Prostate Cancer in the Thies Region, Senegal: Epidemiological, Diagnostic and Therapeutic Aspects

Introduction: Prostate cancer is the leading urological cancer. It is the most common cancer in men over 50. Objective: To determine the epidemiological, diagnostic and therapeutic characteristics of prostate cancer in hospitals in the Thiès region. Patients and Methods: We conducted a descriptive study from January 1st, 2015 to December 31st, 2020. We included all cases of primary prostate cancer confirmed on histology. Results: We collected data on 318 cases of primary prostate cancer during the study period. Mean patient age was 72.7 years (Range: 49;94 years). Family history of prostate cancer was found in 22 patients (6.91%). The average consultation time was 18.6 months. The circumstances of discovery were dominated by obstructive voiding disorders (97.16%). Digital Rectal examination was suggestive in 55.40% of patients. PSA level was above 20 ng/ml in 76.7% of patients. Prostatic adenocarcinoma was the only histological type (100%). Localized cancer represented 7.2% and locally advanced cancer occurred in 36.5% of cases, while metastatic cancer accounted for 56.3%. Radical prostatectomy was performed in 3.18% of cases. Mortality rate was estimated at 8.50% after 1 year. Conclusion: Prostate cancer is the leading urological cancer in the Thies region. It is characterized by the predominance of locally advanced and metastatic forms.

Ambulatory Uretrocystoscopy in the Urology Andrology Department of Grand Mbour Hospital

Background: Urethrocystoscopy is a method of endoscopic exploration that allows direct visualization of the urethra and bladder for diagnosis or treatment of diseases of the lower urinary tract. Purpose: To determine the epidemiological profile of patients who underwent urethrocystoscopy and to present the indications and the results of this endoscopic examination. Patients and Methods: This is a retrospective, descriptive study of all patients who underwent outpatient urethrocystoscopy in the Urology and Andrology department of Grand Mbour hospital. The epidemiological data of the patients, the indications, the results of the endoscopic exploration and the additional procedures performed were entered and analyzed with Excel 2016. We performed descriptive statistics. Results: Of the 216 patients who underwent outpatient urethrocystoscopy, we counted 179 men (82.87%) and 37 women (17.13%). The sex ratio was 4.84. The mean age of the patients was 53.71 ± 18.76 years (age range 17 to 91 years). The main indications were lower urinary tract disorders (60.18%) and hematuria (28.70%). Endoscopic exploration revealed prostatic tumor in 69 patients (31.9%), 29 cases of bladder tumors (13.4%) and 19 cases of bilharzia cystitis (8.8%). The urethrocystoscopy was normal in 32 patients (14.8%). Conclusion: Urethrostoscopy is an endoscopic exploration examination that can be performed on an outpatient basis. Lower tract urinary disorders and hematuria were the main indications.

Torsion of the Spermatic Cord: Clinical and Therapeutic Aspects in the Region of Thies (Senegal)

Introduction: The purpose of this work is to evaluate the epidemiological, clinical and therapeutic aspects of spermatic cord in our context. Patients and Methods: This is a retrospective study over a period of 4 years from January 1, 2014 to June 30, 2018. Results: We collected 55 cases divided into 26 cases, 44.27% for the Thies Regional Hospital, 21% or 38.18% for the Mbour EPS and 8 cases representing 14.55% for the Saint Jean de Dieu Hospital. We found an average age of 20.03 years with extremes of 4 years and 56 years. In 28 patients or 50% of cases, we found no particular pathological history, while in 4 patients or 7.14%, we found a notion of recurrent ipsilateral testicular pain. We recorded 67.27% (n = 37) of the cases received for testicular pain;15 patients or 27.27% presented a large painful pouch. Two patients (3.64%) were received for inguinal swelling and 1 patient (1.82%) presented testicular atrophy. The average consultation time is 16.9 hours with extremes of 2 hours and 96 hours. The torsion was in 59.61% of cases (n = 32) located on the right versus 40.38% (n = 22) on the left. There was no bilateral form. The pick-up time was 3 hours with extremes of 1 h to 24 h. All patients benefited from an exploratory scrotomy. We found a total of 22 patients or 40% of cases with ischemic testis, 8 cases or 14.55% of patients with necrotic testis and 2 cases or 3.64% where the testis was normal. Orchidopexy was performed in 46 patients or 83.63% and orchiectomy in 9 patients. Conclusion: Care is urgent. There is a need for better awareness of the population and the medical staff for the early diagnosis.

