Urinary Lithiases: Epidemiological, Clinical and Therapeutic Aspects of 164 Cases at Sheikh Zayed Hospital in Nouakchott—Mauritania

Urinary lithiases occupy an important position with respect to urological activities in our department. In our Sahel region, lithiasic pathology represents 40% in urology in Senegal [1]. In Mauritania, we did not find a study evaluating the prevalence of this pathology. The frequency and gravity are variable. The objective of the study was to report the clinical profile and the results of management of urinary lithiasis in our environment. Materials and Methods: We conducted a retrospective, descriptive study spanning over two years (April 2015 to March 2017) in the urology department of Sheikh Zayed Hospital in Nouakchott. All patients operated for urinary lithiasis during this period were included in the study. The operative techniques used were semi rigid ureteroscopy, extra corporeal lithotrity, open surgery. Our center did not have flexible ureteroscopy and percutaneous nephrolithotomy. The indications were lithotrity for calculations lower than 20 mm of low density. Biger than 20 mm were by open surgery. Semi rigid ureteroscopy for distal ureteral calculi. Medical treatment or monitoring for non-obstructive calculi is less than 7 mm. Urine drainage by jj probe or nephrostomy are performed. We excluded all patients with lithiasis for the medical treatment. The result was good when absence of lithiasis residues was less than 7 mm and removal of the obstruction. Results: A total of 164 patients were found. The average age was 41 years, and F/M ratio was 1/10. Considering geographical origin, 82% of patients came from rural areas. The presenting complaint was mainly Lower Urinary Tract Symptoms (56%) and Renal Colicky Pain (31%). The bladder and kidneys were the most common (respective 45% and 35%) sites of stone location. Bilateral stones were 18%. Staghorn stones constituted 6% of the cases. Non steroidal anti-inflammatory treatment was administered in 82% of cases, while antibiotic therapy was administered in 32% of cases. Complications occurred in open surgery about 11% like parietal infection and residual stones. 0.6% of ESWL got uretere obstruction that needed jj catheter. 4% of cystolithotomy had infection. Conclusion: Urinary lithiasis often consults at the complication stage. Minimally invasive techniques are limited in our service and offer less complication.

Transurethral Resection of the Prostate (TURP): About 146 Cases at Sheikh Zayed Hospital in Nouakchott Mauritania

Introduction: Transurethral resection of the prostate (TURP), entered our service in October 2015, since then it became a part of the service daily activity. The aim of our study is to assess the acceptance of the technic by our patients and by the nursing staff and to analyze the results of our initial experience. Materials and Methods: Retrospective study over 14-month (October 2015 to December 2016);bringing together all the patients who received TURP. The inclusion criteria are to have benefited from a TURP in our service. The exclusion criteria all patients operated by other techniques. It was a monopolar resection of the prostate using a glycocolle loop, the size limit of the prostate was 65 cc or less. A questionnaire on the knowledge of the technique and its acceptance is made. The parameters studied the age of the patient;surgical indications;the course of the operation, the complications and the course. The frequency of TURP compared to other techniques and the demand for this technique by patients. The urinary catheter was left in place for 4 days, the patients were seen again on day 7 after the catheter was removed to assess the urine flow, a question regarding the opinion of the nursing staff was included and analyzed separately. Results: The total number of patients was 146;the mean age was 68.2 years. The main cause of consultation was urine retention 65%. The average duration of the intervention was 56 minutes. The average length of hospital stay was 28 hours. The urinary catheter was removed on day 4. Complications were bleeding in 7% of cases requiring blood transfusions. Failure to remove the indwelling catheter leads to revision via the transurethral route. The TURP syndrome was observed in 2 patients in our early patients but quickly resolved. The outcome was favorable in 75% of cases. Post operating management give satisfaction for nurse and acceptance was a success. Conclusion: TURP is now a routine surgical activity;it seems to have an upright place for BPH in our department;its impact on morbidity was remarkable.

