[Radiochemotherapy for the treatment ofmuscle invasive bladder tumors in a west african radiotherapy service]. / Radiochimiotherapie pour le traitement des tumeurs de vessie infiltrant lemuscle dans un service de radiotherapie ouest africaine.

OBJECTIF: The aim of this study was to describe the results of radiochemotherapy in patients after transurethral resection of muscle invasive bladder tumors. MATERIAL AND METHODS: A retrospective study from May 2014 to May 2016 in the radiotherapy department of the Mali Hospital. Have been included, all patients with bladder cancer infiltrating the muscle. Secondary cancers of the bladder and metastatic forms have been excluded from our study. Transurethral resection of bladder was performed. Neoadjuvant chemotherapy with paclitaxel- carboplatin was administered every three weeks in all patients, then external phototherapy 6 MV at a dose of 66 Gy due to 2 Gy of 5 sessions per week 6MV photon of external beam radiotherapy at a dose of 66 Gy due to 2 Gy of 5 sessions per week associated with concomitant cisplatin at dose of 40mg / m2 / week. RESULTS: Eight patients were included in ourstudy. The average age of 53.75 ± 14.84 years. The male sex was predominant 87.5% (n = 7). The history of chronic smoking wasfound in four patients. The main carcinogenic risk factor identified in our patients was urogenital bilharzia (6 cases / 8).The histological type found was urothelial carcinomain 12.5% (n = 1) and invasive squamous cell carcinomain 87.5% (n = 7). Transurethral resection of the tumor was performed in 62.5% (n = 5). Endoscopic biopsy was performed in 37.5% (n = 3). The tumor was classified pT2N0M0 in 50% (n = 4), pT3aN0M0 in 37.5% (n = 3) and pT3bN0M0 in 12.5% (n = 1). Neoadjuvant chemotherapy with paclitaxel - carboplatin every three weeks was administered to all patients. The results of radiochemotherapy (see Table: evolution). CONCLUSION: Concomitant radiochemotherapy is a conservative curative treatment that can be proposed as a replacement for cystectomy, for non-metastatic infiltrating tumors after the most complete endoscopic resection.

OBJECTIF: Le but de cette étude était de décrire les résultats d'une radiochimiothérapie chez les patients après résection transurétrale des tumeurs de vessie infiltrant le muscle. MATÉRIEL ET MÉTHODES: Une étude rétrospective allant de mai 2014 à mai 2016 au service de radiothérapie de l'hôpital du Mali. Ont été inclus, tous les patients présentant un cancer de vessie infiltrant le muscle. Les cancers secondaires de la vessie ainsi que les formes métastatiques ont été exclus de notre étude. La résection transurétrale de vessie a été réalisée. La chimiothérapie néoadjuvante à base de paclitaxel ­ carboplatine a été administrée toutes les trois semaines. La radiothérapie externe au photon 6MV à la dose de 66 Gy en raison de 2 Gy de 5 séances par semaine associée à la chimiothérapie concomitante à base de cisplatine (CDDP) 40mg/m2/semaine a été réalisée. RÉSULTATS: Au total huit patients ont été inclus dans notre étude. L'âge moyen de 53,75±14,84 ans. Le sexe masculin était prédominant 87.5% (n=7). L'antécédent de tabagisme chronique était retrouvé chez quatre patients. Le principal facteur de risque cancérigène identifié chez nos patients était la bilharziose urogénitale (6cas/8). Le type histologique retrouvé était le carcinome urothelial dans 12.5% (n=1) et le carcinome épidermoïde infiltrant dans 87.5% (n=7). La résection transurétrale de la tumeur a été réalisée dans 62.5% (n=5). La biopsie par voie endoscopique été réalisée dans 37.5% (n=3). La tumeur été classée pT2N0M0 dans 50% (n= 4), pT3aN0M0 dans 37.5% (n=3) et pT3bN0M0 dans 12.5% (n= 1). La chimiothérapie néoadjuvante à base de paclitaxel ­ carboplatine chaque trois semaines a été administrée chez tous les malades.Les résultats de la radiochimiothérapie (cf. Tableau: évolution). CONCLUSION: La radiochimiothérapie concomitante est un traitement curatif conservateur qui peut être proposée en remplacement à la cystectomie pour les tumeurs infiltrantes non métastatiques après une résection endoscopique la plus complète possible.

