Pilot study comparing steroid-impregnated and non-steroid-impregnated absorbable nasal dressing following endoscopic sinus surgery.

INTRODUCTION: Endoscopic sinus surgery (ESS) is the mainstay for treatment of chronic rhinosinusitis versus maximal medical therapy. We propose a more economical option, by using steroid-impregnated Gelfoam instead of Nasopore post ESS, as it is less expensive and has showed effectiveness in preventing post-operative bleeding. MATERIALS AND METHODS: A randomised, double-blinded, placebo-controlled trial was carried out in eight patients with chronic rhinosinusitis or nasal polyposis who were planned for bilateral endoscopic sinus surgery. A Peri-operative Sinus Endoscopy (POSE) Score and Lund-Kennedy Endoscopic Score (LKES) were recorded. The use of hydrocortisone-impregnated Gelfoam dressing versus normal saline-impregnated Gelfoam dressing were compared. Scores were repeated post-operatively at one week, three weeks and three months interval. RESULTS: For LKES, at the end of three months, 50% of the patients had the same score difference, 37.5% had better results on the study side while 12.5% had better results on the control side. Meanwhile, for POSE Score, at the end of three months, 75% of the patients had better score difference on the study side while 12.5% had better results on the control side. CONCLUSION: Gelfoam can be used as nasal packing material to deliver topical steroid after endoscopic sinus surgery. Steroid-impregnated nasal dressing after endoscopic sinus surgery may not provide better long-term outcome.

[Results of anastomotic urethroplasty for male urethral stricture disease]. / Résultats de l'urétroplastie anastomotique pour rétrécissement de l'urètre masculin.

OBJECTIVE: To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results. PATIENTS AND METHODS: We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure. RESULTS: Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up. CONCLUSION: The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique. LEVEL OF EVIDENCE: 4.

[Inflammatory pseudo-tumor of the bladder expelled through the urethral meatus in a girl]. / Pseudo-tumeur inflammatoire vésicale expulsée par le méat urétral chez une fillette.

Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence.

[Pathology of the processus vaginalis in urological practice]. / La pathologie du canal péritonéo-vaginal en pratique urologique.

PURPOSE: To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams. PATIENTS AND METHODS: We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment. RESULTS: A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences. CONCLUSION: Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams. LEVEL OF EVIDENCE: 5.

[Scrotal calcinosis: clinical and therapeutic aspects in 5 cases]. / La calcinose scrotale : aspects cliniques et thérapeutiques à propos de 5 cas.

Scrotal calcinosis is a rare pathology and etiology still discussed. We report five cases in patients without particular history of another disease. Clinical examination revealed scrotal wall with painless nodules of various sizes producing a whitish substance, pasty. The phosphate levels were normal in all patients. They all had a resection of the lesions associated with scholarships plasty recovery. Histopathological study revealed calcified epidermoid cysts in 4 cases.

[Testicular bilharzioma by Schistosomia haematobium: about two cases]. / Bilharziome testiculaire à Schistosomia haematobium: à propos de deux observations.

Bilharzioma are inflammatory pseudotumors, which often pose the problem of differential diagnosis with neoplastic processes. Using the keywords "testicular" and "schistosomiasis", there are only 14 cases of testicular bilharzioma identified on PubMed. The authors report two new cases in a 6-year-old child and an adult of 38 years, collected over a period of 5 years. In both cases, orchidectomy was performed and histological analysis of the surgical specimen was allowed to diagnose testicular bilharzioma by Schistosomia haematobium. The authors emphasize the need to evoke a bilharzioma before any testicular nodule in a patient living in an endemic area.

[Post-hysterectomy vesicovaginal fistula]. / Fistules vésicovaginales posthystérectomie.

OBJECTIVE: Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF). PATIENTS AND METHODS: We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure. RESULTS: Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure. CONCLUSION: In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.

[Results of repeat midurethral sling for the treatment of recurrent female stress urinary incontinence]. / Résultats d'une deuxième bandelette sous-urétrale dans le traitement de l'incontinence urinaire d'effort féminine persistante ou récidivante.

