Proximal hypospadias repair using the koyanagi-hayashi technique. A review of 15 cases.

BACKGROUND: Several surgical approaches or modifications of existing techniques have been described for the repair of hypospadias. In Sub-Saharan Africa, a two-stage approach is the preferred option in proximal cases with severe penile curvature. OBJECTIVE: The authors describe their experience with one-stage repair of proximal hypospadias with severe penile curvature using the Koyanagi-Hayashi technique. METHODOLOGY: Three hundred and ten patients were seen at the outpatient clinic from November 2009 to November 2015. All patients aged between 2 and 17 years with a confirmed diagnosis of proximal hypospadias and operated according to the Koyanagi-Hashashi technique were included in the study. RESULTS: The mean age at diagnosis was 6.7 ± 4.35 years (81 months). The level of the hypospadias was penile in 60%, scrotal 33.5%, and posterior in 6.6% of cases. The most common complications after primary repair were partial breakdown of the urethroplasty (44.8%), urethra-cutaneous fistula (3.3%), dehiscence of the glanuloplasty (22.2%), and recurrent penile curvature (11.1%). DISCUSSION: The high psychological implication of this condition in children and adolescents at the time of diagnosis in our context was a major weakness of our study. However, it turned out to be an advantage as the patients could be involved in the decision-making in as much as the previous gender was taken into consideration. CONCLUSION: A one-stage repair approach as described by Koyanagi-Hayashi also provides good aesthetic and functional outcome. It thus stands out as an alternative even in our African setting.

[Management Of Undescended Testis In Children In Yaounde. A Report On 71 Cases]. / Prise En Charge Du Testicule Non Descendu Chez L'Enfant A Yaounde: A Propos De 71 Cas.

OBJECTIVE: The aim of this work was to describe the epidemiological, diagnostic and therapeutic aspects of undescended testicle in the of Pediatric Surgery service of the Yaoundé gyneco-obstetric and pediatric hospital. METHOD: Our study was retrospective, descriptive and analytical from June 2008 to December 2016; a period of 8 years and 6 months. Included in this study were records of pediatric patients aged 0 - 15 years who had been managed for an undescended testis in the Pediatric Surgery service of the Yaoundé gyneco-obstetric and pediatric hospital and followed up at our outpatient clinic. Data recorded included age, term of pregnancy at birth, time to presentation, presenting complaint, symptoms, location of the testis, surgical approach and procedure, complications and follow up. Open orchidopexy according to Surraco was the standard operation carried out for all our patients, a scrotal doppler ultrasound was systematic 30 days after the surgery and the child was scheduled for follow-up visits at 3, 6, 9 and 12 months postoperatively. RESULTS: Seventy-one patients were managed during the study period, giving a hospital frequency of 10 cases per annum. The average age of our patients was 5.8 years [1 day and 15 years]. The mean time to consultation was 4.5 years [1 day and 15 years]. Most patients consulted for absence of the testis (n = 62). All patients were full term births. Clinically, the undescended testis was categorized as: cryptorchidism (n = 45), ectopia testis (n = 2), intra-abdominal testis (n = 24), retractile testis (n = 7), vanishing testis (n = 4). The position of the undescended testis was: inguinal (n = 64), pelvic (n = 2) and abdominal (n = 5). Single stage open orchidopexy according to Surraco using an incision in the lower inguinal crease was performed in 66 cases (93%). Laparoscopy was used in 7% of cases for location of non-palpable testis. With a mean follow-up of 3 months, testicular atrophy was found in 5.6% of cases in our series.

BUT: Le but de ce travail était de décrire les aspects épidémiologiques, diagnostiques et thérapeutiques du testicule non descendu dans le Service de Chirurgie Pédiatrique de l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé (HGOPY). PATIENTS ET MÉTHODE: Notre étude a été rétrospective et descriptive de Juin 2008 à Décembre 2016; soit une période de 8 ans et 6 mois dans le Service de Chirurgie Pédiatrique de l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé. Ont été inclus dans cette étude, les dossiers des patients pédiatriques d'âge 10 ­ 15 ans ayant présenté un testicule non descendu pris en charge à HGOPY et revus en consultation.Les paramètres étudiés étaient: âge, terme, délai de consultation, motif de consultation, tableau clinique, topographie du testicule, voie d'abord, geste réalisé, morbidité, recul. L'abaissement testiculaire selon Surraco avait été de mise chez tous nos patients, une échographie doppler scrotale était systématique à J 30 post opératoire et l'enfant était revu en consultation de contrôle à 3 mois, 6 mois, 9 mois et 12 mois. RÉSULTATS: Soixante-onze patients ont été colligés et traités pendant la période d'étude, soit une fréquence annuelle de 10 cas. L'âge moyen de nos patients était de 5,8 ans [1 jour et 15 ans]. Le délai moyen de consultation était de 4,5 ans [1 jour et 15 ans]. L'absence de testicule était le principal motif de consultation (n=62). Tous les patients étaient nés à terme. Les tableaux cliniques étaient les suivant: testicule cryptorchide (n=45), testicule ectopique (n=2), testicule intra-abdominal (n=24), testicule oscillant (n=7), testicule évanescent ou « vanishing testis ¼ (n=4). La topographie du testicule non descendu a été: inguinale (n=64), pelvienne (n=2), abdominal (n=5). La voie d'abord a été inguinale dans un pli abdominal inférieur dans 66 cas (93%) et coelioscopique dans 7% des cas. Les gestes réalisés ont été dominés par l'abaissement testiculaire avec orchidopexie. Avec un recul moyen de 3 mois l'atrophie testiculaire a représenté 5,6% de notre série.

