The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis; we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.

Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.

Open AccessBladder cancer in Senegal: what's new? O Gaye, M Jalloh, M Ndoye, A Tall, NM Thiam, C Dial, I Labou, L Niang and SM Gueye O Gaye1 https://orcid.org/0000-0001-8873-9560 , M Jalloh1 https://orcid.org/0000-0002-2190-328X , M Ndoye1 , A Tall1 , NM Thiam1 , C Dial2 , I Labou1 , L Niang1 and SM Gueye1 Affiliations 1Urology Department, General Hospital Idrissa Pouye, Senegal 2Pathological Anatomy Laboratory, General Hospital Idrissa Pouye, Senegal Published Online:1 Jan 2023https://doi.org/10.36303/AUJ.0061https://hdl.handle.net/10520/ejc-mp_afurol_v3_n1_a3SectionsPDFAbstract ToolsAdd to favouritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InRedditGMailOutlookYammermore AboutAbstractBackground:The histological type determines the outcome of bladder cancers. Our study investigates the epidemiology of bladder cancer histology at our centre and compares it with previous studies carried out in Senegal.Methods:This descriptive and analytical study was conducted among 190 patients observed for bladder cancer at General Hospital Idrissa Pouye over a period of eight years. The parameters studied were age, gender, histological type, tumour stage, smoking exposure, presence of bilharzia eggs, clinical and paraclinical signs, locoregional and distant extension, treatment and recurrence.Results:The mean age of the participants was 62.37 ± 13.96 years. The gender ratio (M/F) was 1.63. Urothelial carcinoma was the most common histological type (79.5% of cases). Squamous cell carcinoma was found in 11.1% of the participants and was more frequent among patients under 40 years of age and among women. The tumour infiltrated the muscle in 78.42% of cases. Active smoking was observed in 45.2% of the participants and the presence of bilharzia eggs was found in 14.2% of cases. Haematuria was the most presenting finding of bladder cancer (91.58% of cases). Six patients had undergone endovesical chemotherapy. Twenty-one patients with non-muscle-invasive bladder tumours (NMIBT) had recurred. Cystectomy had been performed in 35 patients.Conclusion:Urothelial carcinoma has become the most common type of bladder cancer, followed by squamous cell carcinoma. It is necessary to design a care pathway for endovesical chemotherapy and appropriate monitoring.IntroductionBladder cancer is the tenth most common cancer in the world. Differences in incidence worldwide can be explained in part by differences in exposure to bladder cancer risk factors.1 The most common histological type in Africa, in the past, was squamous cell carcinoma,2-4 while urothelial carcinoma is the predominant histological type in northern countries.5,6Urogenital bilharzia is the main aetiological factor for squamous cell carcinoma of the bladder.7 In 1994, the International Agency for Research on Cancer (IARC) confirmed that Schistosoma haematobium is carcinogenic.8 However, the reason why schistosomiasis is more often associated with squamous cell carcinoma than with urothelial carcinoma, is unclear. It is known that Schistosoma haematobium eggs cause metaplastic lesions on the bladder urothelium that can progress to squamous cell carcinoma.9 Schistosomiasis is a highly endemic parasitosis in Senegal and is caused by the construction of dams.10,11 Owing to its high morbidity, a schistosomiasis control programme has been in place in Senegal since 1988.Other risk factors for bladder cancer such as smoking, occupational exposure, repeated urinary tract infections and metabolic syndrome, are more often associated with urothelial carcinoma.12Despite numerous deterrence campaigns, smoking continues to increase in our regions. Furthermore, the increase in industrialisation and a lack of suitable means to protect workers mean that they are experiencing greater occupational exposure to factors that cause bladder cancer.These lifestyle changes in our regions mean that we now share the same risk factors for bladder cancer as westerners. This may have an impact on the histological types