A systematic review of dedicated models of care for emergency urological patients

Objective:To systematically evaluate the spectrum of models providing dedicated resources for emergency urological patients(EUPs).Methods:A search of Cochrane,Embase,Medline and grey literature from January 1,2000 to March 26,2019 was performed using methods pre-published on PROSPERO.Reporting followed Preferred Reporting Items for Systematic Review and meta-analysis guidelines.Eligible studies were articles or abstracts published in English describing dedicated models of care for EUPs,which reported at least one secondary outcome.Studies were excluded if they examined pathways dedicated only to single presentations,such as torsion,or outpatient solutions,such as rapid access clinics.The primary outcome was the spectrum of models.Secondary outcomes were time-to-theatre,length of stay,complications and cost.Results:Seven studies were identified,totalling 487 patients.Six studies were conference abstracts,while one study was of full-text length but published in grey literature.Four distinct models were described.These included consultant urologists allocated solely to the care of EUPs(“Acute Urological Unit”)or dedicated registrars or operating theatres(“Hybrid structures”).In some services,EUPs bypassed emergency department assessment and were referred directly to urology(“Urological Assessment Unit”)or were managed by other dedicated means.Allocating services to EUPs was associated with reduced time-to-theatre,length of stay and hospital cost,and improved supervision of junior medical staff.Conclusion:Multiple dedicated models of care exist for EUPs.Low-level evidence suggests these may improve outcomes for patients,staff and hospitals.Higher quality studies are required to explore patient outcomes and minimum requirements to establish these models.

Urological manifestations and treatment of the primary systemic vasculitides

The primary systemic vasculitides(PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is the most commonly reported finding and is associated with Polyarteritis Nodosa(PAN), Henoch-Sch?nleinPurpura(HSP), anti-neutrophil cytoplasm antibody associated Vasculitides(AAV), Giant Cell Arteritis(GCA) and Kawasaki disease. Prostatic vasculitis has been reported in association with GCA and AAV. Ureteric involvement has been noted in PAN, HSP and AAV. Other urogenital manifestations of PSV include genital ulceration and bladder dysfunction in Beh?ets Disease and haematuria which is commonly seen in many of the PSV. Finally, therapies used to treat the PSV, especially cyclophosphamide, are associated with urological sideeffects including haemorrhagic cystitis and urothelial malignancy. The aim of this review is to examine how the urological system is involved in the PSV. Each PSV is examined in turn, with a brief clinical description of the disease followed by a description of the urological manifestations and management. Identification of urological manifestations of PSV is important as in many cases symptoms may improve with immunosuppressive therapy, avoiding the need for invasive surgery. Additionally, patients who present with isolated urogenital PSV are at higher risk of developing subsequent systemic vasculitis and will need to be followed up closely.

Efficacy and safety of platelet-rich plasma intracavernous injection for patients with erectile dysfunction:A systematic review,meta-analysis,and meta-regression

ObjectiveIntracavernous injection might be offered to patients with erectile dysfunction (ED) who did not respond to the first-line oral treatment. Platelet-rich plasma (PRP) might offer improvement in erectile function since it contains numerous growth factors. This study aimed to evaluate the efficacy and safety of PRP intracavernous injection for patients with ED.MethodsWe conducted relevant literature searches on Cochrane Library, Medline, Scopus, and ClinicalTrials.gov databases using specific keywords. The results of continuous variables were pooled into the mean difference (MD) and dichotomous variables into the odds ratio along with 95% confidence interval (95% CI).ResultsA total of six studies were included. Our pooled analysis revealed that PRP intracavernous injection was associated with a significant increase in the erectile function domain of the International Index of Erectile Function at 1 month (MD 3.47 [95% CI 2.62–4.32], p<0.00001, I^(2)=7%), 3 months (MD 3.19 [95% CI 2.25–4.12], p<0.00001, I^(2)=0%), and 6 months (MD 3.21 [95% CI 2.30–4.13], p<0.00001, I^(2)=0%) after the intervention when compared with baseline values. PRP was also superior to a placebo in terms of improvement in erectile function domain of the International Index of Erectile Function score at 1 month (MD 2.83, p<0.00001), 3 months (MD 2.87, p<0.00001), and 6 months (MD 3.20, p<0.00001) post-intervention. The adverse events from PRP injection were only mild without any serious adverse events.ConclusionPRP intracavernous injection may offer benefits in improving erectile function in patients with ED with a relatively good safety profile.