[Urological Complications of Pelvic Surgery at Point-G Hospital, About 23 Cases]. / Les Complications Urologiques Liees a la Chirurgie Pelvienne au CHU du Point-G, a Proposde 23 cas.

INTRODUCTION: Bladder and ureteral lesions are the most common urologic complications occurring during pelvic surgery with 1% and 0.5% to 3%, respectively. These lesions are rarely recognized intraoperatively and pose a major problem to urologists, gynecologists, and general surgeons. OBJECTIVE: To study the factors favoring urologic complications following pelvic surgery at the University Hospital Point-G. PATIENTS AND METHOD: We conducted a retrospective study at the University Hospital Point-G between 2006 and 2015. It involved 23 patients with a whole urological lesion following pelvic surgery. These patients underwent a clinical and para-clinical examination (intravenous urography, methylene blue test) to confirm the urological lesion and to determine its management. RESULTS: The average age of our patients was 32.00 years with extremes of 18 and 40 years old. The leakage of urine was found in 82.6% (19/23). Interventions that caused urologic injury were: caesarean section 52.2% (12/23), hysterectomy 30.4% (7/23), as well as a caesarean section and hysterectomy 17.4% (4/23). Methylene blue was performed in 19 patients, it was positive in 52.2% (12/23) and intravenous urography (IVU) in 7 patients. The lesions encountered were: retrotrigonal fistula vesico-vaginal 10 cases, vesico-vaginal fistula under trigonal 2 cases, uretero-vaginal fistula 7 cases, and bilateral ureteral ligation 4 cases. Fistulorraphy was performed in 52.2% followed by direct ureterovesical reimplantation. The postoperative outcome was satisfactory in 100% of cases with obtaining a good bladder tightness. The average duration of hospitalization was 12 days (+/- 4 days). CONCLUSION: Pelvic surgery results in urological injuries. Caesarean section and hysterectomy are contributing factors. Vesico-vaginal fistula or ureteral lesions are common.

INTRODUCTION: Les lésions vésicale et urétérale constituent les complications urologiques les plus fréquentes survenant au décours d'une chirurgie pelvienne soit respectivement 1 à 4% et 0,5 à 3% [6,7]. Ces lésions sont rarement reconnues en peropératoire et posent un problème important auquel sont confrontés les urologues, les gynécologues, les chirurgiens généralistes. OBJECTIF: Etudier les facteurs favorisants les complications urologiques consécutives à la chirurgie pelvienne au CHU du Point-G. PATIENTES ET MÉTHODE: Il s'agissait d'une étude rétrospective réalisée au CHU du Point-G entre 2006 et 2015. Elle a concerné 23 patientes présentant toute une lésion urologique au décours d'une chirurgie pelvienne. Ces patientes ont subi un examen clinique et para cliniques (Urographie intra veineuse; le test au bleu de méthylène) dans le but de confirmer la lésion urologique et d'en déterminer la prise en charge. RÉSULTATS: l'âge moyen de nos patientes était de 32,00 ans avec des extrêmes allant de 18 à 40 ans. La fuite d'urine était retrouvée chez 82,6% (19/23). Les interventions pourvoyeuses de lésions urologique étaient : la césarienne 52, 2% (12/23), l'hystérectomie 30, 4% (7/23), une association césarienne et hystérectomie 17,4 % (4/23). Le test au bleu de méthylène a été réalisé chez 19 patientes, il a été positif dans 12 cas soit 52,2 % et l'UIV chez 7 patientes. Les lésions rencontrées étaient : la fistule vésico-vaginale retro trigonale 10 cas, la fistule vésico-vaginale sous trigonale 2 cas, la fistule urétéro-vaginale 7 cas, et la ligature urétérale bilatérale 4 cas. La fistulorraphie a été effectuée dans 52,2 % suivie de la réimplantation urétéro-vésicale directe. Les suites opératoires étaient satisfaisantes dans 100% des cas avec l'obtention d'une bonne étanchéité vésicale. La durée moyenne d'hospitalisation était de 12 jours (+/− 4 jours). CONCLUSION: La chirurgie pelvienne est pourvoyeuse de lésions urologiques. La césarienne et l'hystérectomie sont des facteurs favorisants. Les fistules vésico-vaginales ou des lésions urétérales sont fréquentes.

