Les gangrènes des organes génitaux externes masculins. Aspects épidémiologiques et thérapeutiques

Objectif : Décrire les aspects épidémiologiques et thérapeutiques des gangrènes des organes génitaux externes masculins. Matériel et méthodes : Il s'est agi d'une étude descriptive et descriptive sur une période de 5 ans allant du 1er janvier 2007 au 31 décembre 2011 au cours de laquelle nous avons enregistré 47 cas de gangrènes des organes génitaux externes. Nous avons analysé rétrospectivement les 39 dossiers qui étaient complets et exploitables. Résultats : Les gangrènes des organes génitaux externes étaient relativement peu fréquentes, constituaient 3,25% des urgences urologiques. Elles étaient l'apanage du sujet d'âge mur avec un âge moyen de 50,17 ans, tous de sexe masculin. Les patients provenaient majoritairement du milieu rural avec 56,4%. Le délai de consultation était assez long avec une moyenne de 9,69 jours avec des extrêmes de 2 jours et 30 jours. Les facteurs de comorbidité ont été retrouvés chez 46,11% des patients. L'origine cutanée a été retrouvée dans 48,7% des patients. Les prélèvements bactériologiques effectués chez 23 patients ont retrouvé un germe chez 13 patients et avec E. coli comme principal germe (10 cas) et accessoirement Staphylococcus aureus (1 cas), Klebsiella pneumoniae (1 cas) et Proteus mirabilis (1 cas). Au plan de la prise en charge tous les patients ont bénéficié d'un traitement médicochirurgical précédé d'une réanimation médicale. Un débridement large avec nécrosectomie a été réalisé chez tous les patients associé à une triple antibiothérapie d'abord probabiliste puis ajustée en fonction du résultat de l'antibiogramme lorsqu'un germe a été identifié. Tous les patients ont subi une cicatrisation dirigée et une plastie de recouvrement a été réalisée. La gangrène des organes génitaux externes reste une affection grave souvent invalidante avec un long séjour hospitalier. Le taux de mortalité était de 17,95%. Conclusion : Les gangrènes des organes génitaux externes masculins sont assez graves avec un fort taux de mortalité. Elles sont relativement peu fréquentes dans notre contexte et la prise en charge est médico-chirurgicale et doit être multidisciplinaire pour espérer obtenir des résultats satisfaisants

[Epidemiology, etiology and psychosocial impact of urogenital fistulas in a cohort of 170 consecutive patients managed in three treatment centers in Burkina Faso from 2010 to 2012]. / Aspects épidémiologiques, étiologiques et impact psychosocial des fistules urogénitales dans une cohorte de 170 patientes consécutives, prises en charge dans trois centres du Burkina Faso de 2010 à 2012.

OBJECTIVE: To describe the socio-demographical aspects, etiologies and psychosocial consequences of urogenital fistula patients (UGF) in Burkina Faso (BF). PATIENTS AND METHODS: Descriptive study of a cohort of consecutive patients during a period of 18 months (December 1st 2010 to August 31st 2012) in three centers of treatment in BF. Each patient has had a standardized complete medical observation focused on sociodemographics, clinical finding, past medical history and etiologies of UGF. Some patients had an interview with a psychologist. RESULTS: One hundred and seventy patients with mean age 35 years (minimum: 16, maximum: 70) were enrolled during the study period. The majority of patients were housewives (90.5%, n=152) and illiterates (92.9%, n=158). Among the patients, 62.4% (n=106) lived in rural zones. Obstetrical fistula was the most common cause of UGF (87.6%, n=149) in our study and prolonged labor occurred in 93.3% (n=139) of cases with 17.5% (n=26) who delivered at home. The majority of our cases were vesico-vaginal fistula (70.6%, n=120). Fifty-five patients (32.4%) were divorced after the fistula. The sensation of humiliation and sadness were noted at all the patients who had a psychological evaluation and 87.5% (n=14) of them have had suicidal ideas. CONCLUSION: The UGF are frequent in Burkina Faso and obstetrical etiology is dominant. The physical and psychosocial repercussions are important for the women victims of this pathology. LEVEL OF EVIDENCE: 4.

