Background: Pregnant women may be at risk of unpredictable obstetric complications such as: bleeding, dystocia, acute fetal suffering, pre-eclampsia and eclampsia. This maternal-fetal prognosis of obstetric emergencies is influenced by factors that are most often related to complications that alter the course or outcome of a pregnancy and require prompt care. The objectives of this study are to analyze the factors that influence the maternal-fetal prognosis of obstetric emergencies; determine their frequency, describe the clinical profiles of patients and evaluate the maternal-fetal prognosis.Methods: The study was conducted at the Mamou Regional Hospital. It was a 6-month quantitative, descriptive and analytical study, from July 1st to December 31st, 2016, including all parturient women whose term is greater than or equal to 28 weeks of amenorrhoea.Results: The study covered 377 obstetric emergencies out of a total of 1273 deliveries, or 29.61%. Factors influencing the prognosis were: young age, parity, unfavorable socio-economic conditions and difficult baseline conditions. The main obstetric emergencies recorded were acute fetal suffering, disproportion and narrowed pelvis. The dominant mode of delivery was caesarean section with a frequency of 89.65%. Maternal lethality is 3.44% and fetal lethality is 5.14%.Conclusions: Obstetric emergency is a frequent situation where better management would improve the prognosis of the mother and fetus.

Introduction: With the increasing trend of antibiotic resistance, the management of urinary tract infection (UTI) is likely to become complicated, and there is a need for continuous surveillance of antibiotic susceptibility of uropathogens.Objective: This study aimed to assess the current antimicrobial susceptibility pattern in the common uropathogens isolated from outpatients and hospitalized (<72 h).Subjects and methods: This was a prospective observational study examining urinary isolates from patients aged >= 18 years. Urine samples were collected from 494 consecutive outpatient adults, clinically-suspected cases of urinary tract infections. Bacterial identification and antimicrobial susceptibility testing were carried out using the VITEK (R) 2 Compact kit of bioMerieux.Results: The observed prevalence of UTI was (132/494) 26.7%, 95% CI [22.9%; 30.9%]. Among the 147 organisms isolated from 132 patients, more than 90% (133) were Gram-negative bacteria. Imipenem appeared as the most active drug, with less than 3% resistance of isolates. Amikacin and cefotaxim were in general active with susceptibility rate of 70% and 67% of isolates, respectively. However cefixim was the most active oral drug tested (61%). Trimethoprim/sulfamethoxazole, nalidixic acid and fluoroquinolons were the less active drug displaying a resistance rate of 73%, 69% and 60% respectively.Conclusion: Trimethoprim/sulfamethoxazole, nalidixic acid and fluoroquinolons should no longer be used as empirical treatments of UTI in Dakar. Alternatives must be recommended, such as cefixim the most active oral drugs available in this country. (C) 2017 Pan African Urological Surgeons Association. Production and hosting by Elsevier B.V.

OBJECTIVE:To analyze the management of obstetric vesico-vaginal fistula in the three sites of Engender Health in Guinea.PATIENTS AND METHODS:It was a retrospective study of descriptive type having helped collect 450 cases of vesico-vaginal fistulas in three support sites engender health between January 2008 and December 2011. The variables studied were epidemiological, clinical and therapeutic reasons and treatment outcomes were evaluated after a decline of at least six months.RESULTS:The mean age of onset of the fistula was 25years, ranging from 12 to 55years and 58.8% (n=265) of patients were aged between 18 and 30years. The mean duration of fistula was 11years, ranging from 1 to 38years. Eighty-two percent (n=416) of patients were housewives and 66.4% (n=299) off school. The complex fistula with 66% (n=297) was the most frequent. The treatment consisted of a fistulorraphie after splitting vesico-vaginal in 93.3% (n=420) of cases. Therapeutic results considered after a mean of 8months have resulted in a cure in 79.3% (n=357) of cases, improvement in 4.2% (n=19) of cases and failure in 16 4% (n=74) of cases.CONCLUSION:Vesico-vaginal fistula is a major cause of maternal morbidity in Guinea. The establishment of a real health policy based on sound medical and social structures contributes to its eradication.LEVEL OF EVIDENCE:5.