[Patients' satisfaction survey after tranvesical prostatectomy in the urology department of Gabriel Touré University Hospital]. / Evaluation de la Satisfaction des Patients Apres Adenomectomie Transvesicale de la Prosate dans le Service D'Urologie du Chugabriel Toure.

AIM: This study was aimed to evaluate patients' satisfaction with tranvesical prostatectomy in the Urology department of University Hospital Gabriel Touré according to the (International Prostate Symptoms Score (IPSS) and the quality of life scores. PATIENTS AND METHODS: We conducted a prospective descriptive study over a 12-month period including a consecutive cohort of patients who had transvesical prostatectomy. Each patient was evaluated before and six weeks after the surgery. We used the IPSS as an assessment tool, supplemented by the Quality of Life (SQ) questionnaire. RESULTS: One hundred and thirteen (113) patients aged 71 ± 8 years old on average were evaluated. The mean duration of symptoms associated with benign prostatic hyperplasia was 19 months and 17% of patients had a mechanical complication. All patients had either moderate or severe lower urinary tract symptoms preoperatively, while 99% of them had an IPSS score <8 postoperatively. CONCLUSION: Transvesical prostatectomy allows an important improvement of the IPSS score of the patients and their satisfaction about their quality of life.

BUT: Evaluer la satisfaction des patients après adénomectomie transvésicale de la prostate dans le service d'urologie du CHU Gabriel Touré selon l'International Prostate Symptoms Score (IPSS) et le score de qualité de vie. PATIENTS ET MÉTHODES: il s'agissait d'une étude prospective et descriptive d'une cohorte consécutive de patients opérés pour adénomectomie transvésicale de la prostate réalisée sur une période de 12 mois. Les patients étaient tous évalués avant l'intervention chirurgicale et 6 semaines après. Nous avons utilisé l'IPSS comme outil d'évaluation, complété par la question sur la qualité de vie. RÉSULTATS: Cent treize patients d'âge moyen de 71 ± 8ans ont été évalués. La durée moyenne d'évolution des symptômes liés à l'hypertrophie bénigne de la prostate était de 19 mois et 17 % des patients présentaient une complication mécanique. Tous les patients présentaient des symptômes modérés ou sévères du bas appareil urinaire en préopératoire tandis qu'en postopératoire 99% des patients avaient un score IPSS inférieur à 8. CONCLUSION: l'adénomectomie transvésicale de la prostate permet une amélioration du score IPSS et celui de la qualité de vie des patients avec une importante satisfaction des patients.

Les complications urologiques liées à la chirurgie pelvienne au CHU du Point-G, à propos de 23 cas

