Cancer mortality in the urological department of the Sylvanus Olympio Teaching Hospital in Lome, Togo.

To determine the proportion of cancer mortality seen in the urology department of a teaching hospital in sub-Saharan Africa and to identify the contributing factors. This 10-year retrospective study took place in the urology department of the Sylvanus Olympio Teaching Hospital of Lomé (Togo) and analyzed the records of patients who died of cancer from January 2006 through December 2015. During the study period, 94 deaths were recorded in the department, 84% of them due to a urological cancer. The mean age of patients was 62 years,- and there was a significant male predominance with a sex ratio of 4.3. Prostate cancer was the most common cause of death, accounting for 49 (62%) cases. The mean duration of symptoms was 2.4 months. At diagnosis, 75.9% of patients were metastatic and 66% had comorbidities, such as high blood pressure or diabetes. Palliative treatment was instituted for 87.3% of patients. Deterioration of their general condition was the immediate cause of death in 71% of cases. Urological cancers remain a challenge for specialists in Togo, especially because they are characterized by late presentation with diagnosis at the metastatic stage. Their prognosis is aggravated by the presence of comorbidities.

[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.