of bladder cancer seen at our centres.The identification of histological type prior to treatment is important, as this has therapeutic implications. Endovesical chemotherapy is indicated after transurethral resection of the bladder tumour (TURBT) for non-muscle-invasive urothelial carcinomas. However, for non-muscle-invasive squamous cell carcinomas, a cystectomy is required in the same way as for muscle-invasive bladder tumours (MIBT) or non-muscle-invasive bladder tumours (NMIBT) with a very high recurrence risk. When cystectomy is indicated for urothelial carcinoma, neoadjuvant chemotherapy is recommended.12 In contrast, squamous cell carcinomas are chemoresistant and there is no proven benefit to neoadjuvant or palliative chemotherapy in this type of cancer.13As the management of bladder cancer depends on the histological type, it is necessary to evaluate the impact of preventive measures against bilharzia and of lifestyle changes on the epidemiology of bladder cancer at our centre. Thus, the aim of this study was to describe the evolution of the histological type and the clinical presentation of bladder cancer in Senegal in order to better plan the management thereof.MethodsWe conducted a descriptive and analytical study to evaluate the epidemiology of bladder cancer histology. We collected medical records and histological reports of patients over a period of eight years (January 2013 to December 2020) from the Urology Department and the Pathological Anatomy Laboratory, General Hospital Idrissa Pouye. We included patients who were observed for bladder cancer within these departments and who had complete medical records.The parameters studied were age, gender, histological type, tumour stage, smoking exposure, presence of bilharzia eggs in surgical specimens, clinical and paraclinical signs, locoregional and distant extension, treatment and recurrence. We compared these parameters for the two histological types most frequently encountered in our regions, namely squamous cell carcinoma and urothelial carcinoma.We also compared results published at the Hospital Aristide Le Dantec and those previously published at our centre as these two centres are the reference centres for the management of bladder cancer in Senegal. This comparison allowed us to observe the evolution of the epidemiology of bladder cancer, specifically in Senegal.Data analysis was done with IBM SPSS Statistic software, version 2.0 (IBM Inc., USA). We determined averages for quantitative variables. For qualitative variables, we estimated proportions. The comparison between qualitative variables was done with the chi-square test. Statistical significance was considered for alpha < 0.05.ResultsA total of 190 participants were included in this study. The mean age of the participants was 62.37 ± 13.96 years, with extremes of 21 and 90 years. Of the participants, 111 were older than 60 years. The gender ratio (M/F) was 1.63.Urothelial carcinoma was the most common histological type found in 79.5% of the participants, while squamous cell carcinoma was found in 11.1% of the participants (Table I).We observed an increase in the proportion of urothelial carcinoma between 2013 and 2018 but a decrease in the proportion of squamous cell carcinoma during the same period. We also observed that other cumulative histological types (sarcoma and adenocarcinoma) were more frequent than squamous cell carcinoma from 2017 onwards (Figure 1).Urothelial carcinoma was more common among men, while squamous cell carcinoma was more common among women (Figure 2). There was a significant relationship between gender and these two histological types (p = 0.001). Squamous cell carcinoma was predominant among patients under 40 years of age, while urothelial carcinoma was predominant among patients over 40 years of age (Figure 3). The relationship between histological type and age is statistically significant (p < 0.05) (Table I).Schistosoma haematobium eggs were found in 27 participants (14.21%). There was a relationship between the presence of bilharzia eggs and squamous cell carcinoma (p < 0.05) (Table I).Active smoking was observed in 45.2% of the