[Gynaecomastia and adipomastia on black skin: Clinical and surgical particularity]. / Gynécomastie et adipomastie sur peau noire : particularités clinique et chirurgicale.

AIM: Analyze the management of gynecomastia and adipomastia; and identify the peculiarities in black people in a general surgery department of the CHU Sylvanus Olympio in Lomé (Togo). PATIENT AND METHOD: Descriptive retrospective study included 43 cases of gynecomastia and 5 cases of adipomastia (January 2014 to December 2020). The data taken into account were: epidemiological, clinical, paraclinical and the treatment (surgery and medical). The administration of hydrocortisone (solumedrol 120mg/day) for 3days immediately after surgery and the application of shea butter on the scar were performed. RESULT: Patients consult for aesthetic discomfort, especially with bilateral lesions and fear of breast cancer for unilateral lesions. Morpho-types 3 and 4 are therefore the most frequent in 75% of cases. Age was over 30years in 87% of patients. We noted retro-areolar fibrosis. The etiology was dominated by idiopathic causes. The surgery was performed in 85% of the cases. The morbidities were 5 cases of hypertrophic scars without keloid. CONCLUSION: Surgical difficulties on black skin are not only technical, but also scarring: hypertrophy and keloids. A delay in surgical management after 30years, and the prevention of unsightly scars would be a track for improving the aesthetic result.

[Ambulatory treatment of penile fracture at teaching hospital in Lomé]. / Traitement ambulatoire des fractures de la verge au centre hospitalier universitaire de Lomé.

OBJECTIVES: To study the feasibility of outpatient management of fractures of the penis and to identify factors that promote their occurrence. MATERIALS AND METHOD: This were a prospective, monocentric study of patients who received emergency treatment for fractured penises. It took place from January 2016 to January 2019. The data analyzed were circumstances of occurrence, time elapsed before management, clinic, type of anesthesia, functional outcomes (assessment based on IIEF5 questionnaire) and complications. RESULTS: Seven cases were recorded. The average age of the patients was 35 years. The diagnosis was clinical and surgical treatment in all our patients. Management was outpatient in 6 patients. Sexual function was normal in six patients with an IIEF-5≥21 with a normal erection and no pain at intromission. No complications were objectified. CONCLUSION: Emergency surgical management of patients with clinical and confirmed per-operative penis fractures may be outpatient without negative impact on functional outcomes and regardless of the cause of fracture. LEVEL OF EVIDENCE: 3.

Torsion du cordon spermatique chez l'adulte. Aspects diagnostiques, thérapeutiques et pronostiques au Centre Hospitalier et Universitaire Sylvanus Olympio de Lomé

Objectifs : Etudier les aspects diagnostiques, thérapeutiques et pronostiques des torsions du cordon spermatique. Patients et méthodes : Il s'agissait d'une étude prospective, et était inclus dans l'étude tous les patients de plus de 15 ans admis en urgence pour une douleur scrotale aiguë et chez qui le diagnostic d'une torsion du cordon spermatique était suspecté durant la période d'étude.Résultats : Sur une période de 12 mois allant du 1er janvier 2015 au 31 décembre 2015, 22 patients étaient colligés. L'âge moyen des patients était de 22 ans avec des extrêmes allant de 17 à 35 ans. Le diagnostic était clinique dans tous les cas et dans 100% des cas les constatations per opératoires étaient en faveur d'une torsion du cordon spermatique. Le tour maximum de spire était de 4 tours. L'orchidectomie avait été réalisée chez 4 patients. Dans tous les autres cas une orchidopexie bilatérale était réalisée.Conclusion : La vitalité du testicule dans les torsions du cordon spermatique est surtout fonction de la durée de la torsion et du degré de la torsion

Cancer mortality in the urological department of the Sylvanus Olympio Teaching Hospital in Lome, Togo.

