[Sexuality assessment of homozygous adult sickle cell patients with a history of priapism in Senegal]

OBJECTIVES

The objective of this study was to evaluate the sexuality of SS sickle cell patients with a history of priapism.

METHODS

This was a case-control study of adult SS sickle cell patients. The occurrence of priapism as well as the nature of the priapism had been investigated. The patients were subdivided into three groups: Group 1 (no priapism), Group 2 (intermittent priapism) and Group 3 (acute priapism). The patients' sexuality was studied using the IIEF-15 questionnaire.

RESULTS

We interviewed 191 SS sickle cell patients. The mean age was 27.1±7.1 years. Priapism was observed in 43.5 %. Only 77 patients were eligible for the IIEF15 questionnaire. Groups 1 and 2 performed significantly better than group 3 on erectile function (EF) and orgasmic function (OF) scores. There was no significant difference in the EF and OF scores between groups 1 and 2. No significant difference was observed between the three groups for the scores of sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The impairment of erectile function in group 2 was related to the age of the first episode of priapism and the last episode. The impairment of erectile function in group 3 was related to the duration of evolution (P<0.05).

CONCLUSION

This study shows that priapism is responsible for impaired erectile function in SS adult sickle cell patients. A program to prevent intermittent episodes of priapism should be put in place.

[Advanced prostate cancer in Senegal. Clinical aspects at the General Hospital of Grand Yoff]

Prostate cancer is a common disease, which continues to be discovered at advanced stages in Africa, despite improved diagnostic tools.

AIM

The authors report the experience of the Department of Urology, General Hospital of Grand Yoff Dakar in the diagnostic of advanced prostate cancer.

MATERIAL

This was a retrospective descriptive study on patients followed for advanced prostate cancer during the period from January 1st, 2004 to May 31st, 2010.

RESULTS

There were 102 people aged from 51 to 96 years with an average of 71 ± 9 years. A comorbid condition was associated in 24.5 % of cases. The circumstances of discovery were pain (32 cases), neurological signs (17 cases), and urinary disorders. DRE had objectified an abnormality in all patients. The serum levels of prostate specific antigen ranged from 5.88 ng/mL to 21,660 ng/mL, with an average of 1447.57 ± 812 ng/mL. A prostate biopsy was performed in 44 patients and prostatic adenocarcinoma was found in 97.7 % of cases with Gleason scores greater than 7 (33 cases). We found different metastatic sites at vertebral column (23 cases), at lung (14 cases), and on pelvic bones (11 cases).

CONCLUSION

The prostate cancer is a serious condition with high morbidity and mortality. The diagnosis is not made early in developing countries. We need a strategic plan to improve the early screening and we should develop supportive care too because of the high number of advanced cases diagnosed in our context.

[Management of prostate cancer in Senegal: what is being done?]

OBJECTIVE

To evaluate the management of patients with prostate cancer in Senegal.

MATERIALS AND METHODS

We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities.

RESULTS

We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen.

CONCLUSION

The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

La fracture de verge à Dakar. À propos de 25 cas

Buts

Présenter les caractéristiques épidémiologiques, cliniques et thérapeutiques des fractures de verge dans le service d’urologie-andrologie de l’hôpital général de Grand Yoff de Dakar.

Matériels et méthode

Il s’agit d’une étude descriptive portant sur 25 cas de fracture de verge pris en charge dans le service d’urologie-andrologie de l’hôpital général de Grand Yoff de Dakar entre janvier 2001 et décembre 2011. Les paramètres suivant ont été étudiés: l’âge, la résidence, les antécédents, les données cliniques, les données de l’exploration chirurgicale et les résultats du traitement.

Résultats

En dix ans, 25 cas de fractures de verge ont été enregistrés soit une moyenne de 2,5 cas par an. L’âge moyen de survenue était de 36 ans avec des extrêmes de 22 et 60 ans. Les circonstances de survenue sont dominées par les manipulations forcées (52 %) et les rapports sexuels (32 %). La douleur associée à une latérodéviation controlatérale de la verge, une tuméfaction localisée de la verge ou extensive à la région sus-pubienne ou périnéale sont les principaux signes retrouvés. Une prise en charge urgente (délai moyen de prise en charge de deux heures avec des extrêmes de 45 minutes et 48 h) en milieu chirurgical avec réparation des corps caverneux et albuginorraphie a été la règle.

Conclusion

La fracture de verge est une urgence urologique relativement peu fréquente dans notre contexte. Son diagnostic reste aisé et est essentiellement clinique. Une prise en charge précoce et correcte en milieu chirurgical est garante d’un bon résultat fonctionnel et esthétique.

Prise en charge du priapisme à Dakar

Objectif

Évaluer la prise en charge des patients présentant un priapisme.

Patients et méthodes

Il s’agit d’une étude rétrospective sur quatre ans, du 1er août 2002 au 31 juillet 2006, portant sur 35 patients. Les cadres d’étude ont été les trois grands services d’urologie du Sénégal qui sont tous à Dakar. Les paramètres suivants ont été étudiés: l’âge, le temps d’évolution du priapisme, les données anamnestiques, le type hémodynamique du priapisme, les résultats du bilan paraclinique, le traitement chirurgical (la technique chirurgicale, la technique d’anesthésie), la durée d’hospitalisation, le traitement associé, les complications per- et postopératoires, les résultats immédiats et à long terme.

