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Buts: rapporter les aspects cliniques et thérapeutiques de la maladie de Lapeyronie (MLP). Matériel et méthodes: étude descriptive monocentrique recrutant 17 cas de MLP dans un service d’urologie au Sénégal entre janvier et décembre 2012. L’âge des patients, les motifs de consultation, le délai de consultation, l’examen des plaques de fibrose, le degré de courbure, le traitement et ses résultats ont été analysés. Résultats: l’âge moyen était de 58,2 ans (33 et 80 ans). La courbure était la plainte la plus observée (13 patients/17) et isolée chez 4 patients. La douleur pénienne était observée chez 4 patients et la dysérection chez 7 patients. Le délai de consultation moyen était de 21,2 mois (1 et 72 mois). Le grand axe moyen des plaques de fibrose était 2,8 cm (0,5 et 7,5 cm). Le degré de courbure de la verge moyen était de 31,6 (0 et 95). Neuf patients ont reçu un traitement à base de vitamine E et des infiltrations de corticoïdes dans la plaque. Il a été efficace chez 3 patients vus à la phase inflammatoire. Un redressement satisfaisant de verge par plicature de l’albuginée des corps caverneux selon Nesbit a été réalisée chez 5 malades en phase de séquelle. Trois patients n’ont pas pu être opérés. Conclusion: la MLP a une faible prévalence et la plupart des patients consultent en phase de séquelle. Le traitement médical a été efficace à la phase inflammatoire et la chirurgie a permis de régler la courbure.

Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Purpose: To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams., Patients and Methods: We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment., Results: A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences., Conclusion: Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams., Level of Evidence: 5., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Scrotal calcinosis is a rare pathology and etiology still discussed. We report five cases in patients without particular history of another disease. Clinical examination revealed scrotal wall with painless nodules of various sizes producing a whitish substance, pasty. The phosphate levels were normal in all patients. They all had a resection of the lesions associated with scholarships plasty recovery. Histopathological study revealed calcified epidermoid cysts in 4 cases., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Bilharzioma are inflammatory pseudotumors, which often pose the problem of differential diagnosis with neoplastic processes. Using the keywords "testicular" and "schistosomiasis", there are only 14 cases of testicular bilharzioma identified on PubMed. The authors report two new cases in a 6-year-old child and an adult of 38 years, collected over a period of 5 years. In both cases, orchidectomy was performed and histological analysis of the surgical specimen was allowed to diagnose testicular bilharzioma by Schistosomia haematobium. The authors emphasize the need to evoke a bilharzioma before any testicular nodule in a patient living in an endemic area., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objective: Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF)., Patients and Methods: We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure., Results: Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure., Conclusion: In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objectives: To evaluate the results of Anderson-Hynes open pyeloplasty in our institution. And then to compare them to those of laparoscopic procedure and identify what can be considered now as the indications of the open procedure., Patients and Methods: It was a retrospective study on 30 cases of ureteropelvic junction syndrome managed by Anderson-Hynes open procedure. The clinical, biological and radiologic characteristics of the patients as well as the surgical technique and its results were taken into account. The patients were classified, according to Valdeyer and Cendron classification as type II in eight cases (26.7%), type III in ten cases (33.3%) and type IV in four cases (13.3%). There were also eight cases of giant hydronephrosis (26.7%). The operating time, the length of hospital stay and the outcomes were studied and compared with those of the laparoscopic pyeloplasty found in the medical literature., Results: The mean operating time was 115 ± 33.4 minutes (90-230 min). The mean length of hospital stay was 10.4 ± 5.1 days. Six patients (20%) had postoperative complications. After a mean follow-up of 28 ± 13.7 months (13-48 months), our first-hand success rate was 90% (n=27)., Conclusion: Anderson-Hynes open pyeloplasty reached good results but nowadays its indications can be limited to laparoscopic contraindications, severe hydronephrosis (grade IV or giant hydronephrosis) and second-hand cases. The two latter indications depend on the surgeon experience in laparoscopic surgery., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objective: To identify the etiology and current clinical characteristics of male urethral stricture disease (USD) in Senegal., Patients and Methods: A retrospective and mono-centric study over a 10-year period (between January 1999 and December 2008) was carried out and included all male patients with USD admitted to the Urology Department of Aristide Le-Dantec Hospital (Dakar)., Results: We recorded 414 USD cases. The maximum annual incidence was observed in 2004, and from then, the incidence tended to decrease gradually. The mean age of patients was 43.7 ± 19.6 years (1-89 years), and 43% of patients were younger than 40 years old. The mean time from symptoms onset to the consultation was 20.1 ± 24.9 months (1-120 months). Most patients (42.2%) were admitted because they suffered dysuria. In 57.8% of patients, USD was diagnosed with complications. The most common site of stricture was at the bulbar urethra (72.7%). The length of the urethral stricture was smaller than 1 cm in 59.6% of patients, between 1 and 3 cm in 28.5% and between 3 and 5 cm in 7.7%. The stricture was longer than 5 cm in eight patients and was staged (multifocal) in nine patients. The etiology of urethral stricture was infectious in 63% of patients, traumatic in 13.7% and iatrogenic in 8.2%. The etiology was not identified in 14.9% of cases. The infectious etiology was urethritis in 259 cases and urogenital schistosomiasis in 12 cases. A study of the etiology according to stricture site showed that bulbar USD was infectious in 77.7% of cases and that all membranous USD cases were traumatic., Conclusion: Male urethral stricture in Senegal is often a sequela of gonococcal urethritis and is frequently detected because of infectious complications such as gangrene of the genitalia or urinary tract infections. Its prevention in this geographical region thus requires fighting against sexually transmitted infections and treating appropriately and effectively all urethritis.

