Risk Factors for Urinary Incontinence after Obstetric Vesicovaginal Fistula Closure in Guinea

Introduction: Urinary incontinence after closure of vesicovaginal fistula is any involuntary loss of urine that a patient complains of. We aim to study the risk factors for urinary incontinence after closure of obstetric vesicovaginal fistula in Guinea in order to develop preventive measures to reduce its incidence. Materials and Methods: This was a retrospective, multiple center cohort of women operated on for obstetric vesicovaginal fistula during a 10-year period. Results: In 1770 vesicovaginal fistulas operated, 1347 were closed. 180 women (13.36%) developed urinary incontinence. After multivariate analysis, the risk factors of urinary incontinence after closure of vesicovaginal fistula were: the patient’s age, the anatomical type III, iterative surgical intervention, the brevity of the urethra and decrease in bladder capacity. Conclusion: Urinary incontinence after closure of vesicovaginal fistula is a frequent problem in Guinea, the prevention of which should be integrated into the management of fistulas.

Corticosurrenaloma: About a Pediatric Case

Introduction: This study aims to describe the outcome of adrenocortical cancer in children through observation. Observation: A 10-year-old girl with no previous pathological history. She presented headaches and severe hypertension with clinical and biological signs of hyperandrogenism for 6 months. An abdominal CT scan showed an encapsulated left adrenal mass without local or regional invasion or secondary location. A pheochromocytoma or adrenal neuroblastoma was first suspected. The blood pressure was stable at 130/65 mmHg under antihypertensive drugs. She underwent a complete tumor resection without any intraoperative incident. The pathologic study confirmed the adrenocortical carcinoma scored Weiss 7. The severe high blood pressure reappeared 2-year later despite antihypertensive drugs. The thoracic abdominal and pelvic CT scan showed a locally advanced tumor recurrence in the left adrenal gland with parenchymal nodes in the lungs and liver. The outcome was fatal despite medical and surgical management. Conclusion: Adrenocortical cancer is a rare tumor. It is important to hormonal testing in the presence of Cushing’s syndrome in children. It can give a strong indication of the diagnostic possibilities. Histology confirms the diagnosis. The evolution is covered by complications, in particular recurrence with life-threatening metastases.

Place of Total Self-Skin Transplant in the Management of Burns in Children: Results and Predictive Factors

Introduction: Skin transplant is essential in the management of skin substance losses, especially in deep burns. Our work aims to present, through a series of cases, the results of the skin self-transplant carried out to supplement the treatment of skin burns. Materials and Methods: A one-year prospective study of the total self-skin transplant performed in the management of burns in children was included. After clinic and biologic considerations, a total self-skin transplant was performed. Results: Forty-five burns were hospitalized, of which six patients received a total self-skin transplant. The average age was 7.43 years with male predominance. The burns were deep thermal burns, preferentially located on the trunk and upper limbs covering over 10% - 25% of the body surface of which 3% - 13% was transplanted. Transplant held in all patients. The surfaces left in spontaneous healing took at least 6 months to heal with some complications. Discussion: We performed a total self-skin transplant beyond technical reasons, for the best aesthetic and functional result it offers. The transplant significantly reduced the healing time with better aesthetic and functional results. The burned surfaces left to direct healing took an average of 6 months to heal and there were associated complications such as formation of keloid scars, hypertrophic plaques and skin retractions leading to cosmetic deformities. The final results appear to be independent of the time required to complete the transplant, and it will be necessary to ensure that there is no local and systemic infection and anaemia. Conclusion: Total self-skin grafting still has its place in the initial management of burns in children. It offers good aesthetic and functional results.