Place of urolithiasis in the spectrum of urological pathologies, practices and use of endourological procedures in the management of calculi of the upper urinary tract: results of a survey of referral centres in Africa.

Our aim was to determine the current trend of endourology in the management of upper urinary tract calculi in Africa reference centres. We conducted an online multiple-choice questionnaire survey involving 46 centres from 27 countries using a structured well-designed Google Form (®) questionnaire. The questionnaires were distributed to the head of service through their emails. The questions collected demographic data about the centre, the epidemiology of urolithiasis, diagnostic means and management of upper urolithiasis, especially access to endourology procedures and their practices. Descriptive analyses were performed. The participation rate was 77.9%. Urinary lithiasis was one of the three main pathologies encountered in 42/46 centres. 33 centres had easy access to CT scanners and 34 had operating theatres equipped with endo-urological surgery equipment. Of these 34 centres, 30 perform endourology for the management of upper urinary tract stones. Rigid ureteroscopy is the main technique used by the centres. It is the only endourology technique used for stone management by 12 centres (40%). 7/30 (23.3%) have the option of performing rigid ureteroscopy, flexible ureteroscopy and percutaneous nephrolithotomy. The frequency of procedures varies widely, with 43.3% rarely performing endourological surgery. Seventeen centres have their operating theatre equipped with a fluoroscope and 6/42 centres have extracorporeal lithotripsy. Open surgery is still used in 29/42 centres (69.1%). Laparoscopy is available in 50% of centres, but none reported performing laparoscopic lithotomy. In Africa, urinary lithiasis plays an important role in the activities of referral centres. Modern management techniques are used to varying degrees (not all centres have them) and with very variable frequency. Open surgery is still widely performed as a management. Rigid ureteroscopy is the main endourological technique. It is essential to develop the practice of modern urology in Africa, mainly endourology.

[Epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas in Senegal]. / Profil épidémiologique, étiologique et évolutif des fistules vésico-vaginales au Sénégal.

AIM: To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal. PATIENTS AND METHOD: This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published by our structure. RESULTS: Forty-five (45) VVFs were identified over a period of 6 years. This represents an annual average of 7.5 fistulas. The average age was 40±15.13 years with extremes of 13 years and 75 years; 17 patients (37.8%) were older than 45 years. The average parity was 3 with extremes from 0 to 12 children. Multiparous women represented 68.8% of the patients. Obstetric VVF (OVF) was more frequent (48.9%) followed by iatrogenic VVF (33.3%). The mean age was higher in the IVF group compared to the VVF group (32 years) (P = 0.0004). Thirty patients were from the Dakar region and its suburbs (66.6%). The etiology of VVF did not vary according to the geographical origin of the patients (P=NS). VVF was frequently associated with the management of cervical cancer in 42.2% of cases. Comparison of our current data with previous series shows a reduction in the annual incidence of VVF. VVFs, although they have decreased significantly, are still predominant. There is a constant increase in the number of IVF. CONCLUSION: There is an evolution of the epidemiological and etiological profile marked by a decrease in the frequency of VVFs and an increase in that of IVFs. It is also worth noting the frequent association between cervical cancer and VVF. LEVEL OF EVIDENCE: Level 4: retrospective study.

Total penile glans amputation following circumcision: A case report of a dramatic complication.

Circumcision is one of the most commonly performed surgical procedures. As traditional ritual circumcisions are still practiced in the community, in Senegal the majority of circumcisions are performed in hospitals. We report the case of a 9-year-old boy who underwent a total amputation of the glans after a circumcision in a pharmacy by an unqualified agent. A meatoplasty was performed and the postoperative course were uneventful.

Giant bladder diverticulum in a postmenopausal woman: Case report and literature review.

Bladder diverticulum represents a herniation of the bladder mucosa and submucosa through a point of weakness in the detrusor muscle. Bladder diverticula are rare and most often described in men. We report a symptomatic giant bladder diverticulum in a 56-year-old postmenopausal woman. The symptomatology was marked by acute urinary retention associated with abdominal-pelvic pain. A diverticulectomy by a transvesical approach with placement of a urethral catheter was performed. The postoperative course was uneventful.

Post-abortive vesicovaginal fistula associated with bladder lithiasis: About an observation.