Purpose: To report epidemiological, clinical and paraclinical features of pyonephrosis and describe current management methods in Senegal., Patients and Methods: This retrospective study includes a series of patients admitted for pyonephrosis to the Urology Department of the Aristide Le Dantec Hospital in Dakar between 1995 and 2009. The following information was collected for each patient: age, sex, clinical manifestations, diagnostic findings, treatment modalities and outcomes., Results: A total of 44 patients with a mean age of 34 years were included. The most common clinical manifestations were acute flank pain, sepsis and renal mass. Diagnostic was usually based on medical imaging, i.e., renal utrasonography and computed tomography. Urolithiasis was the underlying etiology in 73.2% of cases. Nephrectomy was performed in 83% of cases with or without preliminary nephrostomy catheterization., Conclusion: Development of both diagnostic (medical imaging) and therapeutic methods for management of pyonephrosis has been consistent with the rarity of this condtion in Senegal.

Objective: To study current epidemiological and clinical features of adult renal cancer in Senegal and the evolution of these features over the two past decades., Patients and Methods: We conducted a retrospective ten years study (2000-2009) that analyzed all the renal cell cancer in adult admitted in the urology department and the pathology department of the university teaching hospital Aristide-Le-Dantec (Dakar). The results of this study were compared with those of the previous decade., Results: We included 74 cases of renal cell cancer. The median age of patients was 49 years (18-72 years). There was a slight female predominance (51.3%). Twenty-eight (37.8%) patients presented at least with one renal cell cancer risk factor. The median duration of symptoms was 10 months (1-96 months). The localization of the renal cancer was right in 42 patients (56.7%) and left in 32 cases (43.8%). Almost all the tumors were symptomatic. Symptoms were dominated by loin pain (87.8%) and abdominal mass (77%). There were only two cases (2.7%) of incidental renal cell cancer. The median tumor size was 12 cm (2.4-26 cm). The more frequent tumor stages according to the TNM 2002 staging system were T2 (39.2%) and T3 (33.7%). Metastases were found in 23 (31%) patients. Forty-four patients underwent nephrectomy (43 radical and one partial). No adjuvant treatment or metastasectomy were done. The main histological subtype of tumors was renal cell carcinoma (47 cases). The mean duration of the follow up was 30.5 ± 33.6 months. Among the 44 patients who underwent nephrectomy, no tumor recurrence was found on 35 cases. Tumor recurrence occurred on nine patients. The specific mortality rate was 47.3%. Epidemiological and clinical features of the adult renal cell cancer in Senegal haven't significantly changed over the 20 past years., Conclusion: The adult renal cell cancer incidence was low in Senegal. Its clinical profile was characterized by a predominance of locally advanced and metastatic forms., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Renal cell carcinoma (RCC) in children is rare. This entity has different clinical and biological presentation characteristics from adult RCC. In contrast to Wilms tumor, the efficacy of chemotherapy and radiation therapy in pediatric RCC remains uncertain. Debate continues on the importance of lymph node dissection. The authors present a case of RCC with lymph node involvement in a 12-year-old boy. The treatment was radical nephrectomy and a limited lymphadenectomy. No adjuvant therapy was given. After 13 months of follow-up, there is no evidence of recurrence. This case shows that lymph node involvement (in the absence of distant metastases) is not associated with a poor prognosis in pediatric RCC and that lymphadenectomy in lymph node-positive cases is important., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Unlabelled: To describe clinical and therapeutic features of ischemic priapism associated with sickle cell disease (SSD) in Senegalese men and to identify risk factors for erectile dysfunction (ED)., Patients and Methods: The charts of all patients admitted to the Urology Department of Aristide Le Dantec University Teaching Hospital (Dakar) for ischemic priapism associated with SSD between January 2000 and September 2008 were retrospectively reviewed., Results: A total of 22 patients with a mean age of 19.5 +/- 9.9 years (6 - 41 years) were identified. The most affected age group was between 21 and 30 years. The mean duration between onset of the episode and admission was 89.6 +/- 103.1 hours (4 - 384 hours). Nine patients (40.9%) were admitted within 24 hours after the onset. Eight patients (36.3%) had a history of stuttering priapism. The sickle cell phenotype identified by electrophoresis was SS in 18 patients and AS in four. The main treatment modalities were corporeal aspiration that was performed with or without intracavernosal injection of sympathomimetics drugs and Al Ghorab shunt surgery that was used in ten patients with a success rate of 90 % (complete detumescence). With a mean follow-up of 3.8 +/- 1.5 years, nine (69.2%) of the 13 patients older than 16 years developed ED. The incidence of ED was significantly correlated with the duration of the priapism but not with SSD phenotype., Conclusion: In Senegal ischemic priapism associated with sickle cell disease occurs mainly in young people. The incidence of ischemic priapism appears to be low but ED is common due to the prolonged duration of priapism.

