Open AccessPyonephrosis: epidemiological, clinical, and therapeutic aspects at Aristide Le Dantec University Hospital Centre (Dakar) NS Ndour, CZ Ondo, A Sarr, A Ndiath, M Ndiaye, A Athie, O Sow, M Diaw, A Thiam, B Sine, B Diao and AK Ndoye NS Ndour1 https://orcid.org/0009-0006-9583-6733 , CZ Ondo1 , A Sarr1 https://orcid.org/0000-0002-6955-7806 , A Ndiath1 https://orcid.org/0000-0001-9115-1629 , M Ndiaye1 https://orcid.org/0000-0001-8402-5640 , A Athie1 , O Sow1 https://orcid.org/0000-0002-1652-7259 , M Diaw1 , A Thiam2 , B Sine1 https://orcid.org/0000-0001-5502-2117 , B Diao1 https://orcid.org/0000-0002-7869-0465 and AK Ndoye1 Affiliations 1Department of Urology, Hôpital Aristide Le Dantec, Senegal 2Department of Urology, Hôpital Militaire de Ouakam, Senegal Published Online:1 Mar 2024https://doi.org/10.36303/AUJ.0109https://hdl.handle.net/10520/ejc-mp_afurol_v4_n1_a2SectionsPDFAbstract ToolsAdd to favouritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InRedditGMailOutlookCopy LinkMendeley AboutAbstractIntroduction:Pyonephrosis is most often secondary to an obstruction in the urinary excretory tract. It is a serious condition that can be life-threatening due to septic shock as well as functionally life-threatening due to the destruction of the renal parenchyma. Our study aimed to analyse the epidemiological, clinical, and therapeutic aspects of pyonephrosis at the Urology Department of the Aristide Le Dantec University Hospital Centre (CHU).Materials and methods:This was a retrospective study of 82 patients followed up for pyonephrosis in the Urology-Andrology Department of the Aristide Le Dantec CHU from 1 January 2005 to 31 December 2021. The parameters studied were the epidemiological, clinical, and therapeutic aspects of pyonephrosis.Results:The annual incidence was 5.1 ± 3.4 patients. The mean age was 44 ± 15.6 years. The mean time to diagnosis was 24.5 ± 8.7 months. Lower back pain and low-grade fever were the symptoms at presentation, with respective percentages of 87.2 % and 69.8%. Fever and lower back pain were the most frequent signs identified in clinical examination, with percentages of 64.6% and 65.8%, respectively. Escherichia coli and Klebsiella pneumoniae were the most frequent germs detected by cytobacteriological examination of urine (CBEU). Pseudomonas aeruginosa and Bacteroides spp. were the most frequent germs found in the cytobacteriological examination of pus. Uro-tomodensitometry (Uro-CT), performed in 57.3% of patients (n = 47), led to a diagnosis of pyonephrosis in 89.3% of patients (n = 42). Urinary lithiasis was the main cause of renal parenchymal destruction. Nephrectomy was performed in 70.7% of patients (n = 58). It was preceded by nephrostomy in 52.4% of cases (n = 43), coupled with bi-antibiotherapy. Extracapsular nephrectomy was the most common procedure, accounting for 84.5% (n = 49). Intraoperative events were noted in 25 patients. Peritoneal and pleural injuries predominated. Conservative treatment was instituted in 26.8% of patients. The average hospital stay was 7.3 ± 10.2 days. The global rate of complications was 4.87% and mortality was 3.65%.Conclusion:The long consultation time means that the main treatment modality remains nephrostomy followed by nephrectomy or nephrectomy from the outset, and does not often allow conservative treatment.IntroductionPyonephrosis is defined as the presence of a purulent collection in the renal cavities associated with significant perinephritis secondary to partial or total destruction of the renal parenchyma by an infectious process, most commonly secondary to an obstruction in the urinary tract.1,2 This obstruction is often a stone. Pyonephrosis has become increasingly rare in developed countries but remains common in countries where access to healthcare remains difficult.3 The prevalence of this condition can rightly be considered as an indicator of the health status of a country. Our study aimed to analyse the epidemiological, clinical, and therapeutic aspects of pyonephrosis at the Urology Department of the Aristide Le Dantec CHU.Materials and methodsThis was a retrospective descriptive study of 82 patients followed up for pyonephrosis at the Urology-Andrology Department of the Aristide Le Dantec CHU from 1 January 2005 to 31 December 2021. All patients with pyonephrosis with a complete medical record were included, regardless of age or sex. The parameters analysed were: epidemiological aspects (incidence, age, and sex);clinical aspects (circumstances of detection, time to consultation, length of hospital stay, side affected, personal history, and clinical examination data); andtherapeutic aspects.Data was collected from consultation, surgery, and hospitalisation registers and analysed using Microsoft Excel software.ResultsThe annual incidence was 5.1 ± 3.4 patients. The mean age was 44 ± 15.6 years. The distribution of patients according to age is shown in Figure 1.The 30–39 age group was predominant (n = 30) with a sex ratio of 0.86. Lower back pain and fever were the most common presenting symptoms with percentages of 87.2% and 69.8%, respectively (Figure 2). The distribution of patients according to the circumstances of presentation is shown in Figure 2. Pyeloplasty was the most common surgical procedure in which a diagnosis was made (n = 10).The mean time to diagnosis was 24.5 ± 8.7 months. The left side was involved in the majority of cases (65.8%). However, one patient had bilateral involvement and underwent bilateral nephrostomy drainage followed by left nephrectomy. Medical history was recorded in 19.6% of patients. Chronic kidney deficiency (CKD) and recurrent urinary tract infections were the most common past medical conditions (5% each). A history of urological surgery was noted in 15% of patients (n = 12). Previous surgery for urinary lithiasis was noted in 10% of patients (n = 8), mainly nephrolithotomy. Fever and lumbar pain were the most common clinical findings in 64.6% and 65.8%, respectively. Table I shows the different clinical manifestations observed.Renal function was impaired in five patients. CBEU results were reported in 42 patients. Urine was sterile in 32% of those patients. Escherichia coli and Klebsiella pneumoniae were the most common organisms. Data from the CBEU is shown in Figure 3.Cytobacteriological results of pus samples were reported in 13 patients. Pseudomonas aeruginosa and Bacteroides spp. were the most common organisms accounting for more than 50% of cases. Ultrasound in 62.1% of patients (n = 51) was in favour of pyonephrosis in 68.08% of patients, with a collection of suspensions in the renal cavities and destruction of the renal parenchyma. Uro-computed tomography (UCT), performed in 57.3% of patients (n = 47), suggested the diagnosis of pyonephrosis in 89.3% of patients (n = 42). Urinary lithiasis was the most common cause of pyonephrosis. Renal scintigraphy was performed in 7.3% of patients (n = 6) and showed a non-functioning kidney in all of these patients. Nephrectomy was performed in 70.7% of patients (n = 58). In 52.4% of cases (n = 43), nephrostomy was preceded by antibiotic therapy with a combination of a third-generation cephalosporin or a fluoroquinolone and an aminoglycoside. Extracapsular nephrectomy was the most common procedure, accounting for 84.5% (n = 49). The distribution of the type of nephrectomy is shown in Figure 4.Intraoperative complications were noted in 25 patients. Peritoneal and pleural injuries were predominant. The distribution of the different types of injuries is shown in Table II.Urinary lithiasis and pyeloureteral junction syndrome were the predominant causes, accounting for 38% (n = 21) and 33% (n = 18), respectively. Table III shows the different causes of pyonephrosis observed.Conservative treatment was given to 26.8% of patients, which consisted of repairing the anomaly caused by the pyonephrosis. The other subgroup included pyonephrosis caused by: textiloma (n = 1);invasion of the ureteral orifice by prostate adenocarcinoma (n = 1);ureteral stenosis (n=1)ureteral bifidity (n = 1); andundetermined causes (n = 21).The mean length of hospital stay was 7.3 days. Overall morbidity was 4.87%. Complications included parietal suppuration in one patient, renal compartment abscess in one patient, and eventration in two patients. These complications were managed with local care, drainage combined with antibiotic therapy, and surgical cure, respectively.Mortality was 3.65% (n = 3). There was one case of death on the operating table, which prevented nephrectomy. The cause of death was related to an anaesthetic problem. Acute generalised peritonitis with multiple digestive lesions (transverse colon, duodenum) resulted in the death of one patient four days postoperatively. Another patient died of septic shock after drainage.DiscussionPyonephrosis is a rare condition and its incidence remains low or non-existent in certain developed countries. However, it is still common in developing countries.4 The incidence of pyonephrosis is considered an indicator of the general health status of a country. Limited or difficult access to health care for a country's population may increase the incidence of this condition.The mean age in our series was 44 ± 15.6 years. The same trend was reported in the series of Ouggane et al.,4 Cissé et al.,5 and Diallo et al.6 The mean ages in these series were 44, 46, and 49 years, respectively. The sex ratio in our series was 0.86. Our results were similar to those of Mosbah et al.7 and Ondongo et al.8 who reported a sex ratio of 0.8 and 0.77, respectively.In our series, the number of cases of pyonephrosis per year was 5.1 ± 3.4. This was the same finding in many series published in other developing countries like ours. Diallo et al.6 and Mosbah et al.7 reported 1.9 and 5.1 cases per year with a length of study of 10 and 4 years, respectively. The mean consultation time in our series was 24.52 ± 16.05 months. This long delay in consultation can be explained by the fact that pyonephrosis often has an insidious onset. Pyonephrosis can sometimes be overlooked and diagnosed only at the stage of complications with the occurrence of renocutaneous or renocolic fistulas.9 Sometimes the diagnosis is made after diffuse peritonitis due to the rupture of a pyonephrotic kidney; M'Bida et al.10 report one case separately in the literature.Lower back pain was the most common finding in our series, accounting for 87.2% of cases. This finding corresponds to that of Ouggane et al.4 where this symptom was also the most common, with percentages of 100%, 90.6%, and 94%, respectively. Conversely, in the series by Mosbah et al.,7 back pain and general deterioration were the main circumstances of detection. In our series, fever and lower back pain were the most common clinical findings, with percentages of 64.6% and 65.8%, respectively. This trend was similar to the series of Diallo et al.,6 where fever and back pain accounted for 100% and 63.2%, respectively.In our series, the left side was the most commonly affected (65.8%), whereas Sow et al.11 reported a predominance of the right side. Bilateral involvement was observed in one patient in our series. This patient had prostatic adenocarcinoma with bilateral invasion of the ureteral orifice. Bilateral drainage by nephrostomy was performed followed by left nephrectomy.Certain antecedents favoured urinary tract infections and the development of pyonephrosis. These were either factors that led to immunodeficiency (diabetes, pregnancy, renal failure) or factors that favoured urinary stasis in the urinary tract (prostate tumour, ureteral stenosis).12 These factors were also used as criteria for the severity of urinary tract infections. A history of urological surgery, particularly lithiasis, was noted in 9.7% of patients (n = 8). In contrast, Diallo et al.6 reported a history of urinary lithiasis in 31.6% of their series.Renal function was impaired in five patients in our series. In contrast, in the series by Ondongo et al.8 and Sow et al.,11 renal function was normal in all patients. This difference may relate to the underlying diseases of our patients (obstructive renal failure, HIV-related immunosuppression, etc.). CBEU was performed in 51.2% of patients (n = 42). Gram-negative Enterobacteriaceae (Escherichia coli and Klebsiella pneumoniae) were the most common. Our results are similar to those reported by Ondongo et al.8 and Masfiyah et al.13In our series, Pseudomonas aeruginosa and Bacteroides spp. were the most common bacteria found in pus samples. There was no concordance between the bacteria isolated from pus and those isolated from urine in the same patients. Ultrasound of the urinary tract was performed in 62.1% of patients (n = 51) and led to the suspicion of pyonephrosis in 68% of patients (n = 35) in our series. Lezin et al.14 reported an estimated diagnostic contribution of 25% in their series. This difference could be explained by the fact that ultrasound is an operator-dependent examination. The sensitivity and specificity of ultrasound in the diagnosis of pyonephrosis are 38% and 96%, respectively, according to Wu et al.15Uro-CT is currently the imaging modality of choice for the diagnosis of pyonephrosis and the detection of the underlying disease.16 It was performed in 57.3% of patients (n = 47) and allowed the diagnosis of pyonephrosis in 89.3% of patients, as well as the determination of the cause in our series. Renal scintigraphy was performed in 7.3% of cases (n = 6) in our series. This result may be explained by the accessibility (low socioeconomic status of the patients) and availability of this imaging technique, as well as the fact that some cases were discovered intraoperatively. This technique is of secondary interest in assessing the residual functional value of the kidney after drainage.The prognosis of pyonephrosis is improved by the use of septic urine drainage, especially nephrostomy. In the past, diagnosis required immediate nephrectomy.17 This was associated with a high mortality rate. Therefore, the current trend in pyonephrosis is to perform a nephrostomy first, combined with antibiotic therapy.18,19Some authors suggest performing a nephrostomy for upgrading antibiotic's efficiency before nephrectomy.20 Drainage is indicated because the obstruction in the urinary tract causes congestion of infected urine and reduces the filtration capacity of the kidney. As a result, medical treatment is ineffective because it is impossible to achieve a urinary concentration of antibiotics. Consequently, more than anywhere else, urine drainage is a life-saving measure in this case. In this regard, Watson et al.21 report the benefits of drainage by: facilitating the diffusion of antibiotics into the renal parenchyma;a reduction in the bacterial load due to the removal of pus and necrotic material; anda reduction in the pressure in the excretory cavities, leading to an immediate increase in perfusion and renal function.Nephrostomy was considered by some authors to be the most effective method of urinary drainage in this context.22 In addition to drainage benefits, nephrostomy has other therapeutic advantages such as in situ alkalinisation for uric acid lithiasis,21-23 endopyelotomy for pyeloureteral junction syndrome, and dilatation and anterograde stenting for ureteral stenosis.5-24In our series, 81.7% of cases (n = 67) were drained by nephrostomy alone. This can be performed under local anaesthesia and has the advantage of being less expensive. However, it can be associated with complications such as vascular wounds, gastrointestinal fistulas, and pleural lesions.24,25 In our series, one complication was associated with nephrostomy. This was an acute generalised peritonitis with multiple digestive perforations, which led to the patient's death on the fourth day postoperatively.Nephrectomy was performed in 70.7% of cases (n = 58) in our series. Subcapsular nephrectomy was the most common type of nephrectomy with a rate of 84.5% (n = 49). In our series, nephrectomy was preceded by a holding nephrostomy in 52.4% of cases (n = 43), whereas in the series by Diallo et al.,6 nephrectomy was performed in all patients and was preceded by a nephrostomy in 57.8% of cases (n = 11).Intraoperative complications were observed in 25 patients, with a predominance of peritoneal and pleural lesions in our series. In the series by Cissé et al.,5 major bleeding due to detachment of the fibrous ganglia was the most common operative event. This situation is explained by the fact that nephrectomy for pyonephrosis is a difficult operation because of the perirenal inflammatory phenomena. Conservative therapy is an alternative to nephrectomy when the viability of the kidney is certain. Conservative therapy was performed in 26.8% of our patients (n = 22).In the series of Ondongo et al.,8 it was recommended in one case after normalisation of renal function two weeks after nephrostomy. Urinary lithiasis and pyeloureteral junction syndrome were the most common causes of pyonephrosis in our series. The same trend was reported by other authors.6,8,17 However, rarer causes of pyonephrosis have been implicated, particularly tumours of the upper urinary tract.10,24 Patients with pyonephrosis should be systematically screened for genitourinary tumours; their detection preoperatively will change the therapeutic approach.25 We also noted pyonephrosis secondary to a textiloma in a case who had undergone pyeloplasty four months previously in our series. Varga et al.26 reported the same observation in a patient who had undergone pyeloplasty 36 years previously.Mortality in our series was 3.6%. Mortality was lower in Harrison et al.20 (2% of cases) and higher in Sow et al.11 (9.1% of cases). This situation could be explained by the fact that Sow et al.11 had a higher number of deaths from sepsis (4/44) relating to the delay in diagnosis. In general, the course of pyonephrosis is favourable and death from pyonephrosis has become rare since the advent of antibiotics and improved management.8ConclusionPyonephrosis is a serious condition still seen in our practice despite advances in medical imaging for the diagnosis and management of underlying conditions. Due to the long delay in presentation, the main treatment modality remains nephrostomy followed by nephrectomy or nephrectomy from the outset. Conservative treatment is often not approved.Figures and TablesFigure 1: Distribution of patients according to ageDownload FigureFigure 2: Distribution of cases according to circumstances of discovery LBP – lower back pain; F – fever, LUTS – lower urinary tract symptoms, AP – abdominal pain, POD – intra-operative discovery, AGC – altered general condition, LBM – lower back mass, LF – lumbar fistula, H – haematuriaDownload FigureFigure 3: Distribution of CBEU resultsDownload FigureFigure 4: Distribution of the different types of nephrectomy performedDownload FigureTable I: Distribution of patients according to the results of additional examinationsClinical manifestations observedn%Lumbar pain5465.8Large kidney2530.4Ureteral points sensitivity4352.4Lumbar fistulas44.8Altered general condition3745.1Fever5364.6Table II: Distribution of cases according to intraoperative incidentsType of intraoperative incidentsnPeritoneal rupture14Pleural rupture8Colon perforation1Intercostal artery lesion1Aortic injury1Total25Table III: Distribution of cases by causeCausesn%Urinary lithiasis2732.92Pyeloureteral junction syndrome1923.17Repetitive urinary infections44.87Urogenital tuberculosis44.87Kidney cysts33.65Others2530.48Total82100Conflict of interestThe authors declare no conflict of interest.Funding sourceNo funding.Ethical approvalThe various professors of magisterial rank at the Urology-Andrology Department of the Aristide Le Dantec CHU met and approved the relevant ethical considerations of research in this study.1. 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De Petriconi de REgghardt GFrohneberg DHautmann R "La sonde urétérale double J: méthode sans complications" J Urol1987 9325963French Google Scholar23. Sharma SKIndudhara R "Chemodissolution of urinary uric acid stones by alkali therapy" Urol Int1992 481816French DOI: https://doi.org/10.1159/000282302 Google Scholar24. Li ACRegalado SP "Emergent percutaneous nephrostomy for the diagnosis and management of pyonephrosis" Semin Intervent Radiol2012 29321825 DOI: https://doi.org/10.1055/s-0032-1326932 Google Scholar25. Bouassel A "Pyonephrose in 25 cases [Internet] [thesis]" Centre Hospitalier Universitaire Hassan II2016French. Available from: http://www.chu-fes.ma/la-pyonephrose-a-propos-de-25-cas/Accessed 17 December 2022 Google Scholar26. Varga ASalah MTóth GTóth C "Renal tumor-like pyonephrosis with foreign body [Internet]" J Urol2001 16538912 DOI: https://doi.org/10.1016/S0022-5347(05)66554-8 Google Scholar Previous article Next article FiguresReferencesRelatedDetails InformationCopyright © 2024, the Author(s)LicensesThis work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.KeywordspyonephrosisnephrostomynephrectomySenegalPDF download Disclosure The authors confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. The authors confirm that they have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. Ethical conduct of research The authors state that they have obtained appropriate institutional review board outlined in the Declaration of Helsinki for all human or animal experimental investigations. A signed informed consent document has been obtained from all participants included in the study.

