[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.

[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.

[Bacterial profile of surgical site infections at Souro Sanou National Hospital Center in Bobo Dioulasso, Burkina Faso]. / Profil bactériologique des infections du site opératoire au centre hospitalier universitaire Souro Sanou de Bobo Dioulasso.

OBJECTIVE: The purpose of this study was to evaluate the bacterial profile and antimicrobial susceptibility of surgical site infection (SSI) as a basis for optimizing probabilistic antibiotherapy. MATERIALS AND METHODS: A 6-month transversal retrospective study was carried out at the Souro Sano Hospital Laboratory from November 1st, 2006 to April 30th, 2007. All positive pus samples collected for etiologic diagnosis of SSI were included. RESULTS: In a series of 681 patients who underwent surgery at the hospital, SSI was observed in 159 cases for an incidence of 23.4%. Pus samples for etiologic diagnosis were collected from 112 patients and led to identification of 103 bacterial strains. The most common strains were enterobacteriaceae in 54.0%, gram-positive cocci in 29.0% and non-fermenting Gram-negative bacilli in 16.5%. Escherichia coli was the most common species (30%) followed by Staphylococcus aureus (16.5%) and Pseudomonas aeroginosa (12.0%). Enterobacteriaceae resistance rates were 71% to amoxicillin, 64% to clavulanic acid-amoxicillin and 15% to third generation cephalosporin. Most S. aureus isolates (85%) were sensitive to methicillin. Non-fermenting Gram-negative bacilli resistance rates were 68.5% to carboxypenicillin and 56% to fluoroquinolones. CONCLUSION: These findings indicate that SSI can be treated using third generation cephalosporin-aminosides in combination with oral fluoroquinolones.

Management of Intrauterine Device Migrated into the Bladder: A Case Report and Literature Review.

Intrauterine device represents the most reversible method of contraceptive worldwide. Its insertion is a medical procedure not free from complication. We report a rare case of intravesical migration of a copper intrauterine device inserted 18 months earlier in a 28-year-old multiparous woman. The patient presented with irritative lower urinary tract symptoms, and she was managed endoscopically. This case underscores the role of cystoscopy in irritative lower urinary tract symptoms post IUD insertion.

[Retrospective study of urogenital fistula in Burkina Faso from 2001 to 2003]. / Bilan rétrospectif des fistules urogénitales obstétricales de 2001 a 2003 au Burkina Faso.

The purpose of this study was to analyze aspects of obstetric urogenital fistulae to provide a foundation for implementation of a national control program in Burkina Faso. A cross-sectional study with quantitative and qualitative components was carried out in 47 hospitals in January 2004. The quantitative component consisted of analyzing available data for 2001, 2002 and 2003. The qualitative component consisted of interviewing women with fistulae to evaluate the impact of the disease on the quality of life and persons in charge of the health reference centers to identify the difficulties and needs of the facility. In the 3-year study period, 1,500,000 deliveries were attended and 347 fistulae were identified in the health reference centers. The incidence rate of obstetric fistulae was 23.1 per 100 000 deliveries (CI 95% 20.8-25.7). Women with fistulae were young and usually without paid employment. Many had a history of dystocia during the labor. Most fistulae were recent, small or average in size and located at the level of the vesico-vaginal septum. The failure rate of surgical treatment was about 17.5%. Four of the 12 women interviewed reported social alienation and ostrasization. Only 4 of the 47 hospitals studied had a personnel qualified to manage women with urogenital fistula on a daily basis. One NGO assisted women in obtaining care. Proposals for improvement of the situation were considered at a national validation workshop. These findings support the need to implement a national program that should be evaluated to see lessons learned from this study.

Microbiological characteristics of community-acquired peritonitis at Souro Sanou Teaching Hospital of Bobo Dioulasso.

The purpose of this study was to describe the microbiological characteristics of community-acquired peritonitis at the Souro Sanou teaching hospital of Bobo Dioulasso, Burkina Faso. This 10-month prospective study, from July 2012 through May 2013 included all cases of community-acquired peritonitis who underwent surgery at our hospital and had a pus sample taken at that time. Bacteriological analyses were performed according to the hospital laboratory's protocol. The study included 72 patients (45 men and 27 women with a sex-ratio of 1.6). Their mean age was 27.3 years (range: 14 months to 67 years). The analysis of 72 samples of pus enabled confirmation of 39 cases and led to the identification of 53 bacterial strains. The most common families were enterobacteriaceae in 58% and Gram-positive cocci in 36%. The most common enterobacteria species was Escherichia coli (47%) followed by Streptococcus species (22%). The microbiological confirmation of peritonitis was most frequent in the 20-30 year-old age group. These bacteria appeared most susceptible to gentamycin, ceftriaxone, and ciprofloxacin, while we observed resistance to amoxicillin and the combination of clavulanic acid-amoxicillin. These findings suggest that the best probabilistic antibiotic treatment for the peritonitis in our context would combine a third-generation cephalosporin with aminoglycosides, with imidazole to cover potential anaerobic bacteria.

[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.

[Comparative study of 3 Schistosoma haematobium foci in Burkina Faso]. / Etude comparative de trois foyers bilharziens à Schistosoma haematobium au Burkina Faso.