Objective: To describe the clinical aspects of varicocele and to evaluate the outcome of its treatment at the Department of Urology and Andrology of Conakry University Hospital, Republic of Guinea.Patients and Methods: This prospective study included 119 patients with varicocele operated on at the Department of Urology and Andrology of Conakry University Hospital over a one-year period. Clinically, the varicoceles were classified into four grades according to the classification of Dubin and Amelar. All patients received at least one semen analysis pre- and postoperatively.Results: The mean age of the patients was 38 (range 22-53) years. In 80.7% (n = 96) of the cases the varicocele was detected in the course of an infertility consultation. The varicocele was located on the left side in 84.9% (n = 101) of the cases, while it was bilateral in 15.1% (n = 18). Preoperative semen analysis was normal in 5% of the cases. Oligo-astheno-teratozoospermia seen in 46.2% (n = 55) of the patients was the most frequently found anomaly. All patients underwent surgical treatment using the Ivanissevich procedure. After a mean follow up of 17 months conducted on 113 patients, significant improvement in sperm quality was observed in 67 patients with normalization of the sperm count in 33 of them. However, no improvement was noted in 6 out of 8 patients who had presented with azoospermia. Forty-two (35.3%) spontaneous pregnancies were recorded during the follow-up period.Conclusion: Varicocele is a common condition in our daily practice. It is most commonly detected in the course of consultation for infertility. The spermatic profile is that of oligo-astheno-teratozoospermia. Surgical treatment significantly improves the hypofertile patient's fertility. (C) 2015 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B.V. All rights reserved.

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.

Préciser les différents aspects anatomo-cliniques et thérapeutiques des accidents de la circoncision reçus en milieu hospitalier guinéen.

Objective: To define the epidemiological features of prostate cancer in the Republic of Guinea.Patients and Methods: This retrospective study was carried out in the Department of Urology and Andrology of Conakry University Hospital between January 2000 and December 2006. The parameters studied were the incidence of prostate cancer, the patients' age at the time of diagnosis, as well as the patients' geographical origin, social level, profession, marital status and urological history. Data are presented as mean values, range and percentage.Results: In total, 3895 men were hospitalized at our Department of Urology during the study period. Of these, 5% were treated for prostate cancer. We noted a marked yearly increase of the number of cases with a mean incidence of 29 cases per year. Our patients' mean age was 70.3 (range 52 91) years. The majority of our patients originated from the coastal region (46%, n=93), while only few came from Upper Guinea and the forest areas. Farmers formed the largest socio-professional group in our study, namely 51.2% (n=104). The majority of our patients were polygamous (70.4%). Ninety-four patients reported a history of purulent urethritis.Conclusion: Although several possible risk factors, such as age, exposure to carcinogenic products at work, and sexual predisposing factors (especially sexually transmitted infections [STIE]) have been suggested in this study, none of them has been proven to be responsible for the development of prostate cancer. Therefore, studies on large patient groups will be necessary to confirm these theories.

Déterminer la fréquence et identifier les facteurs étiologiques de l’infertilité masculine au service d’urologie-andrologie du CHU de Conakry.

Objective : To determine the frequency and to identify the aetiological factors of male infertility in the urology-andrology department of Conakry hospital.Patients and method: This one-year, prospective, descriptive study concerned 117 male patients consulting for fertility problems.Result : Male infertility represented 8.2% of all consultations in the department. Sixty one of the 117 patients of the study were aged between 35 and 44 years; 32.5% were workers and 85.5% had an altered sperm count. A varicocele was diagnosed in 19 patients and Neisseria gonorrhoeae was detected in the semen of 21 patients.Conclusion : Male infertility is a relatively frequent disorder in our department. The aetiological factors of male infertility are multiple. Investigation of the man must be conducted in parallel with that of the woman.

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.

Objectives: To describe the clinical features of prostate cancer in a Guinean population.Patients and Methods: This retrospective study was carried out at the Department of Urology and Andrology of the Ignace Deen University Hospital, Conakry, between January 2000 and December 2006. In total, 203 patients were included in the study. The following parameters were evaluated: the patients' age at diagnosis, the reasons for consultation, the findings on digital rectal examination (DRE), total PSA value, prostate volume on ultrasound, tumor stage according to the 2002 TNM classification and Gleason score. The statistical evaluation aimed at finding significant relationships among the collected parameters.Results: The mean patient age was 70,3 years (range: 52 91 years). The presenting symptoms consisted of irritative and obstructive urinary symptoms in 96.3% of the cases. DRE suggested malignancy of the prostate in 60% of the patients. The mean PSA value was 120.8 ng/ml (range: 0.1 6354 ng/ml). The mean prostate volume on ultrasound was 77.2 cc. Localized tumors (Ti and T2) were found in 21.2% of the patients, with a preponderance of T2 tumors (18.2%), and well differentiated tumors in 44.8% of the patients.Conclusion: The knowledge of these clinical features allows better understanding of the necessity for early diagnosis of prostate cancer in Guinea. Men should be evaluated starting from the age of 50 in order to reduce mortality.

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.