CLINICO-PATHOLOGICAL FEATURES OF PROSTATE CANCER AT THE UNIVERSITY HOSPITAL YALGADO OUEDRAOGO, OUAGADOUGOU, BURKINA FASO.

BACKGROUND: Prostate cancer is not uncommon in Burkina Faso and presents late, often advanced at presentation as is the case in most countries of West Africa. AIM: To describe the clinical and histopathological characteristics of prostate cancer at the University Hospital Yalgado Ouedraogo, Burkina Faso. PATIENTS & METHODS: We conducted a cross-sectional descriptive study of patients treated at the Urology Department of the University Hospital Yalgado Ouedraogo, Burkina Faso for prostate cancer from March 2012 to May 2013. The parameters studied were patients' demographics, clinical features, PSA, histological diagnosis, tumour grading, management and outcome. RESULTS: In this study, 82 patients satisfied the inclusion criteria within the 15 months period of the study. The mean age was 68.9 years (standard deviation: 9.52) with a range of 49-95 years. They presented with symptoms of lower urinary tract obstruction in 57 (69.5%) patients, and irritative symptoms in 59 (72%) patients. At diagnosis 33 (40.2%) of patients had metastases and the most common metastatic sites were the spine in 18(21. 95%), the ribs in 6 (7.31%) and the pelvis in 5 (6.09%) patients. The mean PSA level was 746 ng/ml with a range of 13 - 9224ng /ml. Advanced T3 and T4 tumors accounted for 25.4% and 73.2% respectively. Adenocarcinoma was the only histological form. Gleason score was less than 7 in 41(49.4 %) cases. Androgen deprivation therapy (ADT) was the treatment for 79 (96.34%) patients. In all, 51 (62.19%) patients received medical ADT while 20 (24.39%) patients underwent bilateral orchiectomy. One patient underwent radical prostatectomy. CONCLUSION: In this environment, prostate cancer is diagnosed at an advanced stage with distant metastasis. It is therefore useful to develop effective screening policy for early detection and better outcome of management.

[Epidemiology of a cohort of 450 urolithiasis at the Yalgado Ouédraogo university hospital of Ouagadougou (Burkina Faso)]. / Épidémiologie d'une cohorte de 450 lithiasesurinaires au CHU Yalgado Ouédraogo deOuagadougou (Burkina Faso).

OBJECTIVE: To report the epidemiological and diagnosis characteristics of urolithiasis in the city of Ouagadougou (Burkina Faso). PATIENTS AND METHODS: We performed a retrospective and descriptive study of a cohort of urolithiasis patients from January 2009 to December 2011 at the department of urology of the Yalgado Ouédraogo University hospital of Ouagadougou. The minimum required data were: age, gender, occupation, residence, complete medical observation and medical imaging results. RESULTS: Four hundred and fifty patients with a median age of 35 years were included in this study. Urinary stones prevalence was 12.5%. There was a male predominance with a sex ratio of 1.91. Renal colic found in 32% of patients was the main pattern of consultation. Urinary schistosomiasis was the main etiological factor correlated with the occurrence of urolithiasis (P < 0.05). The majority of urinary stones in this study were located in the upper urinary tract (86.5%). Complications were dominated by urinary tract infections (45.2%) and obstructive renal failure (8.9%). CONCLUSION: The characteristics of urolithiasis in our center were similar to those reported in the developing world but seem to evolve toward those of industrialized countries.

[Epidemiology of urologic cancers at the university teaching hospital of Cotonou, Benin. Review of about 158 cases of urologic cancers]. / Épidémiologie des cancers urologiques au Centre national hospitalier universitaire Hubert Koutoukou Maga Cotonou, Bénin. Analyse d'une série hospitalière de 158 cas.

