostic factors predicting a good postoperative outcome were the age of the patients [less than 35 years], bilateral varicocele, secondary infertility and a shorter duration of infertility. We did not study the possible correlation between the degree of varicocele and pregnancy. The post-operative pregnancy rate was 31.42%. The fertile patients were younger, had a shorter average duration of previous infertility and had parameters which were constantly higher as compared to those patients who remained infertile. The post-operative improvements in fertility and pregnancy were quite limited in this study. Due to the relatively high incidence of varicocele in the male population, it appears necessary to improve awareness on its occurrence, its consequences and the results of its treatment on fertility. Moreover, a stronger cooperation between gynecologists, reproductive biologists, radiologists and uro-andrologists may allow for an integrated study of infertile couples. It also appears necessary to improve the psychological approach to these couples, particularly to the female partner

[Clinical profile of prostate cancer in Senegal]

Objectives: To describe the clinical features of prostate cancer in Senegal

Materials and Methods: We underwent a descriptive and retrospective study including 121 patients managed for prostate cancer in two hospitals of Dakar between 1997 and 2002. The histological diagnosis was assessed on prostate biopsy or after transurethral resection of the prostate or prostatectomy. We studied: the age of the patients, the PSA level, the stage of the tumor using the TNM staging of 1997, and the circumstances of diagnosis

Results: The mean age was 69 years [52-88], the mean PSA was 72,2 ng /ml [6-578,9]. The localized tumors that represented 43,8% of the cases were mainly T2 [42, 1%], while the advanced [T3-T4] tumors represented 41,3% of the cases. Metastases were found in 15% of cases, and in 78% of the cases the metastases could not be assessed. The circumstances of diagnosis were dominated by prostate or cancer-related symptoms which represented 49,6% of the cases. The association between symptoms and high PSA was present in 16,5% of cases

Conclusion: This study shows an elevated age of our patients correlated with a high PSA level, an advanced tumor stage, an important rate of metastases and the presence of symptoms. Screening is needed for a better management of prostate cancer in Senegal