[Sexuality assessment of homozygous adult sickle cell patients with a history of priapism in Senegal]. / Évaluation de la sexualité des drépanocytaires adultes homozygotes ayant des antécédents de priapisme au Sénégal.

OBJECTIVES: The objective of this study was to evaluate the sexuality of SS sickle cell patients with a history of priapism. METHODS: This was a case-control study of adult SS sickle cell patients. The occurrence of priapism as well as the nature of the priapism had been investigated. The patients were subdivided into three groups: Group 1 (no priapism), Group 2 (intermittent priapism) and Group 3 (acute priapism). The patients' sexuality was studied using the IIEF-15 questionnaire. RESULTS: We interviewed 191 SS sickle cell patients. The mean age was 27.1±7.1 years. Priapism was observed in 43.5 %. Only 77 patients were eligible for the IIEF15 questionnaire. Groups 1 and 2 performed significantly better than group 3 on erectile function (EF) and orgasmic function (OF) scores. There was no significant difference in the EF and OF scores between groups 1 and 2. No significant difference was observed between the three groups for the scores of sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The impairment of erectile function in group 2 was related to the age of the first episode of priapism and the last episode. The impairment of erectile function in group 3 was related to the duration of evolution (P<0.05). CONCLUSION: This study shows that priapism is responsible for impaired erectile function in SS adult sickle cell patients. A program to prevent intermittent episodes of priapism should be put in place.

[Advanced prostate cancer in Senegal. Clinical aspects at the General Hospital of Grand Yoff]. / Cancer avancé de la prostate au Sénégal. Aspects diagnostiques à l'hôpital de Grand Yoff.

UNLABELLED: Prostate cancer is a common disease, which continues to be discovered at advanced stages in Africa, despite improved diagnostic tools. AIM: The authors report the experience of the Department of Urology, General Hospital of Grand Yoff Dakar in the diagnostic of advanced prostate cancer. MATERIAL: This was a retrospective descriptive study on patients followed for advanced prostate cancer during the period from January 1st, 2004 to May 31st, 2010. RESULTS: There were 102 people aged from 51 to 96 years with an average of 71 ± 9 years. A comorbid condition was associated in 24.5 % of cases. The circumstances of discovery were pain (32 cases), neurological signs (17 cases), and urinary disorders. DRE had objectified an abnormality in all patients. The serum levels of prostate specific antigen ranged from 5.88 ng/mL to 21,660 ng/mL, with an average of 1447.57 ± 812 ng/mL. A prostate biopsy was performed in 44 patients and prostatic adenocarcinoma was found in 97.7 % of cases with Gleason scores greater than 7 (33 cases). We found different metastatic sites at vertebral column (23 cases), at lung (14 cases), and on pelvic bones (11 cases). CONCLUSION: The prostate cancer is a serious condition with high morbidity and mortality. The diagnosis is not made early in developing countries. We need a strategic plan to improve the early screening and we should develop supportive care too because of the high number of advanced cases diagnosed in our context.

[Management of prostate cancer in Senegal: what is being done?]. / Cancer de la prostate : quelle prise en charge au Sénégal ?

OBJECTIVE: To evaluate the management of patients with prostate cancer in Senegal. MATERIALS AND METHODS: We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities. RESULTS: We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen. CONCLUSION: The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

[Total cystectomies for cancers locally advanced of bladder about 12 cases in the service of urology of the general hospital of Grand-Yoff]. / Cystectomies totales pour cancers localement avancés de vessie au service d'urologie de l'hôpital général de Grand-Yoff.

OBJECTIVE: The goals of the study is to evaluate the feasability of the total cystectomy for cancer infiltrating locally advanced of bladder and to evaluate perioperatitive morbidity and short-term results. PATIENTS AND METHODS: We made a retrospective study concerning 12 first patients having profited from a total cystectomy for cancer infiltrating of the bladder in our hospital over one period of 1 year. The parameters of study were: the age at the time of the diagnosis, circumstances of the diagnosis, antecedents of the patient, the histological type and stage TNM before and after intervention, the type of derivation associated, duration of the intervention, the anesthesia, complications and morbidity per- and postoperational. We carried out calculations of average and frequency for the data analysis. RESULTS: The mean age was 51 years (extreme: 32; 83). They were nine men and three women. The circumstances of diagnosis were dominated by the total hematuria and in less frequency by the bladder irritative symptoms. The antecedents of the patients were dominated by the schistosomia (five cases) and the tobacco addiction (two cases). The histological type obtained in preoperative after biopsy or trans urethral resection of bladder found, seven cases of squamous cell carcinoma, four cases of transitional cell carcinoma and one case of adenocarcinoma. Into preoperative, three patients were at the stage pT2, eight patients pT3, one pT4. Four patients had a replacement of bladder: three by a bladder in Z and a patient had Camey II. They were the three patients pT2 preoperative and a patient pT3. Two patients had a standard ureterosigmoidostomy type coffey: the patient pT4 and a patient pT3. The six other patients had Bricker. All the patients profited from a blood transfusion peroperational (two units on average). We did not record any operational mortality. The complications and morbidity are represented by the suppurations of wall (three cases), the vesicocutaneous fistula (one case), the infections urinary and the anemia which was constant. CONCLUSION: The management of bladder cancer poses a real problem in our countries because of the diagnosis at advanced stage.