OBJECTIVE: To study the epidemiological profile of urologic cancers in the department of urology at the teaching hospital of Cotonou. METHODOLOGY: We analysed the course of all urological cancer data over a 42-month period, from January the 1st 2008 to 30th June 2011. RESULTS: Urologic cancers were frequent in our hospital practice with a frequency of 17.38%. They are dominated by prostatic cancer (69%), the cancer of bladder (28.5%), the cancer of the kidney (8.5%) and cancers of the external genitals (testis and scrotum) which are marginal in our review. We did not report any case of penis cancer and urethral cancer. They occured at an advanced age with an average age 62.89±15.51 years. Urologic cancers were the prerogative of the subjects of male sex with a sex ratio of 9/10. Specific mortality rate which is attached to them was high. CONCLUSION: The epidemiologic profile of urologic cancers in our practice had some essential characteristic for the primary prevention. The improvement of the quality of data, the installation of a cancer register and the improvement of the technical skills will allowed a better approach of urologic cancer in our urology unit.

[Correct placement of left-sided double lumen endotracheal tubes: a simple verification technique]. / Un método sencillo para ayudar a la comprobación del correcto posicionamiento de los tubos endotraqueales de doble luz izquierdos.

OBJECTIVE: Double lumen endotracheal tubes (DLTs) are used in thoracic surgery for selective bronchial intubation, which is required for single lung ventilation. Correct placement of the tube is checked by means of fiberoptic bronchoscopy. We present a simple alternative method to help confirm the correct placement of left-sided DLTs. The method consists of passing a suction catheter through the tracheal lumen of the tube. Our hypothesis was that if the catheter can be inserted without difficulty, the tube is correctly placed. The objective was to determine the sensitivity and specificity of that criterion. MATERIAL AND METHODS: We studied patients scheduled for elective left pneumonectomy or lobectomy. After passing the catheter through the left-sided DLT, placement was checked by means of fiberoptic bronchoscopy (gold standard) and the results were compared with the placement assessment based on ease of insertion. RESULTS: One hundred patients were included. The DLT was judged to be correctly placed in 88% of patients in whom the catheter was inserted without resistance. Bronchoscopy corroborated this finding in 84% of cases; the tube was found to be incorrectly placed in the remaining 4% of cases and had to be reinserted. Resistance was noted in 12% of cases and bronchoscopy confirmed that the tube was incorrectly placed in those patients. CONCLUSIONS: This technique can be very useful in placing left-sided DLTs in situations where fiberoptic bronchoscopy is not available and if the anesthesiologist has a thorough command of the method. Our results support the routine use of this criterion as it is simple and easy to learn. It should be remembered, however, that confirmation of placement by means of fiberoptic bronchoscopy is currently the gold standard technique.

Un método sencillo para ayudar a la comprobacióndel correcto posicionamiento de los tubos endotraquealesde doble luz izquierdos / Correct placement of left-sided double lumen endotracheal tubes: a simple verification

