Management of Priapism in Sickle Cell Patients: Experience of the Urology Department of the University Hospital Centre of Libreville

Introduction: Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. Material and Methods: This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. Result: We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. Conclusion: Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.

Olecranon Fractures in Children: About 21 Cases Treated at the Owendo University Hospital Center at Libreville (Gabon)

Background: The olecranon fractures in children are relatively rare articular fractures. The aim of this work is to study the epidemiological, clinical and therapeutic particularities of this fracture in children at Owendo University Teaching Hospital. Patients and Methods: This was a retrospective analytical, monocentric study over 2 years from January 1, 2018 to January 1, 2020 at the Owendo University Hospital in Libreville and relating to the medical files of patients treated for a fracture of the olecranon in children in the service and regularly followed in outpatient consultation. Results: We collected 21 patients with an average age of 8.7 years. Falls dominated the etiologies. The Bracq classification was the one used in our series with the predominance of type D. The treatment was orthopedic in 33.3% of cases and surgical in 66.7% of cases. With an average follow-up of 12 months, the results were good in 71.5%, average in 19.0% and poor in 9.5%. Conclusion: The analysis of our results compared to those of the authors of the literature according to the precise parameters seems satisfactory.

Preoperative Tracheoscopy for Esophageal Atresia and/or Congenital Esoaerian Fistula: Experience at Cliniques Universitaires Saint Luc in Brussels

Introduction: Congenital septal anomalies between the trachea and the esophagus are rare conditions. It seemed to us interesting to recall the contribution of tracheoscopy in the diagnostic and therapeutic strategy of esophageal atresia and congenital esoaerian fistulas. Patients and methods: This is a retrospective study between June 1994 and June 2014 of children who underwent a tracheoscopy, at the Saint-Luc University Clinics in Brussels, the diagnostic set of esophageal atresia (EA) or a congenital esoaerian fistula was suspected. Results: A total of 43 children with esophageal atresia or congenital esoaerian fistula underwent tracheoscopy. Before the tracheoscopy, the diagnosis of the anatomical type of atresia of the esophagus and esoaerian fistula was as follows: type C, 34 (79.1%);type A, 4 (9.3%);type E, 5 (11.6%). After performing the tracheoscopy, the diagnosis was changed as follows: type C, 34 (79.1%);type A, 3 (7%);type E, 4 (9.3%);type B, 1 (2.3%), a patient with a tracheoesophageal laryngo cleft (2.3%). Tracheoscopy also made it possible to find 2 cases of tracheomalacia, 2 cases with 3 bronchial tubes and one case associating a diverticulum of the trachea. No complications were correlated with the performance of the tracheoscopy. Conclusion: Our study confirms the benefits of tracheoscopy in the laden price of esophageal atresia or congenital esoaerian fistula.