[Management of acquired urethral stricture: our experience in the Division of General Surgery in Sikasso]. / Prise en charge du rétrécissement urétral acquis: expérience du Service de Chirurgie Générale de Sikasso.

Urethral stricture is a disease whose cause and management vary according to the context. This study aims to analyze the epidemiological etiological and therapeutic features of urethral stricture in our department. We conducted a longitudinal cross-sectional study of patients with acquired urethral stricture admitted to our department between March 2014 and February 2016. The average age of our patients was 24.5 years (10 and 81years). The diagnosis was confirmed by retrograde and voiding Urethro-Cystography (UCG). The average stricture length was 2.28cm (0.5-5cm). The therapeutic approaches included: resection with termino-terminal anastomosis; retrograde dilatation etc. Outcome assessment performed 6-15 months after surgery was satisfactory with absence of recidivism, PMR ≤30cc and strong urine flow and weak in the case of recurrence of dysuria or PMR ≥100cc. Urethral stricture accounted for 7.14% of our urologic treatments. Most of our patients were farmers from the rural area. A history of recurrent urethritis was most often reported by our patients and 78,57% of them were married men, among whom 91% were polygamous). The main reason for consultation was dysuria (50% of the study population) and 50.01% of our patients had secondary urinary tract infection, most commonly caused by Escherichia coli. The main cause of urethral stricture was an infection (56.52%). The most affected area was the bulbar urethra (45.60% of cases). UCG was the most used technique (39.13%). Overall outcomes were good (85,65%) and failure rate reached 13.04%; the highest success rate was achieved with resection with anastomosis (94.44% respectively). Urethral stricture is common among young people. Infection is the main cause in our department. Prevention is essential as well as an efficient and effective management of sexually transmitted infections.

[Urogenital fistulas at Sikasso: about 150 cases]. / Fistule urogénitale à Sikasso: à propos de 150 cas.

This study aims to analyze the epidemiological, clinical, therapeutic and anatomopathologic features of urogenital fistulas. We conducted a retrospective study of patients with urogenital fistulas admitted to the department of general surgery and gynecology and obstetrics between January 1, 2014 and December 30, 2015, including the first 5 fistula repair campaigns organized by the Fistula Mali project. Urogenital fistulas account for 19.53% of all urologic disorder treated during our daily practice. The median age at first marriage was 16.57 years. The majority of our patients (96.70%) was illiterate and self-employed, coming from rural areas (85.36%). Obstructed labour was the dominant etiology, with 91.50% of stillborn children. The patients were primiparous women (43.33%) and, among them, 53.60% received no prenatal care. The divorce rate associated with the disease was 7.30%. Most patients underwent simple fistulorraphy, of whom 121 underwent lower fistulorraphy, 26 upper fistulorraphy and 3 mixed fistulorraphy. Outcomes were satisfactory in 65.33% patients and poor in 34.66% of patients. Patients with type I and type V obstetric fistulas had the highest healing rate compared to patients with type IV fistulas. Urogenital fistulas are a real public health problem. Treatment is mainly based on surgery and prognosis is compromised by the narrowness of the surgical field, the complexity of the lesions and the condition of the surrounding tissue. The focus must be on the implementation of women's socio economic development programs and on emergency obstetric care access. The research and discussion should continue to facilitate the development of a standard classification.

Therapeutic efficacy of sulphadoxine-pyrimethamine and chloroquine for the treatment of uncomplicated malaria in pregnancy in Burkina Faso.

BACKGROUND: A reduction in the therapeutic efficacy of chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) has recently been observed in Burkina Faso. As these two drugs are used in pregnancy, their efficacy in pregnant women was studied to directly assess the level of drug resistance in this specific population, rather than to extrapolate results of studies conducted in children < 5 years of age. METHODS: During the malaria transmission season of 2003 in Ouagadougou, the clinical efficacy of SP and CQ, using the WHO 28-day protocol, was assessed in primigravidae and secundigravidae presenting with uncomplicated malaria. RESULTS: PCR-corrected results by day 28 showed that among 62 women treated with SP, eight (12.9%) experienced late parasitological failure, but no clinical failures. Among 60 women treated with CQ, the overall failure rate was 46.7% including 1.7% early treatment failures, 5% late clinical failures and 40% late parasitological failures. SP induced a haemoglobin gain of 0.3 g/dL by day 14 and 0.9 g/dL by day 28. Treatment responses were independent of gravidity, gestational age and prior antenatal care visits. CONCLUSION: While CQ should no longer be used, the efficacy of SP is still compatible with use for intermittent preventive treatment (IPT) in pregnancy. However, given the possible spread of resistance, the drug should be restricted in its use.