Prostate Cancer in the Thies Region, Senegal: Epidemiological, Diagnostic and Therapeutic Aspects

Introduction: Prostate cancer is the leading urological cancer. It is the most common cancer in men over 50. Objective: To determine the epidemiological, diagnostic and therapeutic characteristics of prostate cancer in hospitals in the Thiès region. Patients and Methods: We conducted a descriptive study from January 1st, 2015 to December 31st, 2020. We included all cases of primary prostate cancer confirmed on histology. Results: We collected data on 318 cases of primary prostate cancer during the study period. Mean patient age was 72.7 years (Range: 49;94 years). Family history of prostate cancer was found in 22 patients (6.91%). The average consultation time was 18.6 months. The circumstances of discovery were dominated by obstructive voiding disorders (97.16%). Digital Rectal examination was suggestive in 55.40% of patients. PSA level was above 20 ng/ml in 76.7% of patients. Prostatic adenocarcinoma was the only histological type (100%). Localized cancer represented 7.2% and locally advanced cancer occurred in 36.5% of cases, while metastatic cancer accounted for 56.3%. Radical prostatectomy was performed in 3.18% of cases. Mortality rate was estimated at 8.50% after 1 year. Conclusion: Prostate cancer is the leading urological cancer in the Thies region. It is characterized by the predominance of locally advanced and metastatic forms.

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.

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.

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.

A Shoulder Mass Revealing a Metastatic Prostate Cancer

Introduction: A shoulder mass revealing metastatic prostate cancer is very rare. We report a case of metastatic prostate cancer diagnosed on a shoulder mass and treated with analgesic radiotherapy and chemotherapy and androgen deprivation therapy (ADT). Observations: A 66 years old patient was referred for a painful right shoulder mass whose biopsy and pathological examination found a Gleason 8 (4 + 4) moderately differentiated adenocarcinoma. The PSA level was 508.52 ng/ml. The patient was treated with analgesic radiotherapy on the right shoulder and chemo-hormonal therapy. At 2 years follow-up, the disease was well controlled. Conclusion: A shoulder mass revealing metastatic prostate cancer is not common. Local treatment of the symptomatic metastasis while continuing chemotherapy and ADT improves the quality of life.

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.

Secondary analysis of malaria rapid diagnostic tests from rounds 5–8 of WHO product testing with a focus on false-negative results

Despite the widespread use of malaria rapid diagnostic test(RDT)in clinical practice,there are a lot of challenges.We conducted a secondary analysis of 129 malaria RDT data from rounds 5–8 of the World Health Organization(WHO)product testing summary and discuss the causes of false-negative(FN)results with a focus on low parasite density,improper RDT storage,operation and interpretation,and Plasmodium falciparum with a pfhrp2/3 gene deletion.The results demonstrated that the malaria RDTs currently commercially available might cause FN results in practice.

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.

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.

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.

Severe External Genitalia Lesion by Firearm: A Case Report

Gunshot wounds to external genitalia are rare either in war field and civilian setting accounting for 2% - 4% of all injuries with often a lesion to the urinary tract. We report a case of external genital injury in a 27 years old man, accidentally injured by his own arm when he pressed the trigger of his gun placed in his pants. He had no past medical or surgical history, he presented to the emergency room (ER) with hemorrhagic scrotal and penile injuries with adjacent urethral tissue damage. He underwent a scrotal flap urethroplasty, and realignment of the corpus cavernosa and the tunica albugina. The patient lost his Foley catheter at post-operative day 3 and subsequently developed a urethral stenosis. Gunshot wounds to external genitalia are rare. A good reconstruction is necessary to avoid an impact on sexual and voiding function.