[Urinary incontinence in woman: epidemiologic profile in Sub Saharian countries]. / Incontinence urinaire de la femme: profil épidémiologique au sud du Sahara.

UNLABELLED: The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries. MATERIAL AND METHODS: A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence. RESULTS: Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases. CONCLUSION: Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

L'echographie doppler couleur scrotale dans la recherche etiologique de l'infertilite conjugale

Introduction : l'infertilite masculine est de plus en plus importante(1). Les etiologies sont variees; l'echographie doppler couleur des bourses constitue l'examen d'imagerie de premiere intention dans la recherche etiologique. Le but de notre travail est d'evaluer la place de l'echographie doppler couleur dans l'exploration de l'infertilite masculine. Patients et methodes : Nous avons realise une etude retrospective sur une annee de 53 dossiers de patients ayant consulte pour infertilite du couple. Une echographie doppler couleur des bourses a ete realisee pour tous les patients. Elle a permis de noter pour chaque patient la taille; le volume; les contours du testicule et l'aspect du cordon. Le doppler couleur precisait la cartographie vasculaire. Resultats : la moyenne d'age etait de 39;5 ans; la duree moyenne d'infertilite etait de 07 ans et demi. L'examen clinique avait retrouve 20 cas de varicocele clinique dont 12 gauches et 8 bilaterales. L'echographie Doppler couleur avait retrouve 42 cas de varicocele dont 11 confirmant l'examen clinique (3 varicoceles gauches et 8 varicoceles bilaterales); et 31 infra cliniques avec 13 cas de varicoceles bilaterales; 12 cas de varicoceles droites et 6 cas de varicoceles gauches. Les valeurs du diametre des veines droites et gauches variaient entre 2 et 4;8 mm; un reflux a ete objective chez tous nos patients. 33 patients avaient une atrophie testiculaire droite; 35 patients une atrophie testiculaire gauche. 2 cas de kyste para-epididymaire; 3 cas de micro lithiases testiculaires; deux cas d'hydrocele ont ete retrouves. L'echographie Doppler couleur etait normale chez 3 patients. Conclusion : Cet examen est une methode d'imagerie de premier choix dans la strategie diagnostique de l'infertilite masculine

[Determination of total PSA rate and Gleason score during prostatic cancer in Urologic Hospital Center]. / Détermination du taux de PSA total et du score de Gleason au cours du cancer de la prostate en milieu hospitalier urologique.

AIM: To dress biologic and histopathologic aspects of the prostatic cancer in urologic hospital center about a set of digital transrectal guided biopsies. METHODOLOGY: It is a prospective study realized between January 2002 and March 2002 (26 months) studying patients with positive prostatic biopsy. RESULTS: Seventy two cases of prostatic cancer were noticed. Mean age of these patients was 69,9 years (54-91 years). Mean rate Total PSA was 134,8 ng/ml (6-2500 ng/ml). Repartition according Gleason score has revealed that only 35% of tumors were well differentiated. The study of correlation between Total PSA rate and Gleason grade has revealed that up to 10 ng/ml Total PSA rate, only 33% of patients had a Gleason grade between 2 and 4 (well differentiated tumor). CONCLUSION: Actual biologic and histopathologic profile of prostatic cancer lays emphasis on later management.

Traumatismes des bourses : a propos de 14 Observations

Objectif : Le but de ce travail est de rapporter les aspects epidemiologiques; cliniques; paracliniques et therapeutiques des traumatismes des bourses a partir d'une serie observee au service d'Urologie-Andrologie de l'hopital A. Le Dantec de Dakar. Patients et methodes: Il s'agit d'une etude retrospective; allant de Juillet 1986 a Juillet 2002; de 14 patients pris en charge au service d'Urologie-Andrologie de l'hopital A. Le Dantec de Dakar pour traumatisme des bourses. L'age moyen de nos patients etait de 28 ans. La cause principale etait les accidents de la voie publique.Resultats: Le motif de consultation le plus frequent etait la grosse bourse douloureuse (n=10). Le delai moyen de consultation etait court pour les traumatismes ouverts (45 minutes). Le traumatisme etait ouvert dans 4 cas et ferme dans 10 cas. Le traitement chirurgical a consiste en une orchidectomie (n=2); un parage suivi d'une suture des lesions (n=2); une evacuation d'hematocele avec reparation des lesions (n=6) et une cure d'hydrocele (n=1). Un traitement conservateur a ete realise chez trois patients. Le suivi a long terme n'a pas montre de complications chez onze patients. Deux cas d'atrophie testiculaire et trois cas d'oligo-asthenozoospermie ont ete rapportes. Conclusion : La precocite de la consultation; la systematisation de l'echographie des bourses dans les traumatismes fermes sans hematocele permettent une meilleure prise en charge et constituent le gage de la sauvegarde de la fonction gonadique