Open AccessPathological Pelvic Kidneys A Sarr, T Sangare, CZ Ondo, B Sine, A Thiam, O Sow, M Ndiaye, A Ndiath, M Randriantsalama, B Diao, PA Fall and AK Ndoye A Sarr1 https://orcid.org/0000-0002-6955-7806 , T Sangare1 , CZ Ondo1 , B Sine1 https://orcid.org/0000-0001-5502-2117 , A Thiam1 , O Sow1 https://orcid.org/0000-0002-1652-7259 , M Ndiaye2 , A Ndiath1 https://orcid.org/0000-0001-9115-1629 , M Randriantsalama1 , B Diao1 https://orcid.org/0000-0002-7869-0465 , PA Fall2 and AK Ndoye1 Affiliations 1Service d'Urologie et d'Andrologie, Hôpital Aristide Le Dantec, Sénégal 2Service d'Urologie et d'Andrologie, Hôpital Dala Jaam, Sénégal Published Online:1 Mar 2024https://doi.org/10.36303/AUJ.0128https://hdl.handle.net/10520/ejc-mp_afurol_v4_n1_a10SectionsPDF ToolsAdd to favouritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InRedditGMailOutlookCopy LinkMendeley AboutAbstractAimsTo analyse the surgical management of pathological pelvic kidneys (PPK)Patients and MethodThis was a monocentric descriptive retrospective study carried out between 1 January, 2016 and 31 December, 2019. We collected the files of patients with PPK surgery. The anatomaclinical, therapeutic and evolutionary epidemiological aspects were analysed.ResultsWe identified 17 patients over a period of 4 years, i.e. a frequency of 4.25 cases per year. The mean age of the patients was 33.35 ± 18.03 years [08 years – 72 years]. The sex ratio was 1.42. Abdominal-pelvic pain was reported by all patients and there was a pelvic mass in 2 patients. Uro-CT had made it possible to make the diagnosis of pelvic kidney and to identify the type of complication in all our patients. In 7 patients, there was malrotation of the kidney. Renal ectopia was simple in all our patients and involved the left kidney in 58% of cases. The pyelo-ureteral junction syndrome was the main objectified complication (n = 8, i.e. 47%) followed by pyelic lithiasis (n = 5, i.e. 29.4%). All patients had open surgery; two initially had a JJ probe rise. Pyeloplasty was the most performed intervention (n = 8, i.e. 47%). It was associated in all cases with drainage by a double J catheter. Total nephrectomy was identified in 4 patients. The average hospital stay was 6 days. The evolution was favorable in all our patients.ConclusionOur series is characterised by a diagnostic delay and a considerable rate of radical surgery. We insist on the need for antenatal diagnosis and regular monitoring of PPK Previous article Next article FiguresReferencesRelatedDetails Downloaded 0 times InformationCopyright © 2024, the Author(s)LicensesThis work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.KeywordskidneyspelvispyoloplastynephrectomyPDF download Disclosure The authors confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. The authors confirm that they have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. Ethical conduct of research The authors state that they have obtained appropriate institutional review board outlined in the Declaration of Helsinki for all human or animal experimental investigations. A signed informed consent document has been obtained from all participants included in the study.

