Treatment of Kidney Stones by Percutaneous Nephrolithotomy: Evaluation of the Results of the First Series of Our Experience in the Urology Department of the Idrissa Pouye General Hospital in Dakar

The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis;we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.

Surgical Treatment of the Upper Urinary Tract Lithiasis at the Urology Department of the Hopital General Idrissa Pouye

Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.

Progression of Minimally Invasive Urological Surgery at Hôpital Général Idrissa Pouye in Dakar in 20 Years of Practice

Introduction: Open surgery is gradually being supplanted by minimally invasive surgical techniques worldwide. Our study aimed to describe the place of minimally invasive surgery at the Hôpital Général Idrissa Pouye (HOGIP) in Dakar. Materials and Methods: This is a descriptive cross-sectional study over a 20-years period from 1st June 2000 to 31st December 2021 in the urology department of HOGIP in Dakar. The list of all surgical procedures performed was computed. We evaluated the distribution of minimally invasive procedures (endoscopy, PCNL, laparoscopy) overall and over the years. We made calculations of proportions and statistical significance was considered for alpha = 0.05. Results: In 20 years, 14,855 surgical procedures were performed, of which 5344 (36%) were minimally invasive surgeries. The average age of men was 53.19 years (standard deviation: 21.77) vs 47.32 years (standard deviation: 18.43) for women. Minimally invasive procedures in the lower urinary tract accounted for 71.93% and involved 1033 cystoscopies (26.87%), 1020 Trans Urethral Resection of Prostate (TURP) (26.53%), 931 Direct Vision Internal Urethrotomy (DVIU) (24.21%, and 612 Trans Urethral Resection of the Bladder (TURB) (15.92%). In the upper urinary tract, 1461 (28.07%) minimally invasive procedures were performed, including PCNL in 193 cases (3.61%), laser endopyelotomy in 104 cases (1.95%), ureteroscopy in 486 cases (1.7%) and laparoscopy in 39 cases (0.46%). The proportion of minimally invasive surgery has gradually increased. Among the 5344 minimally invasive procedures, 333 (5.23%) were performed in 2000-2004 and 2332 (43.63%) in 2015-2019. Conclusion: Minimally invasive surgery represents an important part of the activity of the HOGIP urology department. Its development has improved over the years offering its advantages to the patients.

Radiotherapy of Oligoprogressive Lesions in Castration-Resistant Prostate Cancer: Impact on Second-Generation Hormone Therapy

Background: The therapeutic standard for oligoprogressive prostate cancer resistant to castration is second-generation hormone therapy. This systemic treatment is expensive. There are oligoprogressive lesions accessible to radiotherapy. Objectives: To study the impact of radiotherapy of oligoprogressive lesions on the implementation of second generation hormone therapy. Patients and Methods: A retrospective study from 2012 to 2020 was carried out. All patients with oligoprogressive prostate cancer who had received radiotherapy on one or more lesions in progression were collated. Survival was calculated using the Kaplan-Meier method. Results: 8 patients were treated with stereotactic and conformational radiotherapy between August 2012 and August 2020 in the context of oligoprogressive prostate cancer resistant to castration. The median age at diagnosis of oligoprogression was 73 years with a median PSA level of 3.11 ng/ml. Nine lesions were diagnosed with PET scan PSMA. All the lesions were treated by radiotherapy with different regimens. After a median follow-up of 12.5 months, 7 patients showed a biochemical response to treatment with a median decrease in PSA of 67%. The median survival without clinical or biochemical progression was 7 months. The median survival without the need for further systemic treatment was 9 months. During the follow-up period, six patients received second-generation hormone therapy to treat their relapse, and the other two showed no clinical or biochemical relapse. Conclusion: Radiotherapy may be an alternative to delay the introduction of difficult-to-access second-generation hormone therapy in developing countries. A prospective study could validate this therapeutic approach.

