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Yaya Sow, Ousmane Sow, Boubacar Fall, Babacar Sine, Alioune Sarr, Cyrille Zé Ondo, Babacar Diao, Alain Khassim Ndoye, Mamadou BaUrology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, SenegalObjective: To assess the impact of tumor cytoreduction on cancer outcomes and patient survival in metastatic prostate cancer.Patients and methods: It is a prospective study spanning a two-year period between October 1st 2015 and March 31st 2017. We enrolled 102 cases of metastatic hormone-sensitive prostate cancer. Fifty-seven (57) patients had exclusively androgen deprivation therapy (ADT) (group 1) and 45 had, in addition, an open prostatectomy or Transurethral resection of the Prostate (group 2). We compared both groups using the total PSA nadir, the time to PSA nadir, the overall survival (OS), and the progression-free survival (PFS).Results: The average nadir PSA was lower for the tumor cytoreduction group (16.8±1.6 ng/mL (0.01–193.5) versus 110.7±17.9 ng/mL (0.01–1379)). Median time to PSA nadir was shorter in patients in the ADT only group (8 months vs 3 months (p=0.025)). The OS was shorter in patients treated with ADT only compared to the tumor cytoreduction group (median 14 months vs 24 months, respectively (p=0.03)). Similarly, tumor cytoreduction had a positive impact on patient progression (median PFS 20 months (group 1) vs 43 months (group 2)).Conclusion: Tumor cytoreduction has a positive impact on the oncological results and the survival of patients under ADT.Keywords: prostate cancer, cytoreduction, androgen suppression, TURP

Endourology plays an important role in modern urological practice. Compared to open surgery, it offers many advantages. In Africa, endourology is not widely practiced or non-existent in some referral centres. Several factors have been linked to this challenge. This article explores and proposes strategies to improve endourology practice in the African context. Recognising the unique challenges and opportunities in the region, the document discusses key initiatives and recommendations to promote the growth and development of endourological practices, including the identification of local needs, training, technological adaptation, etc. It aims to provide valuable information on the advancement of endourology in Africa., (© 2024 BJU International.)

Our aim was to determine the current trend of endourology in the management of upper urinary tract calculi in Africa reference centres. We conducted an online multiple-choice questionnaire survey involving 46 centres from 27 countries using a structured well-designed Google Form (®) questionnaire. The questionnaires were distributed to the head of service through their emails. The questions collected demographic data about the centre, the epidemiology of urolithiasis, diagnostic means and management of upper urolithiasis, especially access to endourology procedures and their practices. Descriptive analyses were performed. The participation rate was 77.9%. Urinary lithiasis was one of the three main pathologies encountered in 42/46 centres. 33 centres had easy access to CT scanners and 34 had operating theatres equipped with endo-urological surgery equipment. Of these 34 centres, 30 perform endourology for the management of upper urinary tract stones. Rigid ureteroscopy is the main technique used by the centres. It is the only endourology technique used for stone management by 12 centres (40%). 7/30 (23.3%) have the option of performing rigid ureteroscopy, flexible ureteroscopy and percutaneous nephrolithotomy. The frequency of procedures varies widely, with 43.3% rarely performing endourological surgery. Seventeen centres have their operating theatre equipped with a fluoroscope and 6/42 centres have extracorporeal lithotripsy. Open surgery is still used in 29/42 centres (69.1%). Laparoscopy is available in 50% of centres, but none reported performing laparoscopic lithotomy. In Africa, urinary lithiasis plays an important role in the activities of referral centres. Modern management techniques are used to varying degrees (not all centres have them) and with very variable frequency. Open surgery is still widely performed as a management. Rigid ureteroscopy is the main endourological technique. It is essential to develop the practice of modern urology in Africa, mainly endourology., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal., Patients and Method: This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published by our structure., Results: Forty-five (45) VVFs were identified over a period of 6 years. This represents an annual average of 7.5 fistulas. The average age was 40±15.13 years with extremes of 13 years and 75 years; 17 patients (37.8%) were older than 45 years. The average parity was 3 with extremes from 0 to 12 children. Multiparous women represented 68.8% of the patients. Obstetric VVF (OVF) was more frequent (48.9%) followed by iatrogenic VVF (33.3%). The mean age was higher in the IVF group compared to the VVF group (32 years) (P = 0.0004). Thirty patients were from the Dakar region and its suburbs (66.6%). The etiology of VVF did not vary according to the geographical origin of the patients (P=NS). VVF was frequently associated with the management of cervical cancer in 42.2% of cases. Comparison of our current data with previous series shows a reduction in the annual incidence of VVF. VVFs, although they have decreased significantly, are still predominant. There is a constant increase in the number of IVF., Conclusion: There is an evolution of the epidemiological and etiological profile marked by a decrease in the frequency of VVFs and an increase in that of IVFs. It is also worth noting the frequent association between cervical cancer and VVF., Level of Evidence: Level 4: retrospective study., (Copyright © 2023. Published by Elsevier Masson SAS.)

Circumcision is one of the most commonly performed surgical procedures. As traditional ritual circumcisions are still practiced in the community, in Senegal the majority of circumcisions are performed in hospitals. We report the case of a 9-year-old boy who underwent a total amputation of the glans after a circumcision in a pharmacy by an unqualified agent. A meatoplasty was performed and the postoperative course were uneventful., Competing Interests: The authors have no conflicts of interest to declare., (© 2021 The Authors.)