Varicocele and DNA Fragmentation in Senegalese Infertile Males—A Study of 95 Cases

Varicocele is the first etiology of infertility in men worldwide and affects almost half of the men dealing with infertility in Senegal. Varicocele is associated with a high rate of sperm DNA fragmentation so this test is being more and more recommended especially when patients have to benefit from an ART (Assisted Reproductive Technology) procedure. The aim of our study was to assess if our patients with varicocele are concerned by higher DNA fragmentation rate in spermatozoon. Sperm samples were collected (95 cases of varicocele and 30 controls) and analyzed between January 2013 and June 2016 in a prospective study. Sperm DNA damage, characterized by the rate of DNA fragmentation was evaluated by TUNEL assay using fluorescence microscopy. There was a significant higher percentage of DNA fragmentation in patients with varicocele (p < 0.001), compared to controls. We plan to study a bigger cohort to assess this tendency and study the benefits of surgery in varicocele by evaluating DNA fragmentation after the procedure.

Male Infertility as a Circumstance of Discovery of Adult Cryptorchidism: A Retrospective Analysis from the Region of Thies

Introduction: The aim of this work is to study the clinical aspects and the impact of cryptorchidism on male infertility in the region of Thies. Patients and methods: This is a retrospective study involving 28 patients followed up at the Saint Jean de Dieu, Barthimée and Tivaouane hospitals of the region of Thies between January 2007 and December 2016. Results: Among the 223 patients followed up for the undescended testicle, 13% (n = 28) were adults or at least 15 years old. 71% (n = 20) were married. Fourteen patients were followed up for primary infertility lasting for a period of time averaging 7 years. The mean age of the patients was 28 years (range: 17 years and 45 years). Cryptorchidism was unilateral in 82% (n = 23) and bilateral in 18% (n = 5). The mean delay of consultation varied from 1 to 13 years. The main reason for consultation was couple infertility (50%). The semen analysis was requested in all our patients. The levels of FSH, LH and testosterone were measured by immunoassay for the patients with azoospermia (n = 9). We noticed 2 cases of hypotestosteronemia and 3 cases of increased FSH serum level. Computed Tomography scans (CT) were performed in 28.5% of patients (n = 8) and ectopic testicles were found very high in the inguinal area in 5 cases. The open inguinal approach was used. In perioperative period, the testicle was found, high in the inguinal region in 5 patients (17.8% of the cases) and low in inguinal region in 19 patients (67.8%). In 4 cases the testicle was in abdominal position. The testicle was atrophied in 53.5% of the patients (n = 15) and 8 patients presented testicular hypotrophy. An orchidectomy was performed in 1 patient in whom it was impossible to lower the atrophied testicle. The postoperative period was uneventful and simple. The mean follow-up duration after the operation was 36 months (12 - 60 months).

Renal Oncocytoma: Clinical and Therapeutic Aspects about a Case Series and Literature Review

Introduction: The gold of this work was to study the clinical and therapeutic management aspects of renal oncocytoma in our settings. Our Observations: Case 1: there was a 44-year-old patient being followed up for a urinary tract infection due to Escherichia coli. The urological CT-scan showed a tumor-like process on a horseshoe kidney. Radical nephrectomy was performed and the histology report confirmed renal oncocytoma;Case 2: it involved a 62-year-old hypertensive patient. Clinical examination revealed a grade II cystocele and medical imaging showed a tumor-like mass at the lower pole of the right kidney. Radical nephrectomy was performed and histology was concluded in favor of renal oncocytoma;Case 3: there was a 64-year-old patient monitored for chronic renal failure and on dialysis for 6 months. Imaging showed a heterogeneous mass developing from the kidney. Histology and immunohistochemistry confirmed renal oncocytoma. Conclusion: Imaging could contribute greatly to preoperative diagnosis. However, there is a need to think about renal oncocytoma when evaluating kidney tissue masses.