Complications of Circumcision: A Three-Year Experience in N’Djamena Mother &Child Hospital (Chad)

Aim: This study aimed at describing the various aspects of complications of circumcision and their management in patients referred to N’Djamena Mother & Child Hospital (Chad). Material and Methods: All patients referred for complications of circumcision reported on a 3-year period (July 2011-May 2014) were included. Demographic data, circumstances of the circumcision, clinical presentation and management were computed. Results: Thirty-one cases of complications from traditionally performed circumcisions (n = 19) or circumcisions were performed by paramedics (n = 12). The average age was 7.5 ± 2 years. More than 60% of the patients were between 6 and 10 years old. The complications reported included: urethral fistula in the balano preputial sulcus in 10 cases (32%), entire amputation of the glans in 2 cases (6.5%), amputation of the penis in one case (3.5%), stenosis of the urethral meatus in 8 cases (26%), bleeding in 5 cases (16%) and infections in 5 cases (16%). A surgical treatment was performed according to clinical cases. Conclusion: Circumcision is safe when performed in hospitals. Unfortunately, serious complications may occur if it is performed by non-experts. Hence there is a necessity to raise people’s awareness on the importance of the medicalization of circumcision.

Emergency Drainage of Upper Urinary Tract with a Double Catheter in the Hospital General de Grand Yoff of Dakar (HOGGY)

Goals: The goals are to assess the use of Double Jendo-prostheses in urinary obstructions in the Hospital General de Grand Yoff of Dakar (HOGGY). Patients and methods: This is a 4-year retrospective study (1st January 2009-31st December 2012). The study included all patients with obstruction of the upper urinary tract, and with a reversing type Double Jendo-prostheses. Findings: A total of 82 patients were chosen for this study, including 41 males. Patient’s average age was 45 years. Kidney failure accounted for 11.5% of the causes of consultations. Lithiasic obstacles (34.2%) and tumours (21.5%) were the most recurrent. Catheter was successfully placed in 78% of cases, and highly contributed to improve renal function in 69% of cases. The frequently complications found in patients with Double J Catheters were back pain and urinary tract infections. Four cases of catheters calcifications were reported. Catheter was replaced in 62.2% of patients within an average period of 6.9 months. Conclusion: Double J Catheters remain important in the preservation of renal function in case of obstruction. Its use requires a mastery of these indications and a rigorous follow-up.

Epidemiological, Clinical and Management of Benign Prostatic Hypertrophia in Urologie Department in N’Djamena, Chad

Aim: To determine the epidemiological, clinical, paraclinical characteristics and assess the result of surgical treatment of benign prostatic hyperplasia (BPH) in the urological department. Patients and Method: It is a retrospective descriptive study of 757 patient samples whose BPH diagnosis was pronounced and have benefited of the open surgery in urology department from January 2006 to December 2010. The variables studied were sociodemographical, clinical, paraclinical, therapeutical and the follow up. Those variables were: arterial tension, sonography, consultation reasons and hospitalization, the data provided rectal touch, the comorbidity, the prostatic specific antigen (PSA), other blood tests, urinary tests, medical management surgical treatment, the causes of death and the complications. Results: during the study period, 2406 patients were hospitalized, from them 1472 (61.18%) for low urinary tract diseases where 757 for BPH. The mean age was 64.18 years. The acute urine retention was the main cause of hospitalizations and consultations (51.51%). The rectal touch Helped in diagnosing 96.43% of cases. PSA in 74.10%, the sonography evaluated the volume of the prostate and the complications on the upper urinary tract, kidney dilatation and stones. An urgent evacuation of acute retention of urine in the bladder was done in 74.10%, a medical treatment was done in 33.47%. The open surgery was done in 66.47%. The evolution was good for 703 (92.86%), 54 died (7.14%) and the causes were various (anemia, hyperglycemia, HIV…). Conclusion: The BHP was the first reason of consultation and hospitalization in urology department in N’Djamena. Its diagnosis was done after the analysis of a beam clinical and paraclinical arguments. In the absence of an endoscopic resection column, open surgery was the only surgical treatment.