Le dépistage et la prise en charge des dysplasies cervicales HPV induites est la principale stratégie de lutte contre le cancer du col chez l'adulte au Sénégal. L'implication des sages-femmes maillon important du système de santé et premiers contacts de la majorité des femmes en âge de reproduction dans la mise en oeuvre de cette stratégie est un véritable challenge. L'objectif de notre travail est de partager l'expérience d'une stratégie de dépistage par des sages-femmes des dysplasies cervicales et de l'infection à HPV par trois méthodes au niveau des structures de santé surtout périphériques. Il s'agit d'une étude prospective multicentrique réalisée au de niveau de 17 postes de santé, 2 centres de santé et 2 hôpitaux de la région médicale de Ziguinchor. Les sages-femmes de ces structures ont été formées à la réalisation du dépistage par inspection visuelle (IVA/IVL), à la réalisation de Frottis Cervico-Utérins (FCU) et de prélèvements pour la recherche de HPV par Genexpert. Les femmes consentantes appartenant à la population générale ou à des populations clés ont été dépistées. Une prise en charge par cryothérapie ou thermothérapie et conisation du col (LEEP) a été réalisée en fonction du type de lésions. Entre octobre 2019 et juin 2022, 6356 femmes de la population générale, 945 femmes vivant avec le VIH et 288 professionnelles du sexe ont été dépistées par la technique IVA/IVL. La proportion de cols suspects était respectivement de 4,7%, 2,2% et 4,5% pour ces différentes populations. La recherche de HPV au Genexpert a été réalisée chez 1282 femmes de la population générale, 603 femmes vivant avec le VIH et 132 professionnelles du sexe. La proportion de cas positifs était respectivement de 6%, 21% et 0% pour ces différentes populations. Un FCU a été réalisé chez 4927 femmes de la population générale, 909 femmes vivant avec le VIH et 216 professionnelles du sexe. Après confirmation par les gynécologues, 4 patientes ont bénéficié d'une cryothérapie, 42 d'une thermothérapie et 21 d'une LEEP (conisation du col) avec l'appui des gynécologues. Un cas d'hystérectomie a été réalisé sur cancer avancé. 07 néoplasies avancés et 01 tumeur bourgeonnante et saignante du col ont été référés. Cette étude de mise en oeuvre démontre l'intérêt de l'implication des sages-femmes dans le dépistage des dysplasies cervicales HPV induites en zone décentralisée. La prévalence de l'infection à HPV est élevée chez les femmes vivant avec le VIH et dans la population générale. Aucun lien d'intérêt

