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.

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.

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.

Urological Emergencies at Kara Teaching Hospital (Togo): Epidemiological, Clinical and Therapeutic Profile

Background: The urology department of the teaching hospital of Kara is the second urology department in Togo, after that of the teaching hospital Sylvanus Olympio, in Lomé the capital. It is a very young service, created less than 5 years ago. Urological emergencies were previously managed by general surgeons, for lack of urologists. The influx of patients with urological pathologies has increased with the arrival of urologists. The update on urological emergencies having been made in Lomé, we therefore wanted to take stock of urological emergencies at the teaching hospital of Kara. Objective: To describe the epidemiological, clinical, and therapeutic aspects of urological emergencies received at the teaching hospital of Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department, and in the surgical emergency department of the teaching hospital of Kara, over a period of 18 months, from January 2021 to June 2022. The on-call medical team consisted of the intern in on-call medicine, and an on-call urologist, whom the intern called upon when he received a urological emergency. Pediatric urological emergencies were managed by the pediatric surgeon and were not considered in our study. The operating room register, the surgical emergency consultation register, the urology department consultation register, and the records of patients hospitalized in the urology department were used for data collection. The following parameters were studied: age, sex, type of urological emergency, and therapeutic management;epi info 7 software was used for data processing. Results: The average age of the patients was 52.5 ± 19.6 years with extremes ranging from 16 years to 102 years. Note that 57.7% of the patients were over 50 years old. The sex ratio was 8.9. Urinary retention was the most common urological emergency in 47.7% (52) of cases;follow-up of infectious pathologies in 30.2% (33) of cases. Among the patients who had been seen for urinary retention, 84.6% (44) of the cases had presented with acute urinary retention. Urethral catheterization was the type of care most received by patients, in 30.2% (33) of cases;follow-up of medical treatment in 27.5% (30) of cases. The most common etiology of urinary retention was prostate tumours, in 71.1% (37) of cases, followed by urethral stricture in 15.3% (8) of cases. We also found in our series, traumatic emergencies in 10% of cases;these were traumatic urethral injuries, traumatic injuries of external genitalia, traumatic injury of bladder, and traumatic injury of kidney in respectively: 4.5% (5);2.7% (3);1.8% (2);and 0.9% (1) of cases. Torsion of the spermatic cord was found in 2.7% (3) of cases. Conclusion: Urine retention is the most common urological emergency at Kara University Hospital. They are most often found in elderly males. Urethral catheterization was the most common type of care.

Management of Non-Traumatic Urological Emergencies at Souro Sanou University Teaching Hospital of Bobo-Dioulasso (Burkina Faso)

Background: Generally, urological emergencies are assumed not to be very common, however, recent reports showed that they constitute an important aspect of the day-to-day urological practice. If not well and promptly managed, they may lead to serious morbidity or mortality. Objectives: To study the pattern of presentation, diagnosis and outcome of management of non-traumatic urological emergencies seen at the Emergency Department of Souro Sanou University Hospital in Bobo-Dioulasso. Patients and Methods: This was a retrospective and descriptive study over four years. It included patients of all ages and both sexes, admitted for non-traumatic urological emergencies in the surgical emergency department of Souro Sanou University Hospital. It took place from January 1, 2017 to December 31, 2020. Results: A total of 584 patients were reviewed in our study. Non-traumatic urological emergencies account for 6.3% of all surgical emergencies seen during the study period. The male-to-female ratio was 9.2 to 1. The mean age of the patients was 51.9 ± 23.9 years. Forty-five per cent of the patients presented within 48 hours of symptoms. The vast majority of the patients presented with difficulties with passing urine (41.6%), followed by cases of hematuria (18.4%). On admission, 154 patients (26.4%) presented with severe conditions such as anemia as seen in 40.9% of the cases and deterioration in the general health condition as seen in 34.4% of the patients. Leukocytosis was noted in 18.7% of the patients and anemia in 17.9%. Urine culture was positive in 15.4% of the patients and Escherichia coli was the most common pathogen found (40.6%). Ultrasound was the most requested examination (81.2%), followed by a computerized tomography (CT) scan (22%). The most frequent diagnoses were urine retention (42.9%), hematuria (16.9%) and renal colic (10.1%). Emergency interventions were carried out in 525 patients (89.9%) who include bladder catheterization (46.1%), bladder lavage and/or bladder irrigation (20.9%) and suprapubic cystocatheterization (10.1%). Most of the patients (61.3%) were discharged after a mean stay in the hospital of about 5.1 ± 7.5 days. A mortality rate of 3.8% was also recorded among the patients studied. Conclusion: Non-traumatic urological emergencies are common and are an important aspect of daily urological practice. The majority of the patient presents late with usually a severe form of the disease, which adversely affects the outcome even after treatment.