Etiology and Management of Complete Acute Urinary Retention in Urology Department in N’Djamena, Chad

Goal: To study the epidemiological, clinical, etiological, characteristics and ensure earlier management of complete acute urine retention (CAUR) in the urology department of N’Djamena in Chad. Patient and Method: It was a retrospective descriptive study of a sample of 606 patients during the period ranging from November 2008 to December 2010. The patients were consulted first in urology or referred by a colleague for a CAUR. The diagnosis was confirmed by an earlier clinical examination. The patients have benefited from a urine evacuation before looking for the etiologies. Results: We managed a sample of 606 patients suffering from CAUR. Average age was 60 years old with extremes of 1 month and 100 years. There were more patients in the ranks of 60 years and more (n = 436;71.94%). Men were more than women in the proportion of 583/25, and 63.20% of the patients lived In N’Djamena. The benign prostatic hypertrophia was the first cause of CAUR, followed by urethral stricture, urinary infection, lithiasis of the lower urinary tract, adenocarcinoma of the bladder, hymen imperforation in young girls, bilharzias, paraphimosis and ovenbird necrosis. The bladder catheterization was the most urgent gesture done in 61.71%, followed by open cystostomy. In the second case, etiological treatment was done as: open prostatic surgery (n = 306), urethral reconstitution (n = 58), cystololithotomia (n = 54), dilatation of urethral conduct (n = 54), hymenostomia (n = 6). Conclusion: CAUR was the first symptom which motivated the consultation in the department of urology in N’Djamena the main problem of public health in Chad.

Giant Penoscrotal Elephantiasis: A Case Report

Introduction: To present the histopathological, etiologic aspects and the surgical procedure to treat a penoscrotal elephantiasis. Observation: A 60-year-old patient was referred for a giant scrotum for 30 years. His general status was poor. The scrotum was bulky, posed a cosmetic problem and limited the patient mobility. He underwent a surgical treatment with removal of the mass. Pathology of the specimen was suggestive of either a non specific fibrosis or a benign vascular tumor. Conclusion: Giant scrotum is rare. The treatment is surgical.

The Usage of Ultrasound in Diagnosing Retrocaval Ureter

Introduction: Retrocaval ureter is a rare congenital anomaly concerning the inferior vena cava and the ureter, where the infra-renal segment of the vena cava is in front of the ureter embryologically normal. This anomaly is more frequent in the male sex. Its symptoms are dominated by right lumbar pain, which is managed surgically as dictated by its intensity. Observations: The cases involved three male patients aged 42 years, 38 years and 39 years respectively. These patients had consulted for intermittent right lumbar pain similar to that of renal colic. The patients’ general condition was satisfactory. Renal function was normal. Urinary tract ultrasound, IVU and scanning were the main imagery examinations used in diagnosing retrocaval ureter, confirmed by exploratory lumbotomy. Ureteral anastomosis in front of the vena cava was carried out in the 3 patients during simple surgical procedure that resulted in disappearance of the lumbar pain. Conclusion: Retrocaval ureter is a rare congenital malformation, often encountered in the male sex. Clinical symptoms are dominated by right lumbar pain similar to renal colic. Surgical treatment is dictated by the intensity of the pain.

Diagnosing and Managing Androgen Insensitivity Syndrome

Introduction: Androgen insensitivity syndrome is a rare congenital abnormality of genital organs revealing a female phenotype in a person with XY chromosomes. The aim of our work is to describe the clinical aspects, to determine the chromosomal sex and to report our therapeutic management. Observation: A 28-year-old woman with female phenotype, feminine voice, normal breast development, normal underarms and pubic hair, absence of menstruation, fusion of small and large vaginal lips leaving a small pertuis to serve as urethral meatus. On the dorsal surface of the large, left lip was a mass the size of a date. Hormonal balance was normal. A feminizing genitoplasty was performed as well as excision of the mass. Histological analysis of the mass concluded that it was a feminizing testicular. Conclusion: Androgen insensitivity syndrome is a rare abnormality of the genitals. Multidisciplinary management is essential both for the designation of the breeding sex and feminizing genitoplasty.

Diagnostic Approach and Management of a Unilateral Total Ectopy of the Scrotum

Introduction: Total unilateral ectopy of the scrotum can be defined by the abnormal congenital anatomical position of the scrotum and its contents. The aim of the study is to describe the diagnostic and therapeutic approach of a total unilateral ectopy of the right scrotum. Methods: This is a clinical observation of a 46-year-old patient with a right abdominal mass evolving from birth. Analyzing the cluster of arguments clinically, operatively and anatomopathologically, allowed us to retain the diagnosis of a total unilateral ectopy of the right scrotum. The informed consent of the patient was obtained before the use of the images for scientific purposes. Conclusion: the unilateral total ectopy of the right scrotum is a rare congenital malformation of the external genitalia, which clinical diagnosis is difficult. Its management is surgical.

