[Self-amputation of the penis treated immediately: Case report and review of the literature]

Self-amputation of the penis treated immediately: case report and review of the literature. Self-amputation of the penis is rare in urological practice. It occurs more often in a context psychotic disease. It can also be secondary to alcohol or drugs abuse. Treatment and care vary according on the severity of the injury, the delay of consultation and the patient's mental state. The authors report a case of self-amputation of the penis in an alcoholic context. The authors analyze the etiological and urological aspects of this trauma.

[Erectile dysfonction after stroke in Brazzaville]

INTRODUCTION

Erectile dysfunction is one of the disability post-stroke the least documented. However, it affects the quality of life, not only the patient but also the couple.

OBJECTIVE

The purpose of this work was to study the characteristics of erectile dysfunction after stroke.

METHOD

This is a cross-sectional descriptive and analytical data collection survey conducted from February to October 2011, having identified, 104 patients for follow-up post-stroke, seen in outpatient Neurology University Hospital of Brazzaville and in the functional rehabilitation centers. Among them 54 had erectile dysfunction. The parameters studied were: age, marital status, history, vascular risk factors, and the location of the hemiplegic, the etiology of stroke, modified Rankin score and NIHSS. The clinical features and laboratory, the international index of erectile dysfunction (IIEF-5) in its French version. SPSS 12 was used for recording and statistical analysis of data. Chi(2) test was used for comparisons. The significance level was P≤0.05.

RESULTS

The frequency of erectile dysfunction after stroke was 51.92%, the average age was 56.32 years. The mean time to onset of erectile dysfunction after stroke was 5 months. The onset was progressive in 70,4%. The hypercholesterolemia was well correlated with the risk of erectile dysfunction (P=0.007) and its severity (P=0,01). Erectile dysfonction was moderate in 61.1% and almost bearable in half the cases.

CONCLUSION

Erectile dysfunction post-stroke is common with an impact in the lives of the couple. High cholesterol is an independent risk factor of occurrence of post-stroke.

Prise en charge de la cryptorchidie au centre hospitalier et universitaire de Brazzaville

But

contribuer à l’amélioration de la prise en charge de la cryptorchidie en milieu hospitalier.

Patients et méthodes

il s’agit une étude rétrospective descriptive réalisée dans les services de chirurgie pédiatrique et d’urologie-andrologie du centre hospitalier et universitaire de Brazzaville concernant les patients opérés pour cryptorchidie du 1er janvier 2000 au 31 décembre 2009. Les paramètres étudiés ont été: la fréquence, l’âge au moment du diagnostic et du traitement, les renseignements de l’examen physique, les données chirurgicales et évolutives.

Résultats

sur 8100 patients hospitalisés dans les deux services, 163 (2,7 %) l’étaient pour cryptorchidie dont 2,6 % chez les patients de 1 à 16 ans et 0,8 % chez les patients de 19 à 36 ans. L’âge moyen était de 9,6 ans avec des extrêmes de 1 à 36 ans. Les circonstances de découverte étaient: la vacuité de la bourse (77,3 %), la hernie inguinale étranglée (13,5 %), la hernie ombilicale étranglée (3,1 %), l’infertilité (3,1 %), les douleurs abdominales (1,8 %) et l’hypospadias (1,2 %). L’atteinte était unilatérale gauche (82 cas), droite (70 cas) et bilatérale dans 11 cas. À l’exploration chirurgicale, le testicule était intra-abdominal (26,5 %), inguinal profond (62 %), inguinal superficiel (11,5 %). Les testicules étaient d’aspect normal en peropératoire dans 129 cas, atrophiques dans neuf cas et d’aspect non précisé dans 25 cas. Les résultats du traitement après orchidopexie en un temps étaient bons dans 139 cas (92,6) et mauvais dans deux cas (1,3 %); pour l’orchidopexie en deux temps, les résultats étaient bon dans un cas et mauvais dans trois cas.

Conclusion

la cryptorchidie est encore diagnostiquée et traitée tardivement dans notre milieu hospitalier. Une prise en charge thérapeutique entre l’âge d’un et deux an(s) est nécessaire pour l’amélioration du pronostic fonctionnel.

[Stones associated with vesicovaginal fistulas]

OBJECTIVE

To describe the clinical features and treatment of a large stone associated with vesicovaginal fistula and analyze the contributing factors.

PATIENTS AND METHODS

From January 2000 to July 2011, seven patients were operated on for a large stone wedged in the vesicovaginal at the Urology Andrology department of the University Hospital of Brazzaville. For each case, the epidemiological, clinical, therapeutic aspects were analyzed.

RESULTS

Seven of 89 patients operated on for vesicovaginal in 10 years had a large stone. The age of patients ranged from 35 to 63 years with an average of 44 years. The age of the fistula ranged from 3 to 33 years. History were six caesarean sections and one obstructed labor. The urine culture performed in six patients had identified both Escherichia Coli, five times, and Proteus mirabilis, one time. The calculus was extracted five times by the bladder and two times vaginally. The dimensions of the calculi ranged from 3 to 7 cm of large diameter. The suture concomitant fistula was performed with four cures and three failures cured by a second course.

CONCLUSION

Vesicovaginal fistulas may be complicated by calculus. The contributing factors are foreign bodies and infection.

