[Epidemiologic, anatomoclinic and therapeutic profil of urogenital and rectovaginal fistula in TOGO]. / Profil épidémiologique, anatomoclinique et thérapeutique des fistules urogénitales et rectovaginales au Togo.

OBJECTIVE: To describe epidemiologic, anatomic and clinical characteristics of urogenital and rectovaginal fistula and the issue of their surgical management in Togo. MATERIAL AND METHODS: A retrospective study permit us to collect the operated cases during five years in the national center of obstetrical fistula. The parameters evaluated were sociodemographic aspects of patients, clinical characteristics and the issue of surgical repair. RESULTS: The number of patients who enderwent surgery was 197, during 217 surgical interventions. The middle age of patients was 40,7 years with extrems of 18 and 70 years. The main causes of fistula were obstetrical (95%) and 3,5% were caused by surgery. Concerning anatomoclinic characteristic, vesicovaginal fistula was the most comon type representing 87,3%, where vesicouterine fistula represented 4,1%. Multiparity has been a risk factor for obstetrical fistula and ceasarien section was necessary in 70% with a high rate of fœtal mortality (88,2%). Surgical management was late in majority of cases, estimated at 10 years between occurrence of fistula and its reparation. The recovry rate was 78,1%. CONCLUSION: Urogenital fistula are principaly caused by obstetric conditions in Togo and multiparity is a risk factor. Treatment is often late but has a good rate of recovery. Their prevention goes through the fight against dystocia. LEVEL OF EVIDENCE: IV.

[Ambulatory treatment of penile fracture at teaching hospital in Lomé]. / Traitement ambulatoire des fractures de la verge au centre hospitalier universitaire de Lomé.

OBJECTIVES: To study the feasibility of outpatient management of fractures of the penis and to identify factors that promote their occurrence. MATERIALS AND METHOD: This were a prospective, monocentric study of patients who received emergency treatment for fractured penises. It took place from January 2016 to January 2019. The data analyzed were circumstances of occurrence, time elapsed before management, clinic, type of anesthesia, functional outcomes (assessment based on IIEF5 questionnaire) and complications. RESULTS: Seven cases were recorded. The average age of the patients was 35 years. The diagnosis was clinical and surgical treatment in all our patients. Management was outpatient in 6 patients. Sexual function was normal in six patients with an IIEF-5≥21 with a normal erection and no pain at intromission. No complications were objectified. CONCLUSION: Emergency surgical management of patients with clinical and confirmed per-operative penis fractures may be outpatient without negative impact on functional outcomes and regardless of the cause of fracture. LEVEL OF EVIDENCE: 3.

Torsion du cordon spermatique chez l'adulte. Aspects diagnostiques, thérapeutiques et pronostiques au Centre Hospitalier et Universitaire Sylvanus Olympio de Lomé

Objectifs : Etudier les aspects diagnostiques, thérapeutiques et pronostiques des torsions du cordon spermatique. Patients et méthodes : Il s'agissait d'une étude prospective, et était inclus dans l'étude tous les patients de plus de 15 ans admis en urgence pour une douleur scrotale aiguë et chez qui le diagnostic d'une torsion du cordon spermatique était suspecté durant la période d'étude.Résultats : Sur une période de 12 mois allant du 1er janvier 2015 au 31 décembre 2015, 22 patients étaient colligés. L'âge moyen des patients était de 22 ans avec des extrêmes allant de 17 à 35 ans. Le diagnostic était clinique dans tous les cas et dans 100% des cas les constatations per opératoires étaient en faveur d'une torsion du cordon spermatique. Le tour maximum de spire était de 4 tours. L'orchidectomie avait été réalisée chez 4 patients. Dans tous les autres cas une orchidopexie bilatérale était réalisée.Conclusion : La vitalité du testicule dans les torsions du cordon spermatique est surtout fonction de la durée de la torsion et du degré de la torsion

[Ureterovaginal fistula after caesarean: Diagnosis and management in a resource-constrained hospital in Togo]. / La fistule urétérovaginale après césariennes : diagnostic et traitement dans un hôpital à ressources limitées au Togo.

The purpose of this study is to describe a simple, non-expensive, accessible and effective technique of ureterovaginal fistula diagnosis, and to assess the results of surgical management in a resource-constrained hospital. During a campaign of obstetric fistulas repair, we diagnosed ureterovaginal fistulas by vaginal exam with the blue methylene test associated to abdominal ultrasonography, two simple and non-expensive explorations which permitted to identify ureterovaginal fistula and to do differential diagnosis with vesicovaginal fistula. The management was surgery, by ureterovesical reimplantation. Four ureterovaginal fistulas have been diagnosed in 32 women presented with obstetrical fistula. The mean age of those fistulas was 4.85 years; it was located on the left ureter in three cases, on the right in one case. The ureteral lesion was consecutive to a caesarean section in all patients and sited on the pelvic segment of ureter. In three patients, diagnosis was performed by the negativity of the blue test and unilateral dilation of ureter and kidney while the discovery was done during the treatment of vesicovaginal and rectovaginal fistulas associated in the last patient. After effects of surgery were simple, characterized by disappearance of urine leakage and dilation of ureter kidney. In resources-constrained context, techniques such as blue test and ultrasonography are enough to perform diagnosis of ureterovaginal fistula. Ureterovesical reimplantation is an effective therapeutic method for diagnosing ureterovaginal fistula.