Introduction : Les lésions vésicale et urétérale constituent les complications urologiques les plus fréquentes survenant au décours d'une chirurgie pelvienne soit respectivement 1 à 4% et 0,5 à 3% [6,7]. Ces lésions sont rarement reconnues en peropératoire et posent un problème important auquel sont confrontés les urologues, les gynécologues, les chirurgiens généralistes. Objectif : Etudier les facteurs favorisants les complications urologiques consécutives à la chirurgie pelvienne au CHU du Point-G. Patientes et Méthode : Il s'agissait d'une étude rétrospective réalisée au CHU du Point-G entre 2006 et 2015. Elle a concerné 23 patientes présentant toute une lésion urologique au décours d'une chirurgie pelvienne. Ces patientes ont subi un examen clinique et para cliniques (Urographie intra veineuse ; le test au bleu de méthylène) dans le but de confirmer la lésion urologique et d'en déterminer la prise en charge. Résultats : l'âge moyen de nos patientes était de 32,00 ans avec des extrêmes allant de 18 à 40 ans. La fuite d'urine était retrouvée chez 82,6% (19/23). Les interventions pourvoyeuses de lésions urologique étaient : la césarienne 52, 2% (12/23), l'hystérectomie 30, 4% (7/23), une association césarienne et hystérectomie 17,4 % (4/23). Le test au bleu de méthylène a été réalisé chez 19 patientes, il a été positif dans 12 cas soit 52,2 % et l'UIV chez 7 patientes. Les lésions rencontrées étaient : la fistule vésico-vaginale retro trigonale 10 cas, la fistule vésico-vaginale sous trigonale 2 cas, la fistule urétéro-vaginale 7 cas, et la ligature urétérale bilatérale 4 cas. La fistulorraphie a été effectuée dans 52,2 % suivie de la réimplantation urétéro-vésicale directe. Les suites opératoires étaient satisfaisantes dans 100% des cas avec l'obtention d'une bonne étanchéité vésicale. La durée moyenne d'hospitalisation était de 12 jours (+/- 4 jours). Conclusion : La chirurgie pelvienne est pourvoyeuse de lésions urologiques. La césarienne et l'hystérectomie sont des facteurs favorisants. Les fistules vésico-vaginales ou des lésions urétérales sont fréquentes

[Choice of initial regimen for antiretroviral-naïve HIV patients: Analysis of motivation]. / Analyse des motivations du choix des antirétroviraux (ARV) prescrits chez des patients infectés par le VIH (PVVIH) naïfs.

OBJECTIVE: Several therapeutic combination antiretroviral therapy regimen are available for initial treatment in naïve HIV infected patients. The choice of a particular regimen remains often subjective. The aim of this study was to determine factors associated with the choice of molecules in initial ARV prescriptions. METHODS: From 01/01 to 30/10/2014, every initial cART prescription was analyzed regarding patients and physicians characteristics. Then, prescriptions were evaluated by an independent committee of ART prescribers. RESULTS: One hundred and thirty two consecutive initial prescriptions by 34 physicians of 11 medical centers were included: 71 M, migrants: 57 %, MSM: 21 %, CD4<200/mm3: 26 %, HIV RNA>100 000 cp/mL (33 %). cART regimen were: NRTI/PI (43 %), NRTI/NNRTI (29.5 %), NRTI/integrase inhibitor (23 %). 75 % of initial cART regimen were consistent with expert guidelines recommendations. The choice of initial cART was not influenced by the type of HIV contamination risk group, patient's geographic origin, CD4 levels. In contrast, working or not (P=0.007), pregnancy wish (P=0.07), pregnancy (P=0.001), HIV RNA levels (P=0.02) and HIV primary infection (P=0.049) influenced the initial choice. Neither physician's age, nor physician's experience influenced this choice. The prescription's non accordance to 2013 French guidelines was mainly related to integrase inhibitor utilisation (P= 0.0001). CONCLUSION: Overall, cART initial choice is mostly consistent with guidelines. Primary HIV infection, procreation features and high viral load are the main factors influencing this choice. New regimen with better tolerability is prescribed even if it is not yet included in the guidelines.

[Clinical, paraclinical and epidemiological profile of erectile dysfunction in consultation at the urology department of the Point G University Hospital]. / Profil epidemiologique clinique et paraclinique de la dysfonction erectile en consultation dans le service d'urologie du CHU du Point G.