OBJETIVO: Los tubos endobronquiales de doble luz (TDL)se utilizan en cirugía torácica para la intubación selectiva pulmonar,necesaria para la ventilación unipulmonar. La comprobaciónde su correcta colocación se realiza mediante fibrobroncoscopia.Presentamos un método simple y alternativopara ayudar a la comprobación del posicionamiento de losTDL izquierdos, que consiste en pasar una sonda de aspiraciónpor la rama traqueal del TDL. Nuestra hipótesis es quesi la sonda pasa sin dificultad el tubo estaría colocado correctamente.El objetivo de este estudio fue la determinación de lasensibilidad y especificidad de la prueba.MATERIAL Y MÉTODO: Pacientes programados para cirugíatorácica electiva de neumonectomía o lobectomíaizquierdas. Tras pasar la sonda por el TDL izquierdo secomprobó con el fibrobroncoscopio (técnica de referencia),comparándose ambos métodos.RESULTADO: Se incluyeron 100 pacientes. De los casosestudiados, en el 88% se dedujo una correcta posición delTDL por paso de sonda sin resistencia. De estos, en el 84%la fibrobroncoscopia corroboró esta situación mientras queen el 4% restante no fue así y hubo que recolocarlos. En el12% se encontró resistencia al pasar la sonda verificándoseen éstos una mala colocación por fibrobroncoscopio.CONCLUSIONES: Si dominamos esta técnica o si no disponemosde fibrobroncoscopio, esta maniobra puede ser útily de mucha ayuda durante la colocación de los TDLizquierdos. Nuestros resultados apoyan la práctica cotidianade esta maniobra, ya que es un método sencillo y accesible,pero recordando que la comprobación mediantefibrobroncoscopio es la técnica de referencia actualmente (AU)

OBJETIVE: Double lumen endotracheal tubes (DLTs)are used in thoracic surgery for selective bronchialintubation, which is required for single lung ventilation.Correct placement of the tube is checked by means offiberoptic bronchoscopy. We present a simple alternativemethod to help confirm the correct placement of left-sidedDLTs. The method consists of passing a suction catheterthrough the tracheal lumen of the tube. Our hypothesiswas that if the catheter can be inserted without difficulty,the tube is correctly placed. The objective was todetermine the sensitivity and specificity of that criterion.MATERIAL AND METHODS: We studied patients scheduledfor elective left pneumonectomy or lobectomy. After passingthe catheter through the left-sided DLT, placement waschecked by means of fiberoptic bronchoscopy (gold standard)and the results were compared with the placementassessment based on ease of insertion.RESULTS: One hundred patients were included. The DLTwas judged to be correctly placed in 88% of patients inwhom the catheter was inserted without resistance.Bronchoscopy corroborated this finding in 84% of cases;the tube was found to be incorrectly placed in theremaining 4% of cases and had to be reinserted. Resistancewas noted in 12% of cases and bronchoscopy confirmedthat the tube was incorrectly placed in those patients.CONCLUSIONS: This technique can be very useful inplacing left-sided DLTs in situations where fiberopticbronchoscopy is not available and if the anesthesiologisthas a thorough command of the method. Our resultssupport the routine use of this criterion as it is simple andeasy to learn. It should be remembered, however, thatconfirmation of placement by means of fiberopticbronchoscopy is currently the gold standard technique (AU)

Aplicación clínica de los principios farmacocinéticos y farmacodinámicos en anestesia total intravenosa / No disponible

Para obtener una anestesia adecuada, reduciendo el riesgo de toxicidad farmacológica sin comprometer la eficacia, es necesario conocer la evolución temporal de las concentraciones del fármaco en el organismo (farmacocinética), así como la relación que existe entre esta y el efecto (farmacodinamia). Los conceptos farmacocinéticos y farmacodinámicos son la base para la aplicación de los sistemas de infusión utilizados ampliamente en anestesia intravenosa. Es necesario comprender algunos de estos conceptos para poder entender como funcionan los sistemas de infusión abiertos (TCI), como cerrados (sistemas de asa cerrada). Este trabajo pretende explicar brevemente algunos de estos conceptos, como son la teoría de los modelos compartimentales, el concepto de vida media dependiente del contexto, Keo o la ventana terapéutica, que posteriormente se desarrollan en la descripción del funcionamiento de estos sistemas

To obtain an appropriate anesthesia, reducing the risk of pharmacologic toxicity without affecting efficacy, it is necessary to know the chronological evolution of the drug concentrations in the organism (pharmacokinetics) and the relation between this one and the effect (pharmacodynamics). The pharmacokinetic and pharmacodynamic concepts are the basis for applicating the infusion systems widely used in intravenous anesthesia. It is essential to know some of these ideas to be able to comprehend how these infusion systems work, both open systems (TCI) and closed systems (closed loop systems) This article tries briefly to explain some of these concepts, like compartimental model theory, Context Sensitive Half Life, Keo and therapeutic window. These notions will be explained further in the description of the working of these systems

