Les urgences urologiques au CHU de Libreville aspects diagnostiques et délai de prise en charge / Urological emergencies at the University Hospital Center of Libreville: diagnostic aspects and management delay

Objectif : l'objectif de cette étude était de rapporter les aspects diagnostiques ainsi que les délais de prise en charge des urgences urologiques.Patients et Méthodes : nous avions réalisé une étude prospective à visée descriptive, du 1er juin 2018 au 31 mai 2019 au Centre Hospitalier Universitaire de Libreville. Elle concernait tous les patients reçus pour une urgence urologique.Les variables comprenaient les données socio démographiques, diagnostiques et thérapeutiques.Résultats : durant cette période, nous avions enregistré 586 patients. L'âge moyen était de 40,6 ans avec des extrêmes de 3 mois et 96 ans. Le sex ratio était de 4,6. Les urgences étaient obstructives (40,6%) et infectieuses (33,3%). Sur le plan thérapeutique, le geste effectué était le sondage vésical dans 33,5% des cas. Cent quarante (140) interventions chirurgicales (23,9%) avaient été réalisées. Le délai moyen de prise en charge était de 47,4 heures. Les principales causes du retard de prise en charge étaient la consultation tardive, la lenteur des formalités administratives et l'attente du kit chirurgical.Conclusion : les urgences urologiques demeurent des pathologies fréquentes. Elles sont dominées par les rétentions aiguës d'urine et les infections urogénitales dans notre contexte. Le cathétérisme urétral est le geste le plus réalisé au service des urgences chirurgicales. La stratégie de prise en charge requiert une évaluation clinique rigoureuse, un traitement précoce et efficace pour minimiser les séquelles.

Introduction: Urological emergencies are many and varied. The objective of this study was to report the diagnostic aspect as well as the time taken to manage urological emergencies. Patients and Methods: We carried out a prospective study with a descriptive aim, from June 1st, 2018 to May 31st, 2019 at the University Hospital Center of Libreville. It concerned all patients received for an urological emergency.The variables included socio-demographic, diagnostic and therapeutic data.Results: During this period, we registered 586 patients. The average age was 40.6 years with extremes of 3 months and 96 years. The sex ratio was 4.6. Emergencies were obstructive (40.6%) and infectious (33.3%). Therapeutically, the procedure performed was bladder catheterization in 33.5% of cases. One hundred and forty (140) surgeries (23.9%) were performed. The average recovery time was 47.4 hours. The main causes of the delay in treatment were late consultation, slowness of the administrative formalities and wait for the surgical kit.Conclusion: Urological emergencies remain frequent pathologies. They are dominated by acute urine retention and urogenital infections in our context. Urethral catheterization is the most common procedure in the surgical emergency department. The management strategy requires rigorous clinical evaluation, early and effective treatment to minimize sequelae

Acute Scrotum in an Infant with Kawasaki Disease

Kawasaki disease (KD) is a systemic vasculitis that occurs predominantly in infants and young children. The etiology of KD is unknown and coronary heart disease is a major complication of KD. Acute scrotum is a rare complication of acute KD, and not as well recognized as other manifestations of the disease. We report a 2-month-old boy with acute scrotum in the acute phase of KD. He was treated with intravenous immunoglobulin (total 2 g/kg) and aspirin (50 mg/kg/day). The treatment was effective in resolving his fever and other clinical symptoms, but 2 days after starting treatment he experienced scrotal swelling. Scrotal ultrasound and transillumination were used in the diagnosis of acute scrotum. After 2 months, a follow-up testicular ultrasound revealed a remission of the acute scrotum. Subsequently, he has been followed up for KD.