OBJECTIVE: To study the epidemiological, clinical and paraclinical profile of erectile dysfunction in outpatient urology. MATERIAL AND METHODS: It was a prospective longitudinal study from January to August 2012 (8 months) in the urology department of the Point G University Hospital. 72 patients were involved, and were consulting for erectile dysfunction. These patients underwent clinical and laboratory examinations. Erectile dysfunction was evaluated by the Massachusetts Male Aging Study self-assessment (Single question of Self report of Erectile Dysfunction Massachusetts Male Aging Scale). RESULTS: Frequency of erectile dysfunction was estimated at 9.6%, average age was 45 years, 71% of patients were polygamous, and 18% were monogamous. Most patients (82%) resided in Bamako; traders were most represented (34%). The deficit was moderate in 48.61% of patients. The average time of consultation was 2.5 years. Co-morbidity factors were found in 54.16% of patients, the most frequent risk factors were physical inactivity (34.72%). Blood glucose was elevated in 27.78% patients, cholesterol and triglycerides were elevated in 13.15% of patients, testosterone was low in three patients, prolactin was high in six patients. A Doppler ultrasound of the penis revealed a low perfusion of corpus cavernosum in six cases, and three cases of Peyronie's disease. CONCLUSION: At the end of the study the epidemiological, clinical and paraclinical profile is identical to that found in other countries. But a more serious study with specific evaluation scores will help to identify this profile.

OBJECTIF: Etudier le profil épidémiologique, clinique et paraclinique des patients présentant une dysfonction érectile reçus en consultation externe dans le service d'urologie. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude longitudinale prospective réalisée de Janvier 2012 à Aout 2012 (8 mois) dans le service d'urologie du Centre Hospitalier Universitaire du Point G. Elle a porté sur tous les patients qui ont consulté pour dysfonction érectile. Ces patients ont bénéficié d'examens cliniques et paracliniques. La dysfonction érectile a été évaluée par l'échelle de l'unique question d'auto-évaluation de la dysfonction érectile du Massachusetts Male Aging Study. (Single question of Self report of erectile dysfonction Massachusetts Aging Study). RÉSULTATS: La fréquence de la dysfonction érectile a été estimée à 9,6 %, l'âge moyen était de 45 ans; 71% des patients étaient polygames, 18% étaient monogames.La plupart des patients (82%) résidait à Bamako, les commerçants étaient les plus représentés (34%). Le déficit était modéré chez 48,61% des patients. Le délai moyen de consultation était de 2,5 ans. Des facteurs de Co-morbidités ont été retrouvés chez 54,16% des patients, le facteur de risque le plus fréquent a été la sédentarité (34,72%). La glycémie était élevée chez 27,78% patients, les cholestérols et les triglycérides étaient élevés chez 13,15% des patients, la testostérone était basse chez trois patients, la prolactine était élevée chez six patients. L'écho-doppler de la verge a révélé une faible perfusion des corps caverneux dans six cas, trois cas de Maladie de Lapeyronie. CONCLUSION: Au terme de notre étude le profil épidémio-clinique et paraclinique retrouvé reste identique à celui d'autres pays. D'autres études plus détaillées avec des scores d'évaluation précis permettront de mieux cerner ce profil.

Etude des facteurs influencant les resultats cliniques de la chirurgie de la fistule uro-genitale obstetricale au CHU de l'hopital du Point G Bamako Mali

