Characteristics and management of post-circumcision Urethrocutaneous Fistula: a retrospective study in surgical units in Cameroon.

Background: Urethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear-cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced. Patients and methods: From February 2010 to December 2022, 35 patients underwent surgical repair for post-circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu techniques were performed. Results: The mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three-quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow-up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics. Conclusion: Urethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non-qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow-up is mandatory for good long-term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.

[Epidemiology and diagnosis of urinary lithiasis: a cross-sectional study in a Cameroonian based population]. / Epidémiologie et diagnostic de la lithiase urinaire: étude transversale dans une population camerounaise.

Introduction: urinary stone is a multifactorial disease characterized by the presence of concretions in the urinary tract. The diagnosis of urinary lithiasis is based on clinical and imaging findings. The objective of this study was to determine the profile of patients suffering from urolithiasis in the city of Yaounde. Methods: this was a descriptive observational cross-sectional study with retrospective data collection. Patients with an age > 15 years and patients diagnosed with lithiasis confirmed by medical imaging were included in our study. The variables studied were sociodemographic, clinical and paraclinical. Results: a total of 120 patients were included in our study. The mean age was 40.46±12.62 years with extremes from 19 to 74 years. Male gender was predominant at 60.8% (n=73). Renal colic was the circumstance found in 67.5% (n=81). Physical examination was normal in 55.8% (n=67). Insufficient hydration was found in 45% (n=61) of cases. Abdominal scanner was the most performed examination in our study in 50.7% (n=61). The median stone density was 731 Hounsfield units [346; 1183.5]. The stones were predominantly located in the upper tract. The left renal topography was predominant in 35% (n=42) of cases. Urine culture revealed Escherichia Coli at 60% (n=15). Blood calcium, phosphorus and uricemia were requested in 15.8% (n=19), 0.8% (n=1) and 12.5% (n=15) of cases, respectively. The results were normal. In the absence of a laboratory specialized in biochemical analysis of calculi, a minority of patients (n=3) benefited from spectrophotometry. Conclusion: urinary lithiasis is a disease of men in their forties. Renal colic is the main revealing sign. The diagnosis is revealed by the abdominal scanner in half of the cases. Metabolic assessment and constitutional analysis of the calculus are still very rarely requested.

[Urological emergencies in two university hospitals in Douala: a retrospective study (2016-2020)]. / Les urgences urologiques dans deux hôpitaux universitaires de Douala: une étude rétrospective (2016-2020).

Introduction: urological emergencies are critical situations that require rapid response by a qualified urology health care professional. The purpose of this study was to highlight the profile of urological emergencies in two university hospitals in the city of Douala by assessing emergency management. Methods: we conducted a retrospective study of the urological emergencies in two reference hospitals in the city of Douala: the Laquintinie Hospital and the General Hospital. Files were collected over a period of 5 years (January 1st, 2016 to December 31st, 2020). All emergency consultations in the Emergency Unit as well as all clinical and therapeutic data from the on-call list during the study period were included. We excluded all emergencies (consultations during the study period) not recorded in the emergency registry. Results: we conducted a study of 364 patients with an average age of 43 ± 8.34 years; 92.58% (n=337) of patients were male. The most common urological emergencies included: urinary retention (45.05%, n=164), renal colic (15.33%, n=56) and haematuria (13.18%, n=48). The most common cause of urinary retention was prostate tumors, renal colic was mainly due to renal lithiasis (96.45%, n=159) and hematuria was due to tumor in 68.75% (n=33) of patients. Therapeutic management was based on urinary catheterization (39.01%, n=142), medical treatment was associated with monitoring (27.47%, n=100) and suprapubic cystostomy (10.71%, n=39). Conclusion: acute urinary retention due to prostate tumors is the most common urological emergency in the university hospitals in the city of Douala. Early and optimal management of prostate tumors is therefore essential.

Les urgences urologiques dans deux hôpitaux universitaires de Douala: une étude rétrospective (2016-2020) / Urological emergencies in two university hospitals in Douala: a retrospective study (2016-2020)

Introduction: les urgences en urologie sont des situations urologiques critiques qui nécessitent une intervention rapide par un professionnel de santé qualifié en urologie. Cette étude a été menée dans le but de ressortir le profil des urgences urologiques reçues dans deux hôpitaux universitaires de la ville de Douala en appréciant leurs prises en charge en urgence. Méthodes: il s´agit d´une étude rétrospective portant sur les urgences urologiques dans deux hôpitaux de références de la ville de Douala que sont les hôpitaux Laquintinie et Général de Douala. Les dossiers ont été colligés durant une période de 5 ans (1er janvier 2016 au 31 décembre 2020). Nous avons inclus toutes les consultations effectuées en urgence et reçues par le service des urgences ainsi que toutes les données cliniques et thérapeutiques venant du registre de garde durant la période d´étude. Nous avons exclu de notre étude toutes les urgences (consultations reçues pendant la période d´étude, non relevées dans le registre des urgences) Résultats: nous avons étudié 364 patients, l´âge moyen des patients était de 43 ± 8,34 ans. Quatre vingt-douze virgule cinquante huit pourcent (92,58%) (n=337) des patients étaient des hommes. Les principales urgences urologiques reçues étaient la rétention d´urine vésicale (45,05%, n=164), la colique néphrétique (15,33%, n=56) et l´hématurie (13,18%, n=48). Les principales étiologies des rétentions d´urine vésicale étaient les tumeurs prostatiques, la colique néphrétique était principalement d´origine lithiasique (96,45%, n=159) et l´hématurie était d´origine tumorale chez 68,75%(n=33) des patients. Sur le plan thérapeutique, les gestes effectués en urgence étaient le sondage vésical (39,01%, n=142), le traitement médical était associé à une surveillance (27,47%, n=100) et la cystostomie sus pubienne (10,71%, n=39). Conclusion: les rétentions aigues d´urines vésicales sur tumeurs prostatiques constituent l´urgence urologique la plus fréquente dans les hôpitaux universitaires de la ville de Douala. Cela implique une prise en charge précoce et optimale des tumeurs prostatiques.

Dorsal Corporoplasty Techniques in the Management of Chordee Associated with Severe Hypospadias at a Teaching Hospital in Yaoundé, Cameroon: A Retrospective Study.

Introduction: The prevalence of hypospadias is 1 in 300 male births, of whom one in four will have some form of chordee. Correction of the chordee is imperative but presents a challenge with complications, including residual chordee, penile nodulations, and shortening. This study aimed at reporting the outcomes and at sharing our experience with the surgical correction of chordee associated with hypospadias at the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Patients and Methods: We carried out a retrospective cross-sectional study covering an eight-year period from 1 January 2010 to December 2017 at the Pediatric Surgery Service of the YGOPH. The study included all files of patients with severe hypospadias who underwent chordee correction using dorsal corporoplasty techniques and were reviewed for outcome evaluation. Results: A total of 40 patients met the inclusion criteria, of whom 22 (55%) had chordee corrected by the Nesbit corporoplasty technique, 13 (32.5%) by the Tunica Albuginia Plication (TAP) corporoplasty technique, and five (12.5%) by the Yachia corporoplasty technique. The median age at surgery was six (five to seven) years. The median follow-up period for the patients was five (three to six) years. Penile nodules were not observed in our series. Penile shortening was identified in four patients (18.2%) after Nesbit corporoplasty. Four patients had a residual chordee that was significant enough, requiring another correction. Conclusion: Irrespective of the technique of dorsal corporoplasty used in the correction of chordee associated with severe hypospadias, penile nodulation and shortening are not of concern, and residual chordee, if present, is usually mild and does not require any correction.