Results of Trans-Urethral Resection of Bladder (TURB) for the Treatment of Non-Infiltrating Bladder Tumors (NMIBT) in Musk in Bouake

Background: bladder tumors rank 2nd among urological tumors in sub-Saharan Africa, particularly in Côte d’Ivoire. Objective: to report the results of transurethral resection of the bladder (TURB) for the treatment of non-muscle-infiltrating bladder tumors (NMIBT) in Bouaké. Patients and methods: we conducted a cross-sectional, descriptive study of transurethral resection of the bladder (TURB) for the treatment of non-muscle-infiltrating bladder tumors (NMIBT) between January 2022 and April 2023. All patients and their families were informed in advance and had signed an informed consent form. All patients with a non-muscle-invasive bladder tumor confirmed by an initial TURB were included, and patients with a bladder tumor infiltrating the bladder muscle were excluded. Diagnosis was based on cystoscopy and anatomopathological examination of resection shavings. Parameters studied were: age, sex, risk factors, reason for consultation, clinical signs, cystoscopy findings, stage, grade, Evolution. Results: 17 patients with a mean age of 53.7 years (22-73 years) underwent trans-ureteral bladder resection to treat a non-muscle-infiltrating bladder tumor (NMIBT). Male gender predominated with 88.23% (n = 15), the majority of patients came from the ME region with 47.05% (n = 8), farmers were the most numerous (52.94%;n = 9). The most frequent reason for consultation was macroscopic hematuria with 64.1% (n = 11), risk factors were dominated by urinary bilharziasis with 70.58% (n = 12), physical examination was normal in 47.05% (n = 8). Hemoglobin (HB) levels were between 7.5 and 8.5 g/dl in 52.94% (n = 9). On cystoscopy, the tumor was budding in 76.45% (n = 13), the localization was trigonal in 52.9% (n = 9) and the base of implantation was sessile in 70.52% (n = 12). On ultrasound, the tumor was 3 cm or larger in 70.52% (n = 12). Therapeutically, 82.35% (n = 14) of patients received a blood transfusion. TURB was complete in the majority of cases 88.23% (n = 15). Squamous cell carcinoma was the most frequent histological type with 76.47% (n = 13). PTa and PT1 grade accounted for 23.52% (n = 4) and 76.47% (n = 13) respectively. High-grade PT1 accounted for 64.70% (n = 11). Follow-up to TURB was straightforward in 94.11% (n = 16). At three months post-TURB, seven patients presented a tumor recurrence, with 41.17% (n = 7) requiring a second TURB. At 6 months, follow-up noted 14 patients free of any clinical or endoscopic signs of bladder tumors. Conclusion: TURB is a safe and effective means of treating non-muscle-invasive bladder tumors.

Transurethral Resection of the Prostate (TRUP) for the Treatment of Benign Prostatic Hyperplasia (BPH) in Central Cote D’Ivoire: Indications and Results