OBJECTIVE: To evaluate the results of a second midurethral sling (MUS) implantation after immediate or late recurrence of stress urinary incontinence (SUI) in women following a first MUS implantation. PATIENTS AND METHODS: We performed a retrospective study of 36 patients who have had a second MUS between 2000 and 2011. All patients had preoperative urodynamic assessment using French validated scales (measurement of urinary handicap [MUH] and Ditrovie's scale) a correction of SUI by Ulmsten's test. The second tape was placed in the usual way without removal of the first one. The therapeutic results were evaluated by the presence or the absence of leaks as measured by MUH and Ditrovie's scale, and classified as "success" in the absence of leaks or the presence of small leaks without needing protection, "improvement" if significant decrease in urine leakage at subjective patient interview and "failed" in other cases. RESULTS: The mean age of 36 patients was 64 ± 9.6 years. Thirty patients had a tension-free vaginal tape (TVT) as second tape and six patients had a transobturator tape. At 3 months, success rate was 74.3% (n=26). Six patients had partial improvement (17.1%) and three patients had no improvement (8.6%). One was lost sight. After a follow-up of 5 years, these results remained unmodified for the ten patients reviewed. CONCLUSION: The implantation of a second MUS was a good option for women with persistence or recurrence of SUI after a first MUS implantation.

[Anderson-Hynes open pyeloplasty: which indications in the area of laparoscopic surgery?]. / La pyéloplastie à ciel ouvert selon Anderson-Hynes : quelles indications devant le développement de la laparoscopie ?

OBJECTIVES: To evaluate the results of Anderson-Hynes open pyeloplasty in our institution. And then to compare them to those of laparoscopic procedure and identify what can be considered now as the indications of the open procedure. PATIENTS AND METHODS: It was a retrospective study on 30 cases of ureteropelvic junction syndrome managed by Anderson-Hynes open procedure. The clinical, biological and radiologic characteristics of the patients as well as the surgical technique and its results were taken into account. The patients were classified, according to Valdeyer and Cendron classification as type II in eight cases (26.7%), type III in ten cases (33.3%) and type IV in four cases (13.3%). There were also eight cases of giant hydronephrosis (26.7%). The operating time, the length of hospital stay and the outcomes were studied and compared with those of the laparoscopic pyeloplasty found in the medical literature. RESULTS: The mean operating time was 115 ± 33.4 minutes (90-230 min). The mean length of hospital stay was 10.4 ± 5.1 days. Six patients (20%) had postoperative complications. After a mean follow-up of 28 ± 13.7 months (13-48 months), our first-hand success rate was 90% (n=27). CONCLUSION: Anderson-Hynes open pyeloplasty reached good results but nowadays its indications can be limited to laparoscopic contraindications, severe hydronephrosis (grade IV or giant hydronephrosis) and second-hand cases. The two latter indications depend on the surgeon experience in laparoscopic surgery.

[Adult renal cancer in Senegal: Current epidemiological, clinical features, profile's evolution over the two past decades]. / Le cancer du rein de l'adulte au Sénégal : aspects épidémiologiques et cliniques actuels et évolution du profil sur les deux dernières décennies.

OBJECTIVE: To study current epidemiological and clinical features of adult renal cancer in Senegal and the evolution of these features over the two past decades. PATIENTS AND METHODS: We conducted a retrospective ten years study (2000-2009) that analyzed all the renal cell cancer in adult admitted in the urology department and the pathology department of the university teaching hospital Aristide-Le-Dantec (Dakar). The results of this study were compared with those of the previous decade. RESULTS: We included 74 cases of renal cell cancer. The median age of patients was 49 years (18-72 years). There was a slight female predominance (51.3%). Twenty-eight (37.8%) patients presented at least with one renal cell cancer risk factor. The median duration of symptoms was 10 months (1-96 months). The localization of the renal cancer was right in 42 patients (56.7%) and left in 32 cases (43.8%). Almost all the tumors were symptomatic. Symptoms were dominated by loin pain (87.8%) and abdominal mass (77%). There were only two cases (2.7%) of incidental renal cell cancer. The median tumor size was 12 cm (2.4-26 cm). The more frequent tumor stages according to the TNM 2002 staging system were T2 (39.2%) and T3 (33.7%). Metastases were found in 23 (31%) patients. Forty-four patients underwent nephrectomy (43 radical and one partial). No adjuvant treatment or metastasectomy were done. The main histological subtype of tumors was renal cell carcinoma (47 cases). The mean duration of the follow up was 30.5 ± 33.6 months. Among the 44 patients who underwent nephrectomy, no tumor recurrence was found on 35 cases. Tumor recurrence occurred on nine patients. The specific mortality rate was 47.3%. Epidemiological and clinical features of the adult renal cell cancer in Senegal haven't significantly changed over the 20 past years. CONCLUSION: The adult renal cell cancer incidence was low in Senegal. Its clinical profile was characterized by a predominance of locally advanced and metastatic forms.

