Suprapubic Cystostomy at Urological Emergency Unit of CHU-YO, Ouagadougou, Burkina Faso: Indications, Technique and Complications

Introduction: Cystostomy allows under certain circumstances deriving the urine. This is the most performed surgery in uro-andrological emergencies. Complications can occur. We aim to analyze the indications, technical aspects and complications of suprapubic cystostomies in the urological emergency unit at CHU-YO. Patients and Methods: Between October 2013 and May 2014 we conducted a prospective study of all patients who underwent suprapubic cystostomy. Results: 86 cases of cystostomy were noted or 77.5% of surgical procedures performed in uro-andrological emergency. All patients were male. The average age of patients was 52.5 years. The AUR represented 88.4% of indications. The prostate tumor represented 65.8% of the etiologies of AUR. The cystostomy was performed under local anesthesia in 87.2% of cases. Peritoneal gap was noted in 5.8%, parietal suppuration in 12.8%. A death by generalized acute peritonitis was noted in one case. Conclusion: Suprapubic cystostomy presents a non-negligible morbidity and mortality and must be mastered.

Acute Generalized Peritonitis Due to the Migration of a Ballpoint Pen from Bladder to Great Peritoneal Cavity: A Case Report

Foreign bodies of the bladder are rares. The presence of a foreign body in the bladder is often anecdotic. We report a case of acute generalized peritonitis due to migration of a ballpoint pen from bladder to great peritoneal cavity in a 17-year-old man. He was admitted for a peritoneal syndrome after introducing a ballpoint pen into the urethra to masturbation purposes. He has no psychiatric history. Exploration had found an agglutination of small bowel loops around the ballpoint pen. The ballpoint pen was about 13.5 cm long and was transfixing the small intestine. We had noted about 20 cm of ileal necrosis about 30 cm from the ileocecal junction. An exit port was located at the posterior wall of the bladder. We performed a resection of the necrotic portion followed by end-to-end anastomosis. Bladder foreign bodies can have serious complications such as the formation of an acute surgical abdomen after migration of the foreign body. The extraction must be quickly carried as soon as the diagnosis is made to avoid these complications.

From Traditional Management of Mental Illness to Self-Mutilation of the Penile: A Case Report

Introduction: Self-mutilation of the external genitalia is rare. It occurs most often on a psychotic ground. Case Report: Mr. P.O. 25-year-old, a dress maker, admitted to the urological emergency for self-section of the penile. The patient had cut his penile with a razor blade and the amputated distal extremity had been thrown in the water closet. The patient was admitted 19 hours after the act of self-harm. Clinical examination had found a stable hemodynamic status, a section of the penile at its root. Psychiatrically schizophrenia evolving for 08 months was diagnosed. An attempt of penile reconstruction was performed. The patient benefited serum and tetanus vaccine, antibiotic and neuroleptics. The parents asked to go home against medical advice the 5th day. Conclusion: The management of self-mutilation of external genitalia is multidisciplinary including surgery and psychiatry.

Infected Vaginal Hydrocele Due to a Septic Puncture-Aspiration: A Series of Seven Cases Collected at Yalgado Ouedraogo Teaching Hospital of Ouagadougou

Objective: To describe diagnostic and therapeutic outcomes of infected vaginal hydrocele.Material and Methods: This is a retrospective descriptive study over a period of two years from June 2013 to May 2015 at the urological emergency department of Yalgado Ouédraogo University Hospital (CHU-YO). Results: We collected seven cases during the period of study. The average age of patients was 35 years. Two patients (2/7) were from urban and five from rural areas. Five patients (5/7) were married and two (2/7) unmarried. Six patients (6/7) were farmers and one (1/7) was civil servent. Clinical examination findings were dominated by bilateral painful scrotal swelling and fever in all cases, a scrotal necrosis in two cases. The dominant indication of the puncture-aspiration was discomfort during sexual intercourse (5/7). At the opening of the scrotum purulent fluid was aspirated in all cases, and we performed a unilateral orchidectomy in two cases. A hydrocelectomy was performed in all cases. The postoperative evolution was simple in all patients. Conclusion: The puncture-aspiration must be avoided because the risk of infection and the high recurrence rate.

