[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.

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.

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.

[Review of the management of enuresis in a Senegalese hospital]. / Réflexions sur la prise en charge de l'énurésie dans un centre hospitalier au Sénégal.

The profile of enuretic patients consulting a hospital urology department was reviewed over a period of 15 months based on 102 cases. The study concerned 47 male subjects and 55female subjects with a mean age of 15 +/- 5.3 years. The mean weekly frequency of enuresis was 5.2 +/- 1.9 and enuresis occurred more than once a night for 41.6% of patients. Enuresis was primary in almost 67% of cases. Various aetiological factors for enuresis were identified from analysis of the clinical data and were generally associated: sleep factor (n=93), bladder factor (n=84), hormonalfactor (n=52). Patients were managed as a function of the factors identified. With a mean follow-up of 6 +/- 2.1 months, cure was obtained in 30.4% of cases and improvement was obtained in 24.5%. The various management problems are discussed as a function of socio-economic realities in Senegal and the authors emphasize the need for a multifactorial approach.