Prevalence of Comorbidities in the Urological Patients at the Former Military Teaching Hospital of Cotonou

Background: Comorbidities are additive diseases and care burdens in urological patients. Determining the epidemiologic profile of comorbidities in urological patients in our setting may help us to better the management of urological disease. Objective: To evaluate the prevalence of comorbidities in urological patients. Patient and Method: We collected comorbidity, urological disease and demographic data in all urological patients managed at the former Military Teaching Hospital of Cotonou from January 1, 2012, to December 31, 2020. We used the software R 4.2.2 to perform descriptive and bi-varied data analysis. Student’s t test was used to compare means. Results: The prevalence of comorbidities was 14.2%, i.e., 601 comorbidity-affected among 4242 patients. The comorbidities predominantly affected men: the sex ratio was 13:1. The presence of comorbidity was correlated with patients’ age (p < 0.001). The comorbidities observed in the 601 affected patients were hypertension (84.5%), diabetes (26.5%), asthma (2%), and heart failure (1.2%). Hypertension (p = 0.001) and asthma (p = 0.030) were correlated with age. No comorbidity was associated with gender. The comorbidities’ prevalence was highest in patients aged 40 - 80 years who presented urological diseases such as BPH (68.9%), Erectile dysfunction (ED) and ejaculatory disorders, overactive bladder (OAB) and neurogenic lower urinary tract dysfunction (LUTD), renal cyst (5%), inguinal hernia (4.2%), urinary stones (2.8%), and prostate cancer (2.3%). Conclusion: The comorbidities’ prevalence was 14.2% in the urological patients. The main comorbidities were hypertension (84.5%) and diabetes mellitus (26.5%).

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.

A Panorama of the Urological Diseases at the Former Military Teaching Hospital of Cotonou

Background: Urological care has been advancing quickly over the last ten years in Benin. In order to conveniently support that trend towards better urological care standards, decision-makers need sound data on urological diseases in the country. Objective: To determine the prevalence of urological diseases in the former Military Teaching Hospital of Cotonou. Patients and Method: We retrospectively collected the urological diseases that the institution had managed from January 2012 to December 2020. We used Excel© 2010 and SPSS© to analyze the collected data. Results: 4244 patients, i.e. 3717 males (87.58%) and 527 females (12.42%) were managed during the study period. The main diseases diagnosed were benign prostatic hyperplasia (32.61%, n = 1384), erectile dysfunction (10.44%, n = 443), chronic prostatitis (5.94%, n = 252), prostate cancer (4.03%, n = 171), and ejaculatory disorders (3.44%, n = 146). In patients ≤ 15 years, predominant diseases were peritoneal vaginal canal (15.9%, n = 43), circumcision (15.6%, n = 42), testicular dystopia (10.7%, n = 29), hydrocele (7.8%, n = 21), and hypospadias (5.6%, n = 15). Wilms tumor (1.9%, n = 5) was the first cancer, testicular (0.4%, n = 1) and para-testicular (0.4%, n = 1) tumors were the next. In patients > 15 and ≤40 years, the main diseases were infertility (14.1%, n = 189), chronic prostatitis (12.9%, n = 173), erectile dysfunction (10.1%, n = 135), ejaculatory disorders (6.2%, n = 83), genital infections (6.2%, n = 83) and urinary stone (4.9%, n = 66). The first cancer was kidney cancer (0.97%, n = 13) followed by bladder cancer (0.3%, n = 4) and testicular tumor (0.3%, n = 4). In patients >40 years, the most prevalent diseases were BPH (52.0%, n = 1370), erectile dysfunction (11.7%, n = 308), prostate cancer (6.5%, n = 171), inguinal hernia (5.1%, n = 134), and urinary stone (3.9%, n = 102). Prostate cancer is the first cancer;the next were bladder (0.95%, n = 25) and kidney (0.68%, n = 18) cancers. Conclusion: Benign prostatic hyperplasia and urological cancers (prostate, bladder and kidney cancers) were the main urological diseases at the former Military Teaching Hospital of Cotonou. Urological malformations and Wilms tumor were the main diseases in the children.