participants. Urothelial carcinoma was diagnosed in 82% of the active smoking participants and there was a statistically significant relationship between active smoking and urothelial carcinoma (p = 0.01) (Table I).Haematuria was the most presenting finding of bladder cancer (91.58% of participants) and cystoscopy was the main imaging procedure used to diagnose bladder tumours (83.68%). Multifocal location was seen in the majority of participants (44.21%) and node invasion in tomodensitometry was found in 31.1% of cases. Distant metastases were found in 33.3% of cases. There was no significant difference between histological type and lymph node involvement and distant metastases (Table I).The bladder tumour invaded the muscle in 78.42% of cases. There was no significant difference between histological type and muscle invasion (p = 0.85) (Table I).Of the 41 participants with NMIBT, eight participants had papillary carcinoma. Six of them had undergone endovesical chemotherapy with gemcitabine in addition to TURBT. No Bacillus Calmette-Guérin (BCG) therapy was performed for the other NMIBT. Of the 41 participants with NMIBT, 21 had relapsed. Six of these participants had recurred in the NMIBT mode and had undergone cystectomy. Fifty-six participants had non-metastatic MIBT.Total cystectomy was performed in 32 participants and partial cystectomy in three participants, while Bricker diversion was performed in 22 participants and neo-bladder in 10 participants.DiscussionThe mean age of our patients tends to be close to that of Western series.14,15 We have observed an increase in the mean age of patients with bladder cancer in Senegal from 45 years old before 20053 to 62 years currently (Table II). This increase in the age at which cancer occurs is mainly explained by a decrease in the proportion of squamous cell carcinoma, which occurs more in younger people.3,15Like most studies published in Senegal, we observed that bladder cancer is more prominent in males.3,14 However, our study observed that females were associated more with squamous cell carcinoma. This could be explained by the fact that women are the most exposed to schistosomiasis16 and that they consume less tobacco in our regions.As in Egypt, there has also been a change in the predominant type of cancer in our country in recent years. In Egypt, squamous cell carcinoma was predominant at 73% between 2001 and 2005, while between 2006 and 2010 transitional cell carcinoma was predominant at 65%.17 In Senegal, at the Hospital Aristide Le Dantec, squamous cell carcinoma was predominant at 58.4% before 20053 and urothelial carcinoma became predominant at 51.5% between 2014 and 2018.18 This trend was also observed at our centre with the proportions of squamous cell carcinoma decreasing from 48.3%19 to 11.1% (Table II).These results could have the same explanation as in Egypt with a decrease in schistosomiasis infestation on the one hand and an increase in smoking among patients on the other hand. Indeed, in Egypt, bilharzia eggs were found in 70% of surgical parts before 2005 compared to 15% in surgical parts after 2005.17 In Senegal, Diao et al.'s study3 published in 2005 found bilharzia eggs in 29.9% of surgical specimens compared to 14.9% in our study. We also noted that smoking exposure increased from 8.1% before 201319 to 45.2% among patients at our centre.We did not observe any difference between lymph node involvement and distant metastasis, and the different histological types. However, it has been described in the literature that squamous cell carcinoma has lymph node and bloodstream extension.15,20In Senegal, urogenital bilharziasis is prevalent in all regions with a prevalence reaching more than 50% in some areas.10,11 This causes significant morbidity,21 including bladder cancer. The association between bilharzia and squamous cell carcinoma has been described as early as 1911 by Ferguson22 and has also been reported in our study and other African studies.20,22,23 To reduce the morbidity of this parasite, a control programme has been put in place by Senegal's health authorities since 1988. It consists of making regular anti-bilharzia chemotherapy