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.

Surgical Complications of Kidney Transplantation in a Resource Limited Country: Retrospective Study of the First Five Years

Background: Kidney transplantation is the most efficient treatment for renal failure but may be ruined by complications. Objective: To report the surgical complications of renal transplantation and the therapeutic means applied. Method: It was a retrospective study including 42 files of kidney transplantation in Côte d’Ivoire. We report 11 cases of surgical complications of the recipient’s intervention during the first five years. Results: The mean age was 42.64 years (±15.04). In 90.9% of the cases, there was a comorbidity factor. Lymphocele and stenosis of the uretero vesical anastomosis were the most frequent complications. One death was observed. Conclusion: Kidney transplantation is an effective way of managing chronic renal failure. Postoperative complications are polymorphic and unpredictable.

Spontaneous Rupture of Urinary Bladder (SRUB): An Exceptional Presentation

Background: Spontaneous rupture of urinary bladder (SRUB) without trauma is an extremely rare pathology. The incidence is estimated to about 1/126,000. It is difficult to diagnose. Aim: To present an exceptional case report and emphasize on the difficulty of diagnosis. Case Presentation: We report the case of a 63-year-old man. The initial diagnosis of SRUB was obscured by a urinary retention. The pelvic ultrasound finally led to the diagnosis. We will pay particular attention to the circumstances of the diagnosis and the therapeutic measures applied. Conclusion: SRUB is exceptional and misdiagnosis is usual. Management is most of the time surgical.

Intra Uterine Device (IUD) Migration into the Bladder. Diagnosis Issues and Management

Background: Intra uterine device (IUD) is commonly used as contraceptive procedure. A mislocation is possible and may reduce quality of life. Aim: This paper aims to present a rare case report and emphasize on the difficulty of diagnosis. Case Presentation: A 40-year-old woman had a history of IUD implantation after her last delivery. Six years later, she visited a doctor for a pelvic pain going on for a long period. The diagnosis of mislocated intra uterine device (IUD) was made using imaging techniques. Conclusion: A pelvic pain in a woman, going on for a long period, should evoke a migrated IUD. Thorough exploration and management are required.

Expending the Paradigm: Active Surveillance for Intermediate Risk Prostate Cancer

Prostate cancer is the leading male cancer worldwide. There remains a controversy as to which patients have indolent disease and which patients present an aggressive disease needing treatment with intent to cure. Because of quality of life impairment associated with treatment by radiation or surgery, active surveillance (AS) is a valid management option to avoid or differ aggressive treatment. Traditionally, AS was reserved for men with low risk prostate cancer, however intermediate risk patients are more and more found in AS cohorts. The aim of this review is to describe the place of AS in intermediate risk patients and the perspectives offered by such a treatment modality.

Gangrene of the External Genitalia at the Regional University Hospital Center of Ouahigouya: Epidemiological Profile and Therapeutic Aspects

Introduction: Gangrene of extern genitary organs is a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that results from a polymicrobial infection. Mortality remains high despite advances in resuscitation. We report the experience of the surgery department of the Regional University Hospital Center (CHUR) of Ouahigouya in order to describe the epidemiological profile and the therapeutic aspects of GOGE. Patients and methods: We carried out a descriptive and analytical retrospective study collecting 41 cases of Fournier’s gangrene treated over 63 months (from March 2013 to July 2018) in the surgical department of the Ouahigouya regional university hospital center. Ethical clearance was taken from the institutional ethics committee. Results: The mean age of the patients was 65.02 ± 17.92 years with extremes of 23 years and 95 years. All patients were male. Urologic causes were the most common with 36.58% of cases. The average consultation time was 15.44 ± 16.04 days with extremes of 1 day and 60 days. All patients received resuscitation, bi or triantibiotherapy and surgical debridement. The mortality rate was 24.39%. The mean duration of hospitalization was 10.83 ± 6.257 days with extremes of 1 day and 60 days. Conclusion: The Fournier’s gangrene always has a very high lethality. Improving the prognosis requires fast and effective management.

Zinner’s Syndrome: A Confusing Diagnosis in the Face of Chronic Disabling Perineoscrotal Pain in the Young Subject, about a Case

Zinner syndrome is a rare congenital malformation related to an abnormality in the development of the Wolffian duct, the clinical picture of which consists of a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and obstruction of the ejaculatory duct. Chronic perineoscrotal pain may be an indication of the diagnosis of Zïnner syndrome to some extent. We report the observation of a 23-year-old patient, married and father of one child, who presented with chronic perineo-scrotal pain revealing on morphological assessment (ultrasound, uroscanner, prostatic MRI) a cystic formation of the seminal vesicle, left renal agenesis with an empty left renal compartment. Given the patient’s refusal of any surgical procedure, treatment consisted of echo-guided puncture of the seminal vesicle cyst bringing back 30 cc of a seroviscous liquid whose analysis revealed spermatozoa, without atypical cells, compatible with a cyst. The clinical evolution was marked by a progressive remission of the scrotal pain with a delay of several months.

Kidney Transplantation Using Ovarian Vein. Presentation of Two Cases and Review of Literature

A good vascular condition is fundamental for kidney transplantation. A bad arterial or venous supply may compromise graft survival. Discovery in operating theater of vascular anomalies not diagnosed by medical imaging may overwhelm operating protocol. Our cases emphasize the issue of pre operating evaluation. The cases are those of two women, aged 48 and 25 years, with chronic renal insufficiency, for whom living donor kidney transplantation was decided. During the process, a total obstruction of iliac vein was found and led to a change of technique. The dilated ovarian vein was used for the venous anastomosis while the arterial anastomosis was as usually made using the iliac artery. Post-surgical follow up was uneventful. These cases emphasize on the mandatory pre operative evaluation and the respect of guidelines in the process of kidney transplantation. They also open access to other operating strategies. The objective of this publication was to present our experience in dealing with an obstructed iliac vein and emphasize on the necessity to assess accurately vascular state in kidney transplantation.

The role of ureteroscopy for treatment of staghorn calculi: A systematic review

Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.