[Epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas in Senegal]. / Profil épidémiologique, étiologique et évolutif des fistules vésico-vaginales au Sénégal.

AIM: To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal. PATIENTS AND METHOD: This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published by our structure. RESULTS: Forty-five (45) VVFs were identified over a period of 6 years. This represents an annual average of 7.5 fistulas. The average age was 40±15.13 years with extremes of 13 years and 75 years; 17 patients (37.8%) were older than 45 years. The average parity was 3 with extremes from 0 to 12 children. Multiparous women represented 68.8% of the patients. Obstetric VVF (OVF) was more frequent (48.9%) followed by iatrogenic VVF (33.3%). The mean age was higher in the IVF group compared to the VVF group (32 years) (P = 0.0004). Thirty patients were from the Dakar region and its suburbs (66.6%). The etiology of VVF did not vary according to the geographical origin of the patients (P=NS). VVF was frequently associated with the management of cervical cancer in 42.2% of cases. Comparison of our current data with previous series shows a reduction in the annual incidence of VVF. VVFs, although they have decreased significantly, are still predominant. There is a constant increase in the number of IVF. CONCLUSION: There is an evolution of the epidemiological and etiological profile marked by a decrease in the frequency of VVFs and an increase in that of IVFs. It is also worth noting the frequent association between cervical cancer and VVF. LEVEL OF EVIDENCE: Level 4: retrospective study.

Post-abortive vesicovaginal fistula associated with bladder lithiasis: About an observation.

Illegally induced abortions remain a significant public health issue in developing countries. We report a case that was complicated by a vesicovaginal fistula with intravesical calcification of the piece of wood used to perform the illegal abortion. A trans-vesical approach allowed extraction of the calcified foreign body and closure of the vesicovaginal fistula. The postoperative course was uneventful.

Giant bladder diverticulum in a postmenopausal woman: Case report and literature review.

Bladder diverticulum represents a herniation of the bladder mucosa and submucosa through a point of weakness in the detrusor muscle. Bladder diverticula are rare and most often described in men. We report a symptomatic giant bladder diverticulum in a 56-year-old postmenopausal woman. The symptomatology was marked by acute urinary retention associated with abdominal-pelvic pain. A diverticulectomy by a transvesical approach with placement of a urethral catheter was performed. The postoperative course was uneventful.

[Results of two-level urethroplasty according to Bengt Johanson for complex urethral strictures in adults]. / Resultats de l'uretroplastie en deux temps selon Bengt Johanson pour les stenoses uretrales complexes de l'adulte.

AIM: to evaluate the results of two-level urethroplasty in the treatment of complex urethral strictures in our clinical center. PATIENTS AND METHOD: Thiswas a retrospective cross sectional study from January 2012 to September 2015 in our clinical center. Patients operated according to Bengt Johanson technique were included. The parameters studied were age, the urological history, consultation reasons, duration of evolution, stenosis characteristics and treatment outcomes. RESULTS: twelve patients were enrolled in our study. The mean age was 48 ± 20 years. The main reason consultation reason is urine retention. The mean duration of evolution was 30 ± 25 months. The most common etiology identified was scleroinflammatory one . All the patients already had at least one medical background. The physical examination showed a periurethral gangue in 10 patients. The mean length of the urethral stricture was 6.3 ± 2.2 cm. After an average follow-up of 3.8 ± 2.3 months; the treatment outcomes were considered satisfactory in 8 patients and bad in 4 patients. CONCLUSION: Bengt Johanson's two level urethoplasty gives good outcomes in the treatment of complex urethral strictures.

OBJECTIF: évaluer les résultats de l'urétroplastie en deux temps dans le traitement des sténoses urétrales complexes dans notre centre. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective entre Janvier 2012 et Septembre 2015 dans notre centre. Les patients opérés selon la technique de Bengt Johanson ont été inclus. Les paramètres étudiés étaient l'âge, les antécédents urologiques, les motifs de consultations, la durée d'évolution, les caractéristiques de la sténose et les résultats du traitement. RÉSULTATS: douze patients étaient inclus. L'âge moyen était de 48±20 ans. Le principal motif de consultation était la rétention d'urine. La durée moyenne d'évolution était de 30± 25 mois. L'étiologie la plus fréquente était celle d'origine scléro-inflammatoire. Tous les patients avaient déjà eu au moins un antécédent. L'examen physique avait objectivé une gangue péri-urétrale chez 10 patients. La longueur moyenne de la sténose urétrale était de 6,3 ± 2,2 cm. Après un recul moyen de 3,8 ± 2,3 mois ; les résultats étaient jugés bons chez 8 patients et mauvais chez 4 patients. CONCLUSION: L'urétroplastie en deux selon Bengt Johanson donne de bons résultats dans le traitement des sténoses urétrales complexes.