The comparative study of the three most common schistosomiasis foci in Burkinabé villages shows a great disparity both in parasitological and malacological results. Parasitological investigations by reagent strips and urine filtration conducted on school children indicated respective prevalence rates of 85% at Thion, 37.5% at Donsin and 10.5% at Djerma. Malacological prospections found two species (Bulinus senegalensis and Bulinus truncatus) of intermediate hosts of schistosomiasis in the water biotopes in Thion and Donsin, and only one species (B globosus) at Djerma. We speculate that this situation could be related to initial levels of endemicity, to the distance between living quarters and sites of transmission, to sociological practices as well as to the mollusc vector species. Given the large distribution of these foci throughout the country, the Burkinabé medical authorities should recognise their importance with regard to the disease on a public health level and support the current orientation of the national schistosomiasis control programme which is coordinated around district health services.

[Parasitological profile of urinary schistosomiasis of the Sourou hydroagricultural complex of Burkina Faso]. / Profil parasitologique de la schistosomose urinaire du complexe hydroagricole du Sourou au Burkina Faso.

In the Sourou area of Burkina Faso, parasitological and malacological surveys of urinary schistosomiasis have been carried out in the constructed sites of Guédougou, Niasan and Débé dating respectively from 1967, 1986 and 1996. The investigations covered also the traditional villages of Lanfiera, Di, Poro, Tiao and Mara situated in the middle of the hydroagricultural planning for the first, very close to the lake for the second and about twenty kilometres distant for the three last. These towns represent the main sites in the Sourou area. The results of the parasitological surveys showed that urinary schistosomiasis was present in all sites. The levels of prevalence varied considerably: 70.3% in Guiédougou, 40.8% in Niassan, 8.5% in Débè in the irrigated zone, 55.6% in Lanfiéra, 56.8% in Di, 13.2% in Poro, 83.3% in Tiao and 64.7% in Mara. Concerning the malacological investigation, two species (Bulinus senegalensis and B. truncatus) were shown to be intermediate hosts of Schistosoma haematobium. The first was endemic to the area while the second was compatible with S. haematobium from the Sourou and other zones. Compared to the results of earlier investigations, the endemic had worsened with differences according to sites. This disparity of prevalence levels which has already been observed in other hydroagricultural area results from many factors, among which the impact of irrigation activities, the aquatic biotope system (irrigation canals, natural lake, pools and temporary rivers) and the type of contact of human communities with water rank high. Schistosomiasis expansion is amplified by the intermediate host dynamics and the introduction of new schistosomes carried by the new workers arriving from all over the country. In these conditions, in order to reduce rapidly prevalence levels, preventive measures should be centred on chemotherapy for the population. The treatment should be administered during a period of weak intermediate host density and be directed towards in-coming workers. Such an approach should be able to check the spread of schistosomiasis naturally occurring with the irrigation of new sites.

[Transfer of obstetric patients in a pregnant and postpartum condition to an intensive care unit: eighty-two cases in Burkina Faso]. / Transfert de patientes en état gravido-puerpéral en réanimation: à propos de 82 cas au Burkina Faso.

OBJECTIVE: To review all obstetric admissions to an intensive care unit (ICU) of an African hospital. PATIENTS AND METHODS: Retrospective analysis of the records of all obstetric patients admitted to the ICU of Souro Sanou Hospital in Burkina Faso, from January 1st, 1996, to June 30, 1998. RESULTS: Eighty-two patients out of 6119 deliveries were transferred to the ICU, which meant a 1.34% transfer rate. These transfers concerned young patients (mean age of 24 years), coming originally from outlying maternities in 52.4% and having already given birth in 64.63% of the cases. The two main diagnoses at the ICU were: eclampsia and septic shock. The large majority of the patients (73 out of 82) had at least one bad prognosis factor at admission at the ICU. A maternal mortality rate of 60% was noted, the main risk factors for mortality being acute respiratory condition and severe anemia. CONCLUSION: Mortality of obstetric patients admitted to ICUs is very high in our setting. Establishing an ICU within the obstetric unit or early detection of cases to be transferred (scoring system?) should improve the prognosis.

[Urachal cyst: contribution of ultrasound (about a case at Sourou Sanou Sobo-Dioulasso university hospital)]. / Kyste de l'ouraque: apport de l'echographie (a propos d'un cas au centre hospitalier universitaire Sourou Sanou Bobo-Dioulasso).

Urachal cyst is difficult to diagnose and is a rare malformation and the authors report a case in a 10-month old boy. The malformation was associated with posterior urethral valve and simple surgical treatment was successful.The authors emphasize the contribution of perineal ultrasound in the diagnosis of associated posterior urethral valves.

Le kyste de l'ouraque est de diagnostic difficile et constitue une malformation rare dont les auteurs rapportent un cas chez un garçon de 10 mois. La malformation était associée à une valve de l'urètre postérieur et sa cure chirurgicale très simple a été couronnée de succès.Ils insistent sur l'apport de l'échographie par voie périnéale dans le diagnostic associé des valves de l'urètre postérieur.

[Intrauterine ischemia of the right upper limb and hemiface: a case report]. / Ischémie in utero du membre supérieur et de l'hémiface droits: à propos d'une observation.

A case of ischemic gangrene of the right upper limb and hemiface noticed at birth is reported. It was a male baby born at term vaginally from a non diabetic mother. He was allowed in the surgical emergencies, 24 hours after the birth. The injuries were irreversible and required an arm amputation and a debridement of necrotic areas of the hemiface. The authors discuss the aetiology, the clinical features and the management of this rare condition.