INTRODUCTION : Le but était d’évaluer les résultats oncologiques et l’impact de la cytoréduction tumorale sur la survie des patients ayant un cancer de la prostate métastatique. MATERIELS ET METHODES : Il s'agissait d'une étude prospective s'étalant sur une période de deux ans entre le 1er Janvier 2017 et le 31 Décembre 2019. Nous avons inclus 102 cas de cancer de la prostate métastatique hormonosensible. Les patients ont été divisés en un groupe 1 composés de 57 patients avec une suppression androgénique (SA) exclusive et, un groupe 2 constitués de 45 patients avec une SA associée à une chirurgie de désobstruction cervico-urétrale par voie endoscopique (RTUP) ou par voie ouverte (ECP). Nous avons comparé les deux groupes en utilisant les paramètres suivants : la PSA nadir, le délai d’atteinte du nadir de PSA, la survie globale (SG) et la survie sans progression (SSP). RESULTATS : Le nadir moyen du PSA était inférieur pour le groupe 2 (16,8 ± 1,6 ng/ml avec des extrêmes de 0,01 et 193,5 ng/ml) par rapport au groupe 1 (110,7 ± 17,9 ng/ml avec des extrêmes de 0,01 et 1.379 ng/ml). Le délai médian d’atteinte du PSA nadir était plus court chez les patients du groupe 1 (huit mois) que chez les patients du groupe 2 (trois mois) (p=0,025). La SG médiane était plus courte chez les patients du groupe 1 par rapport aux patients du groupe 2 (respectivement 14 et 24 mois ; p=0,03). La SSP était plus longue dans le groupe 2 comparée au groupe 1 (SSP médiane égale à 43 contre 20 mois). CONCLUSION : La cytoréduction tumorale a eu un impact positif sur les résultats oncologiques et la survie des patients avec un cancer de la prostate métastatique sous SA.

