Management of Acute Bowel Obstruction in Adults in Ziguinchor Hospital Establishments: About 163 Cases Followed Up

Acute intestinal obstruction represents a very frequent admission to surgical emergencies. The aim of our study was to make a descriptive analysis of the management of acute intestinal obstructions at the level of hospital establishments in Ziguinchor. Materials and Methods: This was a retrospective, descriptive, multicenter study from the period of January 1, 2017 to December 31, 2021. Patients over 15 years of age admitted for occlusive syndrome in the two surgical departments of the Ziguinchor regional hospitals were included in the study. Epidemiological, diagnostic, therapeutic and evolutionary data were studied. Results: Acute intestinal occlusions accounted for 8.3% of admissions. A total of 163 patients were enrolled, 61.9% were men, sex ratio of 1.6. The mean age was 48.7 years. The average consultation time was 74.8 hours (3.12 days). The total occlusive syndrome was in 48.5% of the cases. Abdominal pain was present in 87.1%, vomiting in 74.2%, cessation of matter and gas in 60.7% and meteorism in 36.2%. Biological lab tests reported hyperleukocytosis in 28.1% of the cases. Abdominal CT scans were performed in 71.2%, confirming the diagnosis in 90.5% and determining the etiology in 93.1%. The zone of the obstruction in the small bowel was 62.7%, and in the colon in 37.3%. Functional occlusions accounted for 22.7% of cases and mechanical for 77.3%, including 120 cases of strangulation occlusion (95.2%) and 6 cases of obstruction. Etiologies were dominated by adhesions and/or fibrous bands (61.2%). Medical treatment resolved the occlusive syndrome in 9.2% of cases, instrumental treatment in 17.1% and surgical treatment in 77.3%. Adhesiolysis/section of fibrous bands (55.7%), detorsion (14.3%) and resection anastomosis (11.9%) were the most common surgical procedures. Overall morbidity was 11.6%, dominated by surgical site infection (7.14%). The mean resumption of intestinal transit was 2.7 days, and the mean hospital stay was 7.9 days. Overall mortality was 6.7%. Conclusion: Acute intestinal obstruction is a frequent, absolute medical-surgical emergency, with multiple etiologies dominated in our series by adhesions and/or fibrous bands, whose morbi-mortality could be reduced by early and appropriate management before the onset of intestinal necrosis.

Bipolar Transurethral Resection of the Prostate: Short-Term Outcome Evaluation in Regional Hospital in Senegal

Introduction: Transurethral resection of the prostate is still the most popular procedure that use for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction in developed countries. Bipolar transurethral resection of the prostate (B-TURP) is a recent technique in our urological practice. The aim of this study was to evaluate our preliminary results on the use of a B-TURP in Kolda (Senegal) in a benign prostatic hyperplasia (BPH). Materials and Methods: This was a 15-month, retrospective and descriptive study from June 2021 to August 31, 2022. It examined the records of patients who had BPH requiring surgical treatment and who received Bipolar transurethral resection of the prostate (B-TURP) during the study period at the Kolda Regional Hospital in Senegal. We used a Karl STORZ bipolar endoscopy column with a 26 sheath and 30˚ optics. The parameters studied were the civil status of the patients, the clinical and para-clinical data as well as the operative indications. The data were entered and analyzed using Epi-info 3.5.1.1. Results: A total of 31 patients underwent bipolar transurethral resection of the prostate during the study period. The mean age of patients was 68.5 ± 12.6 years (range, 56 - 77 years). The mean total PSA was 4 ± 2.3 ng/ml (range, 0.5 - 11 ng/ml). The mean prostate size assessed by ultrasound was 54 ± 12.3 ml (range, 30 - 90 ml). The operative indication was dominated by BPH with impact on the upper urinary tract. The mean of bladder irrigation time was 21.4 ± 3.9 hours (range, 12 - 26 hours). In the immediate post-operative period, blood transfusions were performed in 2 patients (6.5%). In the medium-term follow-up, we noted one 1 (3.2%) case of urine retention requiring bladder catheterization. Conclusion: Bipolar Transurethral resection of the prostate B-TURP in saline system is efficacious and safe. The results of this preliminary study of B-TURP are satisfactory with a low complication rate. B-TURP decreases the duration of the hospitalization and the port of the probe. Our perspectives are oriented towards endoscopy of the upper urinary tract.