Increased DNA Fragmentation in Patients with Infertility in Dakar (Senegal)

The presence of DNA fragmentation in semen is associated with poor results in ART (Assisted Re-productive Technology). This has led to the introduction of sperm DNA integrity testing in the clinical assessment of male infertility. The TUNEL assay is one of the most commonly used tests to measure DNA fragmentation in research studies, but it is now being optimized for routine clinical use. So, the objectives of our study were to install the TUNEL assay in our laboratory and to use it to assess the degree of DNA fragmentation in our patients dealing with couple infertility. Forty seven (47) and 25 samples from patients followed up for infertility and known fertile men were analyzed between August 2013 and July 2015 respectively. The sperm samples were evaluated according to the World Health Organization Guidelines. Sperm DNA damage was assessed by the TUNEL assay, with a standardized protocol that we adapted for reading using fluorescence microscopy instead of flow cytometry. The Sperm DNA Fragmentation Index was significantly higher in patients with infertility compared to the controls (22.2% ± 5.6% vs. 16.7% ± 0.7%) with a p < 0.05. This Index was also high in patients with varicocele compared to the control group (22.8% ± 9.2 vs. 16.7% ± 0.7%) (p < 0.01). After establishing the ROC curve (Receiver Operating Characteristics curve), we found a 15% threshold of DNA fragmentation, separating the patients with infertility from the control group. In our study, a 15% threshold positivity of DNA fragmentation using the TUNEL assay was highly associated with infertility. The results indicate that high level DNA fragmentation is associated with infertility.

Erectile Dysfunction: Clinical and Epidemiological Aspects in Senegal

Introduction: The objective of our study was to analyze the clinical and epidemiologic aspects of erectile dysfunction in subjects with different comorbidities in Senegal. Patients and Methods: This was a retrospective study over a period of 2 years on patients who presented themselves for consultation for erectile dysfunction. The study was carried out in the regions of Dakar and Thies at the Ouakam geriatric center and the Saint Jean of god Hospital of Thies respectively. Results: We enrolled into the study 402 patients with erectile dysfunction. The average age of our patients was 47 ± 5 years. Patients aged more than 60 years were the most. The majority of our patients had less than secondary school level education, 211 in total representing 52.5% of the study population compared to 14.9% having post baccalaureate level. A large number of these patients had professional activities (53.3%), followed by retirees (29.6%). Polygamous patients were more in number (51.5%). In our study sample, we registered 120 active smokers (29.9%). A hundred and ten of our patients were sedentary for periods of 5 months to 22 years. The average length of time before seeking help for erectile dysfunction in our patients was 2.8 years. Severe erectile dysfunction was predominant in the smoking group (54.2%) compared to (9.9%) in the non-smoking group. We found a large proportion of severe and moderate erectile dysfunction (66.3%) and (31.7%) respectively in diabetic than non-diabetic patients. Severe erectile dysfunction was more in hypertensive and diabetics. Severe erectile dysfunction was more present in hypertensive plus smokers (83.9%) than in non-smoking hypertensive patients (68.6%). Severe ED was found more in hypertension and diabetic subjects. Conclusion: Erectile dysfunction is most frequently related on one side to socio-environmental factors, and to co-existing comorbidities on the other side.

Primary Tumors of the Upper Urinary Tract: Report of 4 Cases

Primary tumors of the upper urinary tract are rarely reported in the literature. We thus report here four cases of primary tumors of the upper urinary tract that were difficult to diagnose, in three women and one man. Preoperative diagnosis was established in only two cases requiring a nephro-ureterectomy. The other two cases were surprisingly diagnosed during anatomopatho- logical examination. Preoperative diagnosis was a pyonephrosis in one case and a renal failure resulting from stenosis of the pelvic ureter in the other. Despite modern methods, primary tumors of the upper urinary tract remain difficult to diagnose.

