Men Urethra Strictures: Findings in Urethroplasties Care at the Andrology and Urology Department of Grand Yoff General Hospital in Dakar

Objectives: To report the experiment conducted at the HOGGY Urology department in the management of urethral stricture by urethroplasty, and to determine the factors that influence the results. Material and Method: We conducted a descriptive and analytical retrospective study based on the records of patients who underwent urethroplasty in the department, between February 2001 and September 2013. Results: Ninety-one (91) patients were enrolled. Urethroplasties prevalence was 0.83% of the surgical activity of the service. The mean age of patients was 39.83 years. Dysuria (30.77%) followed by pelvic trauma (28.57%) and urinary retentions (25.27%) was the main discovery mode. A periurethral coating was found in 32 patients. The infectious etiology accounted for 44% of cases. In 63% of cases, diagnostic was made by retrograde cystography. The penile urethra was the favorite seat of the UR in 70% of cases. The average length of the urethral stricture (US) was less than 1 cm in 41.17% of cases. The US was unique in more than half of the cases (58.33%). Anastomotic urethroplasty was the best surgical technique with 73.63% of patients. Postoperative morbidity involved 47 patients and was dominated by urinary infections (36 year old). The average duration of follow-up of operated patients was 29 months. After 6 months of follow-up, the best results were obtained with the termino-terminal urethroplasty technique with 62.5%. After a follow-up of 4 years, the success rate was 58.24%. The length of the stenosis and the allocation of gestures on the urethra were the two factors of failure. Conclusion: Stenosis is common in our regions. Treatment results are disappointing. Urethroplasty is the gold standard of surgical treatment and anastomotic urethroplasty gives better results.

Upper Urinary Tract Calculi in Senegal: A Comparative Study between Open Surgery and Endoscopy, a Review of 89 Cases

Objective: The aim was to assess the place of endourologic intervention in our practice and compare it to open surgery in the management of upper urinary tract calculi in Senegal. Patients and Methods: This was a retrospective study conducted at both the Principal and Grand Yoff Hospitals of Dakar from January 2009 to December 2013 in which 89 patients with upper urinary tract calculi were mobilized. All patients with symptomatic upper urinary tract colic symptoms were included. Results: Eighty-nine were followed up during the study period, 63 men and 36 women (sex of ratio 1.2). The average age was 44 years with extremes 22 - 75 years. Forty two patients, including 28 men and 14 women (sex ratio 1: 2) were treated with open surgery. The mean age was 42.75 years (4 - 75 years). The average duration of hospitalization after open surgery was 8 days (4 - 60 days). The mean stone size in open surgery was 23 mm (5 mm - 45 mm). Complications noted were: 2 cases of urinomas (4.76%), 1 case of lower back fistula (2.38%), 1 case of renal pelvis fistula (2.38%) and 1 case (2.38%) of infection. Forty seven patients including 35 men (55.6%) and 12 women (46.2%) were treated by endourology. The average length of hospital stay was 2 days (2 d - 3 d). The average stone size treated by endourology was 13 mm (5 mm - 40 mm). No complications were observed in this group. The cost of open surgery was a third of that of endourology. Conclusion: Endoscopic surgery, as is observed from industrialized countries occupies a prominent place in the treatment of upper urinary tract calculi in Senegal;however, the only limiting factor encountered is the cost which remains out of reach for patients and burdening the budgets of our hospitals with limited means.

Advanced Bladder Cancer in Senegal: Epidemiological and Clinical Aspects

Advanced bladder cancer remains particularly frequent in our practice. Aim: To evaluate the proportion of advanced bladder cancer at diagnosis and to describe the characterisitics at diagnosis. Materials and methods: We conducted a descriptive and retrospective study assessing 97 cases of advanced bladder cancer over a period of 10 years (January 2002 to January 2012) at the department of Urology of H?pital Principal de Dakar and H?pital Général de Grand Yoff. We included the records of all patients with a pathologic confirmation of locally advanced bladder cancer (T3, T4) and/or a visceral or lymph node metastasis. Results: Mean age was 47 years (Range: 25 - 80 years). The cohort comprised 69 men and 28 women with a sex ratio of 2.46. The reasons for referral were a hematuria (60.82%), pelvic mass (19.2%), irritative urinary symptoms (8.2%). Reported medical histories were: urinary schistosomiasis (13 patients), tobaccoo(10 patients), recurrent cystitis (8 patients). Indications of local extention were: inguinal lymph nodes (6 patients), tumoral hepatomegaly (5 patients), bone pain (15 patients). A cystoscopy was performed in 64.95% of patients in a mean time of 2.5 months. A Trans Urethral Resection of Bladder Tumour (TURBT) was performed in 77 patients with a mean time from referral of 4 months. Pathologic examination showed squamous cell carcinoma (42%), urothelial carcinoma (28%) and adenocarcinoma (9%). Thoraco-abdomino pelvic CT scan showed a loco regional extension in 18 patients, extension to the peri vesical fat in 3 patients and metastasis in 25 patients. Conclusion: Delayed diagnosis of bladder cancer is still common in Africa with a high mortality rate. A better management requires an improvement of the equipment in the hospital with an emphasis on the access to endoscopy allowing for an early diagnosis.