[Renal cell carcinoma in children: Report of a case with lymph node involvement]. / Carcinome à cellules rénales chez l'enfant : à propos d'un cas avec envahissement ganglionnaire.

Renal cell carcinoma (RCC) in children is rare. This entity has different clinical and biological presentation characteristics from adult RCC. In contrast to Wilms tumor, the efficacy of chemotherapy and radiation therapy in pediatric RCC remains uncertain. Debate continues on the importance of lymph node dissection. The authors present a case of RCC with lymph node involvement in a 12-year-old boy. The treatment was radical nephrectomy and a limited lymphadenectomy. No adjuvant therapy was given. After 13 months of follow-up, there is no evidence of recurrence. This case shows that lymph node involvement (in the absence of distant metastases) is not associated with a poor prognosis in pediatric RCC and that lymphadenectomy in lymph node-positive cases is important.

[Pyonephrosis: 44 cases in Senegal]. / Pyonéphrose: 44 observations au Sénégal.

PURPOSE: To report epidemiological, clinical and paraclinical features of pyonephrosis and describe current management methods in Senegal. PATIENTS AND METHODS: This retrospective study includes a series of patients admitted for pyonephrosis to the Urology Department of the Aristide Le Dantec Hospital in Dakar between 1995 and 2009. The following information was collected for each patient: age, sex, clinical manifestations, diagnostic findings, treatment modalities and outcomes. RESULTS: A total of 44 patients with a mean age of 34 years were included. The most common clinical manifestations were acute flank pain, sepsis and renal mass. Diagnostic was usually based on medical imaging, i.e., renal utrasonography and computed tomography. Urolithiasis was the underlying etiology in 73.2% of cases. Nephrectomy was performed in 83% of cases with or without preliminary nephrostomy catheterization. CONCLUSION: Development of both diagnostic (medical imaging) and therapeutic methods for management of pyonephrosis has been consistent with the rarity of this condtion in Senegal.

[Place of bilateral pulpectomy as a method of androgen suppression therapy in prostate cancer]. / Place de la pulpectomie bilatérale dans la suppression androgénique pour cancer de la prostate.

PURPOSE: To report the oncologic results and morbidity of bilateral pulpectomy and to identify factors that make this method of androgen suppression therapy the most used in our country. PATIENTS AND METHODS: We conducted a prospective study in the urology department of Aristide Le-Dantec hospital (Dakar) between January 2008 and June 2010 (30 months). It included 84 cases of prostate cancer treated by bilateral pulpectomy under local anesthesia. RESULTS: The mean age of patients was 72.17±12.48 years (53-91). The median PSA level was 101 ng/mL (12.18-9990). Metastasis have been detected in 75% of cases. The Gleason score was higher than 7 in 40 patients (47.6%). Three months after pulpectomy, an improvement of performance status was seen in 76 patients (90.4%). The back pain significantly decreased in intensity or disappeared in 65.3% (32/49) of cases. A complete recovery of lower limbs motor deficit was observed in 50% of cases (7/14). The PSA levels decreased in 57 of the 76 patients alive and the mean PSA level was then 72±11.7 ng/mL (3.8-2433). At six months, of the 53 patients in urinary retention, 18 had recovered spontaneous and complete urination. The PSA level was below 4 ng/mL in 33.8% (22/65) of cases and between 4 and 10 ng/mL in 52.3% (34/65) of cases. At 12 months, the median PSA nadir was 0.76 ng/mL (0,002-8,17) and 57.4% of the 54 patients alive had a PSA nadir less than 2 ng/mL. The mean follow-up was 11.08±10.34 months (1-30). A rising PSA occurred in 17 patients (20.2%) after an mean progression-free survival of 10.5 months (6-25). The overall survival at 6, 12 and 24 months were respectively 77.3, 64.3 and 52.3%. The overall cost of pulpectomy was 50 000 FCFA (76€). The specific morbidity of pulpectomy was two cases (2.4%) of infection of the operative site. CONCLUSION: The bilateral pulpectomy was a method of androgen suppression immediately effective, efficacious with a low morbidity. Its very low cost is the main reason why it is still the most used method in our country.

