Epidemiological, Clinical and Management of Benign Prostatic Hypertrophia in Urologie Department in N’Djamena, Chad

Aim: To determine the epidemiological, clinical, paraclinical characteristics and assess the result of surgical treatment of benign prostatic hyperplasia (BPH) in the urological department. Patients and Method: It is a retrospective descriptive study of 757 patient samples whose BPH diagnosis was pronounced and have benefited of the open surgery in urology department from January 2006 to December 2010. The variables studied were sociodemographical, clinical, paraclinical, therapeutical and the follow up. Those variables were: arterial tension, sonography, consultation reasons and hospitalization, the data provided rectal touch, the comorbidity, the prostatic specific antigen (PSA), other blood tests, urinary tests, medical management surgical treatment, the causes of death and the complications. Results: during the study period, 2406 patients were hospitalized, from them 1472 (61.18%) for low urinary tract diseases where 757 for BPH. The mean age was 64.18 years. The acute urine retention was the main cause of hospitalizations and consultations (51.51%). The rectal touch Helped in diagnosing 96.43% of cases. PSA in 74.10%, the sonography evaluated the volume of the prostate and the complications on the upper urinary tract, kidney dilatation and stones. An urgent evacuation of acute retention of urine in the bladder was done in 74.10%, a medical treatment was done in 33.47%. The open surgery was done in 66.47%. The evolution was good for 703 (92.86%), 54 died (7.14%) and the causes were various (anemia, hyperglycemia, HIV…). Conclusion: The BHP was the first reason of consultation and hospitalization in urology department in N’Djamena. Its diagnosis was done after the analysis of a beam clinical and paraclinical arguments. In the absence of an endoscopic resection column, open surgery was the only surgical treatment.

Etiology and Management of Complete Acute Urinary Retention in Urology Department in N’Djamena, Chad

Goal: To study the epidemiological, clinical, etiological, characteristics and ensure earlier management of complete acute urine retention (CAUR) in the urology department of N’Djamena in Chad. Patient and Method: It was a retrospective descriptive study of a sample of 606 patients during the period ranging from November 2008 to December 2010. The patients were consulted first in urology or referred by a colleague for a CAUR. The diagnosis was confirmed by an earlier clinical examination. The patients have benefited from a urine evacuation before looking for the etiologies. Results: We managed a sample of 606 patients suffering from CAUR. Average age was 60 years old with extremes of 1 month and 100 years. There were more patients in the ranks of 60 years and more (n = 436;71.94%). Men were more than women in the proportion of 583/25, and 63.20% of the patients lived In N’Djamena. The benign prostatic hypertrophia was the first cause of CAUR, followed by urethral stricture, urinary infection, lithiasis of the lower urinary tract, adenocarcinoma of the bladder, hymen imperforation in young girls, bilharzias, paraphimosis and ovenbird necrosis. The bladder catheterization was the most urgent gesture done in 61.71%, followed by open cystostomy. In the second case, etiological treatment was done as: open prostatic surgery (n = 306), urethral reconstitution (n = 58), cystololithotomia (n = 54), dilatation of urethral conduct (n = 54), hymenostomia (n = 6). Conclusion: CAUR was the first symptom which motivated the consultation in the department of urology in N’Djamena the main problem of public health in Chad.

Diagnosing and Managing Androgen Insensitivity Syndrome

Introduction: Androgen insensitivity syndrome is a rare congenital abnormality of genital organs revealing a female phenotype in a person with XY chromosomes. The aim of our work is to describe the clinical aspects, to determine the chromosomal sex and to report our therapeutic management. Observation: A 28-year-old woman with female phenotype, feminine voice, normal breast development, normal underarms and pubic hair, absence of menstruation, fusion of small and large vaginal lips leaving a small pertuis to serve as urethral meatus. On the dorsal surface of the large, left lip was a mass the size of a date. Hormonal balance was normal. A feminizing genitoplasty was performed as well as excision of the mass. Histological analysis of the mass concluded that it was a feminizing testicular. Conclusion: Androgen insensitivity syndrome is a rare abnormality of the genitals. Multidisciplinary management is essential both for the designation of the breeding sex and feminizing genitoplasty.

Diagnostic Approach and Management of a Unilateral Total Ectopy of the Scrotum

Introduction: Total unilateral ectopy of the scrotum can be defined by the abnormal congenital anatomical position of the scrotum and its contents. The aim of the study is to describe the diagnostic and therapeutic approach of a total unilateral ectopy of the right scrotum. Methods: This is a clinical observation of a 46-year-old patient with a right abdominal mass evolving from birth. Analyzing the cluster of arguments clinically, operatively and anatomopathologically, allowed us to retain the diagnosis of a total unilateral ectopy of the right scrotum. The informed consent of the patient was obtained before the use of the images for scientific purposes. Conclusion: the unilateral total ectopy of the right scrotum is a rare congenital malformation of the external genitalia, which clinical diagnosis is difficult. Its management is surgical.

Symptomatic Pelvic Kidney in Women at Childbearing Potential: Diagnostic Difficulties and Management in Urology Department of N’Djamena in Chad

Introduction: We aim to report, from three observations, the diagnostic difficulties and complications, and ensure the management of pelvic kidney in women at childbearing age in the Urology Department of the National General Referral Hospital of N’Djamena. Pelvic kidney is due to an abnormality of the migration that can be associated or not with a malrotation. Its symptomatology is not specific, causing diagnostic difficulties and therapeutic errors. Observation: There were three observations of female patients aged respectively 26, 29 and 32 years who were taken care of for years in the gynecology department for pelvic inflammatory disease before being routed in urology. The diagnosis of pelvic kidney was retained on the basis of morphological examination (ultrasound, intravenous urography, CT urography). The patients have undergone nephrectomy;the postoperative aftermath was simple. Conclusion: Pelvic kidney is a rare disease. It is often discovered during autopsy. Symptoms are non-specific;nephrectomy is the treatment of choice in symptomatic cases.

Clinical, Paraclinical and Therapeutic Aspects of Chronic Prostatitis

Aim: Present the clinical and paraclinical aspects of chronic prostatitis and report the management in urology. Methods: We conducted a retrospective descriptive study of 47 patients referred to the urology department from January 2011 to December 2013. Analysed variables were epidemiological (age, marital status, place of residence, occupation, education level, taking stimulants), clinical, paraclinical (CBU, chlamydia, syphilis and HIV serologies, urine culture susceptibility testing, semen analysis, ultrasound of urinary tree, radiographs, RCU, IVU), treatment and results. Results: The mean age was 44.6 years. The main reasons for consultation were dysuria (55.3%), prostatorrhea (29.8%) and sexual asthenia (12.8%). The general condition was satisfactory (80.9%). Purulent drop was objectified in the urethral meatus in 10.6% of cases, and the DRE was painful at 44.68%. Escherichia coli was the main isolated germ (23.4%). In 55.3%, calcification of the prostatic area was objectified to ultrasound of the urinary tract. The RCU had objectified bilharzia in 8.5% of calcifications of the bladder area and 19.14% of urethral stricture. The medical treatment was completed in all patients according to the etiology and complications by an instrumental or surgical treatment, offline or emergency. The outcome was favorable in 25 patients. Symptoms were improved in 12 others and a failure for the ten remaining. Conclusion: Chronic prostatitis is relatively frequent in urology. Clinical manifestations are diverse and varied. Treatment is difficult with a significant failure rate.