available to affected communities, regularly treating school-aged children both in schools and Koranic schools (dahras), providing early treatment to cases in isolated communities, promoting clean water supply and sanitation, controlling intermediate host molluscs, and integrating a health prevention component in all hydro-agricultural development projects.This control programme could partly explain the decrease in the proportion of squamous cell carcinoma observed in our country.In addition, hybrid strains (Schistosoma haematobium and Schistosoma bovis) have been observed in northern Senegal. These strains accounted for 24% of the samples infested by Schistosoma haematobium.24 However, this study24 showed that hybrid strains cause less urogenital morbidity than the pure strain.25 Therefore, the appearance of hybrid strains of Schistosoma haematobium could also explain the decrease in squamous cell carcinoma.The predominance of urothelial carcinoma observed in Senegal requires the adaptation of management. In fact, NMIBTs have a high potential for recurrence and therefore require maintenance therapy and monitoring. A care pathway for these patients must be set up and training must be provided for paramedical staff, which is essential for the maintenance therapy to run smoothly. An effort must also be made by the authorities to make BCG therapy available. The recurrence rate of NMIBT is indeed very high in our study as none of the patients who required BCG therapy had the benefit of it.Despite a change in histological type, the majority of tumours diagnosed invade the muscle. Cystectomy still has an important place in the management of our patients. However, we have observed a low rate of cystectomy in patients requiring this treatment.More effort needs to be made for earlier diagnosis of bladder cancer. Urinary biomarkers are less invasive than cystoscopy, and do not require special skills. Therefore, it can be performed in the most remote areas and may help to obtain earlier diagnoses.ConclusionA comparison between our results and those previously published in Senegal shows that urothelial carcinoma has become the predominant histological type of squamous cell carcinoma pattern. The recurrence rate of NMIBT was very high. It is therefore necessary to adapt the management of patients by setting up a care pathway for endovesical instillation and monitoring. A prospective multicentre study will allow for better understanding each risk factor in the occurrence of bladder cancer in our country, and propose new adequate preventive measures.Figures and TablesFigure 1: Distribution of the different histological types of bladder cancer according to the years (2013–2020)Download FigureFigure 2: Distribution of the different histological types of bladder cancer according to genderDownload FigureFigure 3: Distribution of the different histological types of bladder cancer according to age groupDownload FigureTable I: Comparison of epidemiological and clinical parameters according to histological typeVariablesTCCSCCOthersp-valueNumber151 (79.5%)21 (11.1%)18 (9.4%)–Age (%)< 6028.585.755.60.00≥ 6071.514.344.4GenderMale68.223.855.60.001Female31.876.244.4Smoking (%)Ye s49.515.853.30.01Bilharziasis (%)Ye s11.938.15.60.00Pathologic stage (%)< T214.323.216.70.85≥ T285.776.883.3Lymph node (%)N070.56066.70.12N+29.54033.3Metastases (%)M064.869.2800.87M+35.230.820TCC – transitional cell carcinoma, SCC – squamous cell carcinomaTable II: Comparison of the various works published in Senegal on bladder cancerVariableH. Le Dantec 1950–2005H. Le Dantec 2014–2018HOGIP 2009–2013HOGIP 2013–2020Mean age45.555.65562.37Gender ratio1.252.11.81.6Pathologic finding (%) SCC58.432.348.311.1 TCC38.451.537.979.5 Others3.216.213.89.4Smoking (%) Yes––8.145.2Bilharziasis (%) Yes29.9–13.914.2TCC – transitional cell carcinoma, SCC – squamous cell carcinoma, H – hospital, HOGIP – General Hospital Idrissa PouyeConflict of interestThe authors declare no conflict of interest.Funding sourceNo outside funding was required.Ethical approvalThe institutional review board of General Hospital Idrissa Pouye (Dakar, Senegal) approved this study. Informed