Urogenital Complications of Groin Hernia Surgery: A Multicentre Study in Guinea

Context and Objective: Groin hernia is a common pathology in visceral surgery (2nd rank after appendicitis), which affects approximately 4.6% of the African population. Restoring the normal anatomy of the groin region is one of the most benign interventions. However, uro-andrological complications are possible. This study aimed to contribute to the improvement of the management of urogenital complications of groin hernia surgery. Patients and Method: We carried out a prospective study of descriptive type with a duration of 6 months from 1 August 2021 to 31 January 2022. The data were collected using a pre-established survey sheet. The study covered several sites (public hospitals and private clinics) in Guinea. Results: The urogenital complications of the surgery of the hernia of the groin represented 15.22% or 14 cases out of 92 patients. The average age was 37.00 years with extremes of 20-69 years. Polygamists occupied the first place. The reason for consultation was dominated by decreased testicular volume (42.86%), followed by a desire to conceive (21.43%). Unilateral testicular atrophy represented 63.64%, bilateral 27.27%. We performed a left orchidectomy in one patient and a cystorraphy in another simple operative follow-up. The other cases consisting of testicular atrophy, due to lack of a suitable technical platform, did not benefit from any specific therapeutic treatment. Conclusion: Urogenital complications of groin hernia surgery are relatively common. Testicular atrophy was the main clinical complication. The left orchidectomy and cystorraphy were the therapeutic procedures performed.

Comparative Study of Transvesical and Retropubic Prostatic Adenomectomies in the Urology-Andrology Department of Ignace Deen University Hospital Center

Objective: To compare the results of transvesical and retropubic prostatic adenomectomies at the Urology-Andrology Department of Conakry University Hospital. Methodology: This was a prospective multi-operator analytical study lasting 6 months. It included 70 patients operated on for benign prostatic hypertrophy (BPH), divided into 2 groups of 35 according to the retropubic or transvesical technique. The data was collected using a questionnaire and entered into the Epi info application. The analysis was initially descriptive and then univariate. To identify confounding factors, a multivariate analysis was performed. The application conditions of each test were checked before their application. A p-value Results: Upper adenomectomies represented 53.6% of surgeries performed for BPH. The average age was 73.2 years. The mean prostate volume was 117 ± 51.6 cc and the mean total PSA was 9.2 ± 11.4 ng/ml. The majority of patients had an ASA1 (60%) and ASA2 (37.1%) score. Spinal anesthesia, a double-current silicone probe with hinged hinge 22, and drainage of the prevesical space were carried out in all patients, i.e. 100%. The average overall blood loss was 229 ± 98.2 ml. It was lower in the group of patients operated via the retropubic route (187 ± 60.4 ml). The same was true for the duration of intervention (49.1 ± 7.17 vs 55.4 ± 7.9 min), the catheter wearing time (5.14 ± 0.97 vs 9.29 ± 2 .9 days) and the length of hospitalization (=6.26 ± 1.15 vs 12.1 ± 5.74 days). Conclusion: The retropubic technique has advantages over the transvesical one. These advantages are translated by a gain in the duration of the intervention, blood loss, catheter wearing time and length of hospitalization.

Evaluating the Influence of the Prostate Weight on the Morbidity and Mortality of Transvesical Open Prostatectomy: Prospective Analysis of 108 Cases in the Urology-Andrology Department of the Ignace Deen National Hospital in Conakry