Urological Emergencies at the University Hospital of Brazzaville: Epidemiological, Clinical, and Therapeutic Aspects

Introduction: Urological emergencies play a significant role in the medical and surgical activity of a urology department. The objective of this study was to determine the hospital prevalence of urological emergencies at the University Hospital of Brazzaville (CHUB), identify the different pathologies requiring urgent care, and list the various therapeutic methods. Patients and methods: A retrospective study of patients admitted to the medical and surgical emergencies department of CHUB over a 5-year period. Patient records admitted and treated for a urological emergency were included. The variables studied were the frequency of urological emergencies, patient age at admission, gender, nature of the emergency, and various therapeutic options. Results: Urological emergencies accounted for 4.3% of all medical and surgical emergencies. The mean age was 57 ± 28 years with a range of 3 to 93 years. The male-to-female ratio was 7.1. The most common conditions were urinary retention (54.67%), hematuria (17.20%), and renal colic (8.13%). Therapeutically, surgical urinary drainage was dominated by cystostomy. Conclusion: Urological emergencies are infrequent at the University Hospital of Brazzaville. Their management is often delayed.

Adult Urological Cancers at Zinder National Hospital

The aim of this study was to present the epidemiological, clinical and therapeutic aspects of adult urological cancers in the department of urology at Zinder National Hospital. Patients and Methods: This was a cross-sectional study of adult primary urologic cancers during the period of January 2019 to December 2023. Data were obtained from the record of patients admitted to urology, and the medical oncology department. The parameters studied were;frequency, age, sex, urogenital distribution, anatomopathological type, and therapeutic aspects. Data were recorded on Excel 2013 and analyzed with Epi-info version 7.2.5. Results: Epidemiology: About 289 cancers were diagnosed through 6017 consultations during the period, corresponding to 4.80% of urological pathologies: prostate cancer (n = 221;76.47%), bladder cancer (n = 46;15.92%), kidney cancer (n = 13;04.5%), testis cancer (n = 09;03.11%). Median age of patients was 50.42 years. Prostate cancer: was Adenocarcinoma in 100% (n = 221) with Gleason scores > 7 (77.83%) and prostatique specific antigen (PSA) > 20 ng/ml in 90.04%. Extension evaluation 134 cases (60.63%). Treatment was chirurgical castration in (62.44%) and resistance to castration appeared between 8 and 11 months. Hospital mortality for prostate cancer was 16.29%. Bladder cancer was found in 46 cases with Sex ratio 7/1. Cystoscopy was performed for all. Histology revealed squamous cell carcinoma (n = 41;89.13%), and (n = 5;10.87%) urothelial. Endoscopic resection performed (n = 14;30.43%). Kidney cancers were 13 cases (10 men, 03 women). Nephrectomy was performed in (n = 8;61.54%) cases and Histology revealed renal cell cancer in 76.92%. Testicular cancers were diag 09 cases. History of cryptorchidism was found in 4 cases, 4-year infertility in 3 cases. Orchidectomy was done in all cases. Chemotherapy in 3 cases. Conclusion: urological cancers are frequent, dominated by prostate cancer. The endemicity of bilharziasis has increased squamous cell carcinoma. The majority of patients have advanced form of the disease, which poses management problems.

Design and Experiments of Ultrasound Image-Guided Multi-DOF Robot System for Brachytherapy

To implant radioactive seeds through a needle precisely and safely, a novel multi-DOF surgical robotic system is presented in this paper for percutaneous prostate intervention through the patient’s perineum under real-time ultrasound image guidance. The proposed robot, which is designed with 9-DOF, consists of a 3-DOF automatic location platform for position adjustment, 2-DOF for automatic ultrasonic probe adjustment mounted with electromagnetic trackers, and 4-DOF for manually adjusting the guided template. Meanwhile, a new registration method based on the quaternion algorithm and least square method is developed, and the needle insertion is performed under the real-time guidance of a navigation system. Furthermore, the robot system has undergone some preliminary experiments with a laser tracker to evaluate the repeatability and accuracy of the robot system. The location error of the puncture needle tip can be controlled under 0.7 mm in air for the whole robotic system. The acquired results endorse the precision of the robot system for prostate seed implantation brachytherapy. © 2017, Tianjin University and Springer-Verlag GmbH Germany.

Effect of ureteric stents on urological infection and graft function following renal transplantation

AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.RESULTS: Overall, 196(183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3%(12/277) with no difference between those with or without stents- 7/183 vs 5/102, P = 0.746. Overall, 54%(99/183) of stented patients developed a urological infection compared to 38.1%(32/84) of those without stents(P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent(Wald χ2 = 5.505, P = 0.019) and diabetes mellitus(Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.

The evolving Gleason grading system

The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.