consent was waived by the ethics committee as this study is retrospective.1. Ferlay JColombet MSoerjomataram Iet al. "Cancer statistics for the year 2020: an overview" Int J Cancer2021 149477889 DOI: https://doi.org/10.1002/ijc.33588 Google Scholar2. Bowa KMulele CKachimba Jet al. "A review of bladder cancer in sub-Saharan Africa: a different disease, with a distinct presentation, assessment, and treatment" Ann Afr Med2018 17399105 DOI: https://doi.org/10.4103/aam.aam_48_17 Google Scholar3. Diao BAmath TFall Bet al. "Les cancers de la vessie au Sénégal: particularités épidémiologiques, cliniques et histologiques" Prog Urol2008 1874458 DOI: https://doi.org/10.1016/j.purol.2008.04.016 Google Scholar4. Dangou JMMendès VBoye IAGaye GWNdiaye PD "Le cancer vésical au Sénégal, expérience du laboratoire d'anatomie pathologique du C.H.U de Dakar (SENEGAL)" Méd Afr Noire1996 4363625 Google Scholar5. Al-Husseini MJKunbaz ASaad AMet al. "Trends in the incidence and mortality of transitional cell carcinoma of the bladder for the last four decades in the USA: a seer-based analysis" BMC Cancer2019 1946 DOI: https://doi.org/10.1186/s12885-019-5267-3 Google Scholar6. Boustead GBFowler SSwamy RKocklebergh RHounsome L "Stage, grade and pathological characteristics of bladder cancer in the UK: British Association of Urological Surgeons (BAUS) urological tumour registry" BJU Int2014 113692430 DOI: https://doi.org/10.1111/bju.12468 Google Scholar7. Cassell AYunusa BJalloh Met al. "Non-muscle invasive bladder cancer: a review of the current trend in Africa" World J Oncol2019 10312331 DOI: https://doi.org/10.14740/wjon1210 Google Scholar8. Khaled H "Schistosomiasis and cancer in Egypt: review" J Adv Res2013 454616 DOI: https://doi.org/10.1016/j.jare.2013.06.007 Google Scholar9. Jalloh MCassell ADiallo Tet al. "Is schistosomiasis a risk factor for bladder cancer? Evidence-based facts" J Trop Med2020 20208270810 DOI: https://doi.org/10.1155%2F2020%2F8270810 Google Scholar10. Senghor BDiallo ASylla SNet al. 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"Aspects épidémiologiques, cliniques et thérapeutiques des tumeurs de vessie à l'hôpital général de Grand Yoff de Dakar" Afr J Urol2014 202116 DOI: https://doi.org/10.1016/j.afju.2014.03.019 Google Scholar20. El-Bolkainy MNMokhtar NMGhoneim MAHussein MH "The impact of schistosomiasis on the pathology of bladder carcinoma" Cancer1981 4826438 DOI: https://doi.org/10.1002/1097-0142(19811215)48:122643::AID-CNCR28204812163.0.CO;2-C Google Scholar21. Gaye OJalloh MThiam NMet al. "Epidemiological and diagnostic aspects of bladder bilharziomas in the Urology Department of Idrissa Pouye General Hospital (HOGIP)" Adv Urol2021 20214536381 DOI: https://doi.org/10.1155/2021/4536381 Google Scholar22. Ferguson AR "Associated bilharziasis and primary malignant disease of the urinary bladder with observation on a series of 40 cases" J Pathol Bact1911 1676 DOI: https://doi.org/10.1002/path.1700160107 Google Scholar23. Keïta ADSacko MCoulibaly YIet al. "Imagerie des tumeurs urologiques dans une zone d'endémie bilharzienne au Mali" J Afr Cancer2009 113540 DOI: https://doi.org/10.1007/s12558-009-0015-2 Google Scholar24. Léger EBorlase AFall CBet al. "Prevalence and distribution of schistosomiasis in human, livestock and snail populations in Northern Senegal: a One Health epidemiological study of a multi-host system" Lancet Planet Health2020 433042 DOI: https://doi.org/10.1016/S2542-5196(20)30129-7 Google Scholar25. Fall CBLambert SLéger Eet al. "Hybridized zoonotic schistosoma infections result in hybridized morbidity profiles: a clinical morbidity study amongst co-infected human populations of Senegal" Microorganisms2021 981776 DOI: https://doi.org/10.3390/microorganisms9081776 Google Scholar Previous article Next article FiguresReferencesRelatedDetails None InformationCopyright © 2023, the Author(s)LicensesThis work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Keywordshistologybladder cancerSenegalschistosomiasisendovesical chemotherapyAcknowledgmentsSpecial thanks to the Urology Department, General Hospital Idrissa Pouye.PDF 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.