To determine the proportion of cancer mortality seen in the urology department of a teaching hospital in sub-Saharan Africa and to identify the contributing factors. This 10-year retrospective study took place in the urology department of the Sylvanus Olympio Teaching Hospital of Lomé (Togo) and analyzed the records of patients who died of cancer from January 2006 through December 2015. During the study period, 94 deaths were recorded in the department, 84% of them due to a urological cancer. The mean age of patients was 62 years,- and there was a significant male predominance with a sex ratio of 4.3. Prostate cancer was the most common cause of death, accounting for 49 (62%) cases. The mean duration of symptoms was 2.4 months. At diagnosis, 75.9% of patients were metastatic and 66% had comorbidities, such as high blood pressure or diabetes. Palliative treatment was instituted for 87.3% of patients. Deterioration of their general condition was the immediate cause of death in 71% of cases. Urological cancers remain a challenge for specialists in Togo, especially because they are characterized by late presentation with diagnosis at the metastatic stage. Their prognosis is aggravated by the presence of comorbidities.

[Ureterovaginal fistula after caesarean: Diagnosis and management in a resource-constrained hospital in Togo]. / La fistule urétérovaginale après césariennes : diagnostic et traitement dans un hôpital à ressources limitées au Togo.

The purpose of this study is to describe a simple, non-expensive, accessible and effective technique of ureterovaginal fistula diagnosis, and to assess the results of surgical management in a resource-constrained hospital. During a campaign of obstetric fistulas repair, we diagnosed ureterovaginal fistulas by vaginal exam with the blue methylene test associated to abdominal ultrasonography, two simple and non-expensive explorations which permitted to identify ureterovaginal fistula and to do differential diagnosis with vesicovaginal fistula. The management was surgery, by ureterovesical reimplantation. Four ureterovaginal fistulas have been diagnosed in 32 women presented with obstetrical fistula. The mean age of those fistulas was 4.85 years; it was located on the left ureter in three cases, on the right in one case. The ureteral lesion was consecutive to a caesarean section in all patients and sited on the pelvic segment of ureter. In three patients, diagnosis was performed by the negativity of the blue test and unilateral dilation of ureter and kidney while the discovery was done during the treatment of vesicovaginal and rectovaginal fistulas associated in the last patient. After effects of surgery were simple, characterized by disappearance of urine leakage and dilation of ureter kidney. In resources-constrained context, techniques such as blue test and ultrasonography are enough to perform diagnosis of ureterovaginal fistula. Ureterovesical reimplantation is an effective therapeutic method for diagnosing ureterovaginal fistula.

[Heterogeneous testicle on ultrasonography: consider tuberculosis after cancer in endemic zone]. / Testicule hétérogène a l'echographie: penser egalement a la tuberculose après le cancer en zone d'endémie.

The purpose of this report is to describe findings of clinical examination and imaging in a 27-year-old man admitted for nonpainful left testicular enlargement. Initial diagnosis was testicular cancer based on ultrasonography and association with pulmonary metastasis. This diagnosis was revised after histological study demonstrated testicular tuberculosis.

[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.

[Epidemiology and histopronostic of prostatic cancer in Togo: about 202 cases diagnosed at the laboratory of pathology of the Tokoin teaching hospital of Lome]. / Epidémiologie et histopronostic du cancer de la prostate au Togo : à propos de 202cas diagnostiqués au laboratoire d'anatomie pathologique du CHU Tokoin de Lomé.

OBJECTIVES: Describe the epidemiological and histological aspects of the prostate cancer in Togo. METHODS: It was a retrospective descriptive study relating to 202 cases diagnosed between 1984 and 2003 at the Laboratory of Pathology of the Tokoin teaching hospital of Lome. The parameters studied were: frequency, age, circumstances of discovery, PSA value and histological type. RESULTS: The frequency of prostate cancer was 10 cases on average. The average age of patients was 70 years (45 to 95 years). The circumstances of discovery were dominated by voiding disorders and the average PSA was 88.5 ng/ml (7.8 to 560.4). Histologically, it was adenocarcinoma in 97.5% of cases and squamous cell carcinoma in 1.9% of cases. CONCLUSION: The prostate cancer although uncommon in Togo remains a public health problem because of the weak accessibility of the population to the diagnosis. So, a national program of screening is needed.