Mixed gonadal dysgenesis in Yaoundé: A preliminary experience about three cases.

UNLABELLED: Mixed gonadal dysgenesis is characterised by unilateral chromosomal abnormality, which is probably the result of anaphase lag during mitosis. The 45, XO/46, XY karyotype is the most common form of mosaicism involving the Y chromosome. It is a rare clinical entity with a worldwide incidence of 1.5/10,000 live births. Its epidemiology in Sub-Saharan Africa is not known. This study reports experience in the management of 3 cases at the Yaounde Gynecologic-Obstetric and Paediatric Hospital. From November 2009 to November 2014, 3 cases were successfully managed at our institution. RESULTS: All patients presented with asymmetrical gonadal differentiation. On one side of the body, a poorly-developed testicular gonad and on the other side a gonadal streak. A persistent Mόllerian remnant was equally found in the 3 cases. Management of mixed gonadal dysgenesis should be done in tertiary health care centres. A multidisciplinary team approach is recommended.

A case report of Cowper's syringocele in an 18-months old infant at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital.

Syringocele or dilatation of the duct of the bulbo-urethral (Cowper's) gland is usually of congenital origin but can be acquired. It is a very rare deformity, <10 cases have been reported in literature. The main objective is to describe an additional case of syringocele of Cowper's glands and review the literature. An 18-month-old infant presented with a history of acute urinary retention 3 days after birth and a cystostomy was done. Voiding cystourethrogram was normal and cystourethroscopy showed a syringocele. Endoscopic incision was performed in our patient with satisfactory results. No complications were noted. Syringocele or cystic dilatation of Cowper's gland duct usually has a congenital aetiology. Diagnosis is confirmed by endoscopy. Treatment is by marsupialisation in the urethra by endoscopy. Syringocele is a rare pathology usually congenital. It should be suspected in all case of lower urinary tract obstruction in children.

Our experience of proximal hypospadias repair using the Cloutier-Bracka technique at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde-Cameroon.

BACKGROUND: In parts of Africa, routine circumcision is practised and sometimes even on children with hypospadias. The lack of preputial foreskin renders urethroplasty more difficult and often requires to use of a mucosal graft as described by Bracka. OBJECTIVE: The authors describe their experience of hypospadias repair using Bracka's technique. MATERIALS AND METHODS: Over a period of 5 years, 100 cases of proximal hypospadias were operated in our institution. All patients aged 0-18 years who had already been circumcised were included in this study. RESULTS: The outcome of the 12 cases operated according to Bracka's technique was analysed. The mean age was 11.5 years. The ectopic meatus was penoscrotal in three cases, scrotal in one case and perineal in eight cases. After reconstruction, the new meatus was sutured at the top of the glans in one case, at the prepuce in seven cases and at the penile midshaft in one case. The main complications noted were surgical site infection, wound dehiscence, residual chordee and urethrocutaneous fistula. No neourethral stenosis nor uretrocele was recorded. DISCUSSION: The buccal mucosal graft urethroplasty as described by Bracka is associated with a lower risk of meatal strictures compared to other free mucosal grafts. The buccal mucosa is easier to harvest and causes less scarring than bladder mucosa. CONCLUSION: Repair of severe hypospadias remains a challenge for paediatric surgeons. The functional and cosmetic outcomes depend on the choice of the donor site for the graft and objective assessment of successful reconstruction criteria during follow-up.