Le Sénégal est un des pays à forte endémie de l'infection à VHB. L'élimination de la transmission mère-enfant est une des stratégies qui permettront d'éradiquer cette maladie. L'objectif de notre travail est de partager une expérience basée sur l'implication des sages-femmes, acteurs clés du suivi des grossesses en zone décentralisée dans notre contexte. Nous avons réalisé une étude prospective multicentrique au niveau de 18 postes de santé de la région médicale. Toutes les femmes enceintes consentantes ont été incluses. Elles ont été dépistées pour le VHB, puis suivies et mises sous ténofovir en cas de charge virale élevée, d'Ag HBe positif ou d'indication de traitement pour la mère. Les nouveaux nés étaient vaccinés selon le protocole national, puis suivis jusqu'à 6 mois pour évaluer l'efficacité de la stratégie par une charge virale. Entre octobre 2019 et décembre 2021, 6895 femmes enceintes ont été dépistées dont 384 cas positifs (5,6 %). La prévalence variait de 13,8 % à 0,4 % en fonction du site. La moyenne d'âge était de 27 ans avec des extrêmes de 14 ans et 43 ans. Un suivi a été réalisé jusqu'à l'accouchement chez 121 femmes (31,5 %). Sept (7) avortements ont été enregistrés (5,7 %) et 3 morts -nés (2,4 %). Un traitement par le ténofovir a été initié chez 3 femmes enceintes toutes porteuses d'une forte virémie (supérieure à 200.000 UI/ml) avec Ag HBe positif. Une vaccination contre le VHB a été réalisée chez 119 nouveau-nés, en majorité dans les 24 heures (118 cas). Les sérologies et charge virales réalisées à 6 mois chez 41 enfants étaient négatives. Les sages-femmes peuvent jouer un rôle important dans la prévention de la transmission mère enfant de l'infection à VHB à travers le dépistage et traitement des femmes enceintes et la vaccination des nouveau-nés. Il faudra lutter cependant contre les pertes de vue Aucun lien d'intérêt