Illegally induced abortions remain a significant public health issue in developing countries. We report a case that was complicated by a vesicovaginal fistula with intravesical calcification of the piece of wood used to perform the illegal abortion. A trans-vesical approach allowed extraction of the calcified foreign body and closure of the vesicovaginal fistula. The postoperative course was uneventful.

[Outcomes of radical prostatectomy in patients with prostate cancer at the Aristide Le Dantec University Hospital]. / La prostatectomie radicale: résultats carcinologiques au Centre Hospitalier Universitaire Aristide Le Dantec.

The purpose of this study was to assess outcomes of radical prostatectomy in patients with prostate cancer. We conducted a retrospective single-center study in the Department of Urology and Andrology at the Aristide Le Dantec Hospital in Dakar from June 1, 2010 to May 31, 2016. We collected data of 60 patients undergoing radical retropubic prostatectomy associated with dissection of the iliac and obturator nodes. After radical prostatectomy, prostate specific antigen (PSA) levels were undetectable (<0.1 ng/mL) in 20 patients (33.3%). Eleven patients (18.3%), who had biochemical relapse, received complementary hormone therapy. Patients achieved a response after initiation of treatment, and total PSA became undetectable again after an 8-month follow-up period. Mean overall survival was 17.5 months, with a median of 9.49. Cumulative overall survival rates at 1 year, 3 years and 4 years were 42.4, 13.6 and 6.8%, respectively. Mean relapse-free survival was 17.3 months, with a median biochemical relapse-free survival of eleven (11) months. The mean duration of specific survival was 8.1 months, with a median of 3 months. Seven patients had positive resection margins (11.6%). Four patients had lymph node involvement. Radical prostatectomy, suggested in some patients with prostate cancer in our practice, has been shown to be an effective therapeutic method leading to good outcomes.

[Results of two-level urethroplasty according to Bengt Johanson for complex urethral strictures in adults]. / Resultats de l'uretroplastie en deux temps selon Bengt Johanson pour les stenoses uretrales complexes de l'adulte.

AIM: to evaluate the results of two-level urethroplasty in the treatment of complex urethral strictures in our clinical center. PATIENTS AND METHOD: Thiswas a retrospective cross sectional study from January 2012 to September 2015 in our clinical center. Patients operated according to Bengt Johanson technique were included. The parameters studied were age, the urological history, consultation reasons, duration of evolution, stenosis characteristics and treatment outcomes. RESULTS: twelve patients were enrolled in our study. The mean age was 48 ± 20 years. The main reason consultation reason is urine retention. The mean duration of evolution was 30 ± 25 months. The most common etiology identified was scleroinflammatory one . All the patients already had at least one medical background. The physical examination showed a periurethral gangue in 10 patients. The mean length of the urethral stricture was 6.3 ± 2.2 cm. After an average follow-up of 3.8 ± 2.3 months; the treatment outcomes were considered satisfactory in 8 patients and bad in 4 patients. CONCLUSION: Bengt Johanson's two level urethoplasty gives good outcomes in the treatment of complex urethral strictures.

OBJECTIF: évaluer les résultats de l'urétroplastie en deux temps dans le traitement des sténoses urétrales complexes dans notre centre. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective entre Janvier 2012 et Septembre 2015 dans notre centre. Les patients opérés selon la technique de Bengt Johanson ont été inclus. Les paramètres étudiés étaient l'âge, les antécédents urologiques, les motifs de consultations, la durée d'évolution, les caractéristiques de la sténose et les résultats du traitement. RÉSULTATS: douze patients étaient inclus. L'âge moyen était de 48±20 ans. Le principal motif de consultation était la rétention d'urine. La durée moyenne d'évolution était de 30± 25 mois. L'étiologie la plus fréquente était celle d'origine scléro-inflammatoire. Tous les patients avaient déjà eu au moins un antécédent. L'examen physique avait objectivé une gangue péri-urétrale chez 10 patients. La longueur moyenne de la sténose urétrale était de 6,3 ± 2,2 cm. Après un recul moyen de 3,8 ± 2,3 mois ; les résultats étaient jugés bons chez 8 patients et mauvais chez 4 patients. CONCLUSION: L'urétroplastie en deux selon Bengt Johanson donne de bons résultats dans le traitement des sténoses urétrales complexes.