Le but de cette etude etait d'identifier les facteurs influencant les resultats cliniques de la chirurgie de la fistule uro- genitale obstetricale. Il s'agissait d'une etude transversale; qui a porte sur les facteurs influencant les resultats dans la prise en charge de fistule uro-genitale; allant du janvier 2011 au janvier 2012 au service d'urologie du CHU du Point-G. Cette etude a concerne 115 patientes souffrantes de fistule uro-genitale. La cure de la fistule uro-genitale a represente 17 % des activites du bloc. La fermeture de la fistule a ete obtenue dans 68;7% des cas. Ce resultat a ete influence par certains facteurs; dont les facteurs lies a l'etat du tissu peri-fistuleux (bonne trophicite du tissu; ou fibrose peri-fistuleux). Les fistules operees avant tout remaniement tissulaire peri-fistuleux ont ete fermees dans 71;42 % des cas. Les facteurs lies a la patiente et aux soins : celles operees pour la premiere fois ont un taux de reussite de 68;42 %; seulement 47;62 % de succes chez les patientes qui se sont presentees apres cinq ans. Les facteurs lies au siege anatomo-clinique : les fistules de la cloison vesico-vaginale et cervico-uretro-vaginale ont occupe un taux de succes de 76;92 %. Les facteurs lies aux soins regroupent : l'experience du chirurgien; les chirurgiens du service d'urologie contrairement aux autres chirurgiens ont 76;19 % de reussite contre 25%. La voie d'abord de la fistule etait en rapport avec le siege anatomo-clinique; ainsi les fistules trigonales et uretero-vaginales abordees par la voie haute ont ete reussies dans 85 %. En plus de ces facteurs le suivi post-operatoire; les instruments; les fils de suture; la table operatoire; l'eclairage de la salle ont amelioree aussi les resultats

Sexuality and fertility of women operated for obstetric urogenital fistulae.

OBJECTIFS: To study, sexuality of women victims of OUGF after surgical management in the urology department of the University Hospital Center (CHU) Point G Bamako/Mali. MéTHODES: Our study is conducted in the urology department of CHU Point G Bamako/Mali devoted for treatment of the patients affected by OUGF. It's a prospective study done over 13 months period from June 2008 to June 2009. We studied all patients who are operated at least twice for recurrence and the sociodemographic data, the variables in relation with the obstetrics, gynecologics, sexuality, procreation, and the treatment results. RéSULTATS: - Situation before treatment: More than half of the patients (52%) had not any regular sexual activity before surgical treatment. Seventeen percent of the fistular women have pregnancy against 69% who didn't have pregnancy neither before nor during the trials of surgical treatment of the fistula;- situation after treatment: in more than half of cases (62%) the patients had sexual relations with husband. 13% of patients had pregnancy during the surgical treatment of fistula. Nearly 60% of patients do not like to have more children. The declared reason in 65% of this women was that they have already enough children and other for afraid pregnancy, afraid fistula, etc. CONCLUSION: Urogenital fistulae are not a danger for life, but are a real handicap for women who suffer them. The Sexual, cultural and economic factors whom contribute together to the occurrence of this disease in women.

[Social integration of women operated for obstetric urogenital fistula]. / Intégration sociale des femmes opérées de fistule urogénitale obstétricale.

OBJECTIVE: To study the social integration of women supported in the urology department of the University Hospital of Point G for obstetric urogenital fistula. PATIENTS AND METHOD: Prospective study conducted over a period of 13 months from June 2008 to June 2009 in the Department of Urology at the University Hospital of Point G. The study included all patients who have been operated on at least twice for obstetric fistula genitourinary. Records of surgical, medical records and tracking sheets for each patient were the media database. RESULTS: Situation before treatment: before surgical treatment, 76.92% of patients were rejected by their spouses. The family attended the patient in 84.62% of cases. Situation after treatment: after treatment, 90.31% of women with fistula lived in the matrimonial home or family. The resumption of business activity was announced by 11.2% of patients. Among the women, 93.7% participated in housework. The number of patient intervention ranged from two to five. Healing (fistula closed and no sphincter dysfunction) was complete in 50% of cases. Among the women, 11.54% had sphincter dysfunction after closure of the fistula, which makes a total of fistula closed more than 61% after at least two attempts. CONCLUSION: The urogenital fistulas are not a fatal disease but is a real handicap for women who suffer to conduct a socio-cultural and economic mainstream. Generally excluded from the ongoing operations of the company, these women are more integrated after successful surgical treatment of the fistula.

[Issues inherent to the management of disorders of sex development in Point G Hospital]. / Problématique de la prise en charge des anomalies de la différenciation sexuelle dans le service d'urologie : CHU Point G.