Introduction: Open transvesical prostatectomy remains today one of the most effective approaches for the management of benign prostatic hyperplasia despite the fact that, this method is associated with multiple complications. The objective of this study was to evaluate the influence of prostate weight on the morbidity and mortality of transvesical prostatectomy for adenoma in the urology-andrology department of the Ignace Deen National Hospital. Materials and Methods: This was a prospective, longitudinal and analytical study lasting 6 months, from March 1, 2022 to August 31, 2022 including patients admitted and operated on by open transvesical prostatectomy by assessing the influence of prostate weight on the morbidity and mortality of transvesical adenomectomies. Results: 108 patients were included in our study, the average age of our patients was 70 ± 7.7 years, cultivators were the most represented profession with 38.89%, and hypertension was the most represented comorbidity with 75%. 33.06% of cases became complicated and surgical wound infection was the main complication with a frequency of 17.40%. Statistical analysis did not conclude that, the prostate weight does not have a statistically significant influence on the morbidity and mortality of transvesical open prostatectomy for benign prostatic hyperplasia. Conclusion: Prostate weight has no influence on the morbidity and mortality of transvesical prostate adenoma.

Profile of the Infertile Man at the University Hospital of Conakry (Guinea)

Introduction: Male infertility is defined as the inability of a man to impregnate a woman after 12 months of regular sexual intercourse without contraception. Objective: To improve the state of knowledge on the profile of the infertile man in Guinea. Methodology: We conducted a prospective, descriptive study over a period of 6 months from October 1st, 2020 to March 31st, 2021. Results: We collected an overall number of 71 patients seen onroutine consultation for infertility. They had a mean age of 36.4 years. More than half of our patients were monogamous (79% of cases). Civil servants were the most affected with 38.02% of cases. Primary infertility was dominant in 65% (n = 46) of cases. On clinical examination, varicocele was the most remarkable abnormality with 88.73% (n = 63) followed by testicular hypotrophy with 59.15% (n = 42). Azoospermia was the most frequent sperm abnormality with 22.54% (n = 16) followed by oligospermia with 15.49% (n = 11). Hormonal assessment based on FSH and LH was performed in 16 patients with azoospermia (22.53%). FSH elevation was associated with azoospermia in 6 patients, i.e. 8.45%, azoospermia associated with a normal FSH level accounting for 14.08% in our series. Conclusion: In our practice, male infertility is becoming more and more of a concern due to the increasing number of patients seeking treatment. The scarcity of a medical assistance for procreation unit alongside with more efficient diagnostic means constitutes a handicap for its management.

Bipolar Transurethral Resection of the Prostate: Short-Term Outcome Evaluation in Regional Hospital in Senegal

Introduction: Transurethral resection of the prostate is still the most popular procedure that use for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction in developed countries. Bipolar transurethral resection of the prostate (B-TURP) is a recent technique in our urological practice. The aim of this study was to evaluate our preliminary results on the use of a B-TURP in Kolda (Senegal) in a benign prostatic hyperplasia (BPH). Materials and Methods: This was a 15-month, retrospective and descriptive study from June 2021 to August 31, 2022. It examined the records of patients who had BPH requiring surgical treatment and who received Bipolar transurethral resection of the prostate (B-TURP) during the study period at the Kolda Regional Hospital in Senegal. We used a Karl STORZ bipolar endoscopy column with a 26 sheath and 30˚ optics. The parameters studied were the civil status of the patients, the clinical and para-clinical data as well as the operative indications. The data were entered and analyzed using Epi-info 3.5.1.1. Results: A total of 31 patients underwent bipolar transurethral resection of the prostate during the study period. The mean age of patients was 68.5 ± 12.6 years (range, 56 - 77 years). The mean total PSA was 4 ± 2.3 ng/ml (range, 0.5 - 11 ng/ml). The mean prostate size assessed by ultrasound was 54 ± 12.3 ml (range, 30 - 90 ml). The operative indication was dominated by BPH with impact on the upper urinary tract. The mean of bladder irrigation time was 21.4 ± 3.9 hours (range, 12 - 26 hours). In the immediate post-operative period, blood transfusions were performed in 2 patients (6.5%). In the medium-term follow-up, we noted one 1 (3.2%) case of urine retention requiring bladder catheterization. Conclusion: Bipolar Transurethral resection of the prostate B-TURP in saline system is efficacious and safe. The results of this preliminary study of B-TURP are satisfactory with a low complication rate. B-TURP decreases the duration of the hospitalization and the port of the probe. Our perspectives are oriented towards endoscopy of the upper urinary tract.