INTRODUCTION : La prostatectomie radicale est une chirurgie du cancer de la prostate qui consiste à l’ablation de la prostate et des vésicules séminales, d’où l’appellation prostato-vésiculectomie. Elle est indiquée pour les cancers de la prostate localisés ou localement avancés. L’objectif de cette étude était de rapporter les aspects per- et post-opératoires de nos premiers cas de prostatectomie radicale et d’en évaluer les résultats carcinologiques et fonctionnels. MATERIELS ET METHODES : Il s’agit d’une étude rétrospective, colligeant les dossiers des patients ayant eu une prostatectomie radicale dans le service de chirurgie du centre hospitalier national de Pikine (CHNP) entre Janvier 2016 et Décembre 2020. L’exploitation des dossiers médicaux et des registres nous avait permis de recueillir des données anamnestiques, cliniques et paracliniques. Données per-opératoires, de même que les résultats carcinologiques et fonctionnels ont été analysés. RESULTATS : Nous avons effectué 18 prostatectomies radicales durant la période d’étude. L’âge moyen des patients au moment du diagnostic était de 66,55 ans (57 ans et 74 ans). Neuf étaient classés ASA I (50%), et neuf classés ASA II (50%). La PSA totale moyenne était de 41,35 ng/ml avec des extrêmes de cinq et 169 ng/ml. L’examen anatomo-pathologique de la biopsie prostatique avait mis en évidence un adénocarcinome chez tous les patients. Cinquante pour cent de ces patients avaient un score de Gleason égal à six. Le bilan d’extension était sans particularité chez 15 patients. La durée moyenne d’intervention était de 178 minutes avec des extrêmes de 120 et 260 minutes. Le saignement per-opératoire variait entre 250 et 2.000 cc avec une moyenne de 1.105 cc. Treize patients avaient reçu une transfusion sanguine iso-groupe iso-rhésus en per-opératoire. Une discordance entre le stade TNM préopératoire et le stade pTNM était notée dans six cas. L‘incidence des complications immédiates était de 11,11% (une plaie rectale et une plaie urétérale). Un cas de sténose anastomotique a été rapporté. Huit patients étaient totalement continents. Dix patients avaient un dysfonctionnement érectile. A trois mois post-opératoires, le taux de PSAt moyen était de 2,04 ng/ml avec des intervalles de zéro et 8,21 ng/ml. CONCLUSION : Malgré la précarité du plateau technique, la prostatectomie radicale est faisable au CHNP avec des résultats carcinologiques et fonctionnels satisfaisants.

Le dépistage et la prise en charge des dysplasies cervicales HPV induites est la principale stratégie de lutte contre le cancer du col chez l'adulte au Sénégal. L'objectif de notre travail est de partager l'expérience d'une recherche de mise en oeuvre basée sur une stratégie de dépistage par des sages-femmes des dysplasies cervicales et de l'infection à HPV par trois méthodes au niveau des structures de santé surtout périphériques. Il s'agit d'une étude prospective multicentrique réalisée au de niveau de 18 postes de santé, 2 centres de santé et 2 hôpitaux de la région médicale de Ziguinchor. Les sages-femmes de ces structures ont été formées à la réalisation du dépistage par inspection visuelle (IVA/IVL), à la réalisation de Frottis Cervico-Utérins (FCU) et de prélèvements pour la recherche de HPV par Genexpert. Les femmes consentantes appartenant à la population générale ou à des populations clés ont été dépistées. Une prise en charge par cryothérapie ou LEEP a été réalisée en fonction du type de lésions. Entre octobre 2019 et décembre 2021, 6136 femmes de la population générale, 778 femmes vivant avec le VIH et 278 professionnelles du sexe ont été dépistées par la technique IVA/IVL. La proportion de cols suspects était respectivement de 5,3 % ; 2,4 % et 4,3 % pour ces différentes populations. La recherche de HPV au Genexpert a été réalisée chez 1079 femmes de la population générale, 443 femmes vivant avec le VIH et 122 professionnelles du sexe. La proportion de cas positifs était respectivement de 7 % ; 28,2 % et 0 % pour ces différentes populations. Un FCU a été réalisé chez 4709 femmes de la population générale, 750 femmes vivant avec le VIH et 206 professionnelles du sexe. Les résultats de ces examens ne sont pas encore parvenus. Après confirmation par les gynécologues, 30 patientes ont bénéficié d'une cryothérapie et 17 d'une LEEP. Une hystérectomie a été réalisé sur cancer avancé. Huit cas de néoplasies avancés ont été référés en cancérologie Cette étude de mise en oeuvre démontre l'intérêt de l'implication des sages-femmes dans le dépistage des dysplasies cervicales HPV induites en zone décentralisée. La prévalence de l'infection à HPV est élevée chez les femmes vivant avec le VIH et dans la population générale. Aucun lien d'intérêt