Cure de varicocèle sous anesthésie locale: aspects techniques et faisabilité / Varicocele surgery under local anesthesia: technical aspects and feasibilty

Contexte et objectif. Au Sénégal, la chirurgie de la varicocèle, occupe une place non négligeable dans la prise en charge de l'infertilité masculine. Cette chirurgie connait une utilisation de plus en plus fréquente de la voie inguinale ou même sous inguinale. Cette modification progressive des habitudes a été l'origine de l'étude de la faisabilité et de la sécurité de l'anesthésie locale dans notre pratique. Méthodes. Dans une série des cas, trente-cinq (35) patients ayant donné leur consentement ont été opérés sous anesthésie locale selon le même protocole par les médecins de l'équipe. Résultats. L'âge moyen des patients était de 32,5 ± 8 ans (18-54 ans). Le motif de consultation le plus fréquent était l'infertilité du couple (62,9 %). Vingt-deux patients avaient une varicocèle bilatérale et treize une varicocèle unilatérale. Tous nos patients étaient classés ASA I. La moyenne de la durée d'intervention était de 22 ± 9,48 min. La moyenne du degré de la douleur pendant l'opération était à 1,37/10 selon l'EVA chez les 35 patients. Aucun incident peropératoire lié à l'anesthésie ou à un problème technique chirurgical n'a été observé. Après la chirurgie, 94,3% ont déclaré avoir été satisfait du geste. Conclusion. La pratique de la chirurgie ambulatoire sous anesthésie locale de la varicocèle offre une part importante dans la prise en charge de cette affection

Context and objective. In Senegal, varicocele surgery occupies a significant place in the management of male infertility. This surgery is increasingly performed via the inguinal or even sub inguinal route. This gradual change in habits was the origin of the study of the feasibility and safety of local anesthesia in our practice. Methods. In a cross sectional study, thirty-five (35) patients who gave their consent underwent the surgery under local anesthesia according to a standardized protocol by the team's doctors. Results. The average age of the patients was 32.5 ± 8 years (18-54 years). The most frequent reason for consultation was infertility in the couple (62.9%). Twenty-two patients had bilateral varicocele and thirteen had unilateral varicocele. All our patients were classified as ASA I. The average duration of the operation was 22 ± 9.48 min. The average degree of pain during the operation was 1.37/10 according to the Visual analog Scale in the 35 patients. No intraoperative incident related to anesthesia or a surgical technical problem was observed. After surgery, 94.3% said they were satisfied. Conclusion. The practice of outpatient surgery under local anesthesia for varicocele occupies an important part in the management of this condition.

Unusual Presentation of Priapism Associated with Acute and Chronic Myeloid Leukemia in Two Patients: Emergency Management.

Priapism is a rare urological emergency. It is rarely a telltale sign of myeloid leukemia. We report two cases of acute myeloid leukemia in a child and chronic myeloid leukemia in a young adult presenting with priapism. Puncture irrigation of the corpora cavernosa followed by systemic treatment to lower the hyperviscosity of the blood due to leukemia provided optimal outcome. Prompt emergency management is required to lower the complication of erectile dysfunction.

Impact of tumor cytoreduction in metastatic prostate cancer.

Objective: To assess the impact of tumor cytoreduction on cancer outcomes and patient survival in metastatic prostate cancer. Patients and methods: It is a prospective study spanning a two-year period between October 1st 2015 and March 31st 2017. We enrolled 102 cases of metastatic hormone-sensitive prostate cancer. Fifty-seven (57) patients had exclusively androgen deprivation therapy (ADT) (group 1) and 45 had, in addition, an open prostatectomy or Transurethral resection of the Prostate (group 2). We compared both groups using the total PSA nadir, the time to PSA nadir, the overall survival (OS), and the progression-free survival (PFS). Results: The average nadir PSA was lower for the tumor cytoreduction group (16.8±1.6 ng/mL (0.01-193.5) versus 110.7±17.9 ng/mL (0.01-1379)). Median time to PSA nadir was shorter in patients in the ADT only group (8 months vs 3 months (p=0.025)). The OS was shorter in patients treated with ADT only compared to the tumor cytoreduction group (median 14 months vs 24 months, respectively (p=0.03)). Similarly, tumor cytoreduction had a positive impact on patient progression (median PFS 20 months (group 1) vs 43 months (group 2)). Conclusion: Tumor cytoreduction has a positive impact on the oncological results and the survival of patients under ADT.