Adult Kidney Cancer in Mauritania: Clinical and Therapeutic Aspects

Introduction: since its creation, our urology department has taken care of tumor pathologies in particular kidney cancer in adults;our goal is to study the clinical and therapeutic epidemiological profiles of adult kidney cancer in Mauritania. Materials and Methods: We carried out a retrospective study over a period of six years, from January 1, 2012 to December 31, 2017, including all cases of adult kidney cancer registered in the urology-andrology departments of the Cheikh Zayed Hospital and Pathological Anatomy of the National Hospital of Nouakchott (Mauritania). Results: we collected 50 cases of kidney cancer. The average annual incidence was 8.3 cases. The average age of the patients was 52.98 years with extremes of 18 and 84 years. There was a female predominance (52%) or 29 women for 21 men. Lumbar pain was the most frequent clinical expression, more than half of the patients had symptoms over a period of at least 12 months before the first consultation. The left kidney was the most frequently affected. The right localization was demonstrated in 23 patients, the extension assessment was made with thoraco-abdomino-pelvic CT in 40 patients. Twelve patients had a tumor localized in the kidney. The extension assessment had made it possible to objectify the existence of metastases in 17 of our patients (37%). The preferred locations of these metastases were pulmonary and hepatic. Surgical intervention was performed in 44 patients (88%), of whom 36 underwent radical nephrectomy (72%), and two patients underwent partial nephrectomy (4.5%). Surgical abstention was decided from the outset in 6 patients (13.6%). None of our patients had received treatment with anti-angiogenics. The histological type most observed in our patients was renal cell carcinoma, observed in 34 patients, or 77.72%. At the time of the study, more than a third of the patients had died. The mortality rate in our series had reached 24%. A specific survival rate could not be assessed due to lack of information in the files and significant numbers of patients lost to follow-up at the time of the study. Conclusion: adult kidney cancer in Mauritania is characterized by its low incidence, its occurrence in a relatively young population, its female predominance, its often late diagnosis at locally advanced and metastatic stages, and the treatment is the most often surgical.

The Relation between Role of Serum Cortisol Level and Response to Various Respiratory Support Strategies among Preterm Infants

Introduction: Preterm infants are liable to various health problems including respiratory distress syndrome (RDS). There is variation in response to respiratory support. In preterm infants, cortisol hormone is secreted by the adrenocortical gland in response to stress. Objectives: To compare the serum cortisol levels in blood among preterm infants who needed different respiratory support strategies e.g. headbox, continuous positive airway pressure (CPAP), intubation surfactant extubation (INSURE) and mechanical ventilation (MV) and to correlate the cortisol levels to the severity of respiratory distress syndrome (RDS). Material and Methods: Observational prospective study that assessed the serum cortisol levels in preterm infants with RDS after initial respiratory support aged 28 - 34 gestational weeks that were admitted to the neonatal intensive care unit of Al Zahraa hospital of Al-Azhar University and Al-Estekama hospital between February 2019 and November 2019. Infants were classified into three groups, Group 1: 29 infants with severe RDS who needed a mechanical ventilator. Ten of them needed surfactant therapy. Group 2: 33 infants with moderate RDS who needed CPAP. Three of them needed surfactant therapy. Group 3: 28 infants with symptoms of mild RDS who needed headbox. None of them needed surfactant therapy. Blood samples were collected on the first day of life and were processed using the colorimetric ELISA method. Demographic and medical information was collected. Results: A total of 90 preterm infants were included. The serum cortisol reference was 4.3 - 22.4 mg/dl. Group 1 showed significantly higher serum cortisol levels compared to group 2 and group 3 (39.22 ± 9.91 mg/dl vs 28.96 ± 6.48 mg/dl vs 25.88 ± 5.42 mg/dl) respectively, (P-value = 0.001). Infants in group 2 who needed surfactant therapy had higher serum cortisol levels than those who did not need surfactant therapy (32.30 ± 5.92 mg/dl vs 28.33 ± 6.27 mg/dl). The serum cortisol levels were observed having a negative correlation with gestational age and birth weight. No significant differences were observed in terms of gender or type of delivery. Conclusion: Cortisol levels had a positive correlation with the severity of RDS who needed various respiratory support strategies.

ROLE OF ACULASER THERAPY IN CEREBRAL PALSY CHILDERN (INITIAL DATA & RESULTS)

A single, open and non-comparative study was conducted at Anwar Shah’s First C.P. & Paralysis Clinic and Research Center to evaluate the effects of Aculaser (acupoint-laser) Therapy for children suffering from cerebral palsy (CP) of various types. These children were further classified according to their major complaints. Analysis of the data indicated that 11 children with severe spasticity and stiffness all showed marked improvement (100% success rate); of the 8 children with epileptic fits, 6 patients had a significant reduction in the intensity, frequency and duration of epileptic fits, while the rest 2 cases showed no any improvement or aggravation (75% success rate); out of 5 children with cortical blindness, 2 cases showed complete recovery of vision and 3 had marked improvement (40% cure rate); out of 4 children with hearing difficulties, 2 showed marked improvement (50% success rate); out of 14 children with aphasis, 8 showed improvement (57% improvement rate). Results of this study show that Aculaser Therapy has a high improvement rate of CP children, not only improving the spasticity and stiffness but also the cortical blindness, epilepsy, deafness and speech.