L’automutilation genitale est un phenomene rare en pratique urologique. L’objectif de ce travail etait de rapporter un cas clinique d’autoamputation totale des organes genitaux externes (OGE) chez un patient âge de 32 ans, celibataire dans un contexte de delire psychiatrique. Avec une revue de la litterature, nous avons rappele les circonstances dans lesquelles surviennent les automutilations genitales et les principes de prise en charge des malades. Mots-cles : automutilation, genitale, prise en charge.

Analyser les aspects épidémiologiques, diagnostiques et thérapeutiques de la lithiase du bas appareil urinaire au service d’urologie du CHU de Conakry, République de Guinée.

Les lésions génitales masculines dues àSchistosoma haematobium sont rares dans nos régions. Pourtant les travaux de Chaker en 1889 et de Lortet et Vialleton qui ont décrit les premières lésions des vésicules séminales en sont le témoignage. Nous rapportons un cas de prostatite bilharzienne de découverte anatomo-pathologique chez un patient de 65 ans après résection transurétrale de prostate.

Objective: To report on our experience in the management of traumatic rupture of the posterior urethra.Patients and Methods: Eighty-seven patients with traumatic rupture of the posterior urethra were treated at the Department of Urology and Andrology of the Conakry University Hospital between January 1988 and December 2004. Trauma was caused by a car accident in 68 (78.2%) and by a work accident in 19 (21.8%) cases. Only 32 (36.8%) patients presented to the hospital within 72 hours after the accident. The others presented at a stage where urethral stricture had already developed. Pelvic fracture was observed in 56 (64.4%) patients. The predominant presenting symptom was urinary retention in 62 (71.3%) patients, followed by bleeding per urethram in 59 (67.8%) and perineal hematoma in 23 (26.4%) patients.Results: Treatment consisted of immediate realignment with a guiding catheter, deferred urethroplasty between the 8th and 10th day, or delayed urethroplasty, depending on the time elapsed after the injury. Good results were achieved in 32 (36.8%) and satisfactory results in 39 (44.8%) cases. Erectile dysfunction was noted in 19 (21.8%) patients.Conclusions: Treatment of ruptures of the posterior urethra remains controversial. Due to the fact that in our environment endoscopic realignment is not possible, deferred emergency end-to-end urethrorraphy remains the method of choice for ruptures not associated with other serious lesions. In case of associated serious injuries, these are given priority as a life-saving measure before urethral repair.

Objective: To determine the indications for treatment of strictures of the male urethra and to evaluate the results achieved with the various techniques used at the Urology Department of the Conakry University Hospital, Republic of Guinea. Patients and Methods: In this retrospective study, 250 patient files covering a period of 5 years (January 1, 2000 – December 31, 2004) were reviewed. The therapeutic procedures used were internal urethrotomy (with or without urethral dilatation) and urethroplasty. The treatment results were evaluated taking into consideration clinical (micturition profile) and radiological criteria (intravenous urography and retrograde urethrocystography), as well as the need for urethral dilatation. Results: The majority of strictures were caused by infection followed by post-traumatic strictures accounting for 84.4% (n=211) and 10.4% (n=26), respectively. Urethral stricture was associated with other pathologies in 37.6% (n=94) of cases. Internal urethrotomy was the main procedure used in 82.8% (n=207) of patients followed by urethroplasty. After a follow-up period of 22 months, the results were satisfactory in 80% (n=200) of the cases. The best results were achieved in iatrogenic and post-infective strictures, with good results in 85.7% and 62.1%, respectively. Conclusion: The treatment of urethral strictures, be it endoscopic or surgical, is still associated with a high complication rate, and recurrence is not rare. African Journal of Urology Vol. 12 (4) 2006: pp. 200-208

Objective: To evaluate the feasibility and outcome of percutaneous nephrostomy (PCN) in Urology Departments of developing countries with limited resources. Patients and methods: This prospective study was conducted between January 1999 and July 2006 based on 73 patients who underwent percutaneous nephrostomy as an emergency treatment of obstructive uropathy. The procedure was performed under local anesthesia through a posterolateral approach on the upper border of the 12th rib using a cystostomy or nephrostomy set. Results: Percutaneous nephrostomy was successfully done in 94.5 % of cases. There were two failures and two complications. Conclusion: Percutaneous nephrostomy is a simple and effective therapeutic procedure for the emergency treatment of urinary tract obstruction of various etiologies. It is an important step in training for renal endoscopic surgery in developing countries. However, hemorrhagic and infectious complications remain serious risks that should be taken into consideration. African Journal of Urology Vol. 12 (4) 2006: pp. 245-247

Objective: To unravel clinical and therapeutic aspects of penile fistulae managed in a Guinean hospital setting. Patients and Methods: This is a retrospective series of 22 post-circumcision penile fistulae encountered at the University Hospital Center of Conakry over a 58 months period. Results: The mean patients' age was 7 years (range 5 months to 32 years), The mean delay to consultation was 17 months. Circumcision was performed by paramedical personnel in 15 cases and by a physician in 7 cases. Penile fistulae were all glandular and located at the corona ventrally. Surgical treatment consisted of excision of the fistulous tract and fistulorraphy with urethrocutaneous plication (n=11), with pedicled penile flap (n=6), and using the Davis technique (n=5). Primary success was achieved in 16 cases, and 6 patients were re-operated successfully for a residual fistula. Conclusion: Penile fistula is not a trivial complication of circumcision. Prevention lies in mastery of the various steps of circumcision.

From 16 cases collected in eight years (January 1991-December 1999) in the I. Deen Teaching Hospital Department of Urology, the authors study the gynaecological and obstetric surgery urological complications. They noted that these complications interest in 80% of cases the 18-47 years old woman with a high parity in 70% of cases. Hysterectomy, whatever the indication is the main etiology: 62.50%, caeserean takes the second place with 25%. The anatomic lesions are ureteral in 68.75% of cases and bladder in 31.25%. In the 14 cases treated, in the department, uretero reimplantation has been done in 46.66%, bladder suture in 40% and nephrectomy in 6.66%. Thirteen women were healed and one died.

From 16 cases collected in eight years (January 1991-December 1999) in the I. Deen Teaching Hospital Department of Urology the authors study the gynaecological and obstetric surgery urological complications. They noted that these complications interest in 80% of cases the 18-47 years old woman with a high parity in 70% of cases. Hysterectomy, whatever the indication is the main etiology: 62.50%, caeserean takes the second place with 25%. The anatomic lesions are ureteral in 68.75% of cases and bladder in 31.25%. In the 14 cases treated, in the department, ureterie reimplantation has been done in 46.66%, bladder suture in 40% and nephrectomy in 6.66%. Thirteen women were healed and one died. (C) 2001 Editions scientifiques et medicales Elsevier SAS.

À partir de 16 dossiers colligés en huit ans dans le service d'urologie de l'hôpital I. Deen de Conakry, les auteurs analysent les aspects épidémiologiques, anatomiques et thérapeutiques des complications urologiques de la chirurgie gynécologique et obstétricale. Les résultats de leur étude montrent que ces complications intéressent les femmes dont l'âge est compris entre 18 et 47 ans dans 80 % des cas, multipares dans 70 % et non scolarisées dans 87,50 %. L'hystérectomie est la première cause de ces complications (62,50 %) dont l'atteinte urétérale est la plus fréquente : 68,75 % des cas. Les réimplantations et les raphies ont été les gestes réparateurs les plus fréquents avec un décès et 13 guérisons dans les suites opératoires.

The authors report a series of 157 stenoses of the urethra treated by endoscopic urethrotomy between 1991 and 1997. After a first urethrotomy the success rate is 51.8%, with a decline of one year. Mortality is zero, and the morbidity assessed at 9%. For these authors, the result is better when the urethrotomy concerns an uninfected, one-time, short (less than 2 cm) stenosis, whatever the etiology, located on the proximal urethra. The duration of the postoperatory catheter has been fixed at three days. Poor results (35.20%) have been reported in stretched stenoses located on the distal urethra. These poor results have been treated by another urethrotomy, with 25% good results. The remaining 10.2% have needed sessions of urethral dilatation, even a plasty.

Résumé – Les rétrécissements post-traumatiques sont la conséquence des traumatismes accidentels ou de plaies chirurgicales de l'urètre. Le diagnostic repose sur la clinique et l'exploration radiologique. De janvier 1991 à juin 1999, 74 malades ont été hospitalisés pour rétrécissements post-traumatiques de l'urètre masculin. L'adulte jeune paye un lourd tribut avec une moyenne d'âge de 30,9 ans. L'accident de la voie publique reste la cause première, l'urètre postérieur (membraneux) est le siège de prédilection. La résection anastomose terminoterminale dans le rétablissement de la continuité urétrale donne de bons résultats.

Hryntschak Technic is the most common method in the prostatic hyperplasia surgical treatment in the Ignace Deen Urological Department. The aim of the authors in this paper is to study the epidemiological aspects of hryntschak early complications from january 1994 to December 1998. They found, from 96 cases that 41.70% are specifie complications and 58.30% are non specifie complications. Wound infection (35.40%), bladder fistula (15.60%) and epididymitis (11.50%) are the most frequent complications. The 61 to 80 years old rural man, with a uretral cather placed before operation is the first interested by Hryntschak early complications. (C) 2001 Editions scientifiques et medicales Elsevier SAS.

Hryntschak Technic is the most common method in the prostatic hyperplasia surgical treatment in the Ignace Deen Urological Department. The aim of the authors in this paper is to study the epidemiological aspects of hryntschak early complications from january 1994 to December 1998. They found, from 96 cases that 41.70% are specific complications and 58.30% are non specific complications. Wound infection (35.40%), bladder fistula (15.60%) and epididymitis (11.50%) are the most frequent complications. The 61 to 80 years old rural man, with a urethral catheter placed before operation is the first interested by Hryntschak early complications.