Metastatic Prostate Cancer under Androgen Deprivation Therapy: Factors Influencing Castration Resistance

Objective: To evaluate the factors predicting the time to progression to castration-resistant in metastatic prostate cancer under Androgen Deprivation Therapy (ADT) in our center. Patients and Methods: This is a retrospective, descriptive, analytical study in a single center over a period of 2 years. It has interest patients followed for metastasized prostate cancer under ADT. The parameters studied were: epidemiological, clinical, paraclinical, prostate specific antigen (PSA) nadir, time to nadir (TTN) and their link with the castration resistance. Results: The frequency of castration resistant prostate cancer was 28 patients per year. The mean age was 70.4 ± 7.9 years. An ECOG score ≥ 3 was more common as was the cT2c stage. The median of the initial total PSA was 489.6 ng/ml (203.3;1653.2). All patients had adenocarcinoma. The International Society of Urological Pathology (ISUP) 1 was more frequent. Bone metastases were more frequent. The medians of nadir, TTN and the castration resistance were 19.3 ng/ml (3.7;102.1), 5.5 months (3;9) and 11 months (6;15.3), respectively. The Eastern Cooperative Oncology Group (ECOG) score, clinical stage, metastatic site, the nadir and its TTN influenced the DSR. Age, lymph node involvement, initial total PSA and Gleason score did not influence the castration resistance. Conclusion: ADT should be initiated as soon as possible before an attack of general and/or clinical stage advanced to delay resistance. A drilling should be associated with this hormone therapy as much as possible because of its gain on resistance.

Hypospadias: Evaluation of Therapeutic Outcomes and Sexual Function in Adulthood in a University Hospital Setting

Background: Hypospadias is a congenital malformation resulting from hypoplasia of the tissues forming the ventral face of the penis. It is associated to variable degrees with an ectopic urethral meatus, a penis curvature and a sapper’s apron foreskin [1]. The incidence of this malformation varies from country to country. It is estimated at 1/300 male births in France and 0.26/ 1000 in Mexico [1]. In Senegal, the prevalence of this malformation is unknown. Hypospadias surgery has improved significantly in recent years due to a better understanding of the anatomy on the one hand and the improvement of the instruments used during surgery on the other (suture material, surgical magnification, urethral catheter of suitable size). In sub-Saharan Africa and particularly in Senegal, hypospadias surgery remains a challenge due to the unavailability of adequate equipment (lack of microsurgical instruments and surgical loupes). Objective: To evaluate the outcomes of the treatment of hypospadias by the different surgical techniques used in our center as well as their sexual function in adulthood. Patients and Methods: This is a retrospective study, including all patients operated for hypospadias between January 2009 and December 2017 in Urology-Andrology department of Aristide Le Dantec hospital. The studied parameters were: frequency, age, clinical and therapeutic aspects, and their sexual function in adulthood after treatment. The outcomes of the treatment were judged good or poor depending of the quality of penile straightening, the aesthetic appearance of the penis, the position of the urethral neo-meatus, the permeability of the urethra and the existence or not of fistula. The sexual function was assessed by the International Index of Erectile Function 15 (IIEF) score. Results: Fifty-five patients were included. The median age was 6 years (P25 = 2.8 and P75 = 13 years). After a mean follow-up of 58 ± 33 months, 81.8% (45) of patients had a good outcome. Duplay-Snodgrass urethroplasty was the most commonly used urethroplasty technique with better results. Complications were noted in 29 patients. The most common were urethral fistula, surgical site infection and urethral neo-meatus stenosis. The sexual function was rated good in one patient and average in the other two (after an average decline of 53 ± 26 months). Conclusion: Urethroplasty according to Duplay Snodgrass was the most used technique in our studies and its outcomes were better compared to the other techniques used.

