[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.

Prostate rhabdomyosarcoma in a young adult: Case report and literature review.

Primary rhabdomyosarcoma of the adult prostate is rare and associated with an aggressive clinical course. Combined modality therapy has resulted in marked improvement in survival rates and reduced surgical morbidity for children with these tumors. However, in adults the prognosis remains poor.We report on a case of prostate rhabdomyosarcoma in an adult approached with combined-modality treatment, with the administration of 9 courses of doxorubicin, vincristine and endoxan, and, subsequent radiotherapy to the prostaticbed. The patient remained free of progression of disease for about 1 year.

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.

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.

Renal cell carcinoma with MiTF/TFE3 translocation in children: report of a case at the stage of lymph node involvement.

Renal cell carcinoma (RCC) is rare in children. Unlike nephroblastoma, however, it does not respond well to chemoradiotherapy. Its treatment is therefore based on surgical removal of the tumour. However, lymphadenectomy for RCC is controversial, and its prognosis is unclear. The authors report a case of RCC with MiTF/TFE3 translocation at the stage of lymph node involvement without metastasis in a boy of age 12, who was treated with radical nephrectomy and limited lymphadenectomy. This tumour constitutes a newly individualised entity in the World Health Organization's 2004 classification. Eighteen months after the operation, the patient was presented with no sign of recurrence. This case aids in showing that lymph node involvement in RCC with translocation in children is not associated with a poor prognosis and that lymphadenectomy during surgery for enlarged nephrectomy is essential.