Purpose: To report the oncologic results and morbidity of bilateral pulpectomy and to identify factors that make this method of androgen suppression therapy the most used in our country., Patients and Methods: We conducted a prospective study in the urology department of Aristide Le-Dantec hospital (Dakar) between January 2008 and June 2010 (30 months). It included 84 cases of prostate cancer treated by bilateral pulpectomy under local anesthesia., Results: The mean age of patients was 72.17±12.48 years (53-91). The median PSA level was 101 ng/mL (12.18-9990). Metastasis have been detected in 75% of cases. The Gleason score was higher than 7 in 40 patients (47.6%). Three months after pulpectomy, an improvement of performance status was seen in 76 patients (90.4%). The back pain significantly decreased in intensity or disappeared in 65.3% (32/49) of cases. A complete recovery of lower limbs motor deficit was observed in 50% of cases (7/14). The PSA levels decreased in 57 of the 76 patients alive and the mean PSA level was then 72±11.7 ng/mL (3.8-2433). At six months, of the 53 patients in urinary retention, 18 had recovered spontaneous and complete urination. The PSA level was below 4 ng/mL in 33.8% (22/65) of cases and between 4 and 10 ng/mL in 52.3% (34/65) of cases. At 12 months, the median PSA nadir was 0.76 ng/mL (0,002-8,17) and 57.4% of the 54 patients alive had a PSA nadir less than 2 ng/mL. The mean follow-up was 11.08±10.34 months (1-30). A rising PSA occurred in 17 patients (20.2%) after an mean progression-free survival of 10.5 months (6-25). The overall survival at 6, 12 and 24 months were respectively 77.3, 64.3 and 52.3%. The overall cost of pulpectomy was 50 000 FCFA (76€). The specific morbidity of pulpectomy was two cases (2.4%) of infection of the operative site., Conclusion: The bilateral pulpectomy was a method of androgen suppression immediately effective, efficacious with a low morbidity. Its very low cost is the main reason why it is still the most used method in our country., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: To report the cases of urolithiasis in children and to assess epidemiological, clinical and therapeutically aspects., Patients and Methods: We study retrospectively the cases of urolithiasis in children of 0 to 15 years old between 2003 and 2008. The parameters of study were: age, sex, clinical and therapeutically aspects., Results: We report 20 cases. The mean age was 5.4 years. The sex-ratio was 9/1. Dysuria was the most common symptom. Abdominal plain radiography associate with ultrasonography permitted the diagnostic in most cases. Stone location was in the bladder mainly (n = 12). Posterior Urethra valves were the common etiology found. The surgical treatment was performed in all cases and consisted of cystolithotomy in the majority., Conclusion: Children urinary stones are less common than in adults. The etiologies are different but the treatment is coming to be alike.

Objective: To assess the feasibility of selective clamping of segmental renal arteries during partial nephrectomy, in order to limit renal infarction to the pathological area to be resected., Materials and Methods: A dissection of renal artery and its extraparenchymal branches was realised. The study included 30 kidneys from recent nonformolised corpses. The size, distribution, and accessibility of the arteries were considered. All the corpses underwent a lombotomy with or without rib resection., Results: The majority of dissected kidneys had a unique artery (96.66% of cases). The number of segmental arteries was zero in five cases (16.66%), one in four cases (13.33%), two in four cases (13.33%), three in one case (3%), four in 15 cases (50%) and five in five cases (16.66%). The posterior and inferior segmental arteries were more accessible to isolate with a respective ratio of 94 and 100% at segmental level. Apical and middle segmental arteries were least accessible with a respective ratio of 73 and 80%. The majority of accidents during dissection occurred with the middle segmental artery (62.5% of vascular lesions)., Conclusion: This anatomic dissection on corpses showed that selective renal segmental arteries is possible in the majority of cases. This dissection is better indicated in partial nephrectomies for renal tumours located posteriorly or in the lower pole.