[Urogenital fistulas: etiopathogenic and therapeutic aspects at the University Hospital Center of Brazzaville]

INTRODUCTION

The urogenital fistulas continue to be a dangerous complication of the childbirths dystociques in Africa and especially to Congo.

OBJECTIVES

To analyze the étiopathogénic and therapeutic aspects of the urogenital fistulas in order to suggest preventive measures. SICK AND METHODS: It is about a retrospective survey achieved in the service of urology of the univertery hospital center of Brazzaville of January 2001 to December 2005 concerning 34 patients hospitalized for urogenital fistulas. The étiopathogéniques and therapeutic aspects have been analyzed.

RESULTS

The urogenital fistulas represent about 2,7% of the hospitalizations in urology. The middle age is of 31 years (17 - 65 years). 28 (82%) are of obstetric origin with 11 Caesareans and 17 childbirths dystociques. 6 are especially of surgical origin after hysterectomy. 28 patients have been operated among which 2 have been taken. The different surgical techniques were the following: 20 ways transvésicales, 3 Chassar Moirs, 2 LEGUEU, 3 Martius and 2 vaginal ways with Picot Couvelaire. The anatomical shapes were: 29 fistulas vésicovaginales, 1 vésico uterine, 3 vesico vaginorectal and 1 urétérovaginale. After surgery, we got 25 anatomical closings of which 1 with incontinence. 3 recidivisms have been observed: 2 have been reoperate of which 1 success and 1 failure. The 3rd being lost of view. To the total we got 25 successes (89,2%).

CONCLUSION

The urogenital fistulas remain frequent with a predominance of the obstetric reasons. The recidivisms are possible from where the necessity of a mastery of the surgical techniques.

[Open surgery of the urinary tract calculi at the university hospital of Brazzaville: analysis of 68 cases]

AIMS

To report epidemiological, clinical, and outcome of surgical therapeutic aspect of urinary calculi in our department.

PATIENTS AND METHODS

This survey, retrospective, has been achieved from june 2000 to may 2004. It concerned 68 patients carriers of the urinary calculi, confirmed radiologically and operated.

RESULTS

The patients carriers of the urinary calculi represented 7,3%. There was 52 men (76,47%) an 16 women (23,53%).The average age of the patient was 52,13 years (extreme : 14 et 82 years). Symptoms at the diagnostic was : atypical abdominal pen (n=18), dysuria (n=15), hematuria (n=15), la pollakiuria (n=9), nephretic colic (n=15), urinary retention (n=26). The location of urinary calculi was vesical (n=47), renal (n=8), pyelic (n=12), ureteral (n=1). All our patients was operated. The operative continuations one summer simple in 58 cases, and complicate of pariatal suppuration in 7 cases. Mortality was of 3 cases.

CONCLUSION

The urinary lithiasis is little frequent. The open surgery is the only surgical technique that is practiced in our context.

[Scrotal elephantiasis: about seven operated cases]

The authors report seven cases of scrotal elephantiasis operated on nine years in the urology department of a filarial endemic zone. Patients wait for a long time before consulting for big scrotum reaching eventually 15 kg. The final arguments for the filarial origin haven't been found whereas arguments of presumption exist The surgical treatment has enabled to get an aesthetic satisfying result, sometimes after a second cure.

[Retrospective study of 34 urogenital fistulas of obstetricalal origin]

OBJECTIVES

The aim of the study was to determine the etiologic and epidemiological aspects of the obstetrical uro-genital fistulas in Congo in order to propose a strategy of prevention.

PATIENTS AND METHODS

It is a retrospective study concerning 34 files of obstetrical uro-genital fistulas selected within 7 years in the department of Urology of the University Hospital Center of Brazzaville. The etiopathogenic, anatomoclinical and therapeutic aspects have been analysed for each file.

RESULTS

The uro-genital fistula represents 23% of the female admissions in urology and 85% of them are related to obstetrical causes. Fifty-five percent of the patients were less than 30 years old, most of them being primiparas. Sixty-one percent of the patients came from rural areas. The prolonged time of the delivering labour and the foetal extraction manoeuvres were the main mechanisms causing the fistulas. With the surgical therapy, 77% of the abnormalities have been treated.

CONCLUSION

In spite of progress made in the realm of surgical techniques, the best treatment for uro-genital fistulas remains their prevention as targeted on the education for health and the management of pregnant women. Besides, the development of the infrastructure of health and roads, the training and reeducation of the health personnel contribute to improve this management.

A study of beta 2-microglobulin skin deposits in dialyzed patients and healthy controls

This study reports on beta 2-microglobulin (beta 2M) deposits in the skin of 12 uremic patients and three kidney transplant recipients compared with eight healthy controls. Uremic patients were treated by hemodialysis (HD), hemofiltration (HF), hemodiafiltration (HDF), or continuous ambulatory peritoneal dialysis (CAPD) for a period lasting from 1 to 19 years. Congo red staining of the skin was negative in patients and controls. However, immunofluorescent staining with an anti-beta 2-microglobulin monoclonal antibody was positive in the skin of all patients and of six of the eight controls. Beta 2M skin deposition is more intense in patients than in controls and increases with patient age and the duration of dialysis. A stron correlation is observed between the extent of skin beta 2M deposits and clinical manifestations due to beta 2M deposits in internal organs. However, no correlation is found between beta 2M skin deposits and sex or beta 2M serum levels.