Varicocele primitive et fertilite : evaluation postoperatoire des parametres du spermogramme et de la fecondite

Objectif : Il n'existe pas de consensus concernant la capacite de la varicocelectomie a ameliorer la fertilite et la fecondite. L'objectif de cette etude retrospective etait d'etudier l'evolution postoperatoire de la fertilite masculine (par les parametres du spermogramme) et celle de la fecondite du couplePatients et methodes: Il s'agit d'une etude retrospective de 50 patients porteurs de varicocele palpable operes selon la technique de Palomo au service d'Urologie de l'Hopital Grand Yoff; Dakar; Senegal. Les parametres etudies sont les parametres du spermogramme (densite; mobilite totale a la premiere heure; vitalite) et du spermocytogramme (taux de spermatozoides de morphologie normale); une fois avant l'operation et a deux reprises apres (entre le 3eme et le 8eme mois et a partir du 9eme mois) et la fecondite postoperatoire du couple chez 35 patients. Resultats : L'etude du spermogramme retrouve; pour l'ensemble des patients; une elevation de la valeur moyenne de tous les parametres; sans normalisation; exception faite de la morphologie (spermocytogramme). L'evolution postoperatoire n'etait statistiquement significative que pour la densite. La majorite des patients (76a 92) presentaient des valeurs du spermogramme preoperatoires inferieures a la normale; excepte pour la morphologie (28) (spermocytogramme). Les parametres du spermogramme se sont ameliores pour 48 a 64des patients selon le parametre etudie. L'amelioration des parametres est d'autant plus importante que leur valeur preoperatoire moyenne etait basse. Les facteurs de bon pronostic postoperatoires sont representes par les patients les plus jeunes (moins de 35 ans) et ceux qui presentaient une varicocele bilaterale; une infertilite de type secondaire et une duree d'infertilite moins longue. Nous n'avons pas etudie la correlation entre le grade de la varicocele et la fecondite. Le taux de grossesse postoperatoire etait de 31;4. Les sujets feconds etaient plus jeunes; avaient une duree moyenne de l'infertilite moins longue et des parametres constamment plus eleves par rapport aux patients infeconds. Les ameliorations postoperatoires de la fertilite et de la fecondite dans cette etude etaient relatives et limitees. Conclusion: Par la frequence de la varicocele et ses consequences sur la fertilite; il s'avere necessaire aussi de mieux et de plus informer les populations sur cette affection; ses consequences et les resultats de son traitement sur la fertilite. De plus une collaboration plus etroite entre gynecologues; biologistes de la reproduction; radiologues et urologues-andrologues permettrait une prise en charge integree de l'infertilite du couple. Il est egalement necessaire; concernant l'infertilite; d'ameliorer la prise en charge psychologique du couple; et notamment celle de la conjointe

[Anterior hypospadias: one stage repair. Report of 40 cases]. / La reparation en un temps de l'hypospadias anterieur. A propos de 40 cas.

INTRODUCTION: Anterior hypospadias is estimated to 60-71% of whole hypospadias. The treatment is delicate and expose to iterative cures. The aim of this study is to review therapeutic aspects of anterior hypospadias of which treatment are first performed by one-stage repair in two departments of urology from Dakar. PATIENTS AND METHODS: It's a retrospective study reporting 40 cases of anterior hypospadias operated between January 1988 and December 2002. Therapeutic results were judged according following criteria: quality of orthoplasty, cosmetic aspect, situation of neo-urethral meatus, permeability of urethra and existence of fistula or not. The results were classified good, mean or worse. RESULTS: The following techniques were used: Mathieu (18 cases), Duplay (14), MAGPI (Meatal Avancement and Glandulo-Plasty Incorporated) 2 cases, Mustarde (2 cases), TGUA (Trans Glandular Urethral Avancement) 4 cases. The mean age of patients was 7,2 years (5 months-19 years). The hypospadias was granular (5%), subcoronar (25%), and anterior penile (70%). Results were good in 62, 5% of cases and worse in 20% of cases. CONCLUSION: In our way of work, for improving the treatment of anterior hypospadias, it is necessary to have microsurgical material and to modify the urinary drainage mode.

Genetic evidence for an androgen-regulated epididymal secretory glutathione peroxidase whose transcript does not contain a selenocysteine codon.