Objective: To present the epidemiological, clinical and therapeutic features of the urological emergencies in Senegal, West Africa., Material and Methods: The authors conducted a 20 months retrospective study that analyzed the epidemiological, clinical and therapeutic features of all urological emergencies admitted to the urology department of the university teaching hospital Aristide-Le-Dantec (Dakar)., Results: There were 1237 urological emergencies. The mean age of the patients was 58.8 years (range one month-94 years). The sex ratio (M/F) was 20.32. These patients had an age equal to or higher than 60 years in 50.7% of the cases. The most frequent illness was urinary retention (53%) and genitor-urinary system infectious, which represented as a whole 16.4% of the cases. The gangrenes of male external genitalia (Fournier's gangrene) accounted for 4.1% of the cases and the priapism 1.3%. In emergency, 331 surgical operations were performed. The most performed procedures were the installation of a suprapubic catheter (59.8%) and debridement of a gangrene of male external genitalia (15.4%)., Conclusion: The most frequent urological emergency in our country was the acute urinary retention. Some serious illness like gangrene of male external genitalia (Fournier's gangrene) and priapism are not rare there.

Objective: To present the epidemiological, clinical and histological profile of the bladder cancer in Senegal., Material and Method: The authors conducted a retrospective study based on registries and clinical data of patients admitted for bladder cancer confirmed by the histology at the university hospital Aristide-Le-Dantec of Dakar., Results: Four hundred and twenty-eight bladder cancers were recorded. The incidence of the bladder cancer was 2.5% of the whole of cancers. The mean age of the patients was 45.5 years (range 12-86 years). The sex-ratio was 1.25. The majority of the patients consulted for low urinary tract symptoms (94.5%) and hematuria (88%). The prevalent histological type was squamous cell carcinoma (50.70%)., Conclusion: The bladder cancer in Senegal is a cancer of the young adult. The prevalent histological type is squamous cell carcinoma.

Unlabelled: Prune Belly syndrome (PBS) is a rare complex malformation with male predominance. His pathogeny is not yet completely elucidated. The goal of this work is to analyze the epidemiological, anatomoclinical and treatment aspects of a retrospective trial in Aristide-Le-Dantec Hospital., Patients and Methods: We carried out a retrospective study about 22 cases collected in the departments of urology-andrology and pediatric surgery in Aristide-Le-Dantec Hospital between April 1995 and November 2004., Results: The mean age of the patients was 15 months with extremes of one day and 10 years. The somatic examination revealed 20 cases of complete abdominal muscle aplasia, one right partial form and the last case had a left partial form. Nineteen patients were managed with conservative treatment and three patients benefited a surgical act for urinary abnormalities. The Montfort intervention was performed in two patients respectively aged eight and 10 years. The orchidopexy, stage 1, by Fowler-Stephens technique was performed in 13 cases. Five cases of death and nine cases of testicular atrophy after orchidopexy occurred. The followings were satisfactory in the three operated patients for urinary abnormalities., Conclusion: The renal failure is the main cause of death. The management of the urinary tract abnormalities must be performed individually. The testis descending should be performed in newborn period to enhance the fertility chances. The abdominoplasty also should be done early for aesthetic reason and to improve pulmonary, defecation, and voiding functions.

Vulvar localisation of schistosomiasis is a rare presentation. We report a case of a woman of 20 years old hospitalised for a vulvar mass of six months. That mass progressively increased in volume and was tender. It was accompanied by frequency and dysuria. The patient had a history of swimming in fresh water and hematuria when she was eight years old. Initial clinical examination found a good general state, there was a mass involving the clitoris and the small lips. This painless mass had a cauliflower appearance and was soft with a large implantation. Pathology exam of the mass revealed a vulvar schistosomiasis with an important amount of living eggs. A tumour removal with a plasty of small lips was performed. Additionally, praziquantel was administered orally. Vulvar localisation of schistosomiasis might suggest a malignant tumour. Only pathological examination can assess the diagnosis.