La prise en charge de l'ectopie testiculaire a l'hopital central de Yaounde : a propos de 171 cas

INTRODUCTION:L'ectopie testiculaire est frequente. Le diagnostic et la prise en charge precoces sont necessaires a cause des risques d'atrophie; de cancerisation; de subfertilite; et les consequences psychologiques en rapport avec l'absence d'un testicule dans une bourse. Cette prise en charge est tardive dans notre milieu. Le but de ce travail etait d'etudier les facteurs interferant avec cette prise en charge. MeTHODOLOGIE Nous avons revu 172 dossiers des patients operes d'ectopie testiculaire de 1999 a 2012. Nous avons etudie l'age au moment de l'operation; la qualification de la personne ayant assure l'accouchement; les facteurs interferant avec la prise en charge et les resultats de cette prise en charge. ReSULTATS L'age des patients au moment de la chirurgie variait de 1 a 48 ans; avec une moyenne de 8 ans. Seuls 21 patients avaient ete operes dans les delais recommandes. L'information medicale avait ete erronee ou insuffisante dans 93 cas. L'on retrouvait la peur de l'operation dans 42 cas; les problemes financiers dans 14 cas; l'ignorance des parents dans 7 cas. CONCLUSION Le manque d'information des soignants ou des parents; la peur de l'operation et le manque de moyens financiers sont les principales causes de delai dans la prise en charge de l'ectopie testiculaire. Ce travail fait ressortir la responsabilite du personnel de sante dans le la prise en charge precoce de l'ectopie testiculaire

The role of surgery in the management of Pott's disease in Yaoundé. A review of 43 cases.

INTRODUCTION: Pott's disease is a common entity in our hospital. The authors report their experience in the surgical treatment of Pott disease. PATIENTS AND METHODS: This is a retrospective study including all patients who underwent surgery for Pott's disease in our institution between November 1999 and November 2004. RESULTS: Forty-three patients were included, including 23 men and 20 women (ratio 1.15). Location of the disease was cervical (2 cases), dorsal (19 cases), dorsolumbar (2 cases) lumbar (16 cases) and sacrolumbar (4 cases). Ten patients were HIV positive (24%). The surgical indication was sometimes diagnostic, but predominantly therapeutic (medullary compression, instability or deformity). Spinal decompression alone was performed in 23 cases, associated with internal fixation of the spine (17 cases) or external immobilization (Halo Vest) in two cases. The anterior approach was used in four cases and a posterior approach in 38 cases. Decompression by posterior approach included 1 or 2 level laminectomy alone or associated with internal plate fixation (4 pedicle screws and 2 plates). There was no functional recovery in patients with a complete neurological deficit (Frankel A); those with a severe deficit (Frankel B) partially recovered, while those with more moderate deficits (Frankel C and D) recovered completely. Fusion was obtained (graft integration) regardless of the surgical approach used, progression of the deformity was stopped and early mobilization was possible. CONCLUSION: Surgery definitely plays a role in the diagnosis and treatment of Pott's disease, especially in countries where patients are seen at a late stage of the disease when complications have developed. Surgical decompression should not be delayed until lesions become ischemic and irreversible (Frankel A). LEVEL OF EVIDENCE: Level IV. Retrospective study.

Le monitorage respiratoire per operatoire chez l'adulte

Le monitorage respiratoire est necessaire au cours de l'anesthesie car les agents anesthesiques depriment la ventilation. Il donc faut assurer une suppleance et la surveiller. Le monitorage n'exclut pas la surveillance clinique du patient par un personnel anesthesique present attentif en salle d'operation. Il est base sur l'oxymetrie de pouls; la capnographie; les parametres ventilatoires; les concentrations des gaz anesthesiques et les alarmes

[Preliminary study of laparoscopic cholecystectomy in Cameroon]. / Expérience préliminaire de la cholécystectomie par voie laparoscopique au Cameroun.

AIM: The purpose of this study was to evaluate the feasibility of laparoscopic cholecystectomy in Cameroon. MATERIALS AND METHOD: This retrospective study includes all patients who underwent laparoscopic cholecystectomy in three major hospitals in Cameroon from 2001 to 2009. Charts were reviewed for epidemiological data, complications, and outcome. RESULTS: This study included 52 patients. Their mean age was 45 years (range: 17-71). All had symptomatic gallstones, and 15 presented acute cholecystitis. The rate of conversion to open surgery was 7.7%. No deaths occurred. One patient required reoperation due to cystic duct stump leakage complicated by biliary peritonitis. The average duration of hospitalization was 3 days. CONCLUSION: Based on these results, we recommend laparoscopic cholecystectomy for symptomatic gallstones in Cameroon.

Our experience in the management of infantile hydrocephalus: a study on thirty-five regrouped cases in Yaounde, Cameroon.