[Outcomes of radical prostatectomy in patients with prostate cancer at the Aristide Le Dantec University Hospital]. / La prostatectomie radicale: résultats carcinologiques au Centre Hospitalier Universitaire Aristide Le Dantec.

The purpose of this study was to assess outcomes of radical prostatectomy in patients with prostate cancer. We conducted a retrospective single-center study in the Department of Urology and Andrology at the Aristide Le Dantec Hospital in Dakar from June 1, 2010 to May 31, 2016. We collected data of 60 patients undergoing radical retropubic prostatectomy associated with dissection of the iliac and obturator nodes. After radical prostatectomy, prostate specific antigen (PSA) levels were undetectable (<0.1 ng/mL) in 20 patients (33.3%). Eleven patients (18.3%), who had biochemical relapse, received complementary hormone therapy. Patients achieved a response after initiation of treatment, and total PSA became undetectable again after an 8-month follow-up period. Mean overall survival was 17.5 months, with a median of 9.49. Cumulative overall survival rates at 1 year, 3 years and 4 years were 42.4, 13.6 and 6.8%, respectively. Mean relapse-free survival was 17.3 months, with a median biochemical relapse-free survival of eleven (11) months. The mean duration of specific survival was 8.1 months, with a median of 3 months. Seven patients had positive resection margins (11.6%). Four patients had lymph node involvement. Radical prostatectomy, suggested in some patients with prostate cancer in our practice, has been shown to be an effective therapeutic method leading to good outcomes.

Hydrocèle de l'adulte: le surjet hémostatique au cours de la cure, est-il utile sur les berges de la vaginale réséquée au bistouri électrique ? / Adult hydrocele surgery: is the hemostatic running suture useful after resection and electrocoagulation of the tunica vaginalis edge?

Contexte et objectifs. L'hydrocèle conduit dans ses formes évoluées à un retentissement psycho-social, économique et anatomique. Les objectifs de l'étude étaient de décrire les aspects cliniques et le devenir sous traitement de l'hydrocèle vaginale de l'adulte (HVA). Méthodes. Etude documentaire descriptive réalisée, au Centre hospitalier régional Amadou Sakhir Mbaye (CHRASM) de Louga, Sénégal ayant enrôlé des patients de 19 ans et plus présentant une hydrocèle, opérée selon la même technique entre janvier 2011 et décembre 2017. L'opération a consisté en une résection de la vaginale à 0,5 cm du testicule suivi d'hémostase au bistouri électrique, sans surjet hémostatique. Résultats. 1538 patients ont été opérés dont 69 pour HVA (4,5 %) et trente-neuf (n=39) d'entre eux étaient retenus. Leur âge moyen était 61,7 ± 21,3 ans. Le principal motif de consultation était : l'aspect volumineux et inesthétique des bourses. Un total de 48 unités d'hydrocèle ont été opérées : droites (n=19), gauches (n=11) et bilatérales (n=9). La vaginale était épaissie pour l'ensemble des cas. Les suites opératoires ont été simples. Aucun décès. À six mois, les patients étaient satisfaits, aucune récidive. Conclusion. HVA est une pathologie relativement courante dans notre pratique. La résection de la vaginale avec hémostase au bistouri électrique sans surjet hémostatique est une technique sûre et efficace