Résultats

L’âge moyen des patients était de 21,2 ans. Le groupe d’âge le plus représenté était celui de 20 à 30 ans. La majorité des patients (43 %) avaient une notion de drépanocytose connue. La plupart des patients (65 %) ont été pris en charge avant 24 heures d’évolution. Chez tous nos patients, le priapisme était de bas débit. Dans 50 % des cas, les patients drépanocytaires avaient une forme SS. Dans près de la moitié des cas (62 %), la technique d’anesthésie choisie a été le bloc pénien. La ponction des corps caverneux a été le moyen thérapeutique le plus utilisé (63 %). Aucune complication postopératoire majeure n’a été déplorée dans la prise en charge des patients dans notre série. Chez presque tous les patients (95 %), la détumescence durable a été notée le jour même du début du traitement ou le lendemain. Conclusion: Le priapisme, bien que rare en Afrique, est caractérisé par la prédominance de la drépanocytose comme étiologie et le délai particulièrement long de la prise en charge.

[Urinary incontinence in woman: epidemiologic profile in Sub Saharian countries]

The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries.

MATERIAL AND METHODS

A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence.

RESULTS

Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases.

CONCLUSION

Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

Profil épidémiologique et clinique de l’infertilité masculine à l’hôpital général de Grand-Yoff, Sénégal: à propos de 492 cas

Objectif

Décrire le profil général de l’infertilité masculine, au Sénégal, en milieu hospitalier.

Matériels et méthodes

Il s’agit d’une étude rétrospective, descriptive, portant sur 492 dossiers de patients vus en consultation pour infertilité conjugale du couple entre 2000 et 2004. L’ensemble des paramètres étudiés portait sur les éléments cliniques et les explorations paracliniques.

Résultats

L’âge moyen des patients était de 39 ans. La durée d’évolution de l’infertilité était en moyenne de six ans. L’infertilité était de type primaire dans 66,5 % des cas. Sur le plan clinique, la varicocèle était l’anomalie la plus souvent retrouvée, soit dans 64,6 % des cas. Le spermogramme était perturbé dans 84,3 % des cas. Les principales perturbations étaient une oligospermie inférieure à 5 millions de spermatozoïes/ml (35,6 %) et une azoospermie dans 28,6 % des cas.

Conclusion

Le profil général de l’infertilité est polymorphe. L’exploration est limitée par la non-disponibilité de la partenaire et l’absence de coordination entre gynécologues et andrologues. L’amélioration de la prise en charge de l’infertilité doit passer par de nouvelles voies de recherche, notamment génétiques et immunologiques, afin d’identifier les causes habituellement cachées de l’infertilité. Elle doit aussi reposer sur une bonne collaboration entre praticiens de santé de la reproduction et la mise en place d’unités d’assistance médicale à la procréation (AMP).

[Determination of total PSA rate and Gleason score during prostatic cancer in Urologic Hospital Center]

AIM

To dress biologic and histopathologic aspects of the prostatic cancer in urologic hospital center about a set of digital transrectal guided biopsies.

METHODOLOGY

It is a prospective study realized between January 2002 and March 2002 (26 months) studying patients with positive prostatic biopsy.

RESULTS

Seventy two cases of prostatic cancer were noticed. Mean age of these patients was 69,9 years (54-91 years). Mean rate Total PSA was 134,8 ng/ml (6-2500 ng/ml). Repartition according Gleason score has revealed that only 35% of tumors were well differentiated. The study of correlation between Total PSA rate and Gleason grade has revealed that up to 10 ng/ml Total PSA rate, only 33% of patients had a Gleason grade between 2 and 4 (well differentiated tumor).

CONCLUSION

Actual biologic and histopathologic profile of prostatic cancer lays emphasis on later management.

[Anterior hypospadias: one stage repair. Report of 40 cases]

INTRODUCTION

Anterior hypospadias is estimated to 60-71% of whole hypospadias. The treatment is delicate and expose to iterative cures. The aim of this study is to review therapeutic aspects of anterior hypospadias of which treatment are first performed by one-stage repair in two departments of urology from Dakar.

PATIENTS AND METHODS

It's a retrospective study reporting 40 cases of anterior hypospadias operated between January 1988 and December 2002. Therapeutic results were judged according following criteria: quality of orthoplasty, cosmetic aspect, situation of neo-urethral meatus, permeability of urethra and existence of fistula or not. The results were classified good, mean or worse.

RESULTS

The following techniques were used: Mathieu (18 cases), Duplay (14), MAGPI (Meatal Avancement and Glandulo-Plasty Incorporated) 2 cases, Mustarde (2 cases), TGUA (Trans Glandular Urethral Avancement) 4 cases. The mean age of patients was 7,2 years (5 months-19 years). The hypospadias was granular (5%), subcoronar (25%), and anterior penile (70%). Results were good in 62, 5% of cases and worse in 20% of cases.

CONCLUSION

In our way of work, for improving the treatment of anterior hypospadias, it is necessary to have microsurgical material and to modify the urinary drainage mode.