Epidemiological, Clinical and Therapeutic Profile of Obstructive Renal Failure

Aim: To describe the epidemiological, clinical, etiologic and therapeutic aspects of patients with acute obstructive renal failure at the Medical Surgical Center of Urology (MSCU). Materials and methods: this was a descriptive retrospective study of 106 patient records treated for acute renal failure from January 2012 to December 2016. Patients came for spontaneous consultation or were referred. They had benefited from a clinical and paraclinical assessment at the end of which the diagnosis of acute renal failure was retained and then an effective management at the MSCU. The variables studies were clinical, paraclinical, therapeutic and progressive. The treatment included: hemodialysis, urinary diversion (suprapubic, urethrovesical and ureteral), trans-urethral resection of the prostate, trans-urethral resection of the bladder, nephrostomy, endoscopic incision of catheter valves, posterior urethra or laparoscopic nephroureterectomy as indicated. The emergency treatments consisted of removing the obstacle and the etiological treatment was done later. External follow-up consultation varied by etiology. Results: In 4 years we had treated 106 patients, a frequency of 26.5%. The average age was 47.83 years with extreme of 2 and 80 years old. The sex ratio was 68 men for 38 women. The mean serum creatinine level was 37.8 mg/l (335 μmol/l). The etiologies were: prostatic pathologies (n = 38), lithiasic pathologies (n = 20) and gynecological pathologies (n = 18). The treatments were: endoscopic resection of prostate (n = 24), bladder (n = 6), posterior urethral valves (n = 4), JJ probe (n = 27) and nephrostomy (n = 23). The result was good (normalization of creatinine serum) in 79 patients, the persistence of elevated serum creatinine was observed in 4 patients and 18 patients died. Conclusion: Acute obstructive renal failure is a common diagnosis in our exercise setting at MSCU where it can be managed with respect to our technical platform.

Management of the Valves of the Posterior Urethra in Urology

Aim: Describe the clinical, radiological and management of patients with posterior urethral valves. Materials and Methods: This was a retrospective descriptive study over a period going from January 2011 to December 2016, reviewing 12 cases of patients treated for valves of the urethra posterior to the medical surgical center of urology in Cameroon at Douala. The variables studied were clinical, paraclinical, therapeutic and evolutionary. Results: In 5 years, we had diagnosed and treated 12 cases of posterior urethral valves, an average of 2.4 per year. The average age of patients was 41.6 months with extrems of 3 and 156 months. The reason for consultation was dominated by urinary tract infections. Urethrocystography and echography were performed in all patients and allowed to objectify a bilateral ureterohydronephrosis, a diverticular bladder in 9 cases and 4 cases of vesico-ureteral reflux, including a grade 4 according to the classification of Cendron, 8 patients suffered from acute urinary failure. Renal scintigraphyrealised on 3 patients had as objective in 1 patient the existence of a disfunctioning kidney. The treatment consisted of an endoscopic incision of the valves (n = 8), a vesicostomy (n = 3) and an iterative urethral dilatation with double J catheter placement (n = 1). The evolution was favorable (n = 7), and 5 cases of death were recorded. Conclusion: The endoscopic incision is the gold-standard of the treatment of the valves of the posterior urethra. The vesicostomy is an alternative in the absence of adequate technical platform. Despite adequate support, the prognosis remains burdened with significant mortality.

Diagnosis and Management of Prostate Cancer in Urology

Introduction: Describe the diagnostic approach and management of prostate cancer at the medico-surgical center of urology in Douala, Cameroon. Materials and methods: This was a descriptive retrospective study reviewing 100 patient’s records suffering of prostate cancer from January 2011 to December 2015. The studied variables were clinical, paraclinical and therapeutic. Results: The mean age was 65 years with extrems of 50 and 85. Rectal examination was suggestive in 63 cases. 7 patients had a family history. The average PSA rate was 43.23 ng/ml. Histology has concluded to an adenocarcinoma in all patients. The gleason score was equal or greater than to 7 for 53 patients (53%). The extended assessment revealed distant metastasis for 43 patients. The treatment was: surveillance (n = 33), total laparoscopic radical prostatectomy (n = 24), surgical hormone therapy (n = 10), medical hormone therapy (n = 28) and chemotherapy coupled with hormone therapy (n = 5). Conclusion: Prostate cancer is common in Douala;its diagnosis is made late. Radical treatment is possible for localized cancers, hence the interest of early detection.