[Evolution aspect of anatomy clinical lesions of urogenital fistula (UGF) in Cocody Teaching Hospital urological unity from 1990 to 2011]. / Aspect évolutif des lésions anatomo-cliniques des fistules urogénitales (FUG) dans le service d'urologie du CHU de Cocody de 1990 à 2011.

PURPOSE: The aim of this study is to compare anatomy pathological lesions seeing in urogenital fistula in Cocody Teaching Hospital between two decades, 1990 to 2000 and 2000 to 2010. MATERIEL AND METHOD: This survey is retrospective and carries on 20 years (January 1990 to December 2011) 190 urogenital fistulas (140 cases between 1990 and 1999; 50 from 2000 to 2011) hospitalized in our unity. Anatomy clinical characteristics of these fistulas were determined by clinical or paraclinical examination. RESULTS: Between 1990 and 1999, fistulas were classified in 20 bladder-uterine fistulas (14.29%), 16 uretro-vaginal fistulas (11.43%) and 104 bladder-vaginal fistulas (74.29%) of whom 80 isolated UGFs and 24 UGFs associated with recto-vaginal fistula. These 104 UGFs were located at: bladder neck 22 cases (21.15%), bladder trigonal 46 cases (44.23%), urethra 14 cases (13.46%). Twenty-two bladder sphincter were destroyed and represented 21.15% of fistula's bladder-vaginal fistula and 15.71% of all UGFs. The average fistula diameter was 3 cm [extremes: 1 and 12 cm]. In 22 cases (15.71%), fistula diameter was more than 10 cm. It was bladder neck and sphincter destruction. Hundred and twenty-six fistulas were isolated (90%). Only 10% (14 cases) were associated. Fistulas were primitive in 85.71% of cases (120/140), recurrent in 7 cases (7.86%) and multi-recurrent (>3 reinterventions) in 9 cases (6.43%). From 2001 to 2011, no bladder-uterine fistulas were seen, but: 6 (13.95%) isolated uretero-vaginal fistulas and 6 (13.95%) uretero-vaginal fistulas associated with bladder-vaginal fistula, 31 (62%) bladder-vaginal fistulas of whom 20 (64.52%) bladder trigonal fistulas, 6 (19.34%) retro-trigonal fistulas and 2 (6.45%) urethral fistulas. Only three (9,68%) recto-vaginal fistulas were associated. The average fistula diameter was 2 cm. The fistulas were isolated in 40 cases (80%) and associated (VVF+uretero vaginal F) in 10 cases (20%). Thirty-five cases (70%) were primitive and 10 cases (20%) recurrent of whom 5 (10%) many recurrent. Fistulas were classified in simple fistula in 7 cases (14%) and complex fistula in 43 cases (86%) CONCLUSION: UGF remained relatively frequent in Cocody Teaching Hospital, but the lesions have favorably evolved in the last decade. Simple type of fistula became more frequent than complex ones. LEVEL OF EVIDENCE: 4.

Les traumatismes de l'appareil genito-urinaire : aspects epidemiologiques et lesionnels

Objectif: Analyser la frequence; les etiologies et les types de lesions observees lors des traumatismes de l'appareil urinaire et genital. Patients et methodes: Etude retrospective portant sur 38 victimes de traumatisme de l'appareil genito-urinaire traites entre avril 2000 et decembre 2006 au CHU de Cocody; Abidjan; Cote d'Ivoire. Les parametres etudies ont ete: l'age; le sexe; la profession; les causes des traumatismes; le type de lesions constatees; les interventions chirurgicales realisees l'ensemble repertorie sur des fiches de recueil. Resultats: 38 victimes de traumatisme de l'appareil genito-urinaire ont ete enregistrees sur l'ensemble des 16425 traumatises; soit une prevalence de 0;2. Il s'agissait de 37 hommes et d'une femme avec un age moyen de 26;9 ans (extremes: 5-63 ans). Les patients etaient pour la plupart victimes d'accidents de la voie publique (AVP) (16 cas; 42;1); ensuite 11 patients (28;9) ont eu un accident de travail. Les agressions etaient responsables de 9 victimes soit 23;7des traumatises urogenitaux. Chez 2 patients (5;3) le traumatisme a ete engendre par un accident de sport. L'uretre et la vessie etaient le plus souvent atteints (81;6des cas); pendant que les traumatismes du rein et des organes genitaux externes ont ete observes respectivement dans 7;9et 10;5des cas. 25 cas (65;8) ont eu des fractures de bassin associees. Tous les traumatismes etaient directs dont 29 fermes (76;3) et 9 penetrants (23;78). Les gestes chirurgicaux realises etaient en particulier les uretrorraphies termino-terminales (20 cas; 52;6). Conclusion : les traumatismes de l'appareil uro-genital sont rares; surviennent surtout chez les hommes jeunes victimes d'accidents de la voie publique et de travail. Ces traumatismes peuvent etre responsables de sequelles fonctionnelles invalidantes

[Study of urogenital fistulas in the Ivory Coast at the end of the 20th century. Results of 70 cases]. / Le point sur les fistules urogénitales en Côte d'Ivoire à la fin du XXe siècle. Résultats de 70 cas.