Background: Benign prostatic hyperplasia (BPH) is defined histologically as adenomyofromatous hyperplasia of the transitional zone of the prostate. It remains the most common benign tumour in men over the age of 50, and transurethral resection of the prostate (TURP) remains the surgical treatment of choice. Objectives: To determine the indications and present our results of transurethral resection of the prostate. Patients and Methods: After obtaining approval from the ethics committee of the private hospital and the university hospital of Bouaké (Côte d’Ivoire), we conducted a cross-sectional study of transurethral resection of the prostate (TURP) to treat benign prostatic hyperplasia (BPH) between January 2021 and April 2023. All patients and their families were informed beforehand and had signed an informed consent form. All patients with benign prostatic hyperplasia (BPH) with ultrasound weight of less than 80 grams were included. The following parameters were studied: age, reason for consultation, ultrasound prostate weight of benign prostatic hyperplasia, indication for TURP, duration of operation, blood loss, duration of post-PRT urinary drainage, length of hospital stay, morbidity and mortality, and outcome. Results: 39 patients with a mean age of 58.3 years (57-77 years) underwent transurethral resection of the prostate (TURP). TURP was indicated in 46.15% (n = 18) of cases of refractory acute urinary retention with failure of the urinary catheter removal test, 17.94% (n = 7) of cases of lower urinary tract disorders that were incapacitating despite treatment, 15.38% (n = 6) of cases of refractory or recurrent urinary tract infection, 10.25% (n = 4) of cases of failure of medical treatment and 10.25% (n = 4) of cases of iterative hematuria. The mean duration of TURP was 53.68 min (48-57), the mean weight of the resected prostate was 58.7 g (35 and 83 g), blood loss was minimal in 92.30% (n = 36), the mean duration of irrigation-washing was 2. 5 days (1-3 days), the mean time for urinary catheterisation was 2.45 days (3 and 4 days), 5.12% (n = 2) of patients presented complications such as hemorrhage compensated by a blood transfusion. One patient developed orchiepididymitis (2.56%). The average hospital stay was 3.75 days (3-5 days). Pathological examination was in favour of BPH in 92.3% (n = 36) and the coexistence of BPH and prostate adenocarcinoma in 7.69% (n = 3). The results of TURP were considered good in 94.87% (n = 37). Mortality was nil. Conclusion: In view of our results, TURP is a reliable, elegant minimally invasive technique with low morbidity and mortality.

Practice of Endo-Urology in the Centre of Ivory Coast: Overview and Results

Background: Endoscopic exploration and treatment of urinary tract disorders, whether by retrograde, percutaneous or endoscopic approach, defines endo urology. Objective: To report the results of endo urology practice in Bouaké during the two practice sessions. Patients and Methods: Cross-sectional and descriptive study of patients followed up and had benefited from exploration and/or endoscopic surgery in Bouaké. Our study was carried out in a facility in Bouaké, for two years, from January 2021 to December 2022. The parameters of interest were clinical, diagnostic, endoscopic procedure and results. Results: During the study period, 157 patients underwent endoscopic exploration and/or intervention. The mean age was 58.9 years (range 28 - 90 years). Males predominated with 95.5% (n = 150). Acute urinary retention was the most frequent reason for consultation (55.41%). Benign prostatic hyperplasia (BPH) was the most frequent pathology at 22.92% (n = 36). Urethrocystoscopy was performed in 52 cases (33.12%), Transurethral resection of the prostate (TURP) in 36 cases (22.92%), Endoscopic resection of secondary cervical sclerosis in 23 cases (14.64%), Endoscopic internal urethrotomy (EUI) in 15 cases (9.55%) and Transurethral resection of the bladder (TURB) in 10 cases (6.36%). Post-operative management was straightforward in 93.63% of cases (n = 147). Operative times of between 21 and 35 minutes were more frequent in 55.41% of cases (n = 87). Urinary tract infections accounted for 3.8% (n = 6) of surgical morbidity. The germ responsible for the infections was essentially Escherichia coli (E. coli). The mean duration of post-operative urinary drainage was 5.5 days (range: 4 - 6 days) for patients who underwent TURP, TURB and endoscopic resection of secondary sclerosis of the bladder neck. The mean duration of drainage after endoscopic internal ureterotomy was 21.6 days (range 14 - 30 days). Of the 157 endoscopies performed, 154 patients (98.08%) had a favourable outcome, with adenomyofibroma of the prostate being the most common histological type (52.17%, n = 36). Mortality was 1.27% (n = 2) in our series. Conclusion: Endo urology should be the urologist’s first choice for both exploration and surgery, given the satisfactory results.

Urogenital Trauma by Pelvic Impalement: A Case Reported at Bouake University Hospital

Urogenital impalement trauma is a particular form of penetrating trauma to the pelvis. They are rare, spectacular or dramatic because they can be responsible for serious vascular and/or visceral lesions. This study reports a case of hypogastric impalement in a 19-year-old young man that caused musculoaponeurotic and urogenital lesions. Emergency surgical exploration was carried out urgently by a multidisciplinary team.