Diagnostic Rigid Urethrocystoscopy: Indications, Results and Pain Assessment

Background: Over the last 50 years, endourology has revolutionized urological practices worldwide. This is not so in many urological centers in West Africa. Although, some centers have made progress in the level of urological services that they offer;many of such centers provide rigid urethrocystoscopy services. Rigid urethrocystoscopy is an endoscopic examination that explores the urethra, bladder and prostate in men. Aims: We report the indications, results and pain assessment of rigid urethrocystoscopy in our center. Patients and Methods: We carried out a retrospective, descriptive, monocentric study in our center between January 2016 and June 2018. The study included all patients who had a rigid urethrocystoscopy under local anaesthesia. We studied the following parameters: sex, age, indications for the examination, outcomes and the pain assessment. Results: Five hundred and forty-one patients were included. The sex-ratio was 1.49. The mean age was 49.47 ± 18.48 years (12 years and 91 years). Lower urinary tract symptoms (29%) and hematuria (28%) were the most common indications. The rigid urethrocystoscopy was normal in 26.8% of patients. Bladder tumors (21.2%) were the most frequent lesions. In men, prostate tumors were more common (21%) followed by bladder tumors (17.9%), while in women, bladder tumors (26.3%) were predominant followed by cystopathy lesions (12.4%).The mean Simple Verbal Scale (SVS) score was 1.25 in women and 2.1 in men. Conclusion: Rigid urethrocystoscopy was relatively well tolerated by our patients. Hematuria was the primary indication and the main etiologies were bladder and prostate tumors.

Erectile Dysfunction: Clinical and Epidemiological Aspects in Senegal

Introduction: The objective of our study was to analyze the clinical and epidemiologic aspects of erectile dysfunction in subjects with different comorbidities in Senegal. Patients and Methods: This was a retrospective study over a period of 2 years on patients who presented themselves for consultation for erectile dysfunction. The study was carried out in the regions of Dakar and Thies at the Ouakam geriatric center and the Saint Jean of god Hospital of Thies respectively. Results: We enrolled into the study 402 patients with erectile dysfunction. The average age of our patients was 47 ± 5 years. Patients aged more than 60 years were the most. The majority of our patients had less than secondary school level education, 211 in total representing 52.5% of the study population compared to 14.9% having post baccalaureate level. A large number of these patients had professional activities (53.3%), followed by retirees (29.6%). Polygamous patients were more in number (51.5%). In our study sample, we registered 120 active smokers (29.9%). A hundred and ten of our patients were sedentary for periods of 5 months to 22 years. The average length of time before seeking help for erectile dysfunction in our patients was 2.8 years. Severe erectile dysfunction was predominant in the smoking group (54.2%) compared to (9.9%) in the non-smoking group. We found a large proportion of severe and moderate erectile dysfunction (66.3%) and (31.7%) respectively in diabetic than non-diabetic patients. Severe erectile dysfunction was more in hypertensive and diabetics. Severe erectile dysfunction was more present in hypertensive plus smokers (83.9%) than in non-smoking hypertensive patients (68.6%). Severe ED was found more in hypertension and diabetic subjects. Conclusion: Erectile dysfunction is most frequently related on one side to socio-environmental factors, and to co-existing comorbidities on the other side.

Congenital Urethral Diverticulum in Male Subject: Report of Three Cases

Introduction: The urethral diverticulum or urethrocele corresponds to a saccular dilation of a portion of the urethral wall. Our objective was to report the clinical aspects, investigations and therapeutic aspects of three cases of congenital urethrocele. Observations: They were three male patients aged 11, 20 and 42 years, two of whom had consulted for terminal dribbling. The diagnosis of urethrocele was made for all patients with retrograde and voiding cystouretrography. Treatment consisted of resection of the urethrocele followed by urethroplasty for both cases. Conclusion: Diagnostic of congenital urethrocele must always be assessed when there is a persistent terminal dribbling, and systematically ask for a retrograde and voiding cystourethrography to confirm it.