Bladder diverticulum represents a herniation of the bladder mucosa and submucosa through a point of weakness in the detrusor muscle. Bladder diverticula are rare and most often described in men. We report a symptomatic giant bladder diverticulum in a 56-year-old postmenopausal woman. The symptomatology was marked by acute urinary retention associated with abdominal-pelvic pain. A diverticulectomy by a transvesical approach with placement of a urethral catheter was performed. The postoperative course was uneventful., Competing Interests: The authors have no conflicts of interest to declare., (© 2021 The Authors.)

Illegally induced abortions remain a significant public health issue in developing countries. We report a case that was complicated by a vesicovaginal fistula with intravesical calcification of the piece of wood used to perform the illegal abortion. A trans -vesical approach allowed extraction of the calcified foreign body and closure of the vesicovaginal fistula. The postoperative course was uneventful., (© 2021 The Authors.)

The purpose of this study was to assess outcomes of radical prostatectomy in patients with prostate cancer. We conducted a retrospective single-center study in the Department of Urology and Andrology at the Aristide Le Dantec Hospital in Dakar from June 1, 2010 to May 31, 2016. We collected data of 60 patients undergoing radical retropubic prostatectomy associated with dissection of the iliac and obturator nodes. After radical prostatectomy, prostate specific antigen (PSA) levels were undetectable (<0.1 ng/mL) in 20 patients (33.3%). Eleven patients (18.3%), who had biochemical relapse, received complementary hormone therapy. Patients achieved a response after initiation of treatment, and total PSA became undetectable again after an 8-month follow-up period. Mean overall survival was 17.5 months, with a median of 9.49. Cumulative overall survival rates at 1 year, 3 years and 4 years were 42.4, 13.6 and 6.8%, respectively. Mean relapse-free survival was 17.3 months, with a median biochemical relapse-free survival of eleven (11) months. The mean duration of specific survival was 8.1 months, with a median of 3 months. Seven patients had positive resection margins (11.6%). Four patients had lymph node involvement. Radical prostatectomy, suggested in some patients with prostate cancer in our practice, has been shown to be an effective therapeutic method leading to good outcomes., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Ndiaga Seck Ndour et al.)

Aim: to evaluate the results of two-level urethroplasty in the treatment of complex urethral strictures in our clinical center., Patients and Method: Thiswas a retrospective cross sectional study from January 2012 to September 2015 in our clinical center. Patients operated according to Bengt Johanson technique were included. The parameters studied were age, the urological history, consultation reasons, duration of evolution, stenosis characteristics and treatment outcomes., Results: twelve patients were enrolled in our study. The mean age was 48 ± 20 years. The main reason consultation reason is urine retention. The mean duration of evolution was 30 ± 25 months. The most common etiology identified was scleroinflammatory one . All the patients already had at least one medical background. The physical examination showed a periurethral gangue in 10 patients. The mean length of the urethral stricture was 6.3 ± 2.2 cm. After an average follow-up of 3.8 ± 2.3 months; the treatment outcomes were considered satisfactory in 8 patients and bad in 4 patients., Conclusion: Bengt Johanson's two level urethoplasty gives good outcomes in the treatment of complex urethral strictures., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Priapism is a rare urological emergency. It is rarely a telltale sign of myeloid leukemia. We report two cases of acute myeloid leukemia in a child and chronic myeloid leukemia in a young adult presenting with priapism. Puncture irrigation of the corpora cavernosa followed by systemic treatment to lower the hyperviscosity of the blood due to leukemia provided optimal outcome. Prompt emergency management is required to lower the complication of erectile dysfunction., Competing Interests: There is no conflict of interest to declare., (Copyright © 2020 Oumar Gaye et al.)

Objective: to report the indications and the results of the upper urinary tract by endoscopic route by a double J probe in our Center., Patients and Methods: This was a retrospective mono-centric descriptive study from January 1st 2018 to June 30th 2019 including all patients that had a JJ stent as a type of upperurinary tract diversion., Results: seventy four patients were included. The average age of patients was 43.6 ± 17.5 years. The sex-ratio was 0.6. The obstructive renal colic was the most common operative indication in 62.1% (46) of patients. The etiologies were dominated by urolithiasis with 39.1% (29) of patients. Anesthesia was general in 67.5% (50) and locoregional in 32.5% of patients (24). The procedure was performed without fluoroscopic control (blind) in 66.2% of cases(49), therewere 89.7% case of success (44 patients). The success rate was 86.5% (64) patients and the failure rate 13.5% (10) of patients. Five (6.7%) patients had a postoperative acute pyelonephritis complication requiringremoval of the JJ stent., Conclusion: The rise of the double J probe made possible to prepare the ureter, thus facilitating the endoscopic treatment of urinary lithiasis. The complication rate observed in our patients was low. The compliance with the rules of asepsis could reduce these complications., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Objective: To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results., Patients and Methods: We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure., Results: Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up., Conclusion: The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique., Level of Evidence: 4., (Copyright © 2018 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.

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.

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.

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.

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 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.