Introduction: The goal of this study is to access the surgical management of the prostate cancer., Patients and Methods: It was a retrospective study including 96 cases of prostate cancer between June 2002 and December 2004. Parameters studied for every patient was: age, the complaints, results of rectal digital examination, the initial TPSA rate, gleason score, results of extension, the clinical grade according to TNM 2002 classification, the treatment and the future of treated patients., Results: The mean age of our patients was 70.9 years with extremes of 50 years and 93 years. The complaints at presentation were dominated by prostatism (43.5%) and urine retention (37.7%). At rectal digital examination, the prostate was suspicious of cancer in 42.7%. The majority of our patients (79.8%) had a TPSA rate superior to 20 ng/ml. The examination revealed that the tumour was an adenocarcinoma in all patients. The majority of our patients (50.3%) had a gleason score inferior to 7. The extension outcome revealed: a loco-regional extension in 63 patients, dorso-lombar bone metastases in 19 patients and absence of secondary localisation in 14 patients. The repartition of patients according TNM classification was as following: T1 (1%), T2 (14.6%), T3 (18.8%) and T4 (65.6%). The patients were managed as following: bladder neck resection (surgically or endoscopically), pulpectomy and radical prostatectomy., Conclusion: To ameliorate the prostate cancer management, the highlights of radical prostatectomy is imperative as the spreading of endoscopic surgery in the place of opening surgery.

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.

Objectives: The aim of this study was to report the transrectal prostate biopsy complications, to identify the factors involved in their occurring and to insist on their prevention., Patients and Methodology: It is a prospective study interested on patients managed in the urological and andrological service in Aristide le Dantec Hospital in Dakar for prostate tumour from February 2002 to March 2004 and in whom the indication of prostate biopsy was performed. All the patients fulfilling the including criteria were taken in care according to a same protocol that was a transrectal sextant biopsy This act was performed under preventive antibiotherapy based on fluoroquinolones started one day before and going on three days after biopsy associated to a rectal preparation performed the same day of biopsy At the end of the biopsy the patient was managed externally during three days after biopsy Following parameters were studied: age of patients, the histopathological results and the post operative complications., Results: Two hundred and four (204) biopsies were performed. The median age of the patients was 69.1 years with the extremes of 42 years and 93 years. The global rate of complications was 13.5% with a majority of bleeding. There no major complication registered. Rectal and urethral bleeding was over in 24 hours. The complete urine retention was under the form of a unique happening complication. The distribution of complications according to the results of the biopsy did not reveal any particularity., Conclusion: The rectal preparation associated to preventive antibiotherapy seems to reduce infectious complications.

Abdominoscrotal hydrocele is a very rare clinical entity especially in childhood with less than 100 paediatric cases reported in the literature. It is associated with various complications and its pathogenesis is still a matter for debate. The authors report a case of abdominoscrotal hydrocele in the child. The methods of the diagnosis as well as the specific treatment are pointed out.

Patients and Methods: We underwent a retrospective study of five cases of testicular cancer in undescended testis. The parameters of study were: age at diagnosis, circumstances of diagnosis, values of tumour markers, and pathological aspects of tumours after removal. The data were studied using the medical records of patients., Results: Mean age was 30, 6 years (27; 34). Only 1 patient had a child at the time of diagnosis. All patients came to our clinic for a general state impairment associated to an abdominal palpable mass. The increase of the value of tumour markers was not constant. A capsular effraction was found in 3 cases with a rupture into the peritoneum. The pathology exam found 3 embryonic carcinoma and 2 seminomas, a lymph node involvement was found in 3 cases., Conclusion: The scarcity of these tumours should not make us ignore them. The early diagnosis of the tumour can be facilitated by testicular descent, because even if the descent of the testis does not prevent the tumour it can ease the follow-up.

Leiomyosarcomas of the spermatic cord are rare tumours. The authors report the case of a 65-year-old man presenting with painful mass of the left side of the scrotum with scrotal ulceration. Left transinguinal orchidectomy and left hemiscrotectomy were performed and histological examination of the operative specimen revealed leiomyosarcoma of the spermatic cord. No metastases were observed on thoracoabdominopelvic CT. One month after discharge from hospital, the patient presented with delayed healing and complementary scrotal resection and adjuvant radiotherapy were performed. Local and regional extension is frequently observed in leiomyosarcoma of the spermatic cord, justifying radical transinguinal orchidectomy with high ligation of the cord. Cases at greatest risk of recurrence (large tumour, early local recurrence, positive surgical margins) should be identified by multidisciplinary committees and may be eligible for adjuvant radiotherapy.

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.