INTRODUCTION : La tumeur rénale est une néoformation tissulaire bénigne ou maligne (primitive ou secondaire) développée aux dépens du parenchyme rénal. Elle occupe le 2ème rang des cancers urologiques au Sénégal après le cancer de la prostate. Le but de cette étude était d’identifier les facteurs de risques et le type histologique des tumeurs du rein dans notre centre. MATERIELS ET METHODES : Il s’agissait d’une étude rétrospective menée dans notre centre sur une période de 10 ans (2009 à Juillet 2019), incluant tous les patients ayant eu une néphrectomie totale élargie ou une néphrectomie partielle indiquée pour une tumeur rénale avec des résultats histopathologiques de la pièce opératoire. Les paramètres étudiés étaient : l’âge, le sexe, les facteurs de risque, le type histologique, le grade de Fuhrman et la classification pTNM. L’analyse des données était faite à l’aide du logiciel Sphinx Démo© V5 et SPSS©. RESULTATS : Quarante-et-un patients étaient inclus avec un sex-ratio de 0,7. L’âge moyen était de 41,2 ± 16,4 ans. L’hypertension artérielle était le facteur de risque le plus observé dans notre série. La néphrectomie était totale élargie chez 97,5% (40) et partielle chez 2,5 % (un) des patients. A l’histologie, la taille moyenne de la tumeur était de 12,5 ± 4,3 cm. Le carcinome à cellules claires était plus fréquent. L’envahissement du fascia de Gérota était noté chez 2,3 % (un). Trois patients avaient une atteinte ganglionnaire et un seul avait un envahissement de la surrénale homolatérale. La classe pT2bNxMx était plus fréquente. CONCLUSION : Ces résultats montrent que le carcinome à cellules claires est le type histologique le plus observé dans notre centre suivi du carcinome papillaire.

INTRODUCTION : Le but était d’évaluer les résultats oncologiques et la morbidité de la cystoprostatectomie totale (CPT). MATERIELS ET METHODES : Il s’agissait d’une étude rétrospective et descriptive, colligeant 19 patients sur une période allant de Septembre 2011 à Mai 2018, dans le service d'Urologie du CHU Aristide le Dantec. RESULTATS : La moyenne d'âge était de 58 ans avec des extrêmes de 32 et 77 ans. Le sex-ratio était de deux. La CPT avait consisté en une pelvectomie antérieure suivie d’une urétérostomie cutanée trans-iléale selon Bricker chez six femmes, en une cystoprostatectomie radicale associée à une urétérostomie cutanée trans-iléale selon Bricker chez 12 hommes et à une entérocystoplastie de remplacement selon Studer chez un homme. La morbidité postopératoire précoce consistait en un cas de suppuration pariétale (grade I), deux cas d'éviscération (grade IIIb), un cas de fistule digestive (grade IIIb), et un cas de péritonite urinaire (grade IIIb) secondaire à un lâchage de suture de l'anastomose urétéro-iléale chez le patient avec la néovessie de Studer. Ce patient était décédé en réanimation après la réfection chirurgicale de l'anastomose urétéro-iléale. Les complications tardives étaient un cas de pyélonéphrite aiguë, trois mois après la cystectomie et un cas d’occlusion intestinale aigüe. Deux patients atteints de carcinome urothélial avaient reçu une chimiothérapie adjuvante en utilisant le protocole M-VAC. Après un suivi moyen de 15 mois nous avons enregistré 13 décès, trois patients ont été perdus de vue et trois autres ont respectivement vécu 50, 68 et 80 mois après la cystectomie. La survie globale moyenne était de 15 mois (4,2 à 25,8 mois) avec une survie médiane de six mois. Le seul patient qui avait une néovessie selon Studer était décédé une semaine après cystectomie. La survie globale moyenne après pelvectomie précédente était de 17,2 mois et celle après cystoprostatectomie était 15,18 mois. CONCLUSION : Ce travail mettait en évidence le très mauvais pronostic des cancers de la vessie dans notre contexte lié au stade avancé des tumeurs au moment du diagnostic.

This paper presents the design of NaviPBx, an ultrasound-navigated prostate cancer biopsy system. NaviPBx is designed to support an affordable and sustainable national healthcare program in Senegal. It uses spatiotemporal navigation and multiparametric transrectal ultrasound to guide biopsies. NaviPBx integrates concepts and methods that have been independently validated previously in clinical feasibility studies and deploys them together in a practical prostate cancer biopsy system. NaviPBx is based entirely on free open-source software and will be shared as a free open-source program with no restriction on its use. NaviPBx is set to be deployed and sustained nationwide through the Senegalese Military Health Service. This paper reports on the results of the design process of NaviPBx. Our approach concentrates on “frugal technology”, intended to be affordable for low–middle income (LMIC) countries. Our project promises the wide-scale application of prostate biopsy and will foster time-efficient development and programmatic implementation of ultrasound-guided diagnostic and therapeutic interventions in Senegal and beyond.

