Paediatric urologic pathologies at the national teaching hospital in Cotonou: A etiological and therapeutic aspects.

BACKGROUND: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. PATIENTS AND METHODS: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. RESULTS: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, post-circumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%.

Paediatric urologic pathologies at the national teaching hospital in Cotonou: an etiological and therapeutic aspects

BACKGROUND: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. PATIENTS AND METHODS: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. RESULTS: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, post-circumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%

Prevention of venous thromboembolism among inpatients at Cotonou teaching hospital, Benin.

AIM: The aim of this retrospective study was to evaluate the use and appropriateness of preventive measures for venous thrombosis among adult inpatients in a Benin teaching hospital. PATIENTS AND METHODS: All patients were systematically enrolled. The risk of venous thrombosis was estimated according to international guidelines. Thromboembolic events were diagnosed using the Wells score and, when possible, by paraclinical investigations. The following variables were studied: the risk of venous thrombosis, the use and appropriateness of preventive measures, and the frequency of thromboembolic events. The data were analyzed with Epiinfo 6.04.fr and SPSS software, and significance was assumed at p=0.05. RESULTS: The study population consisted of 487 patients recruited in four surgical wards, four general wards and one obstetric-gynecology ward. Mean age was 38.7+/-11.3 years and the sex ratio 0.51. The risk of thrombosis was considered low in 15% of patients, moderate in 60.8%, high in 21.1% and very high in 3.1%. Prophylactic measures were prescribed to 33.9% of the patients overall, 53.6% in the obstetric gynecology ward, 28.5% in the surgical wards and 12.9% in the general wards. The frequency of preventive measures rose with the level of risk (p<0.0001). Preventive measures consisted of passive mobilization, aspirin, enoxaparin and acenocoumarol. The prescriptions were appropriate in only 6% of cases. Among 198 patients who were monitored for two months after hospital discharge, 8% had a venous thromboembolic event. Such events were more frequent in the absence of prophylaxis (12% vs 3.3%, p=0.02). CONCLUSION: The risk of venous thromboembolic is recognized but poorly managed in this Bénin teaching hospital.

[Vesicouterine fistula: report on 15 cases at Cotonou University Urology Clinic]. / La fistule vésico-utérine: à propos de 15 cas à la Clinique Universitaire d'Urologie de Cotonou.

OBJECTIVE: To analyse the clinical and radiological features of cases of vesicouterine fistula (VUF) seen in the department and the results of treatment in order to improve the therapeutic management of patients with VUF. MATERIAL AND METHODS: The medical records of 17 woman admitted to the department and treated for vesicouterine fistula between 01/01/1994 and 15/06/2001 were reviewed. Two were excluded from this essentially retrospective study, as they were considered to be uninterpretable due to missing data. Predefined forms comprising the parameters indicated in the text constituted the basis of this study. RESULTS: The authors indicate that VUF is a rare disease: 17 cases in 7 and a half years. Detailed review of 15 cases showed that the constant presenting complaint is permanent urine leak from the cervix. It was isolated in 12 cases and associated with "vesical menstrual periods" in 3 cases. Women between the ages of 30 and 39 years were the most frequently affected. Pauciparous women were more frequently affected (7 out of 15 cases). Caesarean section was incriminated in 14 out of 15 cases. 11 out of 15 subjects consulted after at least one year of symptoms. The margins of the fistula were fibrotic in 11 cases, which did not prevent satisfactory results, with 14 cures out of 15 cases after the first surgical operation. CONCLUSION: VUF is an uncommon and very frequently iatrogenic disease, in which the presenting complaint is permanent urine leak from the genital tract, either isolated or associated with cyclic haematuria. Even when patients are seen late, with fibrotic margins, surgical treatment of VUF achieves a good cure rate. The best treatment is prevention, based on a perfect caesarean section technique.

[Cystocele]. / Cystocèle.

A cystocele is a bladder hernia through the anterior wall of the vagina. It is common in elderly women. There is no clinico-anatomical correlation, but the functional disturbance, although both variable and variably experienced, remains a major factor in the indication of eventual surgery. Methodologic clinical examination should be made to seek anomalies of pelvic stasis associated with a more or less hidden urinary incontinence. The surgical technique should be chosen according to the age and the classification of the patient, determined by complementary examinations that range from simple to highly technical (echography, cystography and sometimes study of urinary dynamics and MRI). The surgeon should chose the technique of perineal support and clearly explain the possibility of failure or recurrence. Confidence between the patient and the surgeon remains the best guarantee of a good result of management. Such surgery can be proposed to women to request it for physical comfort, whereas the surgeon should be very cautious with regard to those who do not want to undergo surgery (but also with those who strongly insist on surgery).