The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Objective:Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are increasingly being used to treat peritoneal malignancies.Urological resections and reconstruction(URR)are occasionally performed during the surgery.We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients.Methods:A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed.Outcomes between patients who had surgery involving,and not involving URR were compared.Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit(ICU)and hospital.Secondary outcomes were that of overall survival(OS)and prognostic factors that would indicate a need for URR.Results:A total of 214 CRS-HIPEC were performed,21 of which involved a URR.Baseline clinical characteristics did not vary between the groups(URR vs.No URR).Urological resections comprised of 52%bladder resections,24%ureteric resections,and 24%involving both bladder and ureteric resections.All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses,one ureto-uretostomy,five direct implantations into the bladder and three boari flaps.URR were more frequently required in patients with colorectal peritoneal disease(p Z 0.029),but was not associated with previous pelvic surgery(76%vs.54%,p Z 0.065).Patients with URR did not suffer more serious complications(14%vs.24%,p Z 0.42).ICU(2.2 days vs.1.4 days,p Z 0.51)and hospital stays(18 days vs.25 days,p Z 0.094)were not significantly affected.Undergoing a URR did not affect OS(p Z 0.99),but was associated with increased operation time(570 min vs.490 min,p Z 0.046).Conclusion:While concomitant URR were associated with an increase in operation time,there were no significant differences in postoperative complications or OS.Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours,and needs to be considered during pre-operative planning.

Gastrointestinal tract access for urological natural orifice transluminal endoscopic surgery

We conducted a literature review of natural orifice transluminal endoscopic surgery(NOTES),focusing on urologic procedures with gastrointestinal tract access,to update on the development of this novel surgical approach.As part of the methods,a comprehensive electronic literature search for NOTES was conducted using Pub Med and Cochrane Library from March 2002 to February 2016 for papers reporting urologic procedures performed utilizing gastrointestinal tract access.A total of 11 peer-reviewed studies examining utility of gastrointestinal access for NOTES urologic procedures were noted,with the first report in 2007.The procedures reported in the studies were total/radical nephrectomy,partial nephrectomy,adrenalectomy,and prostatectomy.The transgastric approach was identified in five studies examining total/radical nephrectomy(n = 2),partial nephrectomy(n = 1),partial cystectomy(n = 1),and adrenalectomy(n = 1).Six studies evaluated transrectal approach for NOTES,describing total/radical nephrectomy(n = 3),partial nephrectomy(n = 1),robotic nephrectomy with adrenalectomy(n = 1) and prostatectomy(n = 1).Feasibility was reported in all studies.Most studies were preclinical and acute,and limited by concerns regarding restricted instrumentation and infection risk.We concluded that gastrointestinal access for urologic NOTES demonstrates promise as described by outlined feasibility studies in preclinical models.Nonetheless,clinical application awaits further advancements in surgical technology and concerns regarding infectious potential.

Incidence and Risk Factors of Surgical Site Infections in Urological Surgery at Brazzaville Teaching Hospital

Aim: To evaluate the incidence of surgical site infection in the Urology Department of Brazzaville teaching hospital. Methods: This was a prospective study performed in the Urology Department and operating room of the Brazzaville teaching hospital during six months from February 2nd to July 2nd 2017. The study concerned all patients who had undergone surgery, selected during the operating program and those who had been in emergency and then hospitalized in the urology department. These patients were followed for one month after the intervention date. Results: 209 patients were operated on of whom 48 had surgical site infection, a cumulative incidence of 22.96%. The average age of infected patients was 58.3 years ± 17.73 ds (extremes from 13 to 85 years). 43.75% infected patients had co-morbidity factors. The SSI rate was 70% in patients with positive urine culture. Urinary catheters were found in 33.33% of patients. The average length of preoperative hospital stay was two days. The rate of SSI in patients classified Asa I was 10.41%, Asa II 37.5% and Asa III 52.09%. The SSI rate was respectively 5.21%, 56.76% and 38.03%. The infected patients operated first in the operative program accounted for 10.42%. The group of patients who underwent prostatic surgery accounted for 42.58% of patients with an SSI rate of 47.91%. The practice of aseptic measures by staff was found in 70% of cases. The infection rate in patients with drain was 73.23%. The infection rate in patients with catheters was 54.26%. The SSI was superficial in 66.67% of cases, deep in 25% of cases and organ in 8.33% of cases. Escherichia coli was the most frequently isolated germ 50%. Conclusion: Surgical site infection (ISO) is a common feature in our practice. The advanced age of patients and comorbidity factors are associated with a high risk of occurrence of SSI. These infections were not inevitable, their incidence can be greatly reduced by specific preventive measures.

