[Sexuality assessment of homozygous adult sickle cell patients with a history of priapism in Senegal]. / Évaluation de la sexualité des drépanocytaires adultes homozygotes ayant des antécédents de priapisme au Sénégal.

OBJECTIVES: The objective of this study was to evaluate the sexuality of SS sickle cell patients with a history of priapism. METHODS: This was a case-control study of adult SS sickle cell patients. The occurrence of priapism as well as the nature of the priapism had been investigated. The patients were subdivided into three groups: Group 1 (no priapism), Group 2 (intermittent priapism) and Group 3 (acute priapism). The patients' sexuality was studied using the IIEF-15 questionnaire. RESULTS: We interviewed 191 SS sickle cell patients. The mean age was 27.1±7.1 years. Priapism was observed in 43.5 %. Only 77 patients were eligible for the IIEF15 questionnaire. Groups 1 and 2 performed significantly better than group 3 on erectile function (EF) and orgasmic function (OF) scores. There was no significant difference in the EF and OF scores between groups 1 and 2. No significant difference was observed between the three groups for the scores of sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The impairment of erectile function in group 2 was related to the age of the first episode of priapism and the last episode. The impairment of erectile function in group 3 was related to the duration of evolution (P<0.05). CONCLUSION: This study shows that priapism is responsible for impaired erectile function in SS adult sickle cell patients. A program to prevent intermittent episodes of priapism should be put in place.

Management of gestational trophoblastic diseases in a low resource country: establishment of a national center and its results.

To describe the process of establishing a reference center for gestational trophoblastic diseases (GTD) in Senegal and to report its main results so far. We describe the history and establishment of the center, which is based on the experience of the main international centers. The adaptations made to patient follow-up are detailed, while we follow FIGO and WHO diagnostic and management criteria. Finally, we report our main results. Between 2011 and 2017, 878 files were registered at the Center. More than half of the women had no histological confirmation of GTD (60.8 %). The diagnosis was then based on ultrasound images or macroscopic examination of molar vesicles. Spontaneous remission occurred in 64.5 % of the cases, while gestational trophoblastic neoplasia developed in 23.5 %. The FIGO criteria were slightly adapted for hCG monitoring. Methotrexate was the drug of choice in the low-risk group (97.8 %), while the EMACO protocol was financially difficult for nearly half of the high-risk group. The overall remission rate was 83 % and the specific lethality 11.6 %. Our center has demonstrated the efficiency of centralizing the management of GTDs. Difficulty in access to hCG and antimitotic drugs makes management difficult. However, we have introduced alternative solutions that we are working to improve.

Simulation training for emergency obstetric and neonatal care in Senegal preliminary results.

To describe a new training approach for emergency obstetric and neonatal care (EmONC) introduced in Senegal to strengthen the skills of healthcare providers. The approach was based on skills training according to the so-called "humanist" method and on "lifesaving skills". Simulated practice took place in the classroom through 13 clinical stations summarizing the clinical skills needed for EmONC. Evaluation took place in all phases, and the results were recorded in a database to document the progress of each learner. This approach was used to train 432 providers in 10 months and to document the increase in each participants' technical achievements. The combination of training with the "learning by doing" model ensured that providers learned and mastered all EmONC skills and reduced the missed learning opportunities observed in former EmONC training sessions. Assessing the impact of training on EmONC indicators and introducing this learning modality in basic training are the two major challenges we currently face.

Profile of black woman in Senegal with breast cancer.

To describe the profile of Senegalese black women with breast cancer. This is a retrospective and prospective study of patients receiving care for breast cancer in the breast diseases department of the Aristide Le Dantec Teaching Hospital in Dakar from 2010 through June 2014. 188 women patients met the inclusion criteria. Their mean age at diagnosis was 43.3 years. The age of onset of the first menses was early (<12 years) in 7 patients (4.9%). More than two thirds of the women (71.6%) were premenopausal at diagnosis. At least one pregnancy was reported by 161 women (86.1%) and 96.3 had given birth. Mean age at first pregnancy was 19.47 years, and 85.9% had had their first pregnancy before the age of 30. Similarly, 133 (87.3%) had breastfed, for a mean duration of 18.36 months. In our country, breast cancer occurs in young women, who had their first menses after 12 years, are premenopausal, had their first pregnancy before the age of 30, and breastfed for several months. These data suggest that further study of this profile is needed but that the testing policy must change drastically, to start much earlier than 50 years.

Breast cancer in women younger than 35 years : features and outcomes in the breast unit at Aristide le Dantec Teaching Hospital, Dakar.

The aim of this study was to determine the clinical features and outcomes of women younger than 35 years with breast cancer. This study was performed at Gynecologic and Obstetric Clinic of Dakar Teaching Hospital and retrospectively reviewed the records of all women younger than 35 years seen in our department for histologically proven breast cancer. Data were analyzed with SPSS software (Statistical Package for Social Science) Version 23. Between 2007 and 2015, 62 women with breast cancer met the inclusion criteria and were included. The incidence of women in this age group treated in our department was 22.6%. The median age at diagnosis was 29.7 years. The mean time to consultation was 12.5 months, and the disease was locally advanced at diagnosis in 79% of cases. Histological study found 85.5% of cancers were invasive ductal carcinoma. The immunohistochemical study found positive hormone receptors in 12 women (19.4%) and overexpression of HER-2 in 8 (12.9%). Chemotherapy was performed in 54 patients (87.1%), and surgery in 47 (62.9%). Recurrence occurred in 12. In all, 22 women died (35.5%) by the end of the study period. Mean survival was 36.7 months (CI 29.5 to 43.9) and median survival 39.7 months (CI 22.1 to 57.5). This high incidence rate in our study is consistent with that found in young African-American women and is worrisome. These results seem to point towards a genetic origin and call for a thorough search of the profile. They also call also for the involvement of pathologists and collaboration with other research teams.

Gestational trophoblastic neoplasia after achieving a nondetectable serum human chorionic gonadotrophin level.

OBJECTIVE: To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole. DESIGN: A retrospective review of data from a national gestational trophoblastic disease centre. SETTING: The Trophoblastic Disease Unit, Dakar, Senegal. SAMPLE: Women with pregnancies affected by hydatidiform mole registered between 2006 and 2012. METHODS: The women were followed up in accordance with the hospital protocol 'Score de Dakar'. For women who progressed to gestational trophoblastic neoplasia (GTN) the time to onset of GTN, treatment and evolution were evaluated. The rate of evolution to GTN after normalisation of hCG was determined. MAIN OUTCOME MEASURES: Rate of occurrence of GTN after chemotherapy for hydatidiform mole. RESULTS: Five hundred and thirty-one women were diagnosed to have molar pregnancies. According to the hospital's protocol, 107 (20.2%) of these had chemotherapy and 224 (42.2%) had prophylactic chemotherapy. Five hundred and thirteen women (96.4%; 95% confidence interval [95% CI] 95.05-98.14%) achieved remission. Eighteen women (3.4%; 95% CI 1.86-4.94%) developed GTN (11 before remission and seven after remission). Seven women out of the 18 developed GTN after hCG normalisation (1.3%). Five of these seven were diagnosed beyond the recommended period of follow up. The mean interval to diagnosis of GTN was 18.7 months. These seven women underwent combination chemotherapy: five achieved complete remission whereas two died from GTN. CONCLUSIONS: Cytotoxic therapy for hydatidiform mole does not prevent GTN, it delays its diagnosis and promotes GTN after normalisation of hCG.

[Trancesarean intra-uterine device. Pilot study performed at Dakar teaching hospital]. / Dispositif intra-utérin mis en place en cours de césarienne. Étude pilote réalisée au centre hospitalier universitaire de Dakar.

OBJECTIVES: To demonstrate the feasibility of copper IUD insertion following cesarean deliveries and assess its safety. PATIENTS AND METHODS: This is a prospective pilot study at Pikine national hospital from February 15 to November 15, 2012. Were evaluated the efficacy, incidence and spectrum of complications and continuation rates. RESULTS: Fifty-nine subjects were enrolled and 46 received an IUD. The average age of patients was 28 years. No patient had previously used IUDs. Forty-four patients (97.5%) were returned to the first follow-up visit at the first month, 41 patients (89.1%) at the second visit and 39 patients (86.9%) at the third visit. The rate of lost sight was 8.7%. Pain and bleeding were reported rarely: 2.3% at the first month, 4.9% at the third month and 7.7% at the sixth month for the bleeding and 6.8% at the first month, 2.4% at the third month and 2% at the sixth month for pain. The rate of expulsion was 2.2%. CONCLUSION: The insertion of the IUD following cesarean delivery has an acceptable rate of expulsion and no increased rate of adverse effects. This technique should be popularized.

[Management of prostate cancer in Senegal: what is being done?]. / Cancer de la prostate : quelle prise en charge au Sénégal ?

OBJECTIVE: To evaluate the management of patients with prostate cancer in Senegal. MATERIALS AND METHODS: We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities. RESULTS: We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen. CONCLUSION: The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

[Breast cancer on a scar of excision of ectopic breast tissue: a case report]. / Cancer du sein sur la cicatrice d'exérèse d'un tissu mammaire ectopique: à propos d'un cas.

The cancerization of supernumerary breast is uncommon. So when this situation occurs, the diagnosis is often late. Cancers of ectopic breast tissue have been reported in the international literature, but to our knowledge, no cancer after excision of accessory breast gland has been published. This article describes a case of ectopic breast tissue cancer in axillary situation occurring several years after excision and details its specific diagnostic, therapeutic and prognosis.

[Total cystectomies for cancers locally advanced of bladder about 12 cases in the service of urology of the general hospital of Grand-Yoff]. / Cystectomies totales pour cancers localement avancés de vessie au service d'urologie de l'hôpital général de Grand-Yoff.

OBJECTIVE: The goals of the study is to evaluate the feasability of the total cystectomy for cancer infiltrating locally advanced of bladder and to evaluate perioperatitive morbidity and short-term results. PATIENTS AND METHODS: We made a retrospective study concerning 12 first patients having profited from a total cystectomy for cancer infiltrating of the bladder in our hospital over one period of 1 year. The parameters of study were: the age at the time of the diagnosis, circumstances of the diagnosis, antecedents of the patient, the histological type and stage TNM before and after intervention, the type of derivation associated, duration of the intervention, the anesthesia, complications and morbidity per- and postoperational. We carried out calculations of average and frequency for the data analysis. RESULTS: The mean age was 51 years (extreme: 32; 83). They were nine men and three women. The circumstances of diagnosis were dominated by the total hematuria and in less frequency by the bladder irritative symptoms. The antecedents of the patients were dominated by the schistosomia (five cases) and the tobacco addiction (two cases). The histological type obtained in preoperative after biopsy or trans urethral resection of bladder found, seven cases of squamous cell carcinoma, four cases of transitional cell carcinoma and one case of adenocarcinoma. Into preoperative, three patients were at the stage pT2, eight patients pT3, one pT4. Four patients had a replacement of bladder: three by a bladder in Z and a patient had Camey II. They were the three patients pT2 preoperative and a patient pT3. Two patients had a standard ureterosigmoidostomy type coffey: the patient pT4 and a patient pT3. The six other patients had Bricker. All the patients profited from a blood transfusion peroperational (two units on average). We did not record any operational mortality. The complications and morbidity are represented by the suppurations of wall (three cases), the vesicocutaneous fistula (one case), the infections urinary and the anemia which was constant. CONCLUSION: The management of bladder cancer poses a real problem in our countries because of the diagnosis at advanced stage.

Paraneoplastic polymyositis associated with breast cancer: a therapeutic emergency.

The association of polymyositis and cancer was first described in 1916, the most frequent cancers being mammary and gynecological for women, bronchopulmonary for men and digestive for both. This article reports a severe paraneoplastic polymyositis associated with breast cancer. The authors discuss its clinical, pathological and therapeutic particularities.

Capacity building for the modified filarial hydrocelectomy technique in West Africa.

To harmonise the technique of filarial hydrocelectomy throughout the West African subregion, training workshops were organized in 10 endemic West African countries involving surgeries on Filarial hydrocele patients (Filariceles). Countries included Ghana, Nigeria, Niger, Burkina Faso, Senegal, Mali, Liberia, Gambia, Sierra Leone and Togo. Patients were recruited by the Filariasis programme managers in all these countries and workshops were done to train surgeons from teaching, government and district hospitals with funding mainly from the West African Filariasis Project. A total of 16 workshops were held in 10 West African Countries, and a total of 500 filarial hydrocele/chylocele cases were operated using the technique of total tunical resection without drainage with excellent postoperative results. The average operating time for a unilateral hydrocele was 45 min to 1h and for bilateral hydrocele was 1½ h to 2h depending on the size of the hydrocele .All patients were admitted for a minimum of 5 days postoperative. Training workshops were successfully organized in 10 out of the envisaged 12 west African Countries with 214 surgeons trained. Since 2004 till date the trained surgeons have also operated 2500 filaricele cases bringing it to a total of 3000 cases operated so far. Evaluation studies revealed that the infection rates in one country was initially 60% and then it later dropped to 20% and this was actually attributed to poor follow up by the selected National Coordinator. However complication rates in all the Countries where workshops were done ranged between 5% and 7% made up of infection, haematoma and or delayed wound healing. Recurrence rates have been very low about 3-5% per Country.

[Urinary incontinence in woman: epidemiologic profile in Sub Saharian countries]. / Incontinence urinaire de la femme: profil épidémiologique au sud du Sahara.

UNLABELLED: The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries. MATERIAL AND METHODS: A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence. RESULTS: Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases. CONCLUSION: Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

[Breast cancer screening in Dakar: knowledge and practice of breast self examination among a female population in Senegal]. / Dépistage du cancer du sein: connaissance et pratique de l'auto-examen des seins au sein d'une population féminine au Sénégal.

In front of the absence of a mammographic screening program and the late diagnosis of the breast cancers in Senegal, we wanted to evaluate the knowledge and the practice of the breast self examination (BSE) by feminine population in Senegal. During the period between July 10th to August 25th 2006, through five big hospitals in Dakar, we interviewed 300 patients coming from a medical or surgical consultation. For every patient we studied the social and demographic characteristics, the antecedents and arguments about the knowledge and practice of BSE. We found, in majority, a young population (the average age was 34 years), no sent to school (26.7%), without any financial income (58.7%), with a brief knowledge about BSE (42.7%) and a regular practice of BSE (29%). The information about BSE originated essentially from educational television (52.9%). This knowledge and practice were significantly influenced by the study level (p = 0.000) and the level of financial income (p = 0.02). Among these who presented certain factors of breast cancer risk, the knowledge and the practice of the BSE were however low. The authors insist on the need to encourage the women schooling and their socioprofessional insertion so to improve the knowledge and practice of the breast self-examination in our developing countries.

[Pregnancies associated with valvular prosthesis at Dakar Teaching Hospital: prognosis, epidemiological, clinical and therapeutical aspects]. / Prothèse valvulaire cardiaque et grossesse au CHU de Dakar: aspects épidémiologiques, cliniques, pronostiques et modalités thérapeutiques.

OBJECTIVE: The persistence of the rheumatic valvular cardiopathie and the access to cardiac surgery make this association frequent. This work will deal with a description of the epidemiological and clinic profile and the evaluation of the cares to the pregnancies with cardiac valvular prostheses. METHODOLOGY: We took a retrospective study beginning from 1987 to 2006 about 14 cases, which had benefited from collaboration between the Gynaecologic and Obstetric Clinic and the Cardiological Clinic of the University Hospital Center of Dakar. RESULTS: The frequency of pregnancies with valvular prosthesis was of 0.12 per thousand. The average age of our patients was of 27.7 years. The average pregnancy was of 2.3 gestures with extremes of 1st to 12th gestures. The pregnancies were not, in any case, planned. An auricular fibrillation was noticed in four patients. The fraction of ejection of the left ventricle was superior or equal to 60% in 10 cases, the prosthesis was lightly blocked in two cases. Despite the use of anti-vitamin K during the first trimester with 42.86% of the patients, the anticoagulation was effective with the entire cases excepted one who died by lung embolism. The delivery was, in seven cases, realized by caesarean and in two cases by natural way. Two cases of premature and foetal hypotrophy have been noticed. There was no case of malformed children. CONCLUSION: With a multidisciplinary care, the carry of valvular prosthesis can be compatible with pregnancy. The lack of embryopathy and malformed children could incite to propose the oral anticoagulation during the whole sequence of pregnancy.

L'echographie doppler couleur scrotale dans la recherche etiologique de l'infertilite conjugale

Introduction : l'infertilite masculine est de plus en plus importante(1). Les etiologies sont variees; l'echographie doppler couleur des bourses constitue l'examen d'imagerie de premiere intention dans la recherche etiologique. Le but de notre travail est d'evaluer la place de l'echographie doppler couleur dans l'exploration de l'infertilite masculine. Patients et methodes : Nous avons realise une etude retrospective sur une annee de 53 dossiers de patients ayant consulte pour infertilite du couple. Une echographie doppler couleur des bourses a ete realisee pour tous les patients. Elle a permis de noter pour chaque patient la taille; le volume; les contours du testicule et l'aspect du cordon. Le doppler couleur precisait la cartographie vasculaire. Resultats : la moyenne d'age etait de 39;5 ans; la duree moyenne d'infertilite etait de 07 ans et demi. L'examen clinique avait retrouve 20 cas de varicocele clinique dont 12 gauches et 8 bilaterales. L'echographie Doppler couleur avait retrouve 42 cas de varicocele dont 11 confirmant l'examen clinique (3 varicoceles gauches et 8 varicoceles bilaterales); et 31 infra cliniques avec 13 cas de varicoceles bilaterales; 12 cas de varicoceles droites et 6 cas de varicoceles gauches. Les valeurs du diametre des veines droites et gauches variaient entre 2 et 4;8 mm; un reflux a ete objective chez tous nos patients. 33 patients avaient une atrophie testiculaire droite; 35 patients une atrophie testiculaire gauche. 2 cas de kyste para-epididymaire; 3 cas de micro lithiases testiculaires; deux cas d'hydrocele ont ete retrouves. L'echographie Doppler couleur etait normale chez 3 patients. Conclusion : Cet examen est une methode d'imagerie de premier choix dans la strategie diagnostique de l'infertilite masculine

[Sexual abuse: epidemiological, clinical aspects and management at gynaecological and obstetrical department of Dakar University Hospital]. / Profil épidémioclinique et prise en charge des victimes d'abus sexuels à la clinique gynécologique et obstétricale du CHU de Dakar.

OBJECTIVES: To carry out the epidemiological and clinical characteristics of supposed victims of sexual abuse and to evaluate case management. PATIENTS AND METHODS: A prospective study was conducted about cases of presumed sexual abuse received at the gynaecological and obstetrical clinic department of Aristide-le-Dantec hospital from January 2003 to May 2005. RESULTS: A total of 55 cases were reported and represented 0.4% of admissions in the clinic during the period of study. Twenty percent of them (20%) were referred on judicial requisition. The mean time between sexual abuse and consultation was 15 days. Victims were 14 years old in average, nulligeste in 96.5% of cases and living in the suburban area of Dakar. The presumed "violenter" was a man of 32 years, belonging to the environment of the victim in 70% of cases (spiritual guide, joint-tenant, friend of the family...). The type of sexual assault was an unprotected genito-genital intercourse in 67.3% of cases. On the clinical plan, 70.9% of patients suffered recent genital traumatism, 54.5% genital examination showed hymeneal lesions. The HIV test was positive in two cases. During the follow-up of the patients, three pregnancies occurred and for only 9.1%, a psychological assistance was proposed. CONCLUSION: Sexual abuses represent a current sociocultural issue. Prevention required large information campaign. Early management is necessary in order to prevent the sexual transmitted diseases and psychological side effects.

[Advantages of laparoscopic assisted vaginal hysterectomy in surgery of endometrial carcinoma]. / Avantages de la voie vaginale coelio-assistée dans la chirurgie des cancers de l'endomètre.

INTRODUCTION: In to respect the principles of oncological surgery and to reduce the operative morbidity, the authors of this study propose to find the proper place of the laparoscopic-assisted vaginal hysterectomy in the surgery of endometrial carcinomas. PATIENTS AND METHODS: Between the 1st of June 2002 and 31 of May 2005, we realize a retrospective and comparative study for 36 laparoscopic-assisted vaginal hysterectomy and 20 laparotomies concerning 56 patients. RESULTS: In primary stages (stages I and II of FIGO), laparoscopic assisted vaginal hysterectomy is as powerful as the laparotomy whereas in more advanced stages, laparotomy was more complete and effective (p=0,07). One conversion case was observed (2.8%) in a context of peritoneal carcinosis (stage IIIc). There was not statistically significant difference about the operatives complications (p = 0.51). On the other hand, the postoperative comfort was so far better in the laparoscopic-assisted vaginal hysterectomy group (p=0.0002). The average delay of followed without relapses was 22,3 months in the laparoscopic-assisted vaginal hysterectomy group versus 23 months in the laparotomy group (p=0.51). CONCLUSION: Considering these results, the authors retain that, in primary stages (I-II, FIGO), laparoscopic-assisted vaginal hysterectomy represents a real option in the surgery of endometrial carcinoma. On the other hand, the advanced stages should be reserved for laparotomy.

Varicocele primitive et fertilite : evaluation postoperatoire des parametres du spermogramme et de la fecondite

Objectif : Il n'existe pas de consensus concernant la capacite de la varicocelectomie a ameliorer la fertilite et la fecondite. L'objectif de cette etude retrospective etait d'etudier l'evolution postoperatoire de la fertilite masculine (par les parametres du spermogramme) et celle de la fecondite du couplePatients et methodes: Il s'agit d'une etude retrospective de 50 patients porteurs de varicocele palpable operes selon la technique de Palomo au service d'Urologie de l'Hopital Grand Yoff; Dakar; Senegal. Les parametres etudies sont les parametres du spermogramme (densite; mobilite totale a la premiere heure; vitalite) et du spermocytogramme (taux de spermatozoides de morphologie normale); une fois avant l'operation et a deux reprises apres (entre le 3eme et le 8eme mois et a partir du 9eme mois) et la fecondite postoperatoire du couple chez 35 patients. Resultats : L'etude du spermogramme retrouve; pour l'ensemble des patients; une elevation de la valeur moyenne de tous les parametres; sans normalisation; exception faite de la morphologie (spermocytogramme). L'evolution postoperatoire n'etait statistiquement significative que pour la densite. La majorite des patients (76a 92) presentaient des valeurs du spermogramme preoperatoires inferieures a la normale; excepte pour la morphologie (28) (spermocytogramme). Les parametres du spermogramme se sont ameliores pour 48 a 64des patients selon le parametre etudie. L'amelioration des parametres est d'autant plus importante que leur valeur preoperatoire moyenne etait basse. Les facteurs de bon pronostic postoperatoires sont representes par les patients les plus jeunes (moins de 35 ans) et ceux qui presentaient une varicocele bilaterale; une infertilite de type secondaire et une duree d'infertilite moins longue. Nous n'avons pas etudie la correlation entre le grade de la varicocele et la fecondite. Le taux de grossesse postoperatoire etait de 31;4. Les sujets feconds etaient plus jeunes; avaient une duree moyenne de l'infertilite moins longue et des parametres constamment plus eleves par rapport aux patients infeconds. Les ameliorations postoperatoires de la fertilite et de la fecondite dans cette etude etaient relatives et limitees. Conclusion: Par la frequence de la varicocele et ses consequences sur la fertilite; il s'avere necessaire aussi de mieux et de plus informer les populations sur cette affection; ses consequences et les resultats de son traitement sur la fertilite. De plus une collaboration plus etroite entre gynecologues; biologistes de la reproduction; radiologues et urologues-andrologues permettrait une prise en charge integree de l'infertilite du couple. Il est egalement necessaire; concernant l'infertilite; d'ameliorer la prise en charge psychologique du couple; et notamment celle de la conjointe