Metastatic Prostate Cancer under Androgen Deprivation Therapy: Factors Influencing Castration Resistance

Objective: To evaluate the factors predicting the time to progression to castration-resistant in metastatic prostate cancer under Androgen Deprivation Therapy (ADT) in our center. Patients and Methods: This is a retrospective, descriptive, analytical study in a single center over a period of 2 years. It has interest patients followed for metastasized prostate cancer under ADT. The parameters studied were: epidemiological, clinical, paraclinical, prostate specific antigen (PSA) nadir, time to nadir (TTN) and their link with the castration resistance. Results: The frequency of castration resistant prostate cancer was 28 patients per year. The mean age was 70.4 ± 7.9 years. An ECOG score ≥ 3 was more common as was the cT2c stage. The median of the initial total PSA was 489.6 ng/ml (203.3;1653.2). All patients had adenocarcinoma. The International Society of Urological Pathology (ISUP) 1 was more frequent. Bone metastases were more frequent. The medians of nadir, TTN and the castration resistance were 19.3 ng/ml (3.7;102.1), 5.5 months (3;9) and 11 months (6;15.3), respectively. The Eastern Cooperative Oncology Group (ECOG) score, clinical stage, metastatic site, the nadir and its TTN influenced the DSR. Age, lymph node involvement, initial total PSA and Gleason score did not influence the castration resistance. Conclusion: ADT should be initiated as soon as possible before an attack of general and/or clinical stage advanced to delay resistance. A drilling should be associated with this hormone therapy as much as possible because of its gain on resistance.

Hypospadias: Evaluation of Therapeutic Outcomes and Sexual Function in Adulthood in a University Hospital Setting

Background: Hypospadias is a congenital malformation resulting from hypoplasia of the tissues forming the ventral face of the penis. It is associated to variable degrees with an ectopic urethral meatus, a penis curvature and a sapper’s apron foreskin [1]. The incidence of this malformation varies from country to country. It is estimated at 1/300 male births in France and 0.26/ 1000 in Mexico [1]. In Senegal, the prevalence of this malformation is unknown. Hypospadias surgery has improved significantly in recent years due to a better understanding of the anatomy on the one hand and the improvement of the instruments used during surgery on the other (suture material, surgical magnification, urethral catheter of suitable size). In sub-Saharan Africa and particularly in Senegal, hypospadias surgery remains a challenge due to the unavailability of adequate equipment (lack of microsurgical instruments and surgical loupes). Objective: To evaluate the outcomes of the treatment of hypospadias by the different surgical techniques used in our center as well as their sexual function in adulthood. Patients and Methods: This is a retrospective study, including all patients operated for hypospadias between January 2009 and December 2017 in Urology-Andrology department of Aristide Le Dantec hospital. The studied parameters were: frequency, age, clinical and therapeutic aspects, and their sexual function in adulthood after treatment. The outcomes of the treatment were judged good or poor depending of the quality of penile straightening, the aesthetic appearance of the penis, the position of the urethral neo-meatus, the permeability of the urethra and the existence or not of fistula. The sexual function was assessed by the International Index of Erectile Function 15 (IIEF) score. Results: Fifty-five patients were included. The median age was 6 years (P25 = 2.8 and P75 = 13 years). After a mean follow-up of 58 ± 33 months, 81.8% (45) of patients had a good outcome. Duplay-Snodgrass urethroplasty was the most commonly used urethroplasty technique with better results. Complications were noted in 29 patients. The most common were urethral fistula, surgical site infection and urethral neo-meatus stenosis. The sexual function was rated good in one patient and average in the other two (after an average decline of 53 ± 26 months). Conclusion: Urethroplasty according to Duplay Snodgrass was the most used technique in our studies and its outcomes were better compared to the other techniques used.

Diagnostic Rigid Urethrocystoscopy: Indications, Results and Pain Assessment

Background: Over the last 50 years, endourology has revolutionized urological practices worldwide. This is not so in many urological centers in West Africa. Although, some centers have made progress in the level of urological services that they offer;many of such centers provide rigid urethrocystoscopy services. Rigid urethrocystoscopy is an endoscopic examination that explores the urethra, bladder and prostate in men. Aims: We report the indications, results and pain assessment of rigid urethrocystoscopy in our center. Patients and Methods: We carried out a retrospective, descriptive, monocentric study in our center between January 2016 and June 2018. The study included all patients who had a rigid urethrocystoscopy under local anaesthesia. We studied the following parameters: sex, age, indications for the examination, outcomes and the pain assessment. Results: Five hundred and forty-one patients were included. The sex-ratio was 1.49. The mean age was 49.47 ± 18.48 years (12 years and 91 years). Lower urinary tract symptoms (29%) and hematuria (28%) were the most common indications. The rigid urethrocystoscopy was normal in 26.8% of patients. Bladder tumors (21.2%) were the most frequent lesions. In men, prostate tumors were more common (21%) followed by bladder tumors (17.9%), while in women, bladder tumors (26.3%) were predominant followed by cystopathy lesions (12.4%).The mean Simple Verbal Scale (SVS) score was 1.25 in women and 2.1 in men. Conclusion: Rigid urethrocystoscopy was relatively well tolerated by our patients. Hematuria was the primary indication and the main etiologies were bladder and prostate tumors.