Introduction: Open surgery is gradually being supplanted by minimally invasive surgical techniques worldwide.Our study aimed to describe the place of minimally invasive surgery at the Hôpital Général Idrissa Pouye (HOGIP) in Dakar.Materials and Methods: This is a descriptive cross-sectional study over a 20-years period from 1 st June 2000 to 31 st December 2021 in the urology department of HOGIP in Dakar.The list of all surgical procedures performed was computed.We evaluated the distribution of minimally invasive procedures (endoscopy, PCNL, laparoscopy) overall and over the years.We made calculations of proportions and statistical significance was considered for alpha = 0.05.Results: In 20 years, 14,855 surgical procedures were performed, of which 5344 (36%) were minimally invasive surgeries.The average age of men was 53.19 years (standard deviation: 21.77) vs 47.32 years (standard deviation: 18.43) for women.Minimally invasive procedures in the lower urinary tract accounted for 71.93% and involved 1033 cystoscopies (26.87%), 1020 Trans Urethral Resection of Prostate (TURP) (26.53%), 931 Direct Vision Internal Urethrotomy (DVIU) (24.21%, and 612 Trans Urethral Resection of the Bladder (TURB) (15.92%).In the upper urinary tract, 1461 (28.07%) minimally invasive procedures were performed, including PCNL in 193 cases (3.61%), laser endopyelotomy in 104 cases (1.95%), ureteroscopy in 486 cases (1.7%) and laparoscopy in 39 cases (0.46%).The proportion of minimally invasive surgery has gradually increased.Among the 5344 minimally invasive procedures, 333 (5.23%) were performed in 2000-2004 and 2332 (43.63%) in 2015-2019.Conclusion: Minimally invasive surgery represents an important part of the activity of the HOGIP urology department.Its de-

INTRODUCTION : La biopsie de la prostate guidée par l'imagerie par résonance magnétique (IRM) a une sensibilité plus élevée que la biopsie échoguidée, mais sa réalisation nécessite un matériel spécifique d'IRM interventionnelle, ce qui n'est pas disponible dans notre contexte. Par conséquent, la biopsie guidée par ultrasons reste d'un grand intérêt pour le diagnostic du cancer de la prostate. L’objectif de notre travail était d'évaluer notre pratique de la biopsie transrectale échoguidée de la prostate à l'aide d'une sonde endorectale en décrivant la technique et en évaluant la morbidité et les résultats. MATERIELS ET METHODES : Il s'agit d'une étude rétrospective et descriptive des biopsies prostatiques échoguidées réalisées sur une période de deux ans. Les paramètres étudiés étaient la fréquence de la procédure, l'âge, les résultats de l'examen rectal, le taux de PSA total. Des statistiques descriptives ont été réalisées, et la comparaison des variables qualitatives a été faite par le test du Chi-2 avec une signifiance statistique fixée à α<5%. RESULTATS : Deux cent-et-trente-et-un patients ont été inclus sur une période de deux ans. L'âge moyen de nos patients était de 65 ± 8,2 ans. Le résultat de l'examen rectal était suspect dans 36,9% des cas et le PSA total médian était de 19,8 ng/ml (0,1 – 5.936 ng/ml). L'adénocarcinome prostatique a été le plus fréquent, représentant 53,7% des résultats. Des complications ont été observées chez 16 patients (6,9 %) avec une prédominance de l'hématurie initiale. CONCLUSION : Dans notre série, le taux de détection du cancer était significatif et le taux de complications était acceptable à 6.9%.

INTRODUCTION : Le cancer de la prostate fait partie des maladies chroniques non transmissibles qui touche essentiellement les hommes âgés de plus de 50 ans. Son incidence augmente avec l’âge et est connue pour être plus élevée chez les noirs à causes de certaines prédispositions génétiques. Les personnes atteintes sont en majorité à la retraite avec un pouvoir d’achat limité. Le but de notre étude est d’évaluer le coût de la prise en charge du cancer de la prostate en milieu hospitalier. MATERIELS ET METHODES : Nous avons effectué une étude descriptive, médico-économique auprès des patients diagnostiqués de cancer de la prostate et hospitalisés à l’Hôpital Général Idrissa Pouye en 2018. RESULTATS : Un effectif de 105 patients était inclus. La