Abnormal sexual development causes unconformity between gender identity and gender role. In countries with low socio-economic level, the optimal management is difficult. The aim of this study was to evaluate the frequency, the genital anatomy appearance, the diagnostic and the surgical management of disorders of sex development (DSD) discovered during the adolescence. Between January 2005 and November 2006 (23 months), five patients with abnormal sexual development were identified in Point G Hospital. First-line testing included biology measurement and imaging. A surgical management was systematically offered. Median age was 19.5±11.8 years (6-31). All patients were initially assigned male. Sexual dimorphic with genital ambiguity was the first reason of consultation (three children to five). One patient had male breast development and one had pelvic pain. All clinical evaluation suggested genital ambiguity. The diagnostic was female pseudohermaphrodism in three cases, true hermaphrodism in one case and hypogonadism for one patient. A masculinizing genital surgery was performed in three cases. The other patients refused the treatment or were out of sight. Intersex disorders are relatively rare in Mali with a prevalence of 2.30‰ in our hospital. This study highlighted the lack of financial means and local resources for optimal clinical management of individuals with DSD.

[Cystic lymphangioma of the scrotum]. / Le lymphangiome kystique du scrotum a propos d'un cas.

The cystic lymphangioma is a relatively frequent affection. The scrotum is the least common sites. It is a benign tumor discovered during an examination or in a fortuitous way. The diagnosis is done with ultrasonography and the treatment of the limited and circumscribed cases, is a surgical excision. We reported the case of a child of 2 years old which was presented to the surgery emergency for the scrotum traumatism. The clinical and paraclinical exams founded a cystic mass. After mass excision, histopathology founded a cystic lymphangioma.

[Open surgery of the urinary tract calculi at the university hospital of Brazzaville: analysis of 68 cases]. / Chirurgie a Ciel Ouvert de la Lithiase Urinaire au CHU de Brazzaville : Analyse de 68 Cas.

AIMS: To report epidemiological, clinical, and outcome of surgical therapeutic aspect of urinary calculi in our department. PATIENTS AND METHODS: This survey, retrospective, has been achieved from june 2000 to may 2004. It concerned 68 patients carriers of the urinary calculi, confirmed radiologically and operated. RESULTS: The patients carriers of the urinary calculi represented 7,3%. There was 52 men (76,47%) an 16 women (23,53%).The average age of the patient was 52,13 years (extreme : 14 et 82 years). Symptoms at the diagnostic was : atypical abdominal pen (n=18), dysuria (n=15), hematuria (n=15), la pollakiuria (n=9), nephretic colic (n=15), urinary retention (n=26). The location of urinary calculi was vesical (n=47), renal (n=8), pyelic (n=12), ureteral (n=1). All our patients was operated. The operative continuations one summer simple in 58 cases, and complicate of pariatal suppuration in 7 cases. Mortality was of 3 cases. CONCLUSION: The urinary lithiasis is little frequent. The open surgery is the only surgical technique that is practiced in our context.

[Bladder rhabdomyosarcoma apropos of a case in the Urology Service, University Hospital Center du Point G]. / Le Rhabdomyosarcome Vesical a Propos D'un Cas dans le Service D'Urologie Chu Hopital du Point "G"

The bladder rhabdomyosarcoma in children is a rare tumor. We report a case of bladder rhabdomyosarcoma in a child 3 years, who consulted for more dysuria hematuria. The aim of this work is to remind the symptomatology and clinical aspects of para-clinical examinations of this disease in children after a review of the literature of this disease and discuss treatment options. The rhabdomyosarcoma should be discussed before any symptoms of dysuria associated with hematuria in children. His diagnosis is suspected by medical imaging and confirmed by pathology. Our attitude has been resection of the tumor, then chemotherapy.

[Vulval bilharziasis]. / Localisation vulvaire de la bilharziose.