Aim: To insist on clinical and therapeutical aspects of chronic prostatitis., Patients and Methods: The authors relate a prospective study about 30 patients who were followed for chronic prostatitis. All patients were treated and followed up to 6 months., Results: The mean age of the patients was 31,82 years. Sixty percent of them where send by a physician after failure of medical treatment. Mean delay before consultation were 31.5 months. The main symptoms were pain (pelvic pain, perineal pain, or post ejaculatory pain). The distribution of patients according to the US NIH has shown 13 cases of category II, and 17 cases of category III. Outcome of these patients was favourable in ten cases for category II and nine cases for category III., Conclusion: If important efforts were realized for classification and diagnostic approach, many patients often fair to respond to treatment.

The authors relate a retrospective study on 30 cases of urethral stenosis and four cases of urethral rupture with a mean follow up of 28 months (8 to 44 months). The mean age of the patients was 47.5 years (6 to 85 years). The main aetiology was inflammatory sclerosis (73.5%). The predilection was bulbar (52.94%). The main symptom was constituted by dysuria (n = 24). The peri-urethral sclerosis was found in 44, 12% of cases. The penile flap as tube or patch. Immediate complications were a loosen of sutures (n = 7), urinary fistula (n = 4). The later complications were essentially recidives (n = 6). The results were good in 73.5% of cases.

The authors report five cases of ureterocele during six years. Mean age of the patients was 34.2 +/- 11.1 years. There were four female and one male. Pain (N = 3) and dysuria (N = 3) were the most common symptoms at examination. Diagnosis was made by ultrasound (N = 3), IVU (N = 3) or cystoscopy (N = 1). Ureteroceles were bilateral in four cases, unilateral in one case and were always intravesical with single ureter. Two patients presented lithiasis enclosed in the ureterocele. Only four patients had been operated. Surgical treatment was ureterocelectomy with ureteral reimplantation according to Cohen procedure. With mean follow-up of 10.6 +/- 4.7 months results were stable without complications.

The authors report a case of transfixing injury of the scrotum while diving. The patient was seen one hour after the accident. The harpoon traversed the right side of the scrotum from below upwards. Emergency surgical exploration only revealed effraction of the sinus of the epididymis and the abdominal muscles. The overall risk for fertility was suggested in view of a possible lesion of the epididymal canal.

Objective: to study the particularities of the bladder lithiasis in our countries. This was a retrospective study of 94 cases (62 men and 32 women) of bladder lithiasis over a period of 13 years. The lithogenic factors; clinic, paraclinic and therapeutic aspects have been studied. Morphoconstitutional analysis has been carded out in collaboration with Cristal Laboratory (St Cloud hospital center in France)., Results: mean age was 24.2+/-20.7 years old. The principals mains of consultation were: dysuria (n =36), mictionnal pain (n = 28), hematuria (n = 15). Facilitating factors have been found in 27% of cases. In 10 cases, there was an association bladdder lithiasis and bladdder-vaginal fistula. Radiologic test was dominated by intraveinous urographic (53.19 of cases). The metabolic test showed hypercalcemia and cristalluria in 2 cases. In 7,45 % of cases, we have founding a renal failure. An urinary tract infection have been noticed in 42 % of cases. Open surgery has been the main treatement (96 %) associating in 15 % of cases the treatement of an uropathy. In one case the bladder lithiasis weighed 1120 g. The morphologic and spectrophotometric analysis of the lithiasis have been achieved in 13 % of cases showing the predominance of struvite., Conclusion: the bladder lithiasis is still common in our countries; it could be good for us to access endoorporeals and extracorporeals therapeutic equipements in orderto reduce the indications of open surgery.

The authors report 5 cases of uterovesical fistula (UVF) and analyse some of the clinical and therapeutic aspects of this disease. The mean age of these 5 patients was 31.2 +/- 6.9 years. The trauma responsible for the fistula was caesarean section in every case. The presenting complaints were dominated by cyclic haematuria (n = 5). Intravenous urography did not contribute to the diagnosis, while hysterosalpingography demonstrated the UVF in 3 out of 4 cases. Treatment was surgical for all patients and consisted of closure of the fistula in 3 cases and hysterectomy in 2 cases. With a mean follow-up of 2 +/- 1.2 years, no pregnancies were reported in the 3 patients treated by closure of the fistula. On the other hand, the urinary results were satisfactory with good continence and resolution of the cyclic haematuria. The authors emphasize the importance of prevention of UVF by well conducted caesarean section.

The three main penile emergency situations have been examined so as to better define the clinical and therapeutic aspects. In the present study, a fracture of the penis (n = 12) occurred following a coital accident in 8 cases. In general, a clinical diagnosis was made and emergency surgical treatment appeared to be the most efficient means of preventing possible erectile malfunction. Mutilation of the penis was observed (n = 12) following traditional circumcision or circumcision performed by paramedical staff; or was due to self-inflicted mutilation and pyschiatric disorder (n = 6), and in one case to sexual deviation (n = 1) This category of accidents could be more adequately managed by the psychiatric treatment of certain patients and by better training of the personnel carrying out the circumcision. Priapism (n = 42) was due to sickle cell disease in 50% of cases, and relapse was noted in 10% of patients.