[Acute priapism associated with sickle cell disease in Senegal: clinical, therapeutic features and risk factors for erectile dysfunction]. / Priapisme aigu chez les drépanocytaires sénégalais: aspects cliniques, thérapeutiques et évaluation de la fonction érectile.

UNLABELLED: To describe clinical and therapeutic features of ischemic priapism associated with sickle cell disease (SSD) in Senegalese men and to identify risk factors for erectile dysfunction (ED). PATIENTS AND METHODS: The charts of all patients admitted to the Urology Department of Aristide Le Dantec University Teaching Hospital (Dakar) for ischemic priapism associated with SSD between January 2000 and September 2008 were retrospectively reviewed. RESULTS: A total of 22 patients with a mean age of 19.5 +/- 9.9 years (6 - 41 years) were identified. The most affected age group was between 21 and 30 years. The mean duration between onset of the episode and admission was 89.6 +/- 103.1 hours (4 - 384 hours). Nine patients (40.9%) were admitted within 24 hours after the onset. Eight patients (36.3%) had a history of stuttering priapism. The sickle cell phenotype identified by electrophoresis was SS in 18 patients and AS in four. The main treatment modalities were corporeal aspiration that was performed with or without intracavernosal injection of sympathomimetics drugs and Al Ghorab shunt surgery that was used in ten patients with a success rate of 90 % (complete detumescence). With a mean follow-up of 3.8 +/- 1.5 years, nine (69.2%) of the 13 patients older than 16 years developed ED. The incidence of ED was significantly correlated with the duration of the priapism but not with SSD phenotype. CONCLUSION: In Senegal ischemic priapism associated with sickle cell disease occurs mainly in young people. The incidence of ischemic priapism appears to be low but ED is common due to the prolonged duration of priapism.

[Urinary lithiasis in children: a study of 20 cases]. / La lithiase urinaire de l'enfant: a propos de 20 cas.

PURPOSE: To report the cases of urolithiasis in children and to assess epidemiological, clinical and therapeutically aspects. PATIENTS AND METHODS: We study retrospectively the cases of urolithiasis in children of 0 to 15 years old between 2003 and 2008. The parameters of study were: age, sex, clinical and therapeutically aspects. RESULTS: We report 20 cases. The mean age was 5.4 years. The sex-ratio was 9/1. Dysuria was the most common symptom. Abdominal plain radiography associate with ultrasonography permitted the diagnostic in most cases. Stone location was in the bladder mainly (n = 12). Posterior Urethra valves were the common etiology found. The surgical treatment was performed in all cases and consisted of cystolithotomy in the majority. CONCLUSION: Children urinary stones are less common than in adults. The etiologies are different but the treatment is coming to be alike.

[Extraparenchymental distribution and feasibility of selective clamping of segmental renal arteries during partial nephrectomy: a study of the dissection of 30 kidneys from recent nonformolised corpses]. / Distribution extraparenchymateuse et accessibilité au clampage sélectif des artères rénales segmentaires au cours de la néphrectomie partielle : à propos de la dissection de 30 reins de cadavres frais non formolés.

OBJECTIVE: To assess the feasibility of selective clamping of segmental renal arteries during partial nephrectomy, in order to limit renal infarction to the pathological area to be resected. MATERIALS AND METHODS: A dissection of renal artery and its extraparenchymal branches was realised. The study included 30 kidneys from recent nonformolised corpses. The size, distribution, and accessibility of the arteries were considered. All the corpses underwent a lombotomy with or without rib resection. RESULTS: The majority of dissected kidneys had a unique artery (96.66% of cases). The number of segmental arteries was zero in five cases (16.66%), one in four cases (13.33%), two in four cases (13.33%), three in one case (3%), four in 15 cases (50%) and five in five cases (16.66%). The posterior and inferior segmental arteries were more accessible to isolate with a respective ratio of 94 and 100% at segmental level. Apical and middle segmental arteries were least accessible with a respective ratio of 73 and 80%. The majority of accidents during dissection occurred with the middle segmental artery (62.5% of vascular lesions). CONCLUSION: This anatomic dissection on corpses showed that selective renal segmental arteries is possible in the majority of cases. This dissection is better indicated in partial nephrectomies for renal tumours located posteriorly or in the lower pole.

