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.

EXPERIENCE WITH MANAGING SOLID KIDNEY TUMOURS IN COTONOU, BENIN REPUBLIC.

BACKGROUND: Kidney cancer is the third most common urological tumour. Diagnosis is made in most cases at an advanced stage of the disease in our setting. AIM & OBJECTIVES: The aim of this work was to describe the management of solid tumors of the kidney and the outcome at the National University Hospital, Cotonou, Benin Republic, from January 2008 to December 2014. PATIENTS & METHODS: This is a retrospective, descriptive study conducted at the Clinic of Urology and Andrology at the National University Hospital CNHU-Hubert Koutoukou MAGA in Cotonou, Benin Republic. We included patients managed for solid kidney tumours from January 2008 to December 2014. The demographics, clinical presentations, management and outcome were recorded and the data obtained were analyzed using Epi info 3.2.2. RESULTS: Hospital frequency of solid renal mass was 1.9% with a mean age of 54 years and sex ratio of men to women of 1.6. Hematuria, back pain and lumbar mass were the most frequent clinical presentation found in 79.5% of cases. In all, 5% presented at an early stage while 95% presented at a late stage. Diagnosis was based on imaging; histopathological examination was requested in all the case though some could not afford the cost. Radical nephrectomy was performed in 51.5% of cases.The non- operated cases were those whose poor general condition as well as those who could not afford the procedure. Undifferentiated adenocarcinoma was the predominant pathological type found in 78% of operated cases. No patients underwent other treatments such as radiation therapy, immunotherapy or chemotherapy. Mortality occured in 10 cases including 1 intra operative death, 3 patients died in the early post operative period due to respiratory distress and 7 patients died from metatstasis discovered post operatively. CONCLUSION: This study has shown that majority of patients with solid renal tumours in this environment present late with advanced stages of the disease. The absence of the necessary investigative equipment, poverty and absence of adjuvant and adjunct therapeutic facilities make the treatment outcome poor.

[Specialized Studies Diploma (S.S.D): assessment of Urology and Andrology by degree candidates at Faculté des Sciences de la Santé (FSS) at Cotonou]. / Diplome d'Etudes Specialisees (D.E.S) d'Urologie- Andrologie: appreciation de la formation par les candidats au dit diplome a la Faculte des Sciences de la Sante de Cotonou.

PURPOSE: Inventory views of urologists in training on teaching of Urology and Andrology received at Cotonou. METHODS: An anonymous electronic questionnaire was sent by email to 26 doctors in training of specialized studies diploma of Urology and Andrology current month of May and June 2013. The questionnaire asked their knowledge of educational objectives, their appreciation of theoretical courses and practical training Receipts. RESULTS: 16 responses were obtained. The average age of physicians in SSD was 33.9 years± 6.14 (26 years-47 years). The sex ratio was 15 males to 1 female. The training was funded on equity by 25% of doctors. Residents had an understanding of the objectives of their training in urology and andrology: 68.7% knew the objectives of theoretical courses, 87.5% participated in organized lectures, 62.5% knew practical purposes, 93.7% knew the terms of the evaluation at the end of the year. The primary source of documentation was digital document (CD, DVD, computer, websites) 43.7%. In the weekly schedule, 75% of residents assisted consultations carried out by a senior, 93.8% attended a staff operative programming. Over a month, the frequency of assistance in the operating room as first aid procedure had a median of 4 (1 -10). One in 15 received regular debriefing following the completion of care act. The duration of hospital daily work was between 4 and 8 hours for 68.9% of the residents. CONCLUSION: Opinion of doctors in training on urological acquisitions highlights the need to support the development of specialized studies diploma inUrology and Andrology at Faculty of health sciences at Cotonou.

OBJECTIFS: Recenser l'opinion des urologues en formation sur l'enseignement d'urologie et d'andrologie reçu à Cotonou. PATIENTS ET MÉTHODES: Un questionnaire électronique anonyme a été adressé aux 26 médecins en formation du DES d'urologie andrologie courant mai et juin 2013. Le questionnaire recueillait leur connaissance des objectifs pédagogiques, leur appréciation des cours théoriques reçus et des stages pratiques. RÉSULTATS: 16 réponses ont été obtenues. La moyenne d'âge des médecins en DES était de 33,9ans± 6,14 (26ans-47ans). Le sexe ratio était de 15 hommes pour 1 femme. La formation était financée sur fonds propres par 25% des médecins. Les résidents avaient une connaissance des objectifs de leur formation en urologie et andrologie: 68,7% connaissaient les objectifs des cours théoriques. 87,5% participaient aux cours magistraux organisés. 62,5% connaissaient les objectifs pratiques. 93,7% connaissaient les modalités de l'évaluation en fin d'année. La première source de documentation était faite de document sur support numérique (CD, DVD, ordinateur, sites internet) 43,7%. Dans le calendrier hebdomadaire, 75% des résidents avaient assisté à des consultations assurées par un senior. 93,8% avaient participé à un staff de programmation opératoire. Sur un mois, la fréquence d'assistance au bloc opératoire comme premier aide opératoire avait une médiane de 4 (1­10). Une personne sur 15 a bénéficié régulièrement de débriefing après la réalisation d'un acte de soins. La durée de travail quotidien hospitalier était comprise entre 4h et 8h pour 68,9% des résidents. CONCLUSION: L'avis des médecins en formation sur les compétences urologiques souligne la nécessité de soutenir le développement du DES d'urologie et d'andrologie à Cotonou.

[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.