Complete Urethral Duplicity: A Rare Cause of Urinary Incontinence, New Type According to Effman’s Classification

Aim: To describe the clinical, anatomical, therapeutic aspects and propose a diagram of a new type of a complete urethral duplicity in classification of Effman. Material and Methods: This was a case report of a 14-year-old patient who suffered from birth of incontinence occurring while sitting with concept of preservation of normal urination. The patient was carrying two urethral meatus, one continent and the other incontinent. The two urethral meatus were easy to catheterize. The imagery was non-contributory. Resection of accessory urethra helped to make the patient continent. Informed consent was obtained from the patient’s parents for the surgical management, the anonymous use of record and photographs for scientific aims. Results: The diagnosis of urethral duplicity was retained. An explanatory approach is reported, a new scheme is proposed to improve the classification of Effman. Conclusion: The urethral duplicity is a rare urogenital abnormality whose etiology and pathophysiology are not fully understood and has not finished delivering the secret of his classification.

Expending the Paradigm: Active Surveillance for Intermediate Risk Prostate Cancer

Prostate cancer is the leading male cancer worldwide. There remains a controversy as to which patients have indolent disease and which patients present an aggressive disease needing treatment with intent to cure. Because of quality of life impairment associated with treatment by radiation or surgery, active surveillance (AS) is a valid management option to avoid or differ aggressive treatment. Traditionally, AS was reserved for men with low risk prostate cancer, however intermediate risk patients are more and more found in AS cohorts. The aim of this review is to describe the place of AS in intermediate risk patients and the perspectives offered by such a treatment modality.

Symptomatic Pelvic Kidney in Women at Childbearing Potential: Diagnostic Difficulties and Management in Urology Department of N’Djamena in Chad

Introduction: We aim to report, from three observations, the diagnostic difficulties and complications, and ensure the management of pelvic kidney in women at childbearing age in the Urology Department of the National General Referral Hospital of N’Djamena. Pelvic kidney is due to an abnormality of the migration that can be associated or not with a malrotation. Its symptomatology is not specific, causing diagnostic difficulties and therapeutic errors. Observation: There were three observations of female patients aged respectively 26, 29 and 32 years who were taken care of for years in the gynecology department for pelvic inflammatory disease before being routed in urology. The diagnosis of pelvic kidney was retained on the basis of morphological examination (ultrasound, intravenous urography, CT urography). The patients have undergone nephrectomy;the postoperative aftermath was simple. Conclusion: Pelvic kidney is a rare disease. It is often discovered during autopsy. Symptoms are non-specific;nephrectomy is the treatment of choice in symptomatic cases.

Recent Injuries of External Genitalia: Clinical Aspects and Management

Aim: Report the epidemiological, clinicopathological characteristics and ensuring management of recent traumas of the external genitalia in Urology. Methods: This was a descriptive retrospective study of 47 cases of patients suffering from recent traumas of the external genitalia over a period of 5 years. The variables studied were sociodemographic, clinical, paraclinical, therapeutic and evolutionary. Results: A total of 47 patients, including 46 men, were managed. The mean age was 26.8 years, ranging from 6 to 56 years. The circumstances of occurrence were: the missteps of coitus (n = 16), traffic accidents (n = 9) and criminal injuries (n = 8). The fracture of the penis (n = 16) was the most common lesion followed by the scrotal wound (n = 11). The management was medical and surgical and varied by the type of lesion. The outcome was favorable in 91.5% of cases. Conclusion: The incidence of traumas of the external genitalia was 9.4 in urology department in N'Djamena. Penis fracture was the frequent lesion. The management is multidisciplinary, medical and surgical.