Etiology and current clinical characteristics of male urethral stricture disease: experience from a public teaching hospital in Senegal.

OBJECTIVE: To identify the etiology and current clinical characteristics of male urethral stricture disease (USD) in Senegal. PATIENTS AND METHODS: A retrospective and mono-centric study over a 10-year period (between January 1999 and December 2008) was carried out and included all male patients with USD admitted to the Urology Department of Aristide Le-Dantec Hospital (Dakar). RESULTS: We recorded 414 USD cases. The maximum annual incidence was observed in 2004, and from then, the incidence tended to decrease gradually. The mean age of patients was 43.7 ± 19.6 years (1-89 years), and 43% of patients were younger than 40 years old. The mean time from symptoms onset to the consultation was 20.1 ± 24.9 months (1-120 months). Most patients (42.2%) were admitted because they suffered dysuria. In 57.8% of patients, USD was diagnosed with complications. The most common site of stricture was at the bulbar urethra (72.7%). The length of the urethral stricture was smaller than 1 cm in 59.6% of patients, between 1 and 3 cm in 28.5% and between 3 and 5 cm in 7.7%. The stricture was longer than 5 cm in eight patients and was staged (multifocal) in nine patients. The etiology of urethral stricture was infectious in 63% of patients, traumatic in 13.7% and iatrogenic in 8.2%. The etiology was not identified in 14.9% of cases. The infectious etiology was urethritis in 259 cases and urogenital schistosomiasis in 12 cases. A study of the etiology according to stricture site showed that bulbar USD was infectious in 77.7% of cases and that all membranous USD cases were traumatic. CONCLUSION: Male urethral stricture in Senegal is often a sequela of gonococcal urethritis and is frequently detected because of infectious complications such as gangrene of the genitalia or urinary tract infections. Its prevention in this geographical region thus requires fighting against sexually transmitted infections and treating appropriately and effectively all urethritis.

[Testicular cancer is a rare condition in black people. We report 5 cases of testicular cancer in men with undescended testis]. / Cancer sur testicule non descendu intra-abdominal. A propos de 5 cas.

PATIENTS AND METHODS: We underwent a retrospective study of five cases of testicular cancer in undescended testis. The parameters of study were: age at diagnosis, circumstances of diagnosis, values of tumour markers, and pathological aspects of tumours after removal. The data were studied using the medical records of patients. RESULTS: Mean age was 30, 6 years (27; 34). Only 1 patient had a child at the time of diagnosis. All patients came to our clinic for a general state impairment associated to an abdominal palpable mass. The increase of the value of tumour markers was not constant. A capsular effraction was found in 3 cases with a rupture into the peritoneum. The pathology exam found 3 embryonic carcinoma and 2 seminomas, a lymph node involvement was found in 3 cases. CONCLUSION: The scarcity of these tumours should not make us ignore them. The early diagnosis of the tumour can be facilitated by testicular descent, because even if the descent of the testis does not prevent the tumour it can ease the follow-up.

[Leiomyosarcoma of the spermatic cord]. / Le léiomyosarcome du cordon spermatique.

Leiomyosarcomas of the spermatic cord are rare tumours. The authors report the case of a 65-year-old man presenting with painful mass of the left side of the scrotum with scrotal ulceration. Left transinguinal orchidectomy and left hemiscrotectomy were performed and histological examination of the operative specimen revealed leiomyosarcoma of the spermatic cord. No metastases were observed on thoracoabdominopelvic CT. One month after discharge from hospital, the patient presented with delayed healing and complementary scrotal resection and adjuvant radiotherapy were performed. Local and regional extension is frequently observed in leiomyosarcoma of the spermatic cord, justifying radical transinguinal orchidectomy with high ligation of the cord. Cases at greatest risk of recurrence (large tumour, early local recurrence, positive surgical margins) should be identified by multidisciplinary committees and may be eligible for adjuvant radiotherapy.