Incontinence urinaire de la femme en milieu urbain au Burkina Faso : enquete epidemiologique aupres de 759 femmes a Bobo Dioulasso

Objective: To evaluate the prevalence of urinary incontinence; identify its risk factors and describe its effects on the life of women affected by it in an urban area in Burkina Faso. Patients and Methods: This prospective study was carried out between January and April 2003 and was based on interviews with 759 female patients presenting to the Department of Urology; Sanou Souro Teaching Hospital; and five other medical centers in the city of Bobo-Dioulasso. By means of a questionnaire we collected information on socio-demographic patient characteristics; history of previous surgical or gynecological interventions; type of urine loss and the effects of urinary incontinence on the patients' physical; psychological and economical condition. Results: The mean age of the patients was 29;8 years. The majority (63.6) were housewives; 65.5of them married. The overall prevalence of urinary incontinence was 21;3with a predominance (54;6) of stress urinary incontinence. Multivariate analysis of the risk factors (using the logistic regression model) showed that the following risk factors were significantly associated with urinary incontinence: dystocia; repeated urinary tract infections; chronic constipation; episiotomy and obesity. The physical and psycho-social effect of urinary incontinence on the patients is described. Conclusion: Urinary incontinence is frequently encountered in our environment although only few cases are seen in our gynecology and urology departments. A population-based investigation on a national scale will allow for a better judgment of the actual extent of the problem and will help to establish a strategy on how to better control it

Lithiase du haut appareil urinaire au Centre Hospitalier Universitaire Sanou Souro de Bobo-Dioulasso (Burkina Faso) : aspects epidemiologiques; cliniques et therapeutiques: A propos de 110

Objective: To study the epidemiological; clinical and therapeutic aspects of upper urinary tract lithiasis at our department. Material and Methods: This is a retrospective study based on the patients' records and covering the period from January 1; 1992 to December 31; 2002. Results: During a period of 10 years; 110 cases of upper urinary tract calculi out of a total number of 7128 hospitalized patients were seen at our institution; thus constituting 1;54of all hospital admissions. The patients' mean age was 35;49 years (range: one to 75 years); the male to female ratio was 7:1. The main presenting symptom was renal colic followed by lower back pain. Treatment was mainly by open surgery (108 of 109 cases were managed by conventional surgery). Follow-up was uneventful in all cases with a mean hospital stay of 13;5 days. Conclusion: Upper urinary tract lithiasis is rarely encountered in our region; but it seems to be in constant progression. We are still obliged to resort to open surgery in most cases; although this method is not the treatment of choice in developed countries any more

Etude de l'insuffisance érectile dans une population d'hommes jeunes et sexuellement actifs au Burkina Faso