The authors report the case of a patient presenting with recurrent urinary tract infection and deterioration of the general status. Ultrasonography, plain x-rays and especially cystoscopy demonstrated the presence in the bladder of an intrauterine contraceptive device inserted 4 years previously. Endoscopic removal combined with antibiotics ensured cure of this patient.

The objective of this work was to describe the clinical and therapeutical aspects of pathology of the peritoneo-vaginal process. We have performed a retrospective study including 160 patients operated between January 1990 up to December 1996. Mean age at diagnosis was 8 years, ranged from 1 month to 13 years old. All patients were male. The abnormality was located in the right side in 60% of cases and was bilateral in 6.7% of cases. The main clinical features were scrotal mass (81%) and scrotal pain (13.46%). The diagnosis was made at birth only in 20% of cases. A maldescended testis was associated in 7.5% of cases. A groin incision have been used in 91.25% of patients. The average hospital stay after surgery was 1 day. Thus, the pathology of the peritoneo-vaginal process is common and apparently banal. Need for treatment through a groin incision owing to the possibility of associated maldescended testis.

The association of benign prostatic hyperplasia (BPH) and inguinal hernia still pose the problem of the chronology of their repair. Indeed, first hernial repair without removing the cervicoprostatic obstruction exposes to a high rate of recurrence due to the dysuria. The objective of this work was to report our experience about the simultaneous cure of the BPH and inguinal hernia. We have performed a retrospective study including a non consecutive series of 92 patients presenting both BPH and inguinal hernia. Studied parameters was age, occupation, clinical symptoms, the procedure and operative continuations. Mean age was 70.22 years old, range from 57 to 90 years old. Past history of inguinal hernia repair was found in 18.5%. 19.13% had hernial recurrence while 6.5% had contralateral hernia. Main clinical features were inguinal mass (43.5%) and acute urinary retention (11.9%). The average weight of prostatic tumor was 87.1 g. Surgery was performed under spinal anaesthesia in 96.8%. All patients underwent suprapubic transvesical prostatectomy. Hernial repair was done according to Bassini procedure in 82.6%, Mac Way procedure in 14.2% and Forgues procedure in 3.2%. The overall morbidity rate was 15.2%. The hernial recurrence rate was 7.6%. There was no postoperative mortality. The simultaneous repair of BPH and inguinal hernia offers some advantages. First of all, it reduces considerably the anaesthetic risk owing to the importance of cardiovascular diseases in aging patients. On and other hand, the low recurrence rate of the hernia and the substantial savings are adjunct advantages. We conclude that simultaneous repair of BPH and inguinal hernia is simple, safe and economic.

The aim of this study was to analyze problems posed by adult renal malignant tumors both in the diagnostical and therapeutical viewpoints. We have performed a retrospective study including 48 cases of confirmed renal cancer. Have been included adult patients who presented a cancer of the kidney operated or not. Studied parameters were age, sex, clinical signs, complementary explorations i.e. biology, renal ultrasonography, IVU, Computerized tomography, the operative indication and the prognosis. We have used Robson's staging to classify our patients. The average age was 51 years with extremes of 18 and 83 years. However 60% of them were less than 50 years. Adenocarcinoma was the main histological form encountered. It has been found in 93% of cases. The flank mass has been the mode of discovery in 70.8% of cases. The classic symptomatic triad associating hematuria, pain and the renal mass has been found in 20.8% of cases. Ultrasonography and Intravenous urography (IVU) have allowed to pose the diagnosis in 93.75% of cases. Patients were often referred very late with an average delay of consultation of 14 month. So, 25% of them presented with metastasis at the moment of the diagnosis. Radical nephrectomy was performed in 60% of cases. 40% of patients have not been operated due to the advanced evolution of the tumor. The global mortality to 1 year was estimated at 38%. We conclude that renal malignant tumors in the adulthood, in our practice, presents some particularities. Indeed, patients are referred late when clinical symptoms are sufficiently evocative to suspect the diagnosis. At these advanced stages, there is no curative therapeutic. So, a precocious diagnosis is necessary in order to propose to patients radical nephrectomy which remains the only efficient therapeutical procedure of the localized renal cancer in the adulthood.

Medical experts are responsible for evaluation of the urinary and sexual sequelae following traumatic rupture of the posterior urethra. Only definite and direct damage is compensated by the courts, which demands a methodical and meticulous examination by the expert. Sexual damage can be evaluated by certain criteria including the results of intracavernous injections.