BACKGROUND: Hydrocephalus is a frequent central nervous system disorder in children, and despite its importance, it has not been sufficiently studied in developing countries. PATIENTS AND METHODS: A prospective and descriptive study on 35 cases of infantile hydrocephalus was carried out in the neurosurgery unit of the Yaounde Central Hospital, from March 2008 to January 2010. RESULTS: The mean age of the patients was 6.69±1.58 months, and the majority of them were in the 0-6 months age group (71.43%). The most frequent causes were congenital malformations, with stenosis of the aqueduct of Sylvius being the most represented (31.43%). As radiological workup, a CT scan was done in more than half of the cases (57.15%), and ventriculo-peritoneal shunting was the main surgical method of management used (94.29%). Infectious complications were observed in 22.86% of our cases. CONCLUSION: Hydrocephalus is a frequent disorder in this Cameroonian setting affecting mostly the 0-6 months age group. For early diagnosis to be made, the head circumference of neonates should be routinely measured in the labour room and followed-up in all medical visits. To avert complications following surgery, rigorous surgical procedures with effective asepsis and appropriate methods and materials for shunting should be used.

[Mortality of neonatal surgical emergencies at the Gynecology-Obstetric and Pediatric hospital of Yaounde, Cameroon]. / Mortalité des urgences chirurgicales néonatates à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé, Cameroun.

From July 2005 to November 2009, 38 neonates with surgical emergencies died in the neonatal unit of the Gyneco Obstetric and Pediatric Hospital Yaounde. The mortality rate of these emergencies was 43.1%, and those within the age group of 1 to 7 days were the most affected with a sex ratio of 1.2. The mean delay before consultation was 3.7 days. Half of the neonates had a birth weight of less than 2,500 g and 7 cases (18.4%) were premature. A medicalised ambulance was used for transfer to our unit in only half of the neonates. The main disorders were those affecting the digestive tract in 42.1% of our series. In 50% of our cases, there were associated malformations and 28 cases (73.7%) did not undergo surgery. Malnutrition and infection were the main complications in 60% of the cases. The authors discuss this deplorable situation and suggest recommendations for improvement.

[Difficulties in the management of esophageal atresia in developing countries]. / Problematique de la prise en charge de l'atresie de l'œsophageen pays sous medicalises.

Oesophageal atresia is an extreme surgical emergency of the first week of birth. Authors report 10 cases treated in 5 years in two hospitals of Yaounde in Cameroon. This study high line: Difficulties of oesophageal atresia management in less medicalised countries. Possible solutions in this context.

Problematique de la prise en charge de l'atresie de l'oesophage en pays sous medicalises

L'atresie de l'oesophage est une extreme urgence chirurgicale de la 1ere semaine de vie. Les auteurs en rapportent 10 cas colliges et traites en 5 ans dans deux hopitaux de la ville de Yaounde au Cameroun. Cette etude met en relief : - les difficultes de la prise en charge de l'Atresie de l'oesophage en pays sous medicalises - les solutions possibles dans ce contexte

Intestinal Infarctus following Dilatation and Uterine Curettage.

We present a case of intestinal infarctus through the vagina. This was a consequence of induced abortion done clandestinely. The main objective was to point out the surgical complications of uterine dilatation and curettage by means of this rare case.

Morphine versus morphine-ketamine association in the management of post operative pain in thoracic surgery.

The aim of this study was to assess the quality of postoperative analgesia obtained with morphine-ketamine association administered in self-pain controlled analgesia, as well as the amount of morphine that has been spared. Patients who had to undergo thoracic surgery were selected. They were divided into two groups: G1 was made up of patients receiving 0.5 mg/ml of morphine associated with a placebo, with boluses of 2 ml and refractory periods of 5 minutes ; and G2 made up of patients receiving 0.5 mg/ml of ketamine associated with 0.5 mg/ml of morphine with same boluses and refractory periods. The assessment of pain at rest and on stimulation was carried out with the visual analogue scale. The response to pain and the amount of morphine spared were evaluated. Fifty patients with an average age of 34 years were selected. The assessment showed that the response to pain at rest was the same in the two groups as from the twelfth hour. On stimulation, the analgesic response was better in G2 as well as the amount of morphine spared. This study shows that the administration of ketamine in association with morphine in the post operative period procures a favourable efficiency-tolerance relationship and provides a good means of sparing morphine.

Depressed skull fractures in children: Treatment using an obstetrical vacuum extractor.

