Practice of Endo-Urology in the Centre of Ivory Coast: Overview and Results

Background: Endoscopic exploration and treatment of urinary tract disorders, whether by retrograde, percutaneous or endoscopic approach, defines endo urology. Objective: To report the results of endo urology practice in Bouaké during the two practice sessions. Patients and Methods: Cross-sectional and descriptive study of patients followed up and had benefited from exploration and/or endoscopic surgery in Bouaké. Our study was carried out in a facility in Bouaké, for two years, from January 2021 to December 2022. The parameters of interest were clinical, diagnostic, endoscopic procedure and results. Results: During the study period, 157 patients underwent endoscopic exploration and/or intervention. The mean age was 58.9 years (range 28 - 90 years). Males predominated with 95.5% (n = 150). Acute urinary retention was the most frequent reason for consultation (55.41%). Benign prostatic hyperplasia (BPH) was the most frequent pathology at 22.92% (n = 36). Urethrocystoscopy was performed in 52 cases (33.12%), Transurethral resection of the prostate (TURP) in 36 cases (22.92%), Endoscopic resection of secondary cervical sclerosis in 23 cases (14.64%), Endoscopic internal urethrotomy (EUI) in 15 cases (9.55%) and Transurethral resection of the bladder (TURB) in 10 cases (6.36%). Post-operative management was straightforward in 93.63% of cases (n = 147). Operative times of between 21 and 35 minutes were more frequent in 55.41% of cases (n = 87). Urinary tract infections accounted for 3.8% (n = 6) of surgical morbidity. The germ responsible for the infections was essentially Escherichia coli (E. coli). The mean duration of post-operative urinary drainage was 5.5 days (range: 4 - 6 days) for patients who underwent TURP, TURB and endoscopic resection of secondary sclerosis of the bladder neck. The mean duration of drainage after endoscopic internal ureterotomy was 21.6 days (range 14 - 30 days). Of the 157 endoscopies performed, 154 patients (98.08%) had a favourable outcome, with adenomyofibroma of the prostate being the most common histological type (52.17%, n = 36). Mortality was 1.27% (n = 2) in our series. Conclusion: Endo urology should be the urologist’s first choice for both exploration and surgery, given the satisfactory results.

Torsion of the Spermatic Cord in Adults: Epidemiological, Diagnostic and Therapeutic Aspects Observed in 46 Patients at the Bouake Teaching Hospital

Introduction: Torsion of the spermatic cord (TSC) is a serious surgical emergency because it is responsible for acute ischemia that can lead to the loss of the testicle. Very few studies have been carried out in C?te d’Ivoire and particularly in Bouaké, on torsion of the testicle. The general objective of this work was to describe the epidemiological, diagnostic and therapeutic aspects of testicular torsion in our context. Materials and Methods: This is a retrospective study on 46 patients received urgently at the Teaching Hospital of Bouaké over a period of nine (9) years from December 01, 2010 to November 30, 2019 for torsion of the spermatic cord in adults. Results: The mean age of patients was 26.6 years with extremes of 17 to 41 years. 33 patients were seen before the sixth hour and 13 beyond. Scrotal pain, swelling of the hemibursa and testicular ascent were the dominant physical signs. Orchiectomy + contralateral testicular fixation was performed in 11 patients (23.9%). The average length of hospital stay was three (3) days. The immediate post-operative follow-up was simple. Late complications were marked by two testicular atrophy. Conclusion: Our series was marked by a high rate of orchiectomy. Actions to raise caregivers’ awareness of the population must be carried out so that they consult quickly in front of any painful stock market board to avoid the delay in diagnosis and management detrimental to the vitality of the torsional testicle.

Post-Operative Complications of Transvesical Prostatic Adenomectomy at Bouake Teaching Hospital: Epidemiological, Diagnostic and Therapeutic Aspects