Semen Abnormality Patterns and Parameters in Male Partners of Infertile Couples in Dakar (Senegal)

Introduction: Inter individual variation for semen on analysis is well known. Therefore, Semen profile is not the same in individuals from different geographic locations, environments, ways of life, and populations. It is important for a laboratory to have an idea of the semen profile of its population, especially for those who present with infertility. The aim of this study was to draw the pattern of semen abnormalities in male partner of infertile couple in Dakar, Senegal. Materials and Methods: A retrospective study of all the semen samples of male partners of infertile couples submitted for analysis in the laboratory of Cytogenetic and Reproductive Biology of Dakar at the University Teaching hospital from January 2013 to June 2014. Results: A total of 262 male semen analyses were reported. Analysis was performed according to WHO, 2010 manual for examination of human semen. Our study reveals that 80.9% of men in infertile couples present an abnormality in sperm pattern. The main one is oligo-astheno-terato-necrozoospermia (20.2%), followed by azoospermia, (14.1%), astheno-necrospermia (10.3%) and astheno-terato-necro-zoospermia (10.3%). Leucocytospermia was found in 57.8%. Teratozoospermia (80.9%) was the most associated abnormality, followed by necrozoospermia (76.2%). Low sperm count under 5 million per ml concerned 27.7% of the patients, and 11.2% patients had low ejaculate volume. Nearly 42.1% of the male partners are potential candidates for Assisted Reproductive Technology for male infertility. Conclusion: The high rate of semen abnormality in patients of infertile couples and consequently the high rate of potential candidates to Assisted Reproductive Technology for male infertility are important reasons for taking into account rigorously the male subject if we want to improve fertility rate in our context. The pattern of the specific abnormalities found is precious clues to guide management of these patients.

Clinical and Therapeutic Management of Male Infertility in Thies, Senegal

Objective: To evaluate the clinical and therapeutic aspects of male subfertility in the Region of Thies. Patients and methods: This is a retrospective and analytical study involving patients followed for subfertility over a period of 4 years from January 2013 to November 2017 at the level of 3 health structures in the region of Thies. Results: During the period, we collected 201 patients. The average age was 38 ± 8.4 years with a greater distribution in the age group 30-39 years. Primary subfertility was predominant with 81.1% of cases. The average duration was 5 years. We found a history of urethritis (4%) and orchiepididymitis (2.5%). Thirty-three percent of patients presented a varicocele (67 cases). Cryptorchidism was recorded in 2% of cases, testicular hypotrophy in 18.4% and testicular atrophy in 1.5%. The spermogram identified oligospermia-like abnormalities in 40.8% of cases, azoospermia 22.4%, and hypospermia 4%. For the qualitative abnormalities, we recorded cases of asthenospermia in 60.2% of the cases or 121 patients, a necrospermia 58.2% and a teratospermia 20.4%. A combination of these abnormalities was also reported as astheno-necrospermia in 19.4% of cases, oligo-astheno-necrospermia 14.4%, oligo-asthenotera-necrospermia 10% and oligo astero-teratospermia in 2.5%. An assessment of FSH, LH and testosterone was performed in 5.9% of the cases, or 12 patients. Varicocelectomy was performed in 68.4% of cases 19 patients, and (medically) assisted procreation in 2 patients. We recorded 13 cases of pregnancy. Conclusion: Male hypofertility is a real problem of management, and requires a particular approach.

中国—非洲:双边伙伴关系牢不可破

中华人民共和国成立70周年表明:一个决心掌握自己命运的民族,它的前进脚步是不可阻挡的。伟大的民族孕育了伟大的人,伟大的人描绘本民族历史辉煌篇章。今天,国际形势风云变幻,利己主义、民族主义、单边主义和各种形式的极端主义甚嚣尘上,但中国和非洲的友谊依然坚不可摧。在过去的70年,非中关系已经从"饱受压迫的联盟"转变成"共同繁荣的联盟".