[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.

[Tumours of the ovary in young women. The way they arise and the limits of conservative treatment (author's transl)]. / Les tumeurs de l'ovaire de la femme jeune. Modalités et limites du traitement conservateur.

Although tumours of the ovary are rare in woman under the age of 35 they are not exceptional and they form 15 p. 100 of the cases (17 patients) out of a series of 112 tumours of the ovary which were collected in 7 years. 11 of these patients had only one ovary affected and were able to be treated conservatively. In this way 5 of them were able to carry one or more pregnancies to term and another patient who was lost from observation for two years had to have a second operation to deal with a recurrence in the opposite ovary. Conservative treatment is only permissible if one is absolutely sure that the contro-lateral ovary is normal, and if there is the slightest doubt ovariotomy should be carried out to perform a biopsy. Furthermore the authors suggest that in view of the difficulties of strict supervision for a long term the opposite ovary and tube should be removed and hysterectomy carried out once the patient has had one or two children or when they have reached the age of 40.

PIP: Out of 112 ovarian tumors observed by the authors during a 7 year period, only 17, or 15%, were on women below 35. In 6 of these 17 cases total hysterectomy was necessary; in the remaining 11 cases only one ovary was affected by the tumor, so that it was possible to treat the disease with unilateral ovariectomy, allowing 5 patients to become pregnant. Conservative treatment by unilateral ovariectomy is advisable only in cases when the controlateral ovary is normal. Postoperatory surveillance of such cases is difficult and must go on for years; in cases where the patient is over 40 and has children the opposite ovary should also be removed.