Purpose of the Study: The aim of this study was to report the different anatomical types, associated injuries, morbidity and mortality of pelvic ring disruption in child in Dakar traumatological centers., Material and Methods: [corrected] Forty seven children were admitted in two of three traumatology centers in Dakar between 1968 and 1992. This retrospective and intermittent study excluded tendon-bone avulsions and acetabular fractures. Twenty eight boys and nineteen girls presented a fracture with or without ring disruption according to Ducloyer and Filipe classification. In this first group, they make difference between an isolated or combined fracture and distinguished an anterior and a posterior one. Forty five children were treated by a non-operative methods., Results: Forty three boys and girls sustained their injuries in a pedestrian-motor vehicle accidents and 4 among were struck by a truck. A massive fracture-dislocation with complete pelvic disruption was found in 70.3 per cent. Half of them (34.4 per cent) presented an anterior isolated anatomic type. In the other group the high energy forces caused major pelvic instability and also various associated soft-tissue injuries. The majority of complications were open pelvic fractures (21.1 per cent), genito-urinary (34.4 per cent), vascular (16.6 per cent), neurological and perineo-rectal injuries. Four children (8.4 per cent) died. At the last review others presented orthopaedic, genito-urinary, neurological or perineo-rectal sequelae., Discussion: The frequency of pelvic fractures in child present a peak between 6 and 12 years old. These types of fractures are the results of a high energy injury in pedestrian motor vehicle accidents in Dakar suburbs. The anatomo-radiographic types had an interesting bimodal pattern: Among the benign types: a double fracture of the iliopubic ramus is dangerous for the bladder (1 case), and leads to a dysplastic acetabulum with time (1 case). Unstable fractures (70.3 per cent): some of them (23.3 per cent) present a complex dislocation of the pelvis. The present review focuses on double urethral injuries (2 cases), open pelvic fractures (10 cases) and mortal hemorrhagic shock (4 cases). The morbidity rate is high (38.4 per cent) caused by skeletal and soft-tissue sequelae and also management difficulties., Conclusion: Pelvic fracture in children requires early diagnosis and management. In our countries, morbidity and mortality of these injuries must decrease with the popularization of road safety, multidisciplinary management and improvement of working conditions.

The management of posterior urethral injuries is still a matter of controversies. Some authors recommend a primary or delayed emergency repair procedure, while others prefer late repair. The analysis of our series of fifteen cases showed that when patients are treated by delayed emergency operation, the results are usually good. However, when repair is performed later, results are less satisfactory, and the rate of impotence is higher. We conclude that delayed emergency repair operation is the procedure of choice in the management of ruptured posterior urethra.

Injuries to the ureter and the bladder are common complications in female pelvic surgery. Unfortunately, they remain often unrecognized per operatively. Intravenous pyelography and renal ultrasonography are very efficient for post operative diagnosis. The indications of nephrectomy have became rare because of the efficacity of the procedures of plastic and reconstructive urological surgery.

Obstetrical vesico-vaginal fistulas are still very common in developing countries, because of to the difficulties of medical facilities. From a series of 123 cases recorded during 6 years, we analyse their epidemiological, anatomo-clinical, and therapeutic aspects. A simplified classification is purposed.

Severe complications of urethral stricture, acute peri-urethral phlegmon can be localized or diffuse. They are characterized by polymicrobial infections. The mortality rates about 7% is the privilege of diffuses forms. The treatment associates medical and surgical procedures, and consists in polyantibiotherapy and excision of suppurative lesions. From a series of 155 cases we analyse the pathogenical, clinical and therapeutical aspects.

Fourteen pediatric cases of posterior urethral valves in patients aged 6 months to 14 years (with four infants and ten older children) are reported. The main symptoms were vesical, including dysuria, acute urinary retention and dribbling. One patient presented with diarrhea, vomiting and dribbling. Urethral valves were looked for as part of the evaluation for urinary lithiasis in one patient, and in another urinary lithiasis developed following the diagnosis of urethral valves. In half the cases, onset of symptoms occurred within one year of birth. Urethrocystography allowed to evidence the valves and to evaluate repercussions on the bladder including hyperplasia (7 cases) and diverticula (2 cases). The intravenous urogram disclosed bilateral ureterohydronephrosis in eight cases. Pathogens recovered from the urine included Klebsiella (3 patients), Pseudomonas (4 patients), Proteus (one patient), and E. coli (one patient). Most patients were treated by catheter lamination under antimicrobial therapy. Two patients died from renal failure. Results were considered satisfactory in nine cases with follow-ups ranging from 1 month to 4 years. Three patients were lost to follow-up. Early diagnosis is essential and management should rely mainly on endoscopic resection which reduces the length of the hospital stay and the risk of infection.