Objectif: Notre tude avait pour objectif de dterminer la prvalence de l'insuffisance rectile (IE) dans notre environnement et d'valuer les connaissances et les attitudes des sujets qui en souffrent. Mthodologie: Il s'agissait d'une enqute transversale sur six mois concernant des sujets gs de 18 ans et plus du monde de travail, ralise au cours d'une visite annuelle des travailleurs des entreprises de la place et de quelques fonctionnaires. Les sujets ayant accept de participer l'enqute (855 hommes), avaient remplir deux questionnaires: la version 5 items de l'International Iindex of Erectile Function (IIEF5), qui value la fonction rectile et, un questionnaire labor par nous mme, dans le but d'valuer les connaissances et les attitudes des enquts, vis vis de l'IE. Les questionnaires ont ensuite t dpouills et analyss sur micro ordinateur l'aide du logiciel Epi info. Rsultats: Les 855 sujets qui ont particip l'enqute reprsentaient 80% de tous ceux qui ont t sollicits. L'ge moyen des enquts tait de 37,4 ± 9,1; plus des 2/3 (78%) taient maris et monogames dans 69%. La prvalence globale note tait de 47% et on a remarqu que celle-ci augmentait avec l'ge. Trois facteurs de risque ont t mis en exergue: l'ge, l'hypertension artrielle (HTA) et la maladie hmorrodaire. Si l'ge et l'HTA sont des facteurs de risque classiques, la maladie hmorrodaire l'est moins; par contre il a t beaucoup invoqu par de nombreux enquts. 93,2% des sujets interrogs seraient prts consulter pour IE, alors que seulement 3,8% l'avaient effectivement dj fait. Conclusion: L'insuffisance rectile s'est rvl comme un problme rel vcu dans notre environnement. Cependant nos rsultats ne peuvent pas tre gnraliss et nous envisageons d'autres tudes, en population gnrale, qui nous permettraient de tirer des enseignements et de mieux organiser la prise en charge de ces patients

[Internal endoscopic urethrotomy for urethral stricture at the hospital of Bobo-Dioulasso: feasibility of the technique in precarious situations and short term results]. / Urétrotomie interne endoscopique pour rétrécissement urétral acquis à l'hôpital de Bobo-Dioulasso: faisabilité de la technique dans des conditions précaires et résultats à court terme.

Internal optical urethrotomy is one of the harmless and less expensive methods in the treatment of urethra stricture. The aim of this study was to analyze the feasibility, the safety and the short-term results of this method in our urologic department. Seventy patients (age range 17-90 years) treated from 01/01/94 to 31/12/00 were included in this retrospective and descriptive study. Two principal aetiologies were pointed up: infectious strictures (69%) and traumatic strictures (13%). The procedure has been successful in 74% of all cases with 16% of complications. The mortality rate of the procedure was zero. The results were good in 67% of cases at one month and in 44% during a average period of 4.5 months. In conclusion, internal optical urethrotomy in our medical context is feasible with few complications. These ones can be reduced by avoiding unfavourable indications. Since urogenital infection is the predominant aetiology, the best management of urethral stricture is the prevention of these infections.

La résection transurétale de la prostate à l'hôpital Sanou Souro de Bobo-Dioulaso: à propos de 68 cas

Objectif Analyser la faisabilite et l'innocuite des resections transuretrales des prostates (RTUP) dans notre hopital. Patients et Methodes Une etude retrospective a ete faite couvrant la periode du 1er janvier 1994 au 31 decembre 2000. Soixante-huit dossiers ont ete retenus. L'analyse portait sur les resultats peroperatoires et post-operatoires immediats des resections. Resultats Le success de la technique etait de 88;20. Il y avait 11;80de complications peroperatoires. Le taux de conversion etait de 11;80. La duree moyenne de sejour hospitalier postoperatoire a ete de 6;7 jours. La mortalite operatoire a ete de 4;41. Conclusion La RTUP reste une technique a faire passer dans la routine car elle constitue un plus dans la gamme de nos prestations chirurgicales en urologie

[Generalized histoplasmosis due to Histoplasma duboisii with mediastino-pulmonary infection. Cure after 15 months of treatment with ketoconazole]. / Histoplasmose généralisée à Histoplasma duboisii avec atteinte médiastino-pulmonaire. Guérison après 15 mois de traitement par kétoconazole.

We report a case of a young burkinabian, who presented with the disseminated african form of histoplasmosis, Histoplasma duboisii. There was pulmonary mediastinal disease with superficial lymphadenopathy and also hepatic involvement. The diagnosis was achieved by a histological examination of the peripheral glands and micrological examination of the expectorate. A clinical cure (despite the radiological persistence of enlarged but stable left hilar glands) with the follow up 10 months was achieved after 15 months of treatment with ketoconazole in a dose which was increased to 10 mg/kg/day.