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.

Vaginal Cystocele Cure at Bouake University Hospital (Chu): Anatomical and Functional Results

Background: Cystocele is an anatomical form of pelvic organ prolapse. It involves herniation of the bladder through the anterior wall of the vagina. Objectives: To report the anatomical and functional results of vaginal cure of cystocele in five cases. Patients and methods: A cross-sectional descriptive study of five patients presenting with a cystocele between January 2021 and December 2022 at the Urology Department of the Bouaké University Hospital (Côte d’Ivoire). All patients underwent vaginal cure of cystocele. The results of the operation were assessed on the basis of judgment criteria. The parameters studied were: age, marital status, profession, history, reason for consultation and outcome of the operation. Results: During the study period, five patients underwent vaginal cystocele surgery. The mean age was 46.6 years with extremes of 32 and 63 years. Three patients were married. All patients had a history of obstructed labour due to fetal macrosomia. 4 patients had grade II cystocele and one patient had grade III cystocele. All patients underwent anterior colpo-perineorrhaphy. The average operating time was 56 minutes (45 - 65 minutes). There was no morbidity. The average hospital stay was 3.6 days. The average duration of the urinary catheter was 2.2 days. At three months post-op, 4 patients had a good anatomical and functional result with a very good degree of satisfaction, compared with one patient who was moderately satisfied and had an average anatomical and functional result. At six months, all five patients had a good anatomical and functional result with a very good degree of satisfaction. Conclusion: Cure of cystoceles by the vaginal route is a technique that offers several advantages, especially the significant reduction in patient morbidity. Its anatomical and functional results demonstrate its reliability.

Endoscopic Management of Secondary Sclerosis of the Bladder Neck in Bouaké: Our Experience with 23 Cases

Background: Secondary sclerosis of the bladder neck is a rare but serious late complication that occurs after open or endoscopic prostatic adenomectomy. Objective: The aim of this study was to report the results of endoscopic management of secondary sclerosis of the bladder neck in a series of 23 cases. Patients and Methods: Cross-sectional study of 23 patients presenting with secondary sclerosis of the bladder neck following adenomectomy and treated by endoscopic resection of the bladder neck in a private facility in Bouaké (Ivory Coast) over the period from 1 January 2021 to 1 December 2022, i.e. 2 years. The mean age of the patients was 61, 7 years with extremes from 53 to 76 years. The diagnosis of secondary sclerosis of the cervix was based on clinical and radiological data (retrograde uretrocystography). The parameters studied were the reason for consultation, time to onset of signs after adenomectomy, clinical data, results of retrograde uretrocystography (RUC), results of urine cytobacteriological examination (UCT), complications, endoscopic procedure, duration of operation, duration of postoperative urinary drainage, duration of hospitalization, postoperative follow-up and operative morbidity and mortality. Results: 23 patients with secondary sclerosis of the bladder neck were treated by endoscopic neck resection. The mean age of the patients was 61.7 years (5 - 76 years). Dysuria was the most frequent reason for consultation, accounting for 73.9% (n = 17). Retrograde uretrocystography (RUC) was used to make the diagnosis in all patients. It found a steam jet image in 69.6% (n = 16) and tight stenosis of the bladder neck in 30.4% (n = 7). Secondary stenosis of the bladder neck was complicated by uretrohydronephrosis in 47.8% (n = 11). 73.9% of patients had a post-micturition residual of more than 150 ml. The urine cytobacteriological examination (UCE) found four urinary tract infections (17.4%) treated with antibiotics over 14 days, which sterilised the urine. The pathologies associated with cervical sclerosis were urethral stricture (13%) treated by endoscopic internal urethrotomy, and urinary lithiasis (8.7%) (n = 2). The mean duration of the operation was 53 minutes (43 - 60 min), the mean duration of postoperative urinary drainage was 3 days (2 - 6 days), and the mean duration of hospitalization was 5.4 days (3 - 6 days). Follow-up at 3 and 6 months using retrograde uretrocystography (RUC) showed good permeability of the neck and urethra with a post-void residual of less than 20 ml (10 - 36 ml). There was no morbidity. Conclusion: Secondary sclerosis of the bladder neck is a late but serious condition because of its obstructive and recurrent nature.

Prostatic Adenomectomy by High Approach versus Millin: Our Results on a Series of 15 Cases

Background: In 2023, conventional surgery for benign prostatic hyperplasia (BPH) is still used despite the introduction of minimally invasive techniques in the therapeutic arsenal. Objective: To present our results of Millin prostatic adenomectomy in a preliminary series of 15 cases. Patients and Methods: Cross-sectional study conducted at the Urology Department of the Bouaké University Hospital from January 2022 to January 2023. It involved 15 patients with benign prostatic hyperplasia (BPH) who had undergone high adenomectomy using the Millin technique. Results: During the study period, 15 cases of benign prostatic hyperplasia were treated surgically by high adenomectomy using the Millin technique. The mean age of the patients was 63.6 years, ranging from 53 to 78 years. Nine (9) patients were consulted for progressive complications of benign prostatic hyperplasia (BPH), i.e. 60% (n = 9). The mean IPSS score was 28 (20 to 35), and seven (7) patients had a comorbidity (46.44%). The digital rectal examination (DRE) was in favour of benign prostatic hypertrophy in all patients, and the mean weight of the prostate at DRE was 75 g, ranging from 55 g to 100 g. From a paraclinical point of view, prostatic ultrasound revealed a mean BPH weight of 82.7 g with extremes of 55 to 100 g. Post-micturition residue was greater than 150 ml in 60% (n = 9). The mean prostate-specific antigen (PSA) level was 3.8 ng/ml, ranging from 1.4 to 15 ng/ml. There was one case of severe anaemia with a haemoglobin level of 6 g/dl on haemogram, treated by blood transfusion. The cytobacteriological examination of the urine (ECBU) revealed five cases of E. coli infection, i.e. 33.33% (n = 5). Millin prostatic adenomectomy was performed under antibiotic prophylaxis at induction. All patients underwent locoregional anaesthesia. The mean weight of the adenoma was 80 g with extremes of 55 to 155 g. Blood loss was minimal at less than 100 ml, i.e. 86.6% (n = 13). The average operating time was 56.9 minutes, ranging from 45 to 75 minutes. The Retzius space was drained in an average of 2.75 days, with extremes of 2 to 4 days. The average duration of postoperative bladder catheterisation was 8.7 days, with extremes of 7 to 10 days. The average duration of bladder irrigation-washing was 3.6 days. The average hospital stay was 8.55 days, with extremes of 8 to 10 days. Morbidity was represented by Orchi-epididymitis (66%, n = 1) and mortality was 6.66% (n = 1). 6 months later, the 14 patients had good micturition comfort with an RPM of less than 10 ml. Anatomo-pathological examination of the adenomectomy specimen was in favour of an adenomyofibroma of the prostate with no stigma of malignancy. Conclusion: Prostatic adenomectomy using the Millin technique is rarely performed, but a look at the results shows that it is still the least morbid and fatal technique.

Delayed Diagnosis of Isolated Traumatic Rupture of Bladder

Traumatic ruptures of the bladder are relatively rare lesions. They are associated in more than 80% of cases with a fracture of the pelvic girdle. The lesion mechanism is usually a sudden compression on the full bladder. Hypogastric pain and macroscopic hematuria suggest the diagnosis, which is confirmed by cystography. This diagnosis can be difficult and delayed in the absence of these call signs. We report a case of isolated traumatic intraperitoneal rupture of the bladder, diagnosed 24 hours after a public road accident in a 44-year-old patient.