Cancer of the penis associated with HIV: a report of three cases presenting at the CHU cocody, ivory coast.

BACKGROUND: We describe three cases of advanced penile cancer associated with HIV infection. CASE PRESENTATION: Advanced penile cancer associated with VIH infection were discovered in three patients aged respectively 47, 56 and 40. The prognosis was extremely poor. Two patients died without receiving any treatment and one patient was lost to follow-up after refusing all treatment proposed. CONCLUSION: There appears to be a link between HIV infection and penile cancer with concomitant HIV infection worsening the prognosis of the disease.

[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.

[Primary leiomyosarcoma of adrenal gland, in black African woman: diagnosis and therapeutically aspects]. / Léiomyosarcome primitif de la surrénale chez une noire africaine : aspects diagnostiques et thérapeutiques.

We report a bulky adrenal gland in black woman of 52 years old. This patient was submitted to surgery for resection of the mass. The histopathologic exam found primary leiomyosarcoma of adrenal gland. Beyond twelve month after adrenalectomy, the patient was alive without metastasis.

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

Tumeurs malignes du testicule en Côte d'Ivoire: aspect anatomo-pathologique à propos de 54 cas

Objectif : Le but de cette étude est d'étudier les caractéristiques histologiques du cancer du testicule en Côte d'Ivoire. Matériel et méthodes : Cette étude rétrospective porte sur les dossiers de 54 patients âgés en moyenne de 23,41 ans (extrêmes 13 mois et 68 ans) avec des tumeurs malignes du testicule, colligés en 25 ans dans les services d'Anatomie pathologique de Côte d'Ivoire. Les renseignements suivants ont été évalués: l'âge, l'origine géographique des patients ainsi que les caractéristiques cliniques des tumeurs telles leur localisation, leur nature et leur type histologique. Certaines données telles que les marqueurs tumoraux et la stadification de la maladie n'ont pas été prises en compte. Résultats : En moyenne deux tumeurs ont été diagnostiquées par an. Sur le plan histologique, 87% des tumeurs sont primitives. On y distingue: 46,3% de tumeurs germinales parmi lesquelles les tumeurs germinales non séminomateuses sont prédominantes avec un taux de 24.07% de l'ensemble des cas et les séminomes 22.22% des cas; et 40.74% de tumeurs non germinales avec 18,5% de rhabdomyosarcomes. Les tumeurs secondaires représentent 13,9% des tumeurs du testicule de notre série. Il s'agit essentiellement de localisations secondaires des lymphomes de Burkitt (5 cas sur 7). Enfin, l'atteinte bilatérale est importante. La tumeur est bilatérale, d'emblée dans 31% des cas. Conclusion : Il ressort que les tumeurs du testicule sont rares en Côte d'Ivoire, avec une incidence annuelle d'environ deux cas. Elles surviennent chez l'adulte jeune âgé en moyenne de 23 ans et sont souvent de mauvais pronostic à cause de la bilatéralité de leur atteinte. En effet, 31% des tumeurs testiculaires atteignent simultanément les deux testicules

[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%).

[Nosocomial urinary stent infection at the urology service of the Cocody University Hospital Center]. / Infection urinaire nosocomiale sur sonde dans le service d'urologie du CHU de Cocody.

One of the most common complication of urinary stent is urinary infection. At the Cocody University, 28 men and 2 females who had a urinary stent were evaluated for urinary infection, bacterial growth, and their sensitivity to antibiotics. In 85.71% of the cases, the bacteriologic analysis was positive for a mean duration of urinary drainage of 32, 62 days (range 03 to 90 days). Bacterial isolates were: 11 cases of Klebsiella spp, 5 cases of Providencia spp; 1 case of Escherichia coli, 1 case of Serratia marcescens. Among these bacteria, 77.78% were resistant to most of the antibiotics. Therefore, stent urinary infection is mostly due to multi resistant bacteria. Treatment needs an adapted antibiotherapy after removal of the causative agent.

Treatment of dual urinary and fecal incontinence by implantation of two AMS 800 artificial sphincters. Case report.

We report the case of a 61-year-old woman with urinary and anal incontinence due to neurologic disease. An AMS 800 artificial sphincter was implanted first round the bladder neck with recovery of satisfactory urinary continence. Four months later, another AMS 800 artificial sphincter was implanted round the anal sphincter. Two revisional procedures had to be performed: replacement of the pump for mechanical failure, and replacement of the low-pressure balloon by a high-pressure one. Finally the patient has been almost completely continent with only occasional leakage of feces or liquid stools (follow-up 24 months after activation). Defecography shows total rectal evacuation and anorectal manometry records an anal closing pressure of 70 cm H2O. Dual implantation of artificial sphincters is possible for incontinence of neurological origin, provided bladder and rectal compliance are normal.

[First clinical trials of a new endoscopic lithotriptor with ballistic energy (Waltz EL 25 Combilith)]. / Premiers essais cliniques d'un nouveau lithotriteur endoscopique à énergie balistique (Waltz EL 25 Combilith).

The Waltz Combilith EL 25 is an endoscopic lithotriptor equipped with an electrohydraulic and ballistic function. The device which generates the ballistic energy is a hand-piece in which a projectile, driven by an electromagnet, strikes a metal rod which transmits the energy to the stone. The diameter and length of the rod are adapted to the site of the stone (bladder + kidney: 1.7 mm rod; ureter: 0.8 mm rod). 29 stones in 25 patients with a mean age of 43 years (range: 25-72) were treated using ballistic energy: 22 ureteric stones (mean dimensions: 9 x 6 mm), 2 renal stones (mean dimensions: 20 x 30 mm) and 5 bladder stones (mean dimensions: 15 mm). Satisfactory stone fragmentation was obtained for 26 of the 29 stones (89.6%) with a mean fragmentation time of 142 seconds. One minimal ureteric perforation was observed (cure without sequelae after drainage by a double J stent). The Combilith EL 25 presents an excellent efficacy/safety ratio and can be used throughout the urinary tract.