Introduction: Les tumeurs renales mixtes epitheliale et stromale (TMES) constituent une nouvelle entite dans la classification OMS des tumeurs du rein. Nous rapportons un cas de TMES maligne chez un homme de 32 ans revelee par une pyonephrose sur lithiase renale coralliforme.Observation: Il s’agissait d’un patient de 32 ans adresse pour une prise en charge d’une masse renale et d’une alteration de l’etat general. L’examen avait conclu a une pyonephrose sur lithiase renale droite coralliforme. L’examen anatomo-pathologique de la piece de nephrectomie avait mis en evidence une TMES maligne. L’evolution a ete marquee par la survenue de metastases et le deces du patient.Conclusion: La TMES maligne est une entite rare. Du fait de sa potentielle agressivite, des criteres diagnostiques doivent etre mis sur pied afin d’avoir un traitement bien codifie.

Buts: Rapporter les aspects epidemiologiques, cliniques et therapeutiques de l'HBP geante.Patients et methode: Il s'agissait d'une etude retrospective descriptive colligeant les patients ayant une prise en chargechirurgicale d'une HBP geante le 1er janvier 2012 au 30 novembre 2017. Les parametres etudies etaient: l'âge, les aspectscliniques et paracliniques, les donnees peroperatoires, la duree de port de la sonde et la duree d'hospitalisation et les complications.Resultats: L'âge moyen des patients etait de 70.9 ± 9.2 ans. La majorite des patients (13/18) avaient consulte pour une retentioncomplete d'urine (RCU). Le volume prostatique moyen mesure par echographie sus pubienne etait de 246.9 ± 46.1 cc. Laretention complete d'urine (RCU) associee a une vessie de lutte (VL) et la RCU avec echec a l'epreuve d'ablation de la sondeetaient les indications operatoires les plus observees. L'adenomectomie prostatique avait ete realisee par voie transvesicalechez 15 patients et par voie retropubienne chez trois patients. La moyenne du volume prostatique enuclee etait de 148 ± 68 cc(40-299cc). La duree moyenne d’hospitalisation etait de 6.77 jours (3-12 jours).Conclusion: Les progres de la chirurgie mini-invasive dans la prise en charge de l'HBP sont incontestables mais la chirurgieconventionnelle demeure le traitement de reference de cette entite.Auteur correspondant: Ndeye Aissatou Bagayogo, Service d’Urologie-Andrologie du CHU Aristide Le Dantec, Dakar,Senegal, Email: bagaaicha12@yahoo.fr,

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.

Purpose.-To study the topography of retinal breaks and their agreement with Lincoff's rules. Materials and Methods.-We performed a retrospective descriptive study of patients with recent rhegmatogenous retinal detachments followed on the ophthalmology service of Abass Ndao Hospital from January 2006 through December 2016. Patients with no prior retinal treatment were included. Results.-Over 11 years, we reviewed 97 patients with 107 eyes with retinal detachments. The mean age of our patients was 51.7 years, range 23-79 years. There were 69 male patients, for a male:female ratio of 2.46. Refraction revealed that 38.1% of patients were myopes. Fourteen percent (14%) of patients had experienced trauma to the eye with the detachment. The right eye was involved in 54.6% of patients. The onset was insidious in 54.6% of cases and sudden in 23.7% of cases. All patients had decreased visual acuity, associated with a scotoma in 26.8% of cases. Visual acuity was decreased to light perception through 7/10. In 64.9% of cases, Lincoff's rules were observed. Discussion.-Lincoff's rules are still relevant for localization of the breaks in retinal detachments. Conclusion. Diagnosis of a retinal detachment is an essential step, since it determines the treatment. Lincoff's rules still have a role in finding the retinal break in retinal detachments. (C) 2019 Elsevier Masson SAS. All rights reserved.

Objectives: Evaluate the efficacy of extracorporeal lithotripsy (ECL) in the management of urinary lithiasis. Patients and methods: Retrospective, descriptive and analytical study of 76 patients who underwent ECL in a center in Senegal from January 2013 to January 2016. The parameters studied were: age, sex, body mass index (BMI), Calculus characteristics, number of lithotripsy sessions, treatment outcomes and complications. Results: The mean age was 42, 7 +/- 10, 9 years. The male sex was predominant. The majority of patients had normal weight. CT showed calculus in all patients. Ureteral localization was the most frequent. Calculi with a size less than 10 mm were the most numerous. Most patients had only a calculation. The majority of patients underwent between one and three ECL sessions. Patients with normal weight had their calculus fragmented with the least session. There was no correlation between the number of sessions and the size of the kidney stones (p = 0, 19), while there was a correlation between the number of sessions and the size of the ureteral stones (p = 0,008). Patients without residual fragments were more numerous (82, 9%). The success rate was better for the kidney stones of the upper and middle calyxes and better for the ureteral calculi of the pelvic ureter and the lumbar ureter. Transient hematuria was noted in all patients and six had a renal colic attack. Conclusion: ECL is effective in the management of the calculi of the upper urinary tract however; its results can still be improved. (C) 2018 Pan African Urological Surgeons Association. Production and hosting by Elsevier B.V.

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 0.62 cm (0.5-3 cm) with a median length of 1 cm. 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. (C) 2018 Elsevier Masson SAS. All rights reserved.