Context and objectives. Adult hydrocele is a relatively common pathology that causes psychosocial, economic and anatomical repercussions. The objectives of this study were to describe the clinical features and the outcome of hydrocele. Methods. This retrospective study included adults operated for hydrocele, in the Department of Urology of Louga Hospital, from January 2011 to December 2017. The operation begins by a scrotal skin incision that is carried down to the parietal tunica vaginalis which is opened and the content aspirated. Parietal tunica vaginalis is excised. Hemostasis is achieved by only electrocoagulation. Testicle is reintegrated, the wound closed without drain and protected by the dressing. Results. 1538 patients underwent surgery including 69 patients (4.5 %) for adult hydrocele. However, 39 out of these 69 patients (61.7 ± 21.3 years) were enrolled in the present study. Thirty-five were married and the others were unmarried (n=4). The main complaints for patients were inesthetic and scrotal swelling, interference and difficulties in socio-professional activities, negative social comments. The mean duration of the hydrocele evolution was 4 years. Operation procedures were done under spinal (n=38) or general anesthesia (n=1). A total of 48 hydroceles were cured including 11 on the left side, 19 on the right side and 9 bilateral. The mean volume aspirated was 600 ml. The tunica vaginalis was thick in all cases and calcified in 15 cases of hydrocele. No complications (hematoma or wound infection) were observed. No deaths or recurrences were recorded. Six months following the surgery, all patients were satisfied. Conclusion. Adult hydrocele is relatively common in the Department of Urology of Louga Hospital. The treatment consisting in excision of the tunica vaginalis, hemostasis by electrocoagulation, without hemostatic running suture is safe, secure and effective.

Devenir des pathologies du canal péritonéo-vaginal et de la migration testiculaire chez l'enfant: prise en charge au centre hospitalier de Louga, Sénégal / Outcome of processus vaginalis and testicular migration related pathologies in children treated at Louga Hospital, Senegal

Contexte et objectifs. Le devenir des pathologies du canal péritonéo-vaginal (CPV) et de la migration testiculaire chez l'enfant est peu connu. L'objectif de ce travail était de décrire les aspects cliniques et le devenir de ces pathologies. Méthodes. Etude documentaire descriptive portant sur les hernies, hydrocèles, cryptorchidies et torsions du cordon spermatique opérées chez le garçon âgé de 0 à 16 ans, au Centre hospitalier de Louga, Sénégal, de janvier 2018 à décembre 2019. Résultats. 184 dossiers des patients ont été colligés, soit 32,5 % de patients opérés au cours de la période. Leur âge moyen était de 5,4 ± 4,3 ans. Ces pathologies englobaient : hernies inguinales (n=37 dont 3 étranglements), hydrocèles (n=113), cryptorchidies (n=27), testicules oscillants (n=2) et torsions du cordon spermatique (n=5). L'abord a été inguinal dans 96,1 %. Le traitement a consisté en : ligature du CPV, abaissement testiculaire, orchidopexie, orchidectomie. Aucune récidive, atrophie ou fonte testiculaire n'a été observée en trois mois de suivi. Conclusion. La prise en charge en urgence ou non des pathologies du CPV et de la migration testiculaire chez l'enfant est fréquente dans notre pratique, sans complication à courte terme. Le défi réside dans le suivi à long terme en raison des complications tardives

Context and objectives. Little is known about the outcome of patent processus vaginalis and testicular migration pathologies in children. The objectives of this study were to analyze clinical and therapeutic features of these pathologies. Methods. This was a descriptive retrospective study involving boys aged 0 to 16 years, operated for inguinal hernias, hydroceles, cryptorchidisms and testicular torsions, at the Louga Regional Hospital Center, Senegal, from January 2018 to December 2019. Results. 184 patients were recorded, which represented 32.5 % of all patients operated in the same period. Their average age was 5.4 ± 4.3 years. The managed pathologies were: inguinal hernias (n= 37 including 3 incarcerated hernias), hydroceles (n= 113), cryptorchidisms (n= 27), retractile testicles (n=2) and testicular torsions (n= 5). Inguinal approach was performed in 96,1 % of cases. Surgical managements were: ligature of the patent processus vaginalis, relocating the testicle within the scrotum, orchidopexy and orchidectomy. No recurrence, no purulent testicular discharge or testicular atrophy was encountered. Conclusion. Processus vaginalis and testicular migration pathologies are common in our practice. At 3 months of surgical operation, no complication was observed. However, the challenge is long-term follow-up due to late complications