Severe Coital Accident: A Rare Case of Simultaneous Fracture of the Penis and a Complete Urethral Rupture at the University Hospital of Bouake

Cavernous body fracture is a rare urological emergency. Its association with complete rupture of the urethra remains exceptional. This is a report of simultaneous penile fracture and complete rupture of the urethra following a misstep in coitus. It is about a 41-year-old young adult, admitted to the surgical emergency department of the University Hospital of Bouaké on March 2, 2020 for penile pain associated with acute retention of urine. The clinical examination confirmed the diagnosis of a corpus cavernosa fracture associated with a ruptured urethra. The patient underwent cystostomy, right cavernoraphy and urethrorrhaphy. The postoperative follow-up was straightforward and the patient was discharged from the hospital on D3 postoperatively. The urethral catheter was removed on D21 postoperatively. With a follow-up of 1 year, the patient presents a good erection and does not report any voiding disorder.

Taumatic Emergencies of the External Genital Organs

Background: The traumas of scrotum are often traumas caused by accidents on the public highway or in sport. However, fractures of the penis are secondary to a direct trauma to the penis with rupture of the albuginea causing hematoma, pain and deviation of the penis. Animal bites are rare. Purpose: To describe the management of traumatic emergencies of the external genital organs at the CHU Bouaké. Patients and Methods: Retrospective and descriptive study on the patients treated at Bouaké University Hospital for traumatic emergencies of the external genital organs during the period from January 01, 2012 to December 31, 2018. The parameters studied were epidemiological, clinical and therapeutic. Results: The study period registered 26 patients. The mean age was 34.5 years, Closed trauma to the scrotum was a frequent reason with 30.8%, the trauma sat on the scrotum in 53.8%, the penis in 42.3%, the vulva in 3.8% of cases. The circumstances of discovery of trauma to the penis were dominated by coitus missteps (45.5%), on the stock exchange and vulva by accidents on the public highway (60.8%). Scrotal swelling was the frequent clinical sign (26.9%). Treatment was dominated by surgery in 92.30%. Seven patients (29.16%) underwent exploratory scrototomy associated with hematoma evacuation, five patients (20.83%), a simple trimming, five patients (20.83%), an evacuation of the hematoma associated with a cavernous suture, one patient (4.16%), a trimming associated with a suture of the vulva, one patient (4.16%), a trimming associated with a right orchiectomy. The hospital stay was less than 5 days. The course was simple in 92.30% of the cases;two patients (7.7%) had complications such as testicular necrosis and atrophy which have been treated by orchidectomy. Conclusion: Traumatic emergencies of the external genitalia are rare but serious. Treatment is dominated by surgery.

Endoscopic Internal Urethrotomy (EIU) for the Treatment of Ureteral Stenosis: A Review of 233 Cases

Background: Urethral stricture is a not uncommon pathology consisting of the narrowing of the urethra lumen with consequent reduction or cessation of urine flow. Objective: The objective is to retrospectively evaluate the results of treatment of urethral strictures by endoscopic internal urethrotomy in a series of 233 cases. Patients and Methods: It is Retrospective and descriptive study of 233 cases of urethral strictures treated by endoscopic internal urethrotomy under visual control in a private facility in Abidjan (Ivory Coast) over the period from 1 December 2007 to 31 December 2017. The study parameters were epidemiological, etiological, characteristics of the narrowing and the outcome of the treatment according to the predictive elements. Results: 233 patients were treated with endoscopic internal urethrotomy (EIU). All patients were male. The mean age of the patients was 49 years with extremes from 17 to 84 years. Dysuria (55.79%) was the most frequent reason for consultation: the etiologies were infectious (51.50%), traumatic (32.18%), and iatrogenic (13.73%) and not found (2.57%). Retrograde urethrocystography with fictional films performed in all patients showed the following characteristics: the stricture was bulbar (81.04%), unique (55.79%) and short in 68.6%. There was a 39.91% good outcome after the first EUS. The average follow-up was 3 years. Mortality was nil and morbidity was assessed at 4.72%. The result was better when the procedure concerned a short (≤3 cm), single stenosis on the posterior urethra. The average duration of the postoperative urinary catheter was 14 days on average. The poor results (60.08%) were observed in cases of long stenosis, located on the anterior urethra or concerning elderly patients. 69.28% were cured after a second urethrotomy;the remaining cases were managed by urethroplasty or urethral dilatation. Conclusion: IEU is a simple, reproducible and attractive procedure with an overall success rate of 81.54% in 3 years. Its indication must be made in the case of short stenosis, single posterior and in the young subject.