moyenne d’âge était de 70 ans et la tranche d’âge la plus représentée était celle de 60 à 69 ans avec 48%. Une hospitalisation était nécessaire pour la majorité des patients. Le mode d’admission en hospitalisation était à 100% et le mode de sorti le plus fréquent était le retour à domicile à 93% avec une durée moyenne de séjour en hospitalisation de sept jours. Il y avait 62% de patients retraités, 8% de cultivateurs et 7% de commerçants. L’adénocarcinome de la prostate était le seul type histologique retrouvé. La forme avancée de cancer de la prostate avec des métastases était de 81% contre 16% de formes localisées et 3% et de formes localement avancées. Le traitement curatif était possible chez 16% de l’effectif contre 84% de cas de traitement palliatif. En effet, huit patients ont subi une prostatectomie radicale dont deux ayant une radio-hormonothérapie complémentaire et huit autres ont eu une radio-hormonothérapie seule. Le BAC médicamenteux était indiqué chez 63 patients, la pulpectomie testiculaire chez 14 autres. La RTUP était combiné à la pulpectomie chez un patient, suivi d’un traitement hormonal chez neuf patients et suivi d’une radio-hormonothérapie chez un patient. La chimio-hormonothérapie était effectuée chez un patient. Le coût des actes de diagnostic était estimé à 28.497.000 Fcfa, celui des indications thérapeutiques à 168.149.700 Fcfa et celui des actes de suivi estimé à 3.463.900 Fcfa. Le montant annuel de la prise en charge des 105 patients était de 200.110.600 Fcfa, soit un coût moyen estimé à environ 1.905.815 Fcfa par patient et par an. CONCLUSION : Les difficultés de la prise en charge du cancer de la prostate sont en partie liées à une inaccessibilité financière des patients. La réduction de la morbidité et de la mortalité de cette pathologie pourrait passer par la vulgarisation et la mise à disposition élargie des avantages de la CMU à toutes les catégories socio-professionnelles dans les EPS mais également par la recherche génétique et la biologie moléculaire pour une meilleure précision des approches thérapeutiques.

Self-mutilation is a rare situation including all practices leading to tissue or organ damage, with a vital or functional risk without intent of suicide. It is most often observed in vulnerable psychotic conditions, particularly schizophrenia. The diagnosis of self-mutilation is clinical and its management requires collaboration between the urologist and the psychiatrist. We report two cases of genital self-mutilation in our clinic.

Background Magnetic resonance imaging (MRI)-guided prostate biopsy has a higher sensitivity than the ultrasound-guided biopsy, but its realization requires a dedicated interventional MRI, specific material, which is not available in our context; hence, ultrasound-guided biopsy remains of great interest. Currently, ultrasound-guided biopsy outside of a clinical trial is the gold standard for the diagnosis of prostate cancer. The objective of our work is to evaluate our practice of transrectal ultrasound-guided prostate biopsy using an endorectal probe by describing the technique and evaluating the morbidity and results. Methods This is a descriptive study of ultrasound-guided prostatic biopsies performed over a 2-year period. The parameters studied were frequency of the procedure, age, rectal examination findings, total PSA level, prostate biopsy morbidities and results. Descriptive statistics were performed, and comparison of qualitative variables was made by the Chi-square test with statistical significance set for α < 5% Results Two hundred and thirty-one patients were included over a two-year period. The mean age of our patients was 65 ± 8.2 years. Rectal examination finding was suspicious in 36.9% and the median total PSA was 19.8 ng/ml (0.1-5936 ng/ml). Seventy-seven percent of patients reported their pathology results. Prostatic adenocarcinoma was the most common finding accounting for 53.7% of results. Complications were observed in 16 patients (6.9%) with a predominance of initial hematuria, voiding pain and fever. Conclusion In our series, the cancer detection rate was significant and the complications rate was acceptable at 6.9%.