Endometriosis de debut con manifestaciones urinarias: a propósito de dos casos / Debut endometriosis with urinary manifestations: report of two cases

FUNDAMENTO: la endometriosis es una condición benigna que afecta del 15 al 20 % de las mujeres en estado fértil. Generalmente afecta órganos como los ovarios, los ligamentos uterinos, las trompas de Falopio, el recto y la región cérvico-vaginal. Sin embargo, la probabilidad de que afecte el tracto urinario es poco común y sucede solo en el 1% de los pacientes. CASOS CLÍNICOS: se presentan dos casos con endometriosis, una localizada en la trompa derecha y otra en la vejiga, el primero comprometió de forma grave la función renal; el ultrasonido y la cistoscopia fueron fundamentales en el diagnóstico. La Laparotomía exploradora y la anatomía patológica fueron concluyentes se le realizó tumorectomía con Ooforectomía a uno de los casos que necesitó además una remodelación del diámetro ureteral y reimplantación con técnica anti reflujo, al segundo caso se le realizó cistotomía exploradora con exéresis de tumoración en hemitrígono izquierdo y conservación del meato ureteral en su posición anatómica, ambos pacientes egresaron, el primero a los 19 días y el segundo a las 72 horas con seguimiento por la consulta externa. CONCLUSIONES: la Endometriosis afectando las vías urinarias es poco frecuente pero puede presentarse con manifestaciones urinarias inespecíficas, dismenorrea y hematuria, puede diagnosticarse con los estudios imaginológicos y endoscópicos del tracto urinario y puede llegar a ocasionar lesiones irreversibles de la función renal y reproductiva.

BACKGROUND: endometriosis is a benign condition that affects 15 to 20 % of women in fertile state. It generally affects organs like ovaries, uterine ligaments, fallopian tubes, rectum, and the cervico-vaginal region. However, the probability of it affecting the urinary tract is uncommon and happens only in the 1 % of the patients. CLINICAL CASES: two cases of endometriosis are presented. One of the cases presented the endometriosis in the right fallopian tube and the other one in the bladder. In the first case the renal function was compromised; the ultrasound and cytoscopy were essential in the diagnosis. The exploratory laparotomy and pathological anatomy were conclusive. One of the patients underwent a tumorectomy, an oophorectomy, a remodeling of the urethral diameter, and a reimplantation with anti reflux technique. The second case underwent an exploratory cystotomy with exeresis of a tumor in the left hemitrigono and conservation of the ureteral meatus in its anatomical position. Both patients were discharged from hospital; the first patient 19 days later and the second one 72 hours later. A follow-up care was established. CONCLUSIONS: the endometriosis that affects urinary tracts is not very frequent but it can appear with non-specific urinary manifestations, dysmenorrhea and hematuria. It can be diagnosed through endoscopic and imaging studies of the urinary tract and can even

Stent Position Is More Important than alpha-Blockers or Anticholinergics for Stent-Related Lower Urinary Tract Symptoms after Ureteroscopic Ureterolithotomy: A Prospective Randomized Study

PURPOSE: To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. MATERIALS AND METHODS: Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 mg was added for group 3 (n=20). The patients were also subclassified into appropriate or inappropriate group according to stent position. All the patients completed a visual analogue scale (VAS) and International Prostate Symptom Score (IPSS) on the 1st and 7th postoperative days. The VAS and IPSS were analyzed according to the medication groups and the stent position. RESULTS: In the appropriate stent potion group, only the storage symptom scores of groups 2 and 3 on the 1st postoperative day were significantly lower than those of the group 1 (p=0.001). This medication effect on LUTS was not observed in the inappropriate stent position group. In this group, total IPSS (p=0.015) and storage symptom scores (p=0.002) were higher than in the appropriate stent position group on the 7th postoperative day. CONCLUSIONS: Correct placement of the stent was more important than medication for lessening stent-related storage symptoms.

Enuresis nocturna y sindrome de disfunción evacuatoria en niños varones: respuesta al tratamiento con biofeedback urinario de vaciado / Nocturnal enuresis and voiding dysfunction syndrome in boys: response to treatment with biofeedback urinary drainage