Urological and genital surgery in ancient Egypt

Background:Ancient Egypt might be considered the cradle of medicine.The modern literature is somewhat too enthusiastic regarding the procedures given an Egyptian origin.The aim of the current paper is to briefly analyze the claims regarding urological and genital surgery in Egypt,in order to decide what the Egyptian actually do,and what has incorrectly been ascribed to them.Methods:The original sources as well as the modern literature was reviewed regarding surgery in ancient Egypt.Results:There is only one source indicating a urological procedure for medical indications in the Egyptian material.The Ebers papyrus can be interpreted as describing a surgical treatment for hydrocele.The sources are more abundant regarding male circumcision,while female circumcision is mainly documented from a later period.The suggestions that castration and lithotomy were performed are based on a lack of understanding of the sources.Conclusion:The ancient Egyptians did possibly treat hydrocele with a minor surgical procedure,but there are no indications in the sources that other urological procedures were performed.Circumcisions were common,but were not performed on a medical indication.These findings are in line with the general level of Egyptian surgery.

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.

Urgent Urologic Surgery in Patients with Acute Coronary Syndrome

Urgent urologic interventions create a challenging scenario when they occur in patients suffering from concurrent acute coronary syndrome. Herewith we report two patients with this scenario. Case 1, a male patient was admitted with non-ST elevation myocardial infarction in which dual antiplatelet therapy was initiated. He developed symptomatic right obstructive uropathy. Case 2, a male patient developed non-ST elevation myocardial infarction and was commenced on dual antiplatelet therapy. Subsequently, he developed gross hematuria unresponsive to conservative measures. Urgent urological intervention was carried out while on aspirin in both cases with uneventful recovery. Upon coronary angiography, both cases were found to have multi-vessel disease requiring coronary artery by-pass graft later. Due to their concurrent urologic problems the patients described were not optimized fully to undergo coronary angiography. In close collaboration with cardiology, patients with acute coronary syndrome can be carefully selected to undergo urgent urologic interventions prior to coronary angiography/primary coronary intervention.

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 status,limitation and improvement of adoptive cellular immunotherapy in advanced urologic malignancies

In recent years, immunotherapy has been gradually established as the fourth frequently adopted antitumor therapy, following surgery, chemotherapy and radiotherapy, for advanced urologic malignancies with an improved understanding of theoretical basis, such as molecular biology and immunology. Thereinto, adoptive cellular immunotherapy （ACI） has become one of the hotspots, which comprises a variety of treatment approaches, such as TIL, CIK cell, ~＇~ T cell, CAR-engineered T cell and Allogeneie stem cell transplantation （alloSCT）. Although preclinical efficacy has been demonstrated remarkably, clinical trials could not consistently show the benefit due to multi-factors in complex immnnosuppressive microenvironment in vivo compared to that of in vitro. Here we review some timely aspects of ACI for advanced urologic malignancies, and describe the current status and limitation of immunotherapy from the cellular level. It＇s our expectation to provide prompting consideration of novel combinatorial ACI strategies and a resurgence of interest in ACI for advanced urologic malignancies.

Clinical Application of Percutaneous Nephrostomy in Some Urologic Diseases

Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, perinephric and bladder diseases （n=79）. The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4–20 min. 12F–16F single tract was established in nephrohydrop patients and 16F–20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2–12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.

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.

Urologic Complications after Gynaecologic and Obstetric Surgery at the Urology-Andrology Teaching Clinic of Teaching Hospital of Cotonou

Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a retrospective study of patients referred with urologic complications following obstetric and gynaecological surgeries. The study took place at the Teaching Clinic of Urology Andrology at CNHU of Cotonou between April 1, 2008 and March 31, 2013. Results: Forty-one patients were studied. They represented 3.5% of people hospitalized at CUUA throughout the study period. The average age was 41 years swith range of 20 and 57 years. Twenty-one (51.2%) of them were married. Thirty patients (73.2%) were referred from a non-academichospital, while 7 patients (17.1%) were referred from academic hospital. Caesarean section was the primary gynecological surgery in 22 cases (53.7%) and hysterectomy in 19 cases (46.3%). Clinically, the pre- dominant symptoms were leakage of urine throughout the vagina and obstructive anuria with or without back pain. We found 31 cases of VVF, 5 cases of bilateral ligation of the ureters, 3 cases of unilateral ligation of the ureter, 1 ureteralinjury and 1 uretero-vaginal fistula. These complications were diagnosed postoperatively in 95.1% of cases. Surgeries done included VVF repair in 31 cases (75.6%), unilateral ureteral reimplantation in 4 cases (9.8%), removal of ligation of the ureters in 3 cases (7.3%), bilateral ureteral reimplantation for 2 cases (4.9%) and end-to-end anastomosisin 1 case (2.4%). The postoperative period was uneventful in 29 cases and we observed 7 cases of surgical site infection. The overall success rate was 87.8%. Conclusion: Urological complications following gynecologic surgeries managed at the urologic department of teaching hospital of Coto-nou had an even higher incidence. Early diagnosis especially during the operative procedure would save the patients’ serious complications and open surgery due to the lack of endo-urological facilities. The most important factor in prevention is good knowledge of pelvicanatomy and good knowledge of the surgical techniques of caesarean operation section and trans-abdominal hysterectomy.