Vulvar localisation of schistosomiasis is a rare presentation. We report a case of a woman of 20 years old hospitalised for a vulvar mass of six months. That mass progressively increased in volume and was tender. It was accompanied by frequency and dysuria. The patient had a history of swimming in fresh water and hematuria when she was eight years old. Initial clinical examination found a good general state, there was a mass involving the clitoris and the small lips. This painless mass had a cauliflower appearance and was soft with a large implantation. Pathology exam of the mass revealed a vulvar schistosomiasis with an important amount of living eggs. A tumour removal with a plasty of small lips was performed. Additionally, praziquantel was administered orally. Vulvar localisation of schistosomiasis might suggest a malignant tumour. Only pathological examination can assess the diagnosis.

[Complications of transrectal prostate biopsy]. / Complications de la biopsie prostatique transrectale.

OBJECTIVES: The aim of this study was to report the transrectal prostate biopsy complications, to identify the factors involved in their occurring and to insist on their prevention. PATIENTS AND METHODOLOGY: It is a prospective study interested on patients managed in the urological and andrological service in Aristide le Dantec Hospital in Dakar for prostate tumour from February 2002 to March 2004 and in whom the indication of prostate biopsy was performed. All the patients fulfilling the including criteria were taken in care according to a same protocol that was a transrectal sextant biopsy This act was performed under preventive antibiotherapy based on fluoroquinolones started one day before and going on three days after biopsy associated to a rectal preparation performed the same day of biopsy At the end of the biopsy the patient was managed externally during three days after biopsy Following parameters were studied: age of patients, the histopathological results and the post operative complications. RESULTS: Two hundred and four (204) biopsies were performed. The median age of the patients was 69.1 years with the extremes of 42 years and 93 years. The global rate of complications was 13.5% with a majority of bleeding. There no major complication registered. Rectal and urethral bleeding was over in 24 hours. The complete urine retention was under the form of a unique happening complication. The distribution of complications according to the results of the biopsy did not reveal any particularity. CONCLUSION: The rectal preparation associated to preventive antibiotherapy seems to reduce infectious complications.

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

Long-term efficacy on Kaposi's sarcoma of highly active antiretroviral therapy in a cohort of HIV-positive patients. CISIH 92. Centre d'information et de soins de l'immunodéficience humaine.

OBJECTIVE: To assess the efficacy of highly active antiretroviral treatment (HAART) on AIDS-Kaposi's sarcoma (KS). DESIGN: Prospective cohort of patients followed for 24 months. SETTING: Four referral hospitals of the West Paris metropolitan area. PATIENTS/INTERVENTION: Thirty-nine AIDS-KS patients, 42 +/- 9 years old, who began HAART (HIV-protease inhibitor and two nucleoside analogues) between March and December 1996, were enrolled. One was lost to follow-up at month 12. MAIN OUTCOME MEASURES: KS response, using criteria of the AIDS clinical trials group (ACTG), CD4 cell counts, and plasma HIV-RNA, assessed every 6 months. ACTG TIS staging of KS. RESULTS: Eighteen patients had T1 KS and 21 T0 KS. One patient died from KS at month 6. KS improved progressively, with complete and partial response rates of 46% and 28% at month 24, respectively. Only six patients were still receiving systemic KS therapy at month 24. Complete response was observed in 10 of the 19 patients without systemic KS therapy at inclusion. Patients with complete response at month 24 had higher CD4 cell counts than others (465 +/- 343 versus 185 +/- 167 x 10(6)/l; P < 0.01), but the proportion of patients with HIV-1 RNA < 500 copies/ml was not significantly different. An increase in CD4 cell counts from inclusion to month 12 of > 150 x 10(6)/l [odds ratio (OR), 13.4; 95% confidence interval (CI), 2-82] and T0 KS at inclusion: [OR, 7; 95% CI, 1.1-42] were predictive of complete response at month 24. CONCLUSIONS: HAART appears to have prolonged efficacy on AIDS-KS, even without specific KS therapy, and this effect appears to be linked to the restoration of immune function.