Hydronephrose geante à propos de trois observations au CHU Hubert Maga de Cotonou

Introduction : Les hydronephroses geantes sont rares mais non exceptionnelles. Le but de cette etude est de rapporter la frequence de l'affection dans le service d'Urologie et de decrire la tactique operatoire de trois etiologies. Observations No 1 : Mme Nadine H.; 26 ans; admise le 2/ 06 /06 pour douleurs et masse du flanc gauche. Le debut de sa maladie remonte a 8 ans marque par des crises de colique nephretique gauche et de pyelonephrite gauche. Ses antecedents sont sans particularite. L'examen physique ote un bon etat general; dans le service. Elle atteint les deux sexes. Le sex-ratio est de 3 hommes pour 1 femme. L'age moyen est de 21 ans. Le cote dominant est gauche chez la femme et droit chez l'homme. La masse d'un flanc; la douleur; l'hyperthermie et l'hematurie sont les principaux motifs de consultation. L'examen clinique decouvre la masse qui donne le contacte lombaire et le ballottement renal. L'echographie et l'urographie intraveineuse sont la cle du diagnostic. La tactique operatoire est representee par la pyeloplastie et la nephrectomie quand le rein est detruit. Conclusion : L'hydronephrose geante est rare. Le retard a la consultation est un facteur de mauvais pronostic fonctionnel. La masse d'un flanc; la douleur; l'hematurie; la fievre et l'urinome retroperitoneal en sont evocateurs. Dans les meilleurs cas; la pyeloplastie est une solution sinon la nephroureterectomie. Une masse du flanc gauche donnant un contacte lombaire et un ballottement renal. L'echographie et l'urographie intraveineuse revelent une hydronephrose geante. Une pyeloplastie est faite. Les suites sont simples. No 2 : Mme Catherine G.; 55 ans; obese; hypertendue et diabetique; est admise le 27/10/06 pour des douleurs febriles du flanc gauche; evoluant depuis 5 ans sur un fond d'hyperthermie. L'examen physique note un bon etat general; une masse ovoide du flanc gauche; donnant un contact lombaire et un ballottement renal. L'echographie renale et l'urographie intraveineuse revelent une hydronephrose geante lithiasique. Une nephrectomie gauche est pratiquee. Les suites sont simples. No3 : Mlle Tatiana A.; 19 ans; admise le /10 / 05 pour masse abdominale gauche; douleurs et hyperthermie a 39oC. Dans ses antecedents; existe une laparotomie blanche pour une suspicion de kyste de l'ovaire gauche depuis deux jours. L'examen clinique revele une alteration de l'etat general; une temperature a 39oC; une plaie fraiche de laparotomie. La fosse lombaire gauche est comblee; donnant un contacte lombaire et un ballottement renal. Le membre pelvien gauche est en psoitis et une hydrocele du canal de Nuck gauche. L'echographie et l'urographie intraveineuse montrent une hydronephrose geante ectopique. Une nephrectomie gauche est realisee. Une operation de Hartmann est faite pour lesion iatrogene du colon sigmoide avec un retablissement de continuite trois mois plus tard. Les suites sont simples. Discussion : L'hydronephrose geante est une pathologie rare mais non exceptionnelle. Sa frequence est de 0;05 dans le service. Elle atteint les deux sexes. Le sex-ratio est de 3 hommes pour 1 femme. L'age moyen est de 21 ans. Le cote dominant est gauche chez la femme et droit chez l'homme. La masse d'un flanc; la douleur; l'hyper- thermie et l'hematurie sont les principaux motifs de consultation. L'examen clinique decouvre la masse qui donne le contacte lombaire et le ballottement renal. L'echographie et l'urographie intraveineuse sont la cle du diagnostic. La tactique operatoire est representee par la pyeloplastie et la nephrectomie quand le rein est detruit. Conclusion : L'hydronephrose geante est rare. Le retard a la consultation est un facteur de mauvais pronostic fonctionnel. La masse d'un flanc; la douleur; l'hematurie; la fievre et l'urino- me retroperitoneal en sont evocateurs. Dans les meilleurs cas; la pyeloplastie est une solution sinon la nephroureterectomie

[Penile-perineal-scrotal gangrene. Epidemiologic, diagnostic, and therapeutic features. Report of 32 cases]. / Les gangrènes péno-périnéo-scrotales. Aspects épidémiologiques, diagnostiques et thérapeutiques. A propos de 32 cas.

The authors analyse the epidemiological, diagnostic and therapeutic aspects of peno-perineo-scrotal gangrene in the urology department of a university hospital of a developing African country. The frequency of this disease is low, four cases per year, and most patients (about 72%) are between the ages of 40 to 70 years. The authors identified urethral stricture (31.25%) and idiopathic causes as the main predisposing factors, and many pathogenic bacteria, including P. mirabilis, P. aeruginosa, S. aureus, K. pneumoniae etc., as decisive factors. The treatment of peno-perineo-scrotal gangrene must be both medical and surgical. In addition to the medical treatment currently performed in the department, the authors would like to combine hyperbaric oxygen therapy and, as in Japan, the use of argatroban to accelerate wound healing.

[Iatrogenic ureteral lesions. Apropos of 8 cases]. / Les lésions urétérales iatrogènes. A propos de 8 cas.

The authors report 8 cases of iatrogenic ureteric lesions, induced by gynaecological or obstetric operations. The diagnosis was based on a recent history of surgery, clinical features, abdominal ultrasonography and IVU. Treatment consisted of ureterovesical reimplantation.