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.

Urologic Laparoscopic Surgeries in Elderly: Analysis of Pre-Operative Risk Factors and Postoperative Complications

Purpose: The aging of the population leads to increases in the prevalence of symptomatic urologic diseases. The aim of this study is the analysis of pre-operative risk factors and postoperative complications in patients over the age of 60 years undergoing elective laparoscopic urologic surgery. Patients and Methods: A retrospective study was conducted of 113 patients 60 years of age or older who underwent urologic laparoscopic surgery by a single surgeon (SP). The preoperative physical status and systemic complications, operation time, postoperative complications, postoperative hospital stay and other clinical features of the patients were reviewed. Complications were classified according to the recently revised Clavien classification system. Statistical analysis was done using Univariate analysis and the Fisher Exact test. Results: Laparoscopic urologic surgery was performed on 113 patients 60 years old and over, with an average age of 69.6 years. Associated diseases were found in 92% of them. Pelvic surgery (65;57.5%) was the main reason for surgery. There were 5 (4.4%) conversions to open surgery and 0% mortality. The overall complication rate was 10 patients (8.8%). Among 9 (7.96%) patients with post-operative complications;Grade I, II, IIIa, IIIb and IV complications were observed in 1.77%, 12.8%, 3.53%, 0.88% and 0.88% of cases, respectively. Sex with male, operative time ≥ 250 min and cancer had high risk ratio (2.76, 2.11 and 3.02, respectively);however the correlations of all of preoperative risk factors and postoperative complications showed no statistically significant differences. Conclusions: Laparoscopic surgical treatment of urologic disease in elderly patients performed is feasible and well tolerated, with low perioperative morbidity and a good overall survival rate. Pre-operative risk factors may not influence postoperative complications in patients over the age of 60 years undergoing elective laparoscopic urologic surgery.

Possible Chemosensitizing and Potent Anticancer Effects of D-Fraction in Combination with Vitamin C on Three Prevalent Urologic Cancer Cells

Chemotherapy is currently one of the most common therapeutic options for cancer patients despite the poor efficacy with considerable side effects. We then examined if D-fraction (DF), a bioactive mushroom extract, could potentiate (poor) anticancer effects of those drugs?in vitro. Three urologic cancers, prostate, bladder, and kidney cancers, were tested with various chemotherapeutic drugs and their combinations with DF. Compared to individual drugs alone, combinations of drugs and DF have improved anticancer activity, resulting in the significant (P < 0.05) cell viability reduction in all three cancer cells. As vitamin C (VC) has been postulated to potentiate the bioactivity of DF, this possibility was also examined. The specific combination of DF (300 μg/ml) and VC (200 μM) indeed led to the drastic (≥90%) viability reductions in all three cancer cells. To have a better understanding of such a profound viability reduction, the effect of DF/VC combination on cell cycle was examined next. Cell cycle analysis indicated that this combination induced a G1cell cycle arrest, which was also confirmed by the down-regulation of specific cell cycle regulators (CDK2, CDK4, and cyclin D1) detected on western blots. Moreover, it was crucial to address if the DF/VC-induced viability reduction could be also linked to apoptosis. Western blot analysis revealed that anti-apoptotic bcl-2 was down-regulated while pro-apoptotic Bax was up-regulated with DF/VC combination in all cancer cells, indicating induction of apoptosis. Therefore, the DF/VC combination could ultimately induce apoptosis, accounting for the severe cell viability reduction. In conclusion, DF appears to be a promising agent with chemosensitizing effect, enhancing the efficacy of chemotherapeutic drugs, and its combination with VC exhibits a potent anticancer effect, which is far superior to any combinations of drugs and DF tested in three prevalent urologic cancer cells.

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.