Epidemiological Aspect and Evaluation of the Management of Urologic Emergencies at the Urology Unit of Labe Regional Hospital

Aim: To contribute to improving the management of urological emergencies at Labé Regional Hospital. Patients and Method: This was a dynamic, descriptive study lasting six months from July 1 to December 31, 2017. Results: Urological emergencies represented 45.14% (n = 218) of all admissions to the urology unit. The mean age of our patients was 56.60 years with extremes of fifteen days and 93 years. The 71 - 80 age group was the most represented with 28.03% (n = 61) followed by 61 - 70 years with 24.31% (n = 53). Our patients’ activities were dominated by agriculture, with 35.77% (n = 88), and the city center was most affected by urological emergencies, with 39.44% of cases (n = 86). 70.18% (n = 153) of our patients had bladder retention on admission, and 53.21% (n = 116) underwent urethral catheterization, including 3 women. The etiology of bladder retention in these 3 women was dominated by two cases of bladder lithiasis and one case of neurological bladder. Conclusion: The management of urological emergencies requires specific material and human resources. Their knowledge will enable us to better understand this problem and could serve as a basis for a broad reflection on the organization of the management of urological emergencies in our region.

Transection Type, Vesico-Vaginal Fistula Surgery

The objective of the study was to report the results of the surgery of the Vesico-vaginal fistula (VVF) transection types at CHU Conakry. Methods: This was a prospective descriptive study that focused on 64 patients operated for VVF transection type at the Urology department of CHU Conakry between January 2013 and December 2015. Four types of transection were defined according to the state of the urethra and vagina, the size of the fistula, the peri-fistulous tissue and associated lesions. The variables studied were the proportion of transection, age, the type of transection, the number of previous cures, the operative technique, the complications and the results after a follow-up of 3 months. Results: Transection accounted for 47.05% of the obstetric fistulas. The average age was 25.18 years old (14-43 years old). This was a Type I transection (11 cases), type II (27 cases), type III (19 cases) and type IV (7 cases). The surgical approach was vaginal in 64 cases. Fistulorraphy with a confection of a new cervix and cervico-urethral anastomosis was conducted in 19 patients, combined with bladder flap urethroplasty (30 patients) or vaginal flap (15 others). We recorded healing in 37 cases. Conclusion: Transection type VVF is a severe VVF. The preferential surgical approach was vaginal. Technical difficulties were related to associate lesions and the continence system affected.

Pyeloplasty According to Küss-Anderson-Hynes: Results and Complications at the Urology-Andrology Department of the Sino-Guinean Friendship Hospital

Objective: Evaluate pyeloplasty according to Küss-Anderson-Hynes at the urology-andrology department of the Sino-Guinean Friendship Hospital. Patient and Method: This is a 3-year prospective descriptive study from January 1, 2018 to December 31, 2020. It focused on a sample of 21 patients, who had undergone pyeloplasty according to Küss-Anderson-Hynes. Results: The averages age of the patients was 24.24 years. Lumbar pain was the main reason for consultation in 71.43% of cases. pyeloplasty according to Küss-Anderson-Hynes alone was performed in 76.20% of cases. It was associated with lower pole vessel uncrossing in 14.29% of cases and in 9.52% of cases with pyelolithotomy. The main Postoperative complications consisted of surgical site infections (23.81%) and fistula of the pyelo-ureteral junction (9.52%). The result of the pyeloplasty evaluated after three years, was qualified as good in 13 patients (86.67%), conversely the result was declared bad in 2 patients or 13.33%. During the follow-up period, postoperatively, we had lost sight of 6 patients. Conclusion: Pyeloplasty according to Küss-Anderson-Hynes in addition to its excellent results reported by the literature was the only therapeutic alternative performed during this study. However, its indications are considerably reduced with the advancement of laparoscopy.