Epididymal glutathione peroxidase (GPX) has been suggested as a major factor in combating loss of fertility of spermatozoa due to lipid peroxidation. We report here the isolation and sequence of putative GPX cDNAs from rat (Rattus rattus) and cynomolgus-monkey (Macaca fascicularis) epididymis, which exhibit marked sequence identity with known GPXs. In both species the cDNAs encode predicted preproteins containing 221 amino acid residues. Unlike other characterized GPX sequences, epididymal GPX mRNA does not contain a selenocysteine codon (UGA). However, sequence comparison and molecular-modelling studies suggest a high degree of structural conservation between epididymal and other GPXs. Transcripts corresponding to epididymal GPX are not detected in a variety of other tissues (liver, spleen, kidney and testis) and appear to be androgen-regulated in the epididymis.

Isolation and structure elucidation of 12beta-acetoxycoccinic Acid, 12beta-hydroxycoccinic Acid, 12alpha-acetoxycoccinic Acid, and 12alpha-hydroxycoccinic acid1.

Four new triterpenoid acids, possessing a lanost-9(11)-en-3-one skeleton, were isolated from KADSURA HETEROCLITA. Based on chemical and spectral analyses, they were assigned as 12beta-acetoxycoccinic acid, 12beta-hydroxycoccinic acid, 12alpha-acetoxycoccinic acid, and 12alpha-hydroxycoccinic acid.

Triterpenoid Acids from Kadsura longipedunculata. Neokadsuranic Acids B and C: Two Novel Triterpenoids with 14 (13 --> 12)abeo-Lanostane Skeletons.

Six triterpenoid acids were isolated from the stems of KADSURA LONGIPEDUNCULATA, collected in Kuangxi province. Four of them were new compounds and assigned as (24 Z)-3-oxo-12alpha-acetoxylanosta-8,24-dien-26-oic acid ( 1), (24 Z)-3-oxo-12alpha-hydroxylanosta-8,24-dien-26-oic acid ( 2), (24 Z)-3-oxo-14(13-->12) ABEO-lanosta-8,13(18),24-trien-26-oic acid ( 3), and (24 Z)-3-oxo-13beta-hydroxy-14(13-->12) ABEO-lanosta-8,24-dien-26-oic acid ( 4). Compounds 3 and 4 were named neokadsuranic acids B and C, respectively.

Isolation and Structure Elucidation of Neokadsuranic Acid A, the First Triterpenoid with the 14 (13-->12) abeo Lanostane Skeleton, and (24Z)-3-Oxo-lanosta-8,24-dien-26-oic Acid1.

Neokadsuranic acid A, which is the first triterpenoid with the 14(13-->12) ABEO lanostane skeleton, was isolated from KADSURA HETEROCLITA together with (24 Z)-3-oxo-lanosta-8,24-dien-26-oic acid. The present paper deals with the isolation and structure elucidation of these two new compounds.

Isolation and Structure Elucidation of Seco-neokadsuranic Acid A and 3,4-Seco-(24Z)-lanosta-4(30),8,24-triene-3,26-dioic Acid1.

Seco-neokadsuranic acid A, the second natural triterpenoid with the unusual 14(13-->12) ABEO-lanostane skeleton was isolated from KADSURA HETEROCLITA together with 3,4-seco-(24 Z)-lanosta-4(30),8,24,triene-3,26-dioic acid. The present paper deals with the isolation and structure elucidation of these two new compounds and the preparation of two new 7-oxo-lanostane triterpenoid derivatives.

Neokadsuranin, a Tetrahydrofuranoid Dibenzocyclooctadiene Lignan from Stems of Kadsura coccinea.

A tetrahydrofuranoid dibenzocyclooctadiene lignan, which we name neokadsuranin, was isolated from the stems of Kadsura coccinea, collected in Kuangxi, China. The absolute configuration was elucidated by spectral analysis.

Triterpenoids from Roots and Stems of Kadsura coccinea.

24-Methylenecycloartenone ( 1), kadsuric acid ( 2) and a new triterpenoid acid named coccinic acid ( 3A) were isolated from the ether soluble fraction of the dried roots and stems of KADSURA COCCINEA.

Henricine, a New Tetrahydrofuran Lignan from Schisandra henryi.

A new tetrahydrofuran lignan, named henricine ( 1), was isolated from the stems of SCHISANDRA HENRYI. High resolution COSY spectrum was used in the structural elucidation.

Dibenzocyclooctadiene Lignans from Roots and Stems of Kadsura coccinea.

Ten dibenzocyclooctadiene lignans were obtained from the ethereal soluble fraction of the dried roots and stems of KADSURA COCCINEA. Two of them were new compounds, named kadsutherin ( 8) and isokadsuranin ( 10). Their structures were elucidated on the basis of chemical and spectral analysis.