Prostate Cancer Disease Characteristics at the Time of Diagnosis and Initial Treatment Offered in a Tertiary Hospital at Ouagadougou (Burkina Faso)

Objectives: to describe the characteristics of newly diagnosed prostate cancer (PCa) and the initial treatments offered to patients in the most important urological center of Burkina Faso. Methods: We analyzed the data of a cohort of 168 consecutive patients with no prior history of PCa between January 2009 and December 2012. Diagnosis of PCa was based on histological analysis of transrectal prostate biopsies. Patient and disease characteristics and the initial treatment offered were taken in account. Results: The mean age at presentation was 68.59 ± 9.41 years (range 30 to 95 years). There was a 3.6-fold increase in the incidence of PCa through the four years of the study. The mean duration of symptoms prior to presentation was 11.6 ± 10.9 months. The majority of cases (86.9%) were presented as locally advanced or metastatic disease. Androgen deprivation therapy (ADT) was the first therapeutic option for 121 patients (72%) and 73 patients (43.4%) underwent ADT through bilateral orchiectomy. Only 3 patients (1.78%) underwent radical prostatectomy. Conclusion: An increase in the diagnosis of PCa in our country was observed in this study. The diagnosis of prostate cancer was usually tardive in Burkina Faso. Treatment often involves surgical ADT for socioeconomic reasons.

Elderly Men Sexuality in Ouagadougou (Burkina Faso)

Background: In general, sexuality is a taboo subject. It is more so in elderly people, as it is believed that they do not complain about sexual disorder. Objective: To analyse the sexual activity of elderly men in Ouagadougou, Burkina Faso. Methods: This is a descriptive cross-sectional study on the sexual activity of men aged at least 60 years old. The study was carried out in Ouagadougou, Burkina Faso, from 1st June to 31st August 2014. All consenting males who were aged 60 and above at the time of the study were included. Results: We contacted 652 men, but only 200 responded i.e. a response rate of 30.67%. The age of the respondents was between 60 years and 89 years with a mean age of 66.38 ± 5.72 years. 80.15% of the respondents had at least one sexual intercourse in a month. Erection was considered satisfactory or very satisfactory in 45.8% (60/131) of respondents and 63.36% of them always had orgasm during sexual intercourse. Premature ejaculation was noted in 23.66% of respondents, while a decline in libido was noted in 82.44% of them. Conclusion: This study which is the first of its kind in Burkina Faso has helped reveal the importance of sexuality in the lives of elderly men.

Trauma of External Genitalia by Firearm: Therapeutic Strategy and Result, about a Case at CHU-YO, Ouagadougou, Burkina Faso

Introduction: Ballistic traumas of the external genitalia are rare especially in civil practice. Emergency surgical exploration is the rule. Case Report: Mr. F.Y., 29 years old, a security agent, admitted to the Urological Emergency Unit of Yalgado Ouédraogo University Hospital of Ouagadougou for trauma of the penile and left purse by firearm. The clinical examination revealed a good hemodynamic status, bladder distension. A suprapubic catheterization was performed. We noted a transfixing and bleeding wound on the penile, and on the left purse which was edematous. The patient was admitted to the operation room 07 hours after trauma. Exploration found a total destruction of the left testicle classified grade 5 of the classification of the American Association of the Surgery of Trauma (AAST). We performed a left orchiectomy. There was a partial rupture of the ventral face of the penile urethra. We performed an end-to-end anastomosis on a Foley catheter CH 18. The Foley catheter was removed after two weeks. Urination was spontaneous without dysuria. Erections were painless and without kinking of penile. Conclusion: Open traumas of the external genitalia are rare and their treatment is an extreme surgical emergency.