Clinicobiological Profile and Management Outcomes of Male Subfertility

Introduction: We aim to determine the epidemiology, clinical, paraclinical and etiologic aspects and to evaluate the management of male subfertility in urology. Methodology: We conducted a retrospective descriptive study of 137 patients referred to the urology department for male sub-fertility over a period of 4 years. The analyzed variables were: clinical, paraclinical characteristics and the post therapeutic evolution. Results: The mean age was 38.41 years (range: 24 to 67 years). The semen analysis was normal in 18 patients. The semen analysis showed oligoasthenozoospermia (45.3%) and total azoospermia (24.8%). Disease history was represented by: gonorrhea (27.7%), urogenital schistosomiasis (13.2%) and hernia repair (1.2%). The hormonal test showed abnormal hormone levels including: FSH (43.8%), LH (46.7%), testosterone (36.5%), prolactin (22.6%). The incriminated etiologic factors were: varicocele (5.8 %), smoking (23.7%), alcohol intake (25.4%) and sexually transmitted diseases (42.3%). The treatment was medical in 67.9% and surgical in 32.1% of cases. After a year of follow up, 13.9% of patient’s wives were pregnant. Conclusion: Male subfertility is common in Chad. The causes are numerous and diverse. The treatment is etiology based. A better management of sexually transmitted diseases and urogenital schistosomiasis is the best way to prevent it.

Primary Tumors of the Upper Urinary Tract: Report of 4 Cases

Primary tumors of the upper urinary tract are rarely reported in the literature. We thus report here four cases of primary tumors of the upper urinary tract that were difficult to diagnose, in three women and one man. Preoperative diagnosis was established in only two cases requiring a nephro-ureterectomy. The other two cases were surprisingly diagnosed during anatomopatho- logical examination. Preoperative diagnosis was a pyonephrosis in one case and a renal failure resulting from stenosis of the pelvic ureter in the other. Despite modern methods, primary tumors of the upper urinary tract remain difficult to diagnose.

Clinical, Paraclinical and Therapeutic Aspects of Chronic Prostatitis

Aim: Present the clinical and paraclinical aspects of chronic prostatitis and report the management in urology. Methods: We conducted a retrospective descriptive study of 47 patients referred to the urology department from January 2011 to December 2013. Analysed variables were epidemiological (age, marital status, place of residence, occupation, education level, taking stimulants), clinical, paraclinical (CBU, chlamydia, syphilis and HIV serologies, urine culture susceptibility testing, semen analysis, ultrasound of urinary tree, radiographs, RCU, IVU), treatment and results. Results: The mean age was 44.6 years. The main reasons for consultation were dysuria (55.3%), prostatorrhea (29.8%) and sexual asthenia (12.8%). The general condition was satisfactory (80.9%). Purulent drop was objectified in the urethral meatus in 10.6% of cases, and the DRE was painful at 44.68%. Escherichia coli was the main isolated germ (23.4%). In 55.3%, calcification of the prostatic area was objectified to ultrasound of the urinary tract. The RCU had objectified bilharzia in 8.5% of calcifications of the bladder area and 19.14% of urethral stricture. The medical treatment was completed in all patients according to the etiology and complications by an instrumental or surgical treatment, offline or emergency. The outcome was favorable in 25 patients. Symptoms were improved in 12 others and a failure for the ten remaining. Conclusion: Chronic prostatitis is relatively frequent in urology. Clinical manifestations are diverse and varied. Treatment is difficult with a significant failure rate.

Urolithiasis: Diagnostic and Therapeutic Aspects in Urology Department of N’Djamena in Chad

Introduction: To study the clinical, paraclinical, diagnostic aspects and manage patients with urolithiasis according to the available technical facilities in urology department of N’Djamena in Chad. Urolithiasis is defined as the presence of one or more stony concretions located at any level of a segment of the urinary tract: calyx, renal pelvis, ureters, bladder and urethra. Materials and Methods: This was a descriptive type of a prospective study over a period of 4 years, from January 2008 to December 2011, involving 233 patients with urolithiasis treated in the urology department. Clinical and paraclinical examinations were the basis for the selection of patients. Informed consent of patient or their parents (for minors) was obtained for the anonymous use of records and photographs for scientific aims. Results: Urolithiasis represented 5.72% (233/4072) of all urological pathologies. Male dominance was significant with a sex ratio of 4.5/1. The age group of 0 - 10 years was the most affected with a staff of 67 (28.75%). The clinic was dominated by dysuria (44.63%), renal colic (33.91%) and hematuria (9.01%). The main anatomical location was bladder (62.23%). The management was essentially medical and surgical. We recorded 7 cases of death or post-interventional hospital mortality rate of 3%. Conclusion: Urolithiasis is a real public health problem in Chad. Due to the inadequacy of the technical platform, the management was based on the open surgery. Etiological research was impossible by lack of technical laboratory platform.