INTRODUCTION: A depressed skull fracture is an inward buckling of the skull bones. It is referred to as a ping-pong ball fracture in neonates; in older children, some fractures take a cup shape mimicking 'ping-pong' ball fractures. OBJECTIVE AND METHODS: The aim of this study was to assess the use of an obstetric vacuum extractor to elevate cup-shaped depressed skull fractures in children irrespective of age. All children admitted into the Central Hospital of Yaounde between 1999 and 2004 with a cup-shaped simple depressed skull fracture and treated with the vacuum extractor were included. RESULTS: Nine children aged from 3 months to 17 years were treated with the vacuum extractor. The cosmetic and radiographic results were satisfactory. The procedure was simple and without any complication. CONCLUSION: The elevation of 'ping-pong-ball-like' or 'cup-shaped' skull fractures in older children (beyond the neonatal period) is a simple, effective and safe procedure.

Growing skull fractures.

INTRODUCTION: Growing skull fractures are a rare complication of head injuries (Ersahin et al. in Neurosurg Rev 23:139-144, 2000; Hayashi et al. in Childs Nerv Syst 13:349-351, 1997; Ramamurthi and Kalyanaraman in Neurosurgery 32:427-430, 1970; Zegers et al. in Eur J Pediatr 162:556-557, 2003). Although early diagnosis and prompt treatment are important to prevent the underlying progressive brain damage, the clinical presentation and the morphological investigations are rarely specific or sensitive shortly after the trauma. DISCUSSION: The authors present three cases of growing skull fractures: the use of ultrasonography (US) via the fracture line contributed to early diagnosis and prompt treatment in two cases. US was not performed in the third case, and this delayed management. Treatment consisted of a watertight duraplasty with a free flap of pericranium without cranioplasty. US via the fracture line appears to be a sensitive and reliable method of detecting the dural tears in the early stages of growing skull fractures. CONCLUSION: Duraplasty alone with a flap of pericranium remains the simplest and least expensive method of treatment. Cranioplasty is not necessary in young children.

Les hematomes extra-duraux post traumatiques : prise en charge medico-chirurgicale a Yaounde (post-traumatic extra dural hematoma: medical and surgical management in Yaounde)

Introduction : L'hematome extra dural (HED) est une urgence chirurgicale majeure. Son diagnostic et sa prise en charge dans les pays en voie de developpement se heurtent a des difficultes inherentes a la fois a la modestie des plateaux techniques et au cout trop onereux des soins pour des malades souvent demunis; sans systeme d'entraide national. Objectif : Le but de cette etude est d'etablir le profil epidemiologique des patients victimes d'un HED a Yaounde; de relever les difficultes dans la prise en charge et d'evaluer les resultats a court et a moyen terme.Patients et Methodes Il s'agit d'une etude descriptive allant de Janvier 1999 a Decembre 2004. Tous les patients pris en charge (trousse neurochirurgicale d'urgence) pour un hematome extra dural dans l'une des formations hospitalieres de Yaounde ont ete inclus. Resultats : Sur les 38 patients recrutes; le sexe masculin etait preponderant avec un sexe ratio de 3.8/1. L'age moyen etait de 24;5 ans (extreme allant de 3 a 48 ans). Les accidents de la voie publique constituaient l'etiologie la plus frequente (55;3des cas). Le traitement chirurgical etait principalement une craniotomie (81;1des patients operes). Le traitement medical avant la chirurgie etait variable. Le GOS dans le collectif etait evalue a 5 (2 patients decedes); 2 (4 patients avec des sequelles) et 1 (32 patients avec une recuperation complete). Conclusion : Ce travail demontre l'interet de disposer d'une trousse neurochirurgicale d'urgence pour une prise en charge optimale dans notre contexte

[Traumatic jejuno-ileal ruptures: apropos of 18 cases at the Central Hospital of Yaounde]. / Les ruptures traumatiques jéjuno-iléales: àpropos de dix huit (18) observations àl'hôpital Central de Yaoundé

Eighteen blunt small bowel traumas were reviewed in this retrospective study (1986-1996) concerning 12.8% of laparotomies for blunt abdominal trauma. The clinical presentation at admission was peritonitis (9 cases) or hemoperitoneum (4 cases) whereas 5 cases were diagnosed lately because of non specific signs at the beginning. All patients underwent surgery: simple suture or suture after excision of edges (12 cases); resection anastomosis (6 cases). There were no post-operative complications in most of the cases. The mortality rate was 5%. Blunt small bowel traumas are not frequent in our practice. Their diagnostic is often per-operative. If the clinical signs of intraperitoneal lesion are not present, a clinical follow-up by repeated and thorough physical examination can permit an early diagnosis. The surgical treatment is simple, and the prognosis more linked to severe associated lesions than the bowel lesion.