La enuresis o síndrome de la "cama mojada" representan un porcentaje importante de la consulta diaria del pediatra y del urólogo pediatra. Se estima que entre el 15 y el 20% de los niños a los 5 años de edad mojan la cama (Moffatt 1994). El Síndrome de disfunción evacuatoria se asocia con mucha frecuencia a niñas enuréticas nocturnas. De los niños varones enuréricos un 20.9% presenta además incontinencia diurna y constipación. OBJETIVOS: demostrar que los niños enuréticos que asocian síntomas diurnos de incontinencia y constipación, presentan una incoordinación miccional por hábito retencionista y que mejoran con re-educación miccional mediante biofeedback de vaciado. MATERIAL Y METODOS: se estudiaron 50 niños que asociaban enuresis y síntomas diurnos de inestabilidad vesical y constipación. Fueron tratados mediante biofeedback urinario de vaciado, enseñando a los pacientes a relajar su periné durante la micción. Estadísticamente los resultados se obtuvieron con una alfa de 0.005 y una beta de 0.30. El delta observado en estudios previos fue bastante amplio de que no permitió obtener un power o poder del 70% con el estuido de 50 pacientes. RESUTLTADOS: La enuresis nocturna mejoró un 86%(p=<0,001), la urgencia mejoró del 98% al 8% y la incontinencia diurna paso de 7,22 veces por día a 0,36.(p=<0,001). La constipación mejoró de un promedio de 4,34 deposiciones por semana a 6,44(p=<0,001). CONCLUSIONES: El biofeedback urinario de vaciado resulto útil en el tratamiento de la enuresis y síntomas de vejiga hiperactiva así como de la constipación en niños portadores de síndrome de disfunción evacuatoria. No hubo diferencias significativas entre los resultados obtenidos en las dos primeras semana de tratamiento y al final (7 meses) lo que muestra la persistencia de los resultaods durante este tiempo...

Malformaciones de las vías urinarias en un recién nacido: revisión bibliográfica / Malformations of the urinary tract in newborns: bibliographic review

Ante un caso de insuficiencia renal en un recién nacido de 21 días se hallaron en la ecografía imágenes de ectasia renal bilateral, quistes renales, megauréter bilateral y probable ectopia de los mismos.

A Case of Left Ureteral Obstruction due to Acute Appendicitis / 영남의대학술지

Appendicitis is a common cause of acute abdomen in pediatrics. Periappendiceal abscesses are frequently found in the pediatric population. Acute appendicitis in children can, at times, be a difficult clinical diagnosis because of its highly variable history? and physical manifestations and its unpredictable course. Despite the uncertainty of the diagnosis, appendicitis demands prompt treatment because of the risk of perforation, which occurs in approximately one third of cases. Urological manifestations of appendicitis and appendiceal abscess can vary. Acute appendicitis presenting with ureteral stenosis and hydronephrosis is very rare. Here, we report a case of acute appendicitis with perforation and left hydronephrosis in a 3-year-old female. This case presents a 3-year-old girl with dysuria having hydronephrosis that originated from a perforated appendix.

The Relationship of Pressure-Flow Parameters and Urethral Pressure in Female Patients with Lower Urinary Tract Symptoms

PURPOSE: This study aimed to evaluate the relationship between pressure-flow parameters and urethral pressure in women with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Urodynamic traces of women with stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and detrusor overactivity (DO) were retrospectively studied. The urodynamic parameters such as detrusor opening pressure (DOP), detrusor pressure at maximum flow rate (PdetQmax), maximum flow rate (Qmax), detrusor closing pressure (DCP), and maximal urethral closing pressure (MUCP) were measured and compared. The relationship between pressure-flow parameters and MUCP were evaluated as well as the differences between each urodynamic group. RESULTS: One hundred fifty-one women were investigated between June 2004 and May 2008. One hundred twenty-one (80%) women had good-quality urodynamic studies and were included in the present study. The mean age was 56 years (range, 32-77). Women with DO had higher DOP, PdetQmax, and MUCP than did women with SUI (p<0.05). Qmax was significantly greater in women with SUI than in women who had DO (p<0.05). Women with MUI had DOP, PdetQmax, and Qmax that were intermediate between women with SUI and those with DO. There was a significant positive correlation between DOP, PdetQmax, DCP, and MUCP measurements and a significant negative correlation between Qmax and MUCP measurements (p<0.01). CONCLUSIONS: Pressure-flow parameters are reliable surrogates of urethral pressure. Therefore, an accurate evaluation of the pressure-flow parameters might give important information in the assessment of urethral and detrusor function in women with LUTS. Further study is needed to confirm our results.