The urogenital fistulas (UGF), mostly in Africa and particularly in Ivory Coast, still represent a great flail nowadays. However, the authors notice, through a study of 70 cases done in Ivory Coast over (ten) 10 years, that a relative decrease of the impact of the urogenital fistulas troubles still remains a serious affection of young women who can give birth. They are about 30 years old and more; that is to say primipares (44.28%) but over all multipares (54.28%) and poor ones (100%). Most cases are obstetrical causes which expose those women to genital mutilations (25.71%) linked to birth giving difficulties which also bring about many dead born (14.11%) and divorces (20%).

[False step in coitus. Apropos of a case of unilateral isolated fracture of the corpus cavernosum]. / Le faux-pas du coït. A propos d'un cas de fracture unilatérale isolée du corps caverneux.

Surgery was performed within 24 hours after penile fracture which occurred during coitus due to isolated damage to the corpus cavernosum. Post-operative follow-up was uneventful and the patient recovered normal erectile function which was only lost at the moment the of the accident.

[The treatment of pelvic ureteral calculi using the Dornier lithotripter. Apropos of 20 cases]. / Le traitement des calculs urétéraux pelviens par le lithotripteur Dornier. A propos de vingt cas.

The authors report a series of twenty patients with pelvic ureteric stones treated by the Dornier lithotriptor. Sixteen men and 4 women were treated over a period of 8 months (November 1988 and June 1989). A single treatment session was sufficient to ensure destruction and elimination of the stones. This technique, which does not require anaesthesia, but at most simple neuroleptanalgesia, has a low morbidity (15%). In the series of 20 patients: the stones were completely eliminated in 16 cases, 1 case was a failure at 3 months and 3 patients were not reviewed. These results are assessed with a minimum follow-up of three months and a maximum follow-up of eight months. This simple, rapide, repeatable and effective therapeutic technique appears to constitute an alternative to operative endoscopy (flexible or rigid ureteroscopy) in the treatment of stones of the pelvic ureter.

[Milk of calcium syndrome: a diagnosis to be made before the scheduling of lithotripsy. Consideration apropos of 6 cases]. / Lait calcique: diagnostic à faire avant une programmation pour lithotripsie. Considérations à propos de six cas.

The authors report six cases of milk of calcium syndrome. As in previously published cases, the diagnosis was established by the film taken in the standing position: the "lithiasic density" shrinks, densifies and exhibits a horizontal upper edge. Four patients were at first mistakenly diagnosed as having urinary lithiasis for which extracorporeal lithotripsy was scheduled. In one case, the lithotripsy was actually performed and the diagnosis of milk of calcium disease was established only immediately after the procedure. In another patient, lithotripsy was performed because small stones were thought to be present in the milk of calcium. In the two other cases, the diagnosis was made on the day before scheduled lithotripsy and this procedure was therefore cancelled. The purpose of the authors in reporting these cases is above all to point out the diagnostic value of a plain film of the abdomen in the standing position. Diagnosis must be made in time to avoid extracorporeal lithotripsy since, in milk of calcium syndrome, this procedure is illogical, inefficient and probably more hazardous than useful. On the basis of the six cases reported herein and of data from the literature, several characteristics of milk of calcium syndrome can be emphasized. Milk of calcium syndrome predominantly affects individuals with a positive personal or family history for renal lithiasis. It occurs in both sexes and all age groups, including childhood. Milk of calcium syndrome complicates partial or total dilatation of the urinary tract. Crystallization may be of the phosphatic or oxalic type. Concomitant urinary tract infection is common.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of deferential permeability in rats after microsurgical vasovasotomy using the Howard technique and vasovasotomy using microsurgical low energy CO2 laser]. / Etude comparative de la perméabilité déférentielle chez le rat après vaso-vasostomie microchirurgicale selon la technique de Howard et vaso-vasostomie utilisant le laser CO2 microchirurgical á faible énergie.

Microsurgery is the technique of choice for vasectomy reversal. This study was undertaken to compare the patency of the vas deferens in rats after vasovasostomy performed either according to the technique described by Howard or using low energy Co2 laser. Two groups of rats were operated on using a surgical microscope. Results were evaluated on the external appearance and histopathological studies of the anastomosis, as well as on patency as documented by a methylene blue test. Both techniques proved satisfactory, but results were clearly better with the laser method. These findings suggest that the laser technique should be preferred in human surgery.