Epidemiology of Urological Emergencies at the Regional University Hospital Center of Ouahigouya, Burkina Faso

Introduction: Urological emergencies are less frequent compared to other emergencies, particularly traumatological and digestive emergencies. The objective of this study was to determine the epidemiological profile of urological emergencies in a regional hospital in Burkina Faso. Patients and methods: This was a cross-sectional study of urological emergencies admitted to the Surgical Department of the Ouahigouya Regional University Hospital in Burkina Faso over a period of 41 months. The study covered a 41-month period from March 2015 to July 2018. Ethical clearance was taken from the institutional ethics committee. Results: Urological emergencies accounted for 3.7% of all emergencies. The mean age of the patients was 56.59 ± 25.93 years (range 1 year - 95 years). The sex ratio was 12.05. Bladder urinary retention was the main urological emergency in 48.28% of cases. Suprapubic cystostomy was the most performed surgical procedure (56.25%) followed by debridement of external genitalia gangrene (27.68%). Conclusion: Urological emergencies occupy a significant place in our work context. An increase in the number of urologists would improve their management.

Patterns of Antiplatelet and Anticoagulant Agents Use in Urological Inpatients and Their Perception of Adverse Reactions

Purpose: To evaluate the rate of any type of anticoagulant drug use in urological inpatients and patients awareness of their effect on coagulation. Material and methods: This observational study was conducted prospectively in a cohort of 193 consecutive urological inpatients who were asked to state the medications they were taking and following that, were specifically asked whether they were taking aspirin or other antiplatelet/anticoagulant agents. In case they did so, they were further asked why they were taking them, whether they knew their effect on coagulation and who had informed them on the matter. Results: Forty-seven patients received some kind of antithrombotic treatment. Twenty-nine per cent of aspirin users had to be specifically prompted in order to state its use, in comparison to 35.7% and 25% of other antiplatelets and warfarin users, respectively. Half of patients receiving warfarin were not aware of its effect on coagulation in comparison to 32.3% and 21.4% of those taking aspirin and other antiplatelets, respectively. Conclusion: Urologists should be aware of the high use of such agents by their patients and that not all patients are aware of their effect on coagulation, while some, even fail to report their use and have to be specifically prompted.

Intraoperative laparoscopic complications for urological cancer procedures

AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery(radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery(radical prostatectomy and radical cystectomy).CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.

Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients:A single center experience

Objective To determine incidence and risk factors for venous thromboembolism(VTE)development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.Methods Consecutive 1453 inpatients who were admitted to a non-oncological urological ward in the tertiary hospital from January 1,2018 to December 31,2018 were enrolled in the study,and the VTE events were diagnosed by ultrasound or computed tomographic pulmonary angiography.Patients’occurrence of VTE and characteristics which may contribute to the development of VTE were collected and analyzed as incidence and risk factors.Results The incidence of VTE in non-oncological urological inpatients is 2.3%.In our cohort,patients who experienced previous VTE(adjusted odds ratios[aOR]14.272,95%CI 3.620-56.275),taking anticoagulants or antiplatelet agents before admission(aOR 10.181,95%CI 2.453-42.256),D-dimer(max)≥1μg/mL(aOR 22.456,95%CI 6.468-77.967),lower extremity swelling(aOR 10.264,95%CI 2.242-46.994),chest symptoms(aOR 79.182,95%CI 7.132-879.076),operation time of more than or equal to 180 min(aOR 10.690,95%CI 1.356-84.300),and Caprini score(max)of more than or equal to 5(aOR 34.241,95%CI 1.831-640.235)were considered as risk factors for VTE.Conclusion In this study,we found that the incidence of VTE in non-oncological surgery was about 2.3%,which was higher than some previous studies.Risk factors could be used for early detection and diagnosis of VTE.

The impact of the cor on avirus disease 2019 Checkfol pandemic on elective urological procedures in Australia

Objective:To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic.Methods:Data were extracted from publicly available datasets from Medicare Ben efits Schedule using item nu mbers assig ned to each comm only performed urological interve ntion.These procedures were divided into three groups:Oncological therapeutic,diagnostic,and non-oncological therapeutic procedures.A smoothing model,based on the historic procedure numbers from 2017 to 2019,was used to forecast monthly number of procedures performed in each category between January 2020 and June 2020.These forecasted models were compared with reported figures.Results:A total of 108169 procedures were performed between January 2020 and June 2020 based on the Medicare Ben efits Schedule item nu mbers listed.There was a sign ifica nt reducti on(perce nt-age cha nge)in total procedures performed in April 2020(22.6%,95%con fide nee in terval[CI]:-28.7%to-15.4%)and May 2020(-33.2%,95%CI:-37.5%to 28.3%).There was a significant reduction in oncological therapeutic,non-oncological therapeutic,and diagnostic procedures performed in April 2020 and May 2020(p<0.05).These nu mbers did not in elude procedures performed in public sector.Conclusion:There was a significant reduction in total urological procedures(including diagnostic,oncological,and non-on cological)performed in mon ths of April 2020 and May 2020 during time of federal restrictions.Both public and private healthcare sectors need to be supported in the up-comi ng mon ths to preve nt further delays in treatme nt and poorer clinical outcomes.