Objective. The aim of our study is to assess the diagnostic aspects of bladder bilharzioma in the Urology Department of Idrissa Pouye General Hospital (Senegal). Materials and Methods. It is a descriptive study from January 2013 to December 2018. The patients included in the study were those who had anatomopathological examination of bladder biopsy that showed a schistosomiasis pseudotumor of the bladder. The variables studied were sociodemographic, clinical symptoms, imaging findings, histology, and treatment. The data have been saved and analyzed by the 2013 Excel software. Results. Thirteen patients were included in our study. The average age was 27 ± 12.1 years. Sex ratio was 1.6. The majority of the patients were from the northern part of Senegal. Hematuria was the main symptom for all the patients. Cystoscopy was performed for all the patients and showed 5 granulomas and 8 fibrocalcic polyps. A transurethral resection of the bladder was performed, and treatment with praziquantel (40 mg/kg of bodyweight) has been carried out. One patient presented precancerous lesions such as metaplasia and dysplasia of the bladder mucosa. After a median follow-up of 40 months (6–57 months), ten patients had a favorable clinical and endoscopic outcome. Conclusion. Granulomas and fibrocalcic polyps of the bladder mucosa are, respectively, confused with squamous cell carcinoma and bladder lithiasis in endemic areas of schistosomiasis. Good cystoscopy interpretation can provide the diagnosis of bladder bilharzioma and start the treatment.

Testicular cancer is a common malignancy in young males with higher incidence in developed nations but with the lowest incidence in Africa (0.3-0.6/100 000). Ironically, the global testicular cancer mortality rate has shown a reverse trend to its incidence with higher rates in low- and middle-income countries (0.5 per 100 000) than in high-income countries. Data from GLOBOCAN 2008 have shown relatively high mortality rates in sub-Saharan countries like Mali, Ethiopia, Niger and Malawi. The prognosis of testicular tumor is good with remarkable chemosensitivity to cisplatin-based regimen. Early diagnosis, careful staging and a multidisciplinary management approach is crucial to achieve this optimal result. These results are achievable in the sub-Saharan region if the relevant resources are appropriated for cancer care and clinical guidelines are formulated in a regional context.

Teaching of surgery has long relied on live practice. The advent of endo-urology and laparoscopy have favored the development of simulation. The purpose of this study was to evaluate the role of simulation in the development of a center of excellence center in Senegal. Simulation has become the standard for surgical training students in Europe and the USA, allowing for a better and faster learning. The routine practice of minimally invasive surgery in urology along with a high number of residents should favor the use of simulation in this setting. The experts achieved a higher percentage of prostate tissue resection within the allotted time for this procedure. The quality of the control of hemostasis evaluated on a basic procedure and during a resection is significantly better in the expert group. The satisfaction survey was conducted at the end of the seminar.

Background . Globally, approximately 20% of malignancy are caused by infection. Schistosoma infection is a major cause of bladder in most part of Africa. In 2018 alone, there were approximately 549,393 new cases and 199,922 deaths from bladder cancer. The presence of Schistosoma ova in the venous plexus of the bladder induces a cascade of inflammation causing significant tissue damage and granulomatous changes. Methodology. A literature review was conducted from 1995 to 2019 using PubMed, Google Scholar, African Journal Online, and Google databases. Relevant data on the association of "Schistosomiasis and Bladder cancer" in sub-Saharan Africa (SSA) were retrieved. Evidence Synthesis. Results from research using animal models to establish the carcinogenesis of Schistosoma and bladder cancer have been helpful but inconclusive. Immunoregulatory cytokines and genetic marker have been identified to play a role in the pathogenesis. In some parts of sub-Saharan Africa, there has been close association of squamous cell carcinoma and histological evidence of Schistosoma ova. Conclusion. There are some data to support the association between schistosomiasis and bladder cancer in sub-Saharan Africa. However, these have been limited by their design and may not sufficiently establish carcinogenesis. There is a need for more genomic and molecular research to better characterize S. haematobium and its effects on the bladder. Such goal will contribute immensely to Schistosoma bladder cancer prevention and control.

Urolithiasis is a global pathology with increasing prevalence rate. The lifetime recurrence of urolithiasis ranges from 10-75% creating a public health crisis in affected regions. The epidemiology of urolithiasis in most parts of Africa and Asia remains poorly documented as incidence and prevalence rates in these settings are extrapolated from hospital admissions. The surgical management of kidney and ureteral stones is based on the stone location, size, the patient's preference and the institutional capacity. To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy. However, regarding the lack of endourological equipment and expertise in most parts of Sub-Saharan Africa (SSA), most urological centers in these regions still consider open surgery for kidney and ureteral stones. This review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines.