Background: Klingsor syndrome refers to genital self-mutilation in man following delusional religious beliefs. Later, Schweitzer proposed expanding the term to include all psychotic disorders, drug and alcohol abuse. Apart from the noted hemorrhagic emergency and difficult surgical operation, there is a psychosocial impact, sexual and urinary complications (stenosis, urethral fistula) which make this pathology complex. Aim: The Aim of this study is to describe the clinical case of Klingsor syndrome and evaluate its management in light of the literature. Case Presentation: We report a rare case of genital self-mutilation in a 35-year-old man, non-compliant schizophrenic, received 04 days after the trauma and whose treatment consisted of remodeling of the penis stump and follow-up by psychiatrists. Conclusion: Klingsor syndrome is a rare but serious phenomenon. Its management remains complex, but it must be early and multidisciplinary.

Background and rationale: Urine drainage after renal secretion and excretion requires an unobstructed urinary tract. In the event of an obstruction, and depending on the etiology of the obstruction, endoscopic drainage of the urinary tract is indicated. This study aimed to identify the indications and assess the quality of life of patients who have undergone endoscopic drainage of the upper urinary tract at the Clinique Universitaire d'Urologie - Andrologie of the CNHU-HKM in Cotonou over the past five years. Patients and method: This was a descriptive, retrospective study of patients who underwent endoscopic drainage of the upper urinary tract (JJ stent assembly) at the CNHU-HKM University Urology-Andrology Clinic from January 1, 2018, and December 31, 2022. The English-language "ureteral stent symptom questionnaire (USSQ)" developed and validated by Joshi et al, then translated and validated in French in 2010, enabled us to assess the tolerance of JJ stents in our patients. Results: A total of 173 patients were selected, with an average age of 46. Males accounted for 64.61 % of cases. JJ catheterization was indicated in 51.44 % of cases (n=89), due to ureterohydronephrosis. Etiologies were dominated by lithiasis obstacles in 73.41 % of cases. Pain and discomfort associated with the presence of the JJ stent were found in 27.75 % of cases (n=48). Sexual activity was impeded by pain in 4 patients (8.0 %). Conclusion: The use of JJ stent is common practice in urology, but they are responsible for significant morbidity. In our study, the indication is dominated by renal colic complicating lithiasis. Studies aimed at assessing the quality of life of JJ stent patients remain a challenge, as they very often lead to subjective conclusions and are generally influenced by confounding variables such as age and comorbidities. A better understanding of the areas of daily life impacted by JJ stent use will enable us to better inform our patients, as well as develop new JJ stent models to improve their tolerability.

Background: Glandular cystitis is a metaplastic lesion of the bladder urothelium primarily affecting men. There are two types: typical glandular cystitis and intestinal glandular cystitis. Therefore, the definitive diagnosis relies on histopathology. The controversial theory surrounds the malignant degeneration of these lesions. Here, we present a case of florid glandulo-cystic cystitis of intestinal origin. Clinic observation: A 20-year-old man presented to the clinic with intermittent total hematuria associated with obstructive and irritative symptoms that had been ongoing for more than a year. In Histology examen, there was an absence of malignant tumor proliferation and signs indicative of typical inflammation: Florid glandulo-cystic cystitis of intestinal type. Conclusion: Intestinal glandular cystitis is a rare condition affecting primarily men and involving the bladder mucosa. Its symptoms are nonspecific and often go undiagnosed. Transurethral bladder resection remains the treatment of choice, but other therapeutic modalities, proven effective, should not be dismissed. The issue of malignant degeneration remains a controversial topic for debate, but the course of the disease is primarily marked by recurrences, necessitating cystoscopic monitoring.

Context and objective. The double J catheter is widely used nowadays in the drainage of upper tract urine. The objective of the present study was to describe the outcome of double J probe. Methods. This was a retrospective study of serial cases of patients who underwent upper tract urinary drainage with a double J probe, at the Centre National Hospitalo-Universitaire Hubert Koutoukou Maga in Cotonou, Benin, between April 1st, 2018 and March 31st, 2021. Results. Records of 103 patients were reviewed. Double J catheterization accounted for 84.74 % of all upper urinary tract shunts. The average age of patients was 48.46 years and men were in the majority (58.31 %). The placement of the double J catheter was unilateral in 76.74 % of cases with a predominance of the right (56.06 %). The endoscopic approach for the placement of the double J catheter was the most common (89.32 %). In 73.78 % of patients, the double J tube was inserted without fluoroscopic guidance (blind) and the average duration of the double J tube after placement was 118.37 days. Kidney reduction (eGFR < 60 mL/minute/1.75 m2) was found in 33.01 % of patients. The etiologies underlying upper urinary tract obstruction were dominated by lithiasis of the upper urinary tract (63.10 %). The success rate of double J catheterization was 77.66 %. The failures of the double J catheter were due to tumor pathologies in 15.53 %. The average length of hospitalization after endoscopic double J tube placement was 7.72 days. Conclusion. The obstructive syndrome of the upper urinary tract, especially of lithiasis origin, remains the most important indication for the use of the double J catheter. Its realization without fluoroscopic guidance (blind) is possible in the environment lacking an image intensifier. Contexte et objectifs. La sonde double J est très utilisée de nos jours dans le drainage des urines du haut appareil. L’objectif de la présente étude était de décrire le devenir de la pose de la sonde double J. Méthodes. Il s’est agi d’une étude documentaire d’une série des cas ayant bénéficié d’un drainage urinaire du haut appareil par une sonde double J au Centre National Hospitalo-Universitaire Hubert Koutoukou Maga de Cotonou, Bénin ; entre les 1er avril 2018 et 31 mars 2021. Résultats. Les dossiers de cent trois patients (âge moyen 48,4 ans, sexe masculin, 58,3 %) ont été colligés. La pose de la sonde double J représentait 84,74 %. La pose de la sonde double J était unilatérale dans 76,7 % des cas avec une prédominance à droite (56,0 %). L’abord par voie endoscopique pour la pose de la sonde double J était la plus pratiquée (89,3 %). La pose de la sonde double J a été effectuée sans guidage fluoroscopique (à l’aveugle) dans 7 ,7 % et la durée moyenne du port de cette sonde était 118,37 jours. La fonction rénale était perturbée avec un débit de filtration glomérulaire < 60 ml/minute/1,75 m2 chez 33,0 % des patients. Les étiologies à la base d’une obstruction étaient dominées par la pathologie lithiasique (63,1 %). Le taux de réussite de la sonde double J était de 77,6 %. Les échecs de la sonde double J étaient dus aux pathologies tumorales dans 15,53 %. La durée moyenne d’hospitalisation après la pose de la sonde double J par voie endoscopique était de 7,72 jours. Conclusion. Le syndrome obstructif surtout d’origine lithiasique reste la plus importante indication de l’usage de la sonde double J. Sa réalisation sans guidage fluoroscopique (à l’aveugle) est possible dans le milieu ne disposant pas d’amplificateur de brillance.

INTRODUCTION AND OBJECTIVE: Surgical missions are still largely on pause due to COVID-19, leading to missed opportunities for skill sharing between high-income and middle to low-income countries. New commercially available augmented reality (AR) technology facilitates surgical training, allowing mentors in one country to virtually train and skill-share with a mentee in another country during surgical cases in real-time. We hypothesize that AR technology is an effective live surgical training and mentorship modality. METHODS: To evaluate perceived effectiveness of AR technology in global urologic surgery training, surgeon mentors in the USA and UK worked with mentees in Benin performing surgical cases using the Proximie AR system. Proximie includes audiovisual capabilities allowing a mentor in any location to provide a mentee with real-time guidance during the procedure. Following each case, mentor and mentee individually completed a questionnaire assessing the technology. RESULTS: Trainers reported AR technology as easy to set-up and use in 73.3% of cases while the trainee reported easy set-up and use in 100% of cases. The visual quality was acceptable to trainers in 60% of cases and “looks like I'm there” in 40%. Visual input/ability to draw on screen had high impact in 80% of cases, with trainers rating the ability to provide anatomical guidance as invaluable or significant in 93.4% of cases. Audio and anatomical guidance had a significant impact for the trainee in 100% of cases. The quality of virtual training v. in-person training was equivalent in 100% of cases for the trainee while trainers found virtual training inferior in 66.7% of cases and equivalent in only 6.7% of cases. Difficulty connecting occurred often in only 1% of cases for trainers but in 12.5% of cases for the trainee. Trainers reported delay or time lag while using the technology in 40% of cases, with lag being problematic in 12.5% of cases. In contrast, the trainee reported rarely experiencing delay or time lag while using the technology in 100% of cases. CONCLUSIONS: AR technology is useful in facilitating realtime surgical mentorship during the COVID-19 pandemic. The Proximie technology provides visualization that is acceptable and audiovisual capabilities that have significant positive impact on successful case completion. Though AR technology presents its own set of challenges such as difficulty in connecting virtually between trainer and trainee as well as delay or time lag during surgical cases, AR technology may prove a welcome alternative when in-person training is unavailable or limited.

La majorité des cancers de la prostate sont diagnostiqués à un stade tardif en Afrique subsaharienne. Les complications hématologiques du cancer de la prostate surviennent au cours d’une évolution péjorative. Nous rapportons un cas révélé par une complication hématologique. Un patient de 70 ans a présenté une bicytopénie. Il avait des antécédents de myocardiopathie et de polytransfusion. Il a été admis en hématologie pour recherche étiologique d’une bicytopénie sévère. La réalisation d’un myélogramme à visée de recherche étiologique a identifié des cellules métastatiques d’origine prostatique. L’examen anatomopathologie des carottes de biopsie prostatique a révélé un adénocarcinome prostatique infiltrant, score de Gleason 7 (4 + 3), ISUP (International Society of Urological Pathologie) 3. L’hormonothérapie et les transfusions sanguines associées aux bisphosphonates ont constitué l’essentiel du traitement. L’évolution sous ce traitement a été favorable sur le plan clinique avec une amélioration de l’état général et biologique avec une normalisation de la lignée rouge à 3mois de traitement et un PSA (Prostate Specific Antigen) au nadir après 6mois de traitement. Les complications hématologiques de la néoplasie prostatique notamment dues à l’envahissement médullaire sont source d’égarement diagnostique. Elles méritent d’être connues des cliniciens puisqu’elles peuvent être révélatrices de ce cancer au stade métastatique. The majority of prostate cancers are diagnosed at a late stage in sub-Saharan Africa. The haematological complications of prostate cancer occur during a pejorative course. We report a case revealed by a haematological complication. A 70-year-old patient presented with bicytopenia. He had a history of cardiomyopathy and polytransfusion. He was admitted to hematology for a etiological investigation of severe bicytopenia. Performing a myelogram for etiological research identified metastatic cells of prostate origin. The pathology examