Les traumatismes majeurs du rein : aspects diagnostiques et thérapeutiques au CHU-Gabriel Touré de Bamako au Mali

Le but de ce travail était d'évaluer la prise en charge des traumatismes majeurs du rein dans un hôpital de troisième référence au Mali.Patient et méthodes:Il s'agit d'une étude rétrospective portant sur 7 cas de traumatismes majeurs du rein, colligés au service d'urologie de l'Hôpital Gabriel Touré de Bamako sur une période de 15 mois.Résultats : Les patients se répartissaient en 6 hommes et 1 femme.Nous avons enregistré6 cas de traumatisme fermé et 1 cas de plaie pénétrante du rein. L'âge moyen était de 19 ans. Les étiologies étaient dominées par les accidents de la circulation. Les principaux signes cliniques étaient l'hématurie et les lombalgies. L'état hémodynamique était stable à l'entrée.L'échographie puis la tomodensitométrie rénale ont été réalisées chez tous les patients permettant le diagnostic de traumatisme rénal.Le bilan radiologique permettait de classer les traumatismes selonl'AAST (American Association for the Surgery of Trauma) en : 3 cas de grade IV, et 4 cas de grade III.Notre prise en charge, a consisté en un traitement conservateur chez 5 patients et une chirurgie différée chez 2 patients. L'exploration chirurgicale réalisée a aboutit à une néphrectomie. Par ailleurs, 1 patient a présenté un urinome ayant régressé spontanément au cours de l'hospitalisation. L'évolution clinique était favorable chez tous les patients avec un délai moyen de 3 mois. La tension artérielle était normale chez tous les patients de même que le dosage du taux sérique de la créatinine. Le contrôle radiologique effectué chez les patients ayant présenté un traumatisme au stade IV a montré une reconstruction du rein et une absence d'extravasion de produit de contraste.Conclusion :Les traumatismes du rein sont de plus en plus fréquents. Cette situation est liée à l'augmentation des accidents de la voie publique. Le traitement conservateur même en cas de traumatisme majeur reste la méthode thérapeutique de choix en l'absence d'instabilité hémodynamique. Une surveillance accrue des traumatismes pénétrants par armes à feu semble indispensable pour une exploration chirurgicale précoce en cas de nécessité

Skin diseases of the male external genitalia in the Tanlangai Hospital in Brazzaville, Congo.

To determine the frequency of diseases responsible for skin lesions of the male external genitalia. This descriptive retrospective study examined the medical records of patients older than 14 years treated for genital symptoms as outpatients at the Dermatology Department of Talangaï Hospital in Brazzaville in 2009-2011. Patients' sociodemographic, medical history, clinical, and laboratory data were collected on a standardized individual form. The data were processed with Epi Info 3.5.4 software. The records revealed 76 dermatoses of the male external genitalia treated in the three-year study period. Causes were infectious for 69.7 %, with a predominance of scabies (22.4 %), warts (18.4 %), and genital herpes (11.8 %). Sexually transmitted infections accounted for 31.6 % of the cases. Inflammatory dermatoses (19.8 %) included eczema (10.6 %), fixed drug eruptions (7.9 %), and psoriasis (1.3 %). Vitiligo accounted for 4 % of the genital skin diseases. One case of Kaposi's sarcoma was reported. Parasitic and viral dermatoses, and particularly sexually transmitted diseases are common causes of skin conditions of the male genitalia.

Cancer de la prostate : Corrélation entre le taux de PSA et le score de Gleason

Objectif : Evaluer la corrélation entre le taux de PSA et le score de Gleason. Patients et méthode : Il s'est agi d'une étude rétrospective où ont été retenus les malades ayant un diagnostic histologique de cancer de la prostate avec score de Gleason et un taux de PSA total initial. Trois groupes de différenciation ont été constitués. Le taux de PSA a été regroupé en six classes : < 10 ng/ml, [10-50 ng/ml], ]50-100 ng/ml], ]100-500 ng/ml], ]500-1000 ng/ml], >1000 ng/ml. Le test de Fisher et un modèle de régression logistique ont permis d'apprécier la corrélation entre le taux de PSA et le score de Gleason. Résultats : Soixante-deux cas ont répondu aux critères d'inclusion. L'âge moyen était de 66 ans (extrêmes 49-80 ans). Dans 83,9% le taux de PSA variait entre 10 et 500 ng/ml. Cinquante virgule cinq pour cent (50,5%) avait un score de Gleason compris entre 8-10. Les taux de PSA variaient entre 3 et 3025 ng/ml avec une médiane à 68,5 ng/ml, une moyenne à 211,37 ng/ml et un écart-type de 474,05 ng/ml. Le taux moyen de PSA était de 42,39 ng/ml pour les cancers bien différenciés, 222,8 ng/ml pour les cancers moyennement différenciés, et 249,09 ng/ml pour les cancers peu différenciés. La probabilité d'avoir un cancer bien différencié diminuait significativement avec l'augmentation du taux de PSA selon un rapport de cotes variant entre 1,46 et 1,82 (p = 0,029). Conclusion : Le taux de PSA pourrait permettre de prédire le grade de différenciation du cancer de la prostate mais pas le score de Gleason. Cette prédiction pourrait être améliorée en tenant compte du stade d'extension du cancer

[Self-amputation of the penis treated immediately: Case report and review of the literature]. / Auto-amputation de verge traitée par réparation d'emblée: à propos d'un cas et revue de la littérature.

Self-amputation of the penis treated immediately: case report and review of the literature. Self-amputation of the penis is rare in urological practice. It occurs more often in a context psychotic disease. It can also be secondary to alcohol or drugs abuse. Treatment and care vary according on the severity of the injury, the delay of consultation and the patient's mental state. The authors report a case of self-amputation of the penis in an alcoholic context. The authors analyze the etiological and urological aspects of this trauma.

[The urological complications of pelvic fractures: about 22 cases at the University Hospital, Brazzaville]. / Les complications urologiques des fractures de la ceinture pelvienne : à propos de 22 cas au CHU de Brazzaville.

OBJECTIVE: To analyze the epidemiology, injury mechanisms and therapeutic aspects of urological complications of fractures of the pelvic girdle. PATIENTS AND METHODS: Retrospective study including 22 cases of urological complications of pelvic fractures analyzed between 2003 and 2010 at the University hospital, Brazzaville. Tile classification modified AO was used to understand the mechanisms underlying urological complications. The variables studied were: frequency, age, sex, origin, etiology, type of pelvic fracture, type of urological complications, clinical urological lesions, the therapeutic delay, the therapeutic method, the long-term prognosis. RESULTS: In total, 22 cases (11.40%) of urological complications were collected on 193 pelvic fractures. Men dominated the series with a sex ratio of 4.5, the average age was 33.8 years (12 to 64). Street accidents were the leading cause with 13 cases (59.09%). The urethra was the most affected in 16 cases (72.73%), the membranous portion in 10 cases (45.45%), the bladder in six cases (27.27%). Type A fractures were complicated four bladder lesions, types B, 12 urological lesions (1 bladder and urethra 11) and six type C lesions (1 bladder and urethra 5). Bone lesions were supported functionally in 18 cases (81.82%). Urethral injuries in men were repaired remotely by anastomotic urethroplasty. Urethral injury in females has been repaired urgently delayed. The bladder lesions were repaired by emergency laparotomy and suture of the breach, or urethral catheterization. In monitoring, seven patients had urological sequelae: erectile dysfunction in one case and urethral stenosis in six cases, they have been treated by dilatation (4 cases) and endoscopic internal urethrotomy (2 cases). CONCLUSION: The urological complications of pelvic fractures were rare in our experience, and must be systematically searched. Unstable fractures (types B and C) were the major providers of these complications. Remote processing was possible with good functional results.

[Stones associated with vesicovaginal fistulas]. / Fistules vésicovaginales avec calculs enclavés.

OBJECTIVE: To describe the clinical features and treatment of a large stone associated with vesicovaginal fistula and analyze the contributing factors. PATIENTS AND METHODS: From January 2000 to July 2011, seven patients were operated on for a large stone wedged in the vesicovaginal at the Urology Andrology department of the University Hospital of Brazzaville. For each case, the epidemiological, clinical, therapeutic aspects were analyzed. RESULTS: Seven of 89 patients operated on for vesicovaginal in 10 years had a large stone. The age of patients ranged from 35 to 63 years with an average of 44 years. The age of the fistula ranged from 3 to 33 years. History were six caesarean sections and one obstructed labor. The urine culture performed in six patients had identified both Escherichia Coli, five times, and Proteus mirabilis, one time. The calculus was extracted five times by the bladder and two times vaginally. The dimensions of the calculi ranged from 3 to 7 cm of large diameter. The suture concomitant fistula was performed with four cures and three failures cured by a second course. CONCLUSION: Vesicovaginal fistulas may be complicated by calculus. The contributing factors are foreign bodies and infection.

[Urological complications of gynecologic surgery]. / Les complications urologiques de la chirurgie gynécologique.

OBJECTIVE: To analyze the epidemiological, anatomoclinical, surgical and evolutionary aspects of the urological complications of gynecological surgery. MATERIAL AND METHODS: It was about a retrospective survey, concerning 81 patients hospitalized in the department of urology of the university hospital, Brazzaville from 2000 to 2008 for urological complications of the gynecological surgery. The epidemiological, diagnostic, surgical and evolutionary parameters have been analyzed. RESULTS: The urological complication of the gynecological surgery has been recovered in 3% of patients hospitalized in urology. The middle age was 37±14.52 years (17 and 74 years). The median was about 36 years. The middle delay of diagnosis was 15 days (0 and 350 days). The revealing clinical signs were: the oligoanuria (n=12), the urinary incontinence (n=57), the lumbar pain (n=9) and the cyclic hematuria (n=2). The surgical interventions in reason were: the Caesarean (n=50), the hysterectomy for fibroma (n=26), the myomectomy (n=3) and the hysterectomy for cancer (n=2). Anatomical lesion were 55 (67.9%) vesicovaginal fistulas, 12 (14.8%) ureteral ligatures, eight (10%) uretero-vaginal fistulas, three (3.7%) vesico-uterine fistulas, two (2.4%) wounds ureteral and one (1.2%) vaginal vesico-fistulas and uretero-vaginal fistulas. The treatment consisted in one termino-terminal ureterorraphia, 20 uretero-vesical reimplantation, 57 cures of vesico-vaginal fistulas and one nephrectomy. The recovery was obtained at 96% of the ureteral lesions and 90% of the vesico-vaginal fistulas. CONCLUSION: The lesions of the ureteral and the bladder were often met during the gynecological surgery. The treatment requires knowledge of the anatomy of pelvis.

[Prostate cancer: Gleason scores correlation between biopsies and surgical gross specimen]. / Cancer de la prostate : corrélation des scores de Gleason entre les biopsies et les pièces opératoires.

UNLABELLED: The Gleason score is a histopronostic criterion which gives an appraisal of prostate cancer aggressiveness and outcomes. OBJECTIVE: The goal of this retrospective study was to assess the relationship between Gleason scores appreciated on biopsies and later on surgical gross specimen. RESULTS: During the period of the study, 123 patients benefit of a histological diagnosis of prostate cancer recording Gleason score on biopsies and postsurgical intervention on gross specimen. After analysis of biopsies and for gross specimen the reported Gleason scores vary from 3 to 9 and the mean was 5.9 and 6.1 respectively. There was a good concordance between the Gleason scores for biopsies and gross specimen in about 32.5% of cases. We noted a difference of score of one point in 37.3% of patients and a difference of two points and more in 30% of cases. In 28.4% the Gleason scores were overestimated while in 39% they were underestimated. More than half of the patients' cohort was classified in the group of histologically moderately differentiated cancer. When grouping the patients according to the histological types well, moderately or less differentiated cancers, the Gleason scores concordance for biopsies and for gross specimen change from 32.5% up to 74.8%. The correlation can be considered good for the less differentiated cancers. CONCLUSION: Gleason score showed some limits in the appreciation of the prediction. The grouping of patients according to the three distinct histological differentiation groups increases the concordance between the score of Gleason on biopsy specimen and gross specimen but it seems less powerful for cancers well and moderately differentiated cancers.

[Urogenital fistulas: etiopathogenic and therapeutic aspects at the University Hospital Center of Brazzaville]. / Les fistules urogenitales: aspects ethiopathogeniques et therapeutiques au CHU du Brazzaville.

INTRODUCTION: The urogenital fistulas continue to be a dangerous complication of the childbirths dystociques in Africa and especially to Congo. OBJECTIVES: To analyze the étiopathogénic and therapeutic aspects of the urogenital fistulas in order to suggest preventive measures. SICK AND METHODS: It is about a retrospective survey achieved in the service of urology of the univertery hospital center of Brazzaville of January 2001 to December 2005 concerning 34 patients hospitalized for urogenital fistulas. The étiopathogéniques and therapeutic aspects have been analyzed. RESULTS: The urogenital fistulas represent about 2,7% of the hospitalizations in urology. The middle age is of 31 years (17 - 65 years). 28 (82%) are of obstetric origin with 11 Caesareans and 17 childbirths dystociques. 6 are especially of surgical origin after hysterectomy. 28 patients have been operated among which 2 have been taken. The different surgical techniques were the following: 20 ways transvésicales, 3 Chassar Moirs, 2 LEGUEU, 3 Martius and 2 vaginal ways with Picot Couvelaire. The anatomical shapes were: 29 fistulas vésicovaginales, 1 vésico uterine, 3 vesico vaginorectal and 1 urétérovaginale. After surgery, we got 25 anatomical closings of which 1 with incontinence. 3 recidivisms have been observed: 2 have been reoperate of which 1 success and 1 failure. The 3rd being lost of view. To the total we got 25 successes (89,2%). CONCLUSION: The urogenital fistulas remain frequent with a predominance of the obstetric reasons. The recidivisms are possible from where the necessity of a mastery of the surgical techniques.

Le cancer du rein de l'adulte : 25 observations

Objectifs : analyser les aspects épidémiologiques, cliniques, para cliniques, anatomopathologiques, thérapeutiques et évolutifs des cancers du rein pris en charge dans le service d'urologie - andrologie du CHU de Brazzaville. Matériel et méthodes : étude rétrospective de 25 tumeurs malignes du rein, colligées durant une période de 9 ans (2000-2008). Le diagnostic était retenu sur des arguments cliniques, radiologiques et anatomopathologiques. Les aspects épidémiologiques, cliniques, para cliniques, anatomopathologiques, thérapeutiques et évolutifs ont été analysés. Résultats : Le cancer du rein a représenté 0,01% des hospitalisations. L'âge moyen des patients était de 47,6 ans, (extrêmes 19 et 80 ans). Il s'agissait de 16 hommes et 9 femmes. La douleur lombaire était présente chez 8 patients. La triade clinique lombalgie-hématurie-masse palpable était présente chez 3 patients. L'échographie a permis d'évoquer le diagnostic dans tous les cas et la TDM dans 10 cas. Le traitement a consisté en une néphrectomie élargie (n=9), une néphrectomie élargie associée à une chimiothérapie (n=3), et une néphrectomie élargie associé à une chimio-immunothérapie (n=1). L'abstention thérapeutique a été décidée dans 12 cas du fait d'un stade avancé de la tumeur. L'adénocarcinome à cellules claires était la forme histologique la plus fréquente. La rémission a été complète chez 3 patients.Conclusion : Le cancer du rein de la l'adulte est rare dans notre contexte. Le diagnostic est souvent tardif, justifiant ainsi l'abstention thérapeutique dans beaucoup de cas. Le pronostic reste mauvais