Total versus subtotal abdominal hysterectomy influence on the urinary bladder function

To evaluate lower urinaiy tract flinctions in asymptomatic patients after subtotal abdominal hysterectomy and total abdominal hysterectomy. Forty mtdtiparous premenopausal patients, subjected to subtotal and total abdominal hysterectomy for non malignant causes, and with no urinary complains, were divided into two groups: Group A: Twenty patients in whom subtotal abdominal hysterectomy was performed. Group B: Twenty patients in whom total abdominal hysterectomy was undertaken. Urodynamic data [cystometry, uroflowmeny, and abdominal detrusor leak point pressure] were collected preoperatively, at the 4[th] week, and at the 4[th] month postoperative in both groups. The mean age of group A and B were 42.58 +/- 12.09 years and 43.9 +/- 13.21 years respectively. The mean parity of group A and B were 2.01 +/- 1 1.08 deliveries and 2.61 +/- 1 1.36 deliveries respectively. The mean body mass index of group A and B were 31.25 +/- 12.85 kg/m[2] and 30.7 +/- 1 3.01 kg/m[2] respectively. There were no statistically significant differences between both groups as regards the age, parity, and body mass index. Four weeks postoperative, patients of group A and B complain of frequency [in 20% and 40%], urgency [in 5% and 25%], urge incontinence[in 5% and 20%] respectively. After 4 months of the operation, frequency persisted in [10% and 25%]; urgency persisted in [5% and 20%], However, urge incontinence disappeared in the only one case of group A, which suffered from, while diminished in group B to 10% of the cases. Stress incontinence had never occurred in both studied groups postoperatively. No statistical significant differences were found in the bladder capacity and detrusor muscle activity preoperatively compared with follow up at 4 weeks and at 4 months postoperatively in both groups. Also, No statistical sign[ficant difference was found in residual urine volume preoperative compared with follow up at 4 weeks and at 4 months postoperatively of group [A]. However, significant postoperative increase in the residual urine volume is observed in patients of group [B]. Insignificant urinary complainsand functions changes, except, urgency and residual urine volume are significantly complicating total hysterectomy more than subtotal hysterectomy, with improvement occurred 4 months after the operation

Postoperative urological complications of renal transplantation; Al Karama hospital experience

Studying early post kidney transplant urological complication will provide a feed back evaluation for the surgical technique used and the way of complication management. To study the postoperative urological complications and their management in the first 6 months following renal transplantation. This is a retrospective study in which 123 patients with end stage renal disease [ESRD] underwent renal transplantation from January 2001 to October 2004 in Al Karama teaching hospital, Baghdad -Iraq. All the transplanted kidneys were from living donors. Direct matching between the serum of recipient and lymphocytes of the donor was negative. Extravesical ureteroneosystostomy was carried out using a stent across the anastomotic site. Postoperatively recipients were followed for 6 months by clinical and regular laboratory tests. Ultrasound and color Doppler examinations were performed when there was any evidence of decreased urinary output, allograft dysfunction, or clinical suspicion of rejection. In 123 patients aged 5-59 years with a mean age of 34 years, renal transplantation was carried out. Postoperative urological complications within the first 6 months were reported in 12 [9.75%] patients including urinary leakage in 6 [4.8%], ureteral obstruction in 3 [2.4%], and lymphocele in 3 [2.4%] patients. Major urological complications after renal transplantation contribute to patient morbidity and compromise graft function. Early diagnosis and treatment will avoid loss of the graft

Role of urodynamic studies in evaluation of lower urinary tract symptoms

To emphasize the role of urodynamic studies in the evaluation of lower urinary tract symptoms and to describe the technique and report results of tracings from a urodynamic center in a tertiary care settings. Descriptive Study. This study was carried out at Armed Forces Institute of Urology, Rawalpindi, over thirty months from January 2003 to June 2005. sixty seven patients referred to the urodynamic centre of AFIU, Rawalpindi with complaints of urinary incontinence or voiding disorders were evaluated with conventional urodynamic tests. During cystometry, the detrusor activity, bladder sensation, bladder capacity and bladder compliance were measured with simultaneous urinary flow measurement in those who were able to void. Results were grouped into eight different types of urodynamic diagnoses. There were 51 females [76%] and 16 males [24%] patients. Majority of patients [48%] were in age group of 20-50 years. Ages ranged from 5-84 with a mean of 41.3 +/- 17.3 years. Majority of the patients found to have neuropathic bladder [25.3%] followed by patients with pure stress incontinence [23.9%]. In 38 female patients who presented with urinary incontinence, majority of them i.e. 16 [42.1%] were found to have pure stress incontinence on urodynamic evaluation while 11 [28.9%] patients had normal cystometric findings and 5 patients [13.1%] had hypersensitive cystometrogram signifying sensory urge incontinence while motor urge incontinence implying detrusor instability occurred in 1 patient [2.7%]. Urodynamic studies are useful in evaluation of lower urinary tract symptoms not responding to conventional medical treatment as they help clinician in identifying the underlying causes for the symptoms, and to quantify the related pathophysiological processes. Treatment of the underlying pathophysiology facilitates better treatment of symptoms

Comparison of sacral ratio in normal children and children with urinary and/or faecal complaints

Sacral ratio [SR] measurements in children with urinary and faecal complaints is less than that in normal children. We performed the current study on 401 normal and 193 children with urinary and/or faecal complaints from April 2002 to April 2003. None of the children in either group had a history of a known neurologic disease, myelodysplasia, cloacal exstrophy, Hirschprung's disease, ureteropelvic junction obstruction, ureterovesical junction obstruction or anorectal malformation. Due to ethical and health aspects, we couldn't request radiography in completely normal children to determine SR. The normal value for SR in antero-posterior view [APSR] ranged from 0.36-1.33 with an average of 0.71. The mean APSR in patients with urinary and/or faecal signs and symptoms [case group] was 0.554. The differences of SR values between the two groups were statistically significant [P<0.05]. The curve of mean APSR and age in normal group shows no obvious steepness but the curve in case group has an obvious slope with increasing age to adolescence. The SR is considered as a reliable tool to evaluate sacral development in patients with urinary and/or faecal complaints. It has a wide range of values and should be noted abnormal when it is less than 0.4. Age has a significant influence on SR values in children with urinary and/or faecal complaints

Fraturas do anel pélvico e complicações urológicas / Pelvic fractures and urologic complications

A presente revisão aborda aspectos relativos às fraturas pélvicas e às complicações associadas. com especial ênfase às complicações urológicas. As fraturas da pelve por trauma de alta energia são lesões graves com mortalidade e morbidade significativas, sendo o atendimento precoce do politraumatizado de vital importância para um bom resultado do tratamento. As complicações mais freqüentes das fraturas pélvicas incluem hemorragias maciças, rupturas da bexiga. da uretra e de outras vísceras e lacerações do períneo. O fixador externo é predominante indicado nas rupturas pélvicas instáveis, como medida de tratamento inicial, além de poder constituir um método terapêutico definitivo

[Labial fusion and urinary tract symptoms]

Labial fusion is a common benign prepubertal gynecologic condition that is defined as partial or complete adherence of the labia minora. Most cases are mild and/or asymptomatic, but in some cases may be presented with urinary symptoms. Clinical course and management of 87 cases with labial fusion and urinary tract symptoms, presented between 1372 and 1382, was reviewed retrospectively. Patients age was between 8 months to 6 years [mean= 2y and 8 mo]. 56 cases had been visited by physicians but without genital examination. None of mothers were informed of normal genital condition. 36 cases [41%] had UTI without urologic abnormalities. Topical conjugated estrogen was effective in all patients with minor side effects. Recurrence was noted in 23 cases [26%] which responded to estrogen re-treatment. All of girls with any complaints especially urinary symptoms and UTI must be examined with high index of suspicion for labial fusion

effect of acute urinary retention on serum prostate-specific antigen level

Our aim was to evaluate the effect of acute urinary retention on serum prostate-specific antigen [PSA] level. Men aged 50 years and older who presented with acute urinary retention were studied. Patients with urethral stricture, neurogenic bladder, prostate cancer, and those with a history of recent instrumentation or prostate biopsy were excluded. Blood samples for serum PSA measurement were obtained [PSA1], and an indwelling urethral catheter was inserted for 2 weeks. Before catheter removal, a second blood sample for measurement of serum PSA level [PSA2] was obtained. In patients who were able to void, a third sample was obtained 3 weeks later [PSA3]. In the first and second visits, digital rectal examinations [DRE1, DRE2] were performed to assess prostate volume. Mean PSA levels [PSA1, PSA2, and PSA3] and prostate volumes [DRE1, DRE2] were compared. Forty-five patients with a mean age of 70.18 years [range 56 to 85 years] participated in this study. Mean PSA1 and PSA2 levels were 9.8 ng/mL and 5.05 ng/mL, respectively [P<0.001; medians, 6.2 and 4.2 ng/mL]. Mean prostate volumes at the time of retention and 2 weeks later were 43.4 mL and 37.8 mL, respectively [P<0.001; medians, 45 and 40 mL]. PSA3 was measured in 31 patients 2 weeks after catheter removal. In this group of patients, mean PSA2 and PSA3 levels were 5.03 ng/mL and 4.97 ng/mL, respectively [P=0.49; medians, 4.3 and 4.1 ng/mL]. Acute urinary retention can increase serum PSA levels by approximately 2 fold. In this series, we found that this effect may continue up to 2 weeks

Clinical manifestations of benign ovarian tumours

To examine the cases of Benign Ovarian Tumours and their clinical manifestations. Prospective study of consecutive cases of Ovarian tumours, identified using gynaecological case records. Tertiary care teaching hospital affiliated with Fatima Jinnah Medical College Lahore, managing more than 1500 gynaecological cases annually. 50 cases of Ovarian tumours managed in Department of Gynaecology and Obstetrics Sir Ganga Ram Hospital, Lahore between 1st May 2004 to 1st May 2005. The most common presenting complaints were abdominal pain or discomfort and palpable tumour causing abdominal distension. Abdominal pain was present in 70% of benign ovarian tumours. 20% of the patients had pain due to torsion of ovarian cyst. The complaint of a palpable tumour was found in 4 7% of cases. Vague abdominal and bowel complaints were present in 2 2.5% of cases. 6[15%] patients were asymptomatic. Of these 2 were diagnosed by ultrasound and 3 at the time of emergency Cesarean section and one on routine pelvic examination. Menstrual irregularity and urinary complaints were present in a small number of patients. None of the patient complaint of weight loss or post menopausal bleeding. Benign Ovarian Tumours are most common cause of ovarian enlargement and a very common cause of hospital admission. Symptoms and signs are non specific and presentation is a late stage

diagnosis and management of the urological complications of renal transplantation: a series of 1100 patients

To analyse the Urological Complications after Renal Transplantation and their management. A retrospective analysis of 1150 consecutive live donor renal transplants was performed. The study period extended from December 1995 to December 2004. The surgical procedure for ureteral reimplantation was modified Lich anastomosis. Ultrasonography, renal scanning, antegrade pyelography, retrograde pyelography and cystography were the diagnostic tools. Overall, 68 primary urological complications [5.9%] were identified during the 15-year experience in 65 patients. The Urological Complications in our series included 35 ureteral obstruction [3.0%], 25 ureteral or bladder leaks [2.17%], 05 out flow obstruction, 02 cases of vesicoureteral reflux and 01 case of ureteral stone. The incidence of Urological Complications in our study is 5.9%. Early exploration of the ureteric leaks and timely intervention to obstructed kidney reduced the morbidity and improves graft su rvival. The causes of these complications and techniques for their prevention are discussed in this study

Management of the lower urinary tract symptoms [LUTS] due to benign prostatic hyperplasia [BPH], with terazosin

This study was designed to assess the efficacy, safety and compliance of terazosin in the management of lower urinary tract symptoms due to benign prostatic hyperplasia. Study was conducted in the department of urology, DHQ Hospital Vehari, in about 1-year i-e from July 2004 to June 2005. Sixty patients with an age range of 45-85 years were included in the study. Data was collected prospectively. Patients were assessed according to the international prostate symptom score [I-PSS] at the start of study, during follow up and at the end of study. Out of sixty patients, fifty-two were able to complete the study. It was observed that most of the patients obtained a significant decrease in the prostate symptoms score and improvement in QoL score, with only a few side effects. Terazosin is a safe and effective treatment for BPH with good compliance