Urological Affections after Laparoscopic Hernia Repair in Long-Term Follow up

Objectives: Chronic pain is a severe complication of mesh-based inguinal hernia repair. Pain upon ejaculation, testicular touch sensitivity and dysuria are apparent. Regarding the large amount of patients undergoing laparoscopic hernia repair, the problem seems quite evident. In this prospective, clinical, randomized, double-blind study we intended to investigate the biocompatibility of three different meshes and their influence on urological affections after operative procedure. Methods: 180 male patients with primary inguinal hernia undergoing TAPP were randomized for using a heavyweight (108 g/m2), double-filament PP mesh (Prolene, 10 9 15 cm, group A, n = 60), a multifilament, heavyweight variant (116 g/m2) of PP mesh (Serapren, 10 9 15 cm, group B, n = 60), or a composite mesh (polyglactin and PP) (Vypro II, 10 9 15 cm, group C, n = 60). We compared in terms of complications (seromas, recurrence rate), urological affections and life quality (SF-36 Health Survey). The follow-up period was 60 months. Results: Convalescence in group A was slower than in groups B and C: mean-term values of the visual scales for pain development were significantly (p th week postoperatively. There were no significant differences between groups B and C. Beyond the 12th post-interventional week the differences diminished. Conclusions: Independent which kind of mesh was implanted still 5% of patients suffered from urological affections 60 month later.

Urological Cancers in Burkina Faso: Epidemiological and Anatomopathological Aspects of 2204 Cases

Purpose: To study the epidemiological and anatomopathological aspects of urological cancers in Burkina Faso from 1988 to 2018. Patients and Methods: A cross-sectional, retrospective and descriptive study of histologically confirmed cancers that are collected from pathological anatomy laboratory records. The aspects studied were age, sex, location and histological type. Results: A total of 2204 cases of urological cancer were collected. The predominance was male with a sex-ratio of 9.6. The average age was 63.32 years. We found 1602 cases of prostate cancer (72.68%), 361 cancers of the bladder and excretory tract (16.4%), 180 cancers of the kidney (8.16%), 33 testis cancers (1.5%) and 28 penile cancers (1.3%). The predominant histological type of prostate cancer was adenocarcinoma (96.4%) with a Gleason score 7 in 30.4% of cases. Bladder cancer consisted of 50% epidermoid carcinomas. Kidney cancer was mostly nephrotoblastomas with 42.2% of cases. We noted 42.4% of seminomas among testis cancers and 89.3% of epidermoid carcinomas within penile cancers. Conclusion: The incidence of urological cancers is increasing in Burkina Faso. These cancers occur at a relatively advanced age with male predominance. Prostate cancers are at the forefront of these urological cancers. The establishment of a cancer registry would allow better follow up of cancers in our countries.

Epidemiological Profile of Diagnosed Disorders in Urological Consultation at Sylvanus Olympio Teaching Hospital in Lome

Context: Thanks to the increase in the number of urologists in Togo, urological activity is improving rapidly. Objective: This study aims at presenting the epidemiological aspects of the diseases diagnosed in urology consultation at the Sylvanus Olympio Teaching Hospital in Lome. Materials and Methods: This research was a two-year retrospective and descriptive study. The data for the analysis were collected from the records of patients received in consultation for urological pathology. The parameters taken into account are: frequency, age, sex, occupation, patient history and diagnosis. Results: 602 patients were admitted at the department of urology within two years, with an annual frequency of 301. The average age of the patients was 48.63 ± 19.69 years;the sex ratio (M/F) was equal to 12.08. Patients over 60 years of age accounted for 33.3% of the patients seen. The medical history of 88 cases showed that the bladder catheterization was most frequent (22 cases) followed by hypertension (15 cases). Benign prostatic hyperplasia was the most frequently diagnosed pathology accounting for 24.9% of the consultations. Conclusion: Benign prostatic hyperplasia is the most frequent pathology in urology consultation at the Sylvanus Olympio Teaching Hospital in Lome.

Management of Urological Lesions Secondary to Obstetrical Gyneco Surgery in the Urology Department of the Gabriel Toure University Hospital Centre

Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.