Introduction: The treatment of benign prostatic hyperplasia (BPH) responds to a medical aspect at first, the effectiveness of which is indisputable. However, the curative treatment is surgery. Trans-urethral resection of the prostate (TURP) represents the reference surgical technique when the technical platform is correct. In Bouaké, the FREYER HRYNTCHACK trans vesical approach is the technique used in our department. It sometimes leads to complications that can be life-threatening. The general objective of this work was to describe the morbidity and mortality of trans-bladder adenomectomy and their management at the Bouaké University Hospital. Material and Methods: This is a retrospective descriptive study carried out at the Bouaké Teaching Hospital over a period of 5 years from January 2016 to December 2022. It involved 150 patients operated on for BPH by the trans vesical route and who experienced postoperative complications. The parameters studied were age, postoperative complications, treatment, and mortality. Results: The mean age of the patients was 67.2 ± 7.37 years. Hemorrhage was the main immediate complication. Parietal suppuration, in 48% of cases, was the most common secondary complication, followed by vesicocutaneous fistula (18%), orchiepididymitis (15.33%) and urinary leakage (3.33). Late complications were: retrograde ejaculation in 73.33%, urethral stricture (10.66%) and sclerosis of the compartment (6.66%). Mortality was 1.33%. Conclusion: Post-operative complications of adenomectomies according to Freyer Hrynstchak remain dominated by infections. However, postoperative hemorrhage remains the surgeon’s fear because it can cause the death of the patient.

Urogenital Trauma by Pelvic Impalement: A Case Reported at Bouake University Hospital

Urogenital impalement trauma is a particular form of penetrating trauma to the pelvis. They are rare, spectacular or dramatic because they can be responsible for serious vascular and/or visceral lesions. This study reports a case of hypogastric impalement in a 19-year-old young man that caused musculoaponeurotic and urogenital lesions. Emergency surgical exploration was carried out urgently by a multidisciplinary team.

Endoscopic Management of Secondary Sclerosis of the Bladder Neck in Bouaké: Our Experience with 23 Cases

Background: Secondary sclerosis of the bladder neck is a rare but serious late complication that occurs after open or endoscopic prostatic adenomectomy. Objective: The aim of this study was to report the results of endoscopic management of secondary sclerosis of the bladder neck in a series of 23 cases. Patients and Methods: Cross-sectional study of 23 patients presenting with secondary sclerosis of the bladder neck following adenomectomy and treated by endoscopic resection of the bladder neck in a private facility in Bouaké (Ivory Coast) over the period from 1 January 2021 to 1 December 2022, i.e. 2 years. The mean age of the patients was 61, 7 years with extremes from 53 to 76 years. The diagnosis of secondary sclerosis of the cervix was based on clinical and radiological data (retrograde uretrocystography). The parameters studied were the reason for consultation, time to onset of signs after adenomectomy, clinical data, results of retrograde uretrocystography (RUC), results of urine cytobacteriological examination (UCT), complications, endoscopic procedure, duration of operation, duration of postoperative urinary drainage, duration of hospitalization, postoperative follow-up and operative morbidity and mortality. Results: 23 patients with secondary sclerosis of the bladder neck were treated by endoscopic neck resection. The mean age of the patients was 61.7 years (5 - 76 years). Dysuria was the most frequent reason for consultation, accounting for 73.9% (n = 17). Retrograde uretrocystography (RUC) was used to make the diagnosis in all patients. It found a steam jet image in 69.6% (n = 16) and tight stenosis of the bladder neck in 30.4% (n = 7). Secondary stenosis of the bladder neck was complicated by uretrohydronephrosis in 47.8% (n = 11). 73.9% of patients had a post-micturition residual of more than 150 ml. The urine cytobacteriological examination (UCE) found four urinary tract infections (17.4%) treated with antibiotics over 14 days, which sterilised the urine. The pathologies associated with cervical sclerosis were urethral stricture (13%) treated by endoscopic internal urethrotomy, and urinary lithiasis (8.7%) (n = 2). The mean duration of the operation was 53 minutes (43 - 60 min), the mean duration of postoperative urinary drainage was 3 days (2 - 6 days), and the mean duration of hospitalization was 5.4 days (3 - 6 days). Follow-up at 3 and 6 months using retrograde uretrocystography (RUC) showed good permeability of the neck and urethra with a post-void residual of less than 20 ml (10 - 36 ml). There was no morbidity. Conclusion: Secondary sclerosis of the bladder neck is a late but serious condition because of its obstructive and recurrent nature.

Delayed Diagnosis of Isolated Traumatic Rupture of Bladder

Traumatic ruptures of the bladder are relatively rare lesions. They are associated in more than 80% of cases with a fracture of the pelvic girdle. The lesion mechanism is usually a sudden compression on the full bladder. Hypogastric pain and macroscopic hematuria suggest the diagnosis, which is confirmed by cystography. This diagnosis can be difficult and delayed in the absence of these call signs. We report a case of isolated traumatic intraperitoneal rupture of the bladder, diagnosed 24 hours after a public road accident in a 44-year-old patient.