Surgical Treatment of Upper Urinary Tract Lithiasis in Conakry

Introduction: The management of urinary lithiasis in our settings has long been conventional surgery. The recent introduction of endoscopy of the upper urinary tract represents a major advance in our department. The aim was to contribute to the study of the treatment of lithiasis of the upper urinary tract in Conakry and to report on our initial experience of ureteroscopy in Conakry. Methodology: This is a prospective descriptive study lasting one year, from January 1 to December 31, 2022, carried out at the Urology Department of the Ignace Deen National Hospital and at the PERCHIN Urological Clinic. The study included all patients treated surgically for lithiasis of the upper urinary tract who met the selection criteria. Results: The study included 57 patients. The mean age was 30 years, with extremes of 20 and 73 years;the most represented age group was 31 to 40 years, followed by 20 to 30 years with 29.9% and 26.3% respectively. Males predominated in 36 cases (63.15%), with a M/F sex ratio of 1.71. Left-sided renal colic was the most common, at 75.43% (n=43), and right-sided renal colic at 40.35%, associated with digestive signs at 43.85%. 77.19% had normal creatinine levels before surgery, versus 22.81% with elevated creatinine levels, i.e. 15.78% improvement in renal function after surgery. Urinary tract infection was found in 47.36%, and Escherichia coli in 31.57%, followed by staphylococcus aureus in 8.77%. Overall, 82.45% of patients had organic damage to the kidneys or ureters. Right ureterohydronephrosis was noted in 56.14%, followed by left hydronephrosis in 26.32%. Open surgery was predominant in 52.63% of cases, with endoscopic surgery (URS) accounting for a significant 47.36% during the study period. The endoscopic treatment used was laser ureteroscopy. In our study, 73.68% underwent drainage of the upper excretory tract, including 64.91% with a JJ catheter. The average length of stay was 07 days, with extremes of 02 and 28 days, and 81.4% of patients who underwent URS had a length of stay of less than 4 days. Conventional surgery had the highest complication rate (14.28%). The stone free rate for the two surgical treatment methods (open and endoscopic surgery) was 73% and 92.59%.

Profile of the Infertile Man at the University Hospital of Conakry (Guinea)

Introduction: Male infertility is defined as the inability of a man to impregnate a woman after 12 months of regular sexual intercourse without contraception. Objective: To improve the state of knowledge on the profile of the infertile man in Guinea. Methodology: We conducted a prospective, descriptive study over a period of 6 months from October 1st, 2020 to March 31st, 2021. Results: We collected an overall number of 71 patients seen onroutine consultation for infertility. They had a mean age of 36.4 years. More than half of our patients were monogamous (79% of cases). Civil servants were the most affected with 38.02% of cases. Primary infertility was dominant in 65% (n = 46) of cases. On clinical examination, varicocele was the most remarkable abnormality with 88.73% (n = 63) followed by testicular hypotrophy with 59.15% (n = 42). Azoospermia was the most frequent sperm abnormality with 22.54% (n = 16) followed by oligospermia with 15.49% (n = 11). Hormonal assessment based on FSH and LH was performed in 16 patients with azoospermia (22.53%). FSH elevation was associated with azoospermia in 6 patients, i.e. 8.45%, azoospermia associated with a normal FSH level accounting for 14.08% in our series. Conclusion: In our practice, male infertility is becoming more and more of a concern due to the increasing number of patients seeking treatment. The scarcity of a medical assistance for procreation unit alongside with more efficient diagnostic means constitutes a handicap for its management.

Urethrocystoscopy: Indications and Results in the Urology Department of the Ignace Deen National Hospital in Conakry

Introduction: Urethrocystoscopy is an examination of choice in the assessment of voiding disorders and especially macroscopic hematuria. The objective of this study was to analyze the indications and results of urethrocystoscopy in the urology department of the Ignace Deen National Hospital in Conakry. Material and Methods: We carried out a prospective descriptive study over 6 months, from 1st June to 30th November 2022, which included all patients who underwent urethrocystoscopy in the Urology Department of the Ignace Deen National Hospital in Conakry. We studied the following parameters: sex, age, indications and results of the examination, and complications. Results: 77 patients were included. The average age was 56.5 ± 19.5 years with extremes of [15 to 88 years]. The sex ratio was 2.9. Hematuria (50.7%) and lower urinary tract symptoms (32.4%) were the most frequent indications. Cystocystoscopy was normal in 14.3% of patients. Bladder tumors (29.9%) and prostatic hypertrophy (18.2%) were the most found lesions. Conclusion: Rigid urethrocystoscopy occupies an important place in the exploration of hematuria and lower urinary tract symptoms in our department. Bladder tumors and prostatic hypertrophy were the main lesions observed.

Post-Operative Mortality Analysis in the Urology Department of Conakry University Hospital

Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure operates with limited resources and more than half of the population lives below the poverty line. The objective of this study was to determine the frequency of post-operative mortality, to describe the main comorbidity factors responsible for this mortality and to identify the main cause of post-operative death in the urology department of the Ignace Deen National Hospital Material and Method: This was a retrospective descriptive study lasting 5 years from January 1, 2015 to December 31, 2019. It had focussed on all the files of patients operated on at the Urology Department of the Ignace Deen National Hospital, either in an emergency or planned and who died in per or post-operative immediately or 30 days later. Results: We recorded 63 cases of post-operative death, or a frequency of 1.84%. The average age was 61.92 ± 16.91 with the extremes of 12 and 91 years. Bladder (20.63%) and prostate tumours (60.3%) were the main admission diagnoses. High blood pressure was the main comorbidity factor found with 38.09% of cases followed by diabetes with 12.69%. Transurethral resection of the prostate, transurethral resection of the bladder and prostate adenocomectomy were the most performed surgical procedure with respective proportion of 19.04%, 20.63% and 38.09%. Probable cause of death were anemia in 25 cases (39.68%), septic in 20 cases (31.75%), heart failure in 6 cases (9.52%), pulmonary embolism in 5 cases (7.94%), obstructive renal failure 4 cases (6.35%) and stroke in 3 cases (4.76%). Conclusion: The majority of deaths occurred in patients over the age of fifty. Anaemia was the main cause of deaths. Difficulties in procuring blood products as well as the lack of modern therapeutic means are factors that make it difficult for patients to adequately manage.

Cancer on Testicle Not Descended: Clinical and Therapeutic Aspects of 7 Cases

Objective: To study the clinics and therapeutics of testicular cancer not descended in Senegal. Patients and Methods: This is a retrospective study over a period of 15 years between January 1997 and January 2012. It focused on 07 patients. Results: The average hospital incidence was less than one case per year. The average age of patients was 30.7 years with a median of 28 (range, 21 years and 38 years). The reasons for consultation were dominated by the existence of an abdominal or pelvic mass associated with an emptiness of the stock market. Orchiectomy was the main therapeutic gesture. It was performed by transperitoneal route. CT-TAP was performed in all cases and revealed a tumor independent of the liver of the spleen or kidneys, developed on an undescended testicle. Four cases of lumbar-aortic lymph node metastasis were noted. Histologically, we noted four cases of embryonic carcinoma and three cases of seminoma. Four patients died within six months postoperatively. Two in an intestinal obstruction chart, one in a peritoneal carcinomatosis chart and one patient in a pulmonary embolism chart. Two had a 4-year survival without recurrence. One patient had a 7-year survival without recurrence. At the time of the counting, these three patients were lost sight off. Conclusion: Intra-abdominal or pelvic development of testicular cancer is rare. It constitutes a major subsequent risk of the undescended testicle.