[Urological emergencies at the Dakar university teaching hospital: epidemiological, clinical and therapeutic features]. / Les urgences urologiques en milieu hospitalier universitaire à Dakar : aspects épidémiologiques, cliniques et thérapeutiques.

OBJECTIVE: To present the epidemiological, clinical and therapeutic features of the urological emergencies in Senegal, West Africa. MATERIAL AND METHODS: The authors conducted a 20 months retrospective study that analyzed the epidemiological, clinical and therapeutic features of all urological emergencies admitted to the urology department of the university teaching hospital Aristide-Le-Dantec (Dakar). RESULTS: There were 1237 urological emergencies. The mean age of the patients was 58.8 years (range one month-94 years). The sex ratio (M/F) was 20.32. These patients had an age equal to or higher than 60 years in 50.7% of the cases. The most frequent illness was urinary retention (53%) and genitor-urinary system infectious, which represented as a whole 16.4% of the cases. The gangrenes of male external genitalia (Fournier's gangrene) accounted for 4.1% of the cases and the priapism 1.3%. In emergency, 331 surgical operations were performed. The most performed procedures were the installation of a suprapubic catheter (59.8%) and debridement of a gangrene of male external genitalia (15.4%). CONCLUSION: The most frequent urological emergency in our country was the acute urinary retention. Some serious illness like gangrene of male external genitalia (Fournier's gangrene) and priapism are not rare there.

[Determination of total PSA rate and Gleason score during prostatic cancer in Urologic Hospital Center]. / Détermination du taux de PSA total et du score de Gleason au cours du cancer de la prostate en milieu hospitalier urologique.

AIM: To dress biologic and histopathologic aspects of the prostatic cancer in urologic hospital center about a set of digital transrectal guided biopsies. METHODOLOGY: It is a prospective study realized between January 2002 and March 2002 (26 months) studying patients with positive prostatic biopsy. RESULTS: Seventy two cases of prostatic cancer were noticed. Mean age of these patients was 69,9 years (54-91 years). Mean rate Total PSA was 134,8 ng/ml (6-2500 ng/ml). Repartition according Gleason score has revealed that only 35% of tumors were well differentiated. The study of correlation between Total PSA rate and Gleason grade has revealed that up to 10 ng/ml Total PSA rate, only 33% of patients had a Gleason grade between 2 and 4 (well differentiated tumor). CONCLUSION: Actual biologic and histopathologic profile of prostatic cancer lays emphasis on later management.

[Surgical treatment place in the management of prostate cancer: report of 96 cases]. / Prise en charge chirurgicale du cancer de la prostate à Dakar: analyse d'une série de 96 cas.

INTRODUCTION: The goal of this study is to access the surgical management of the prostate cancer. PATIENTS AND METHODS: It was a retrospective study including 96 cases of prostate cancer between June 2002 and December 2004. Parameters studied for every patient was: age, the complaints, results of rectal digital examination, the initial TPSA rate, gleason score, results of extension, the clinical grade according to TNM 2002 classification, the treatment and the future of treated patients. RESULTS: The mean age of our patients was 70.9 years with extremes of 50 years and 93 years. The complaints at presentation were dominated by prostatism (43.5%) and urine retention (37.7%). At rectal digital examination, the prostate was suspicious of cancer in 42.7%. The majority of our patients (79.8%) had a TPSA rate superior to 20 ng/ml. The examination revealed that the tumour was an adenocarcinoma in all patients. The majority of our patients (50.3%) had a gleason score inferior to 7. The extension outcome revealed: a loco-regional extension in 63 patients, dorso-lombar bone metastases in 19 patients and absence of secondary localisation in 14 patients. The repartition of patients according TNM classification was as following: T1 (1%), T2 (14.6%), T3 (18.8%) and T4 (65.6%). The patients were managed as following: bladder neck resection (surgically or endoscopically), pulpectomy and radical prostatectomy. CONCLUSION: To ameliorate the prostate cancer management, the highlights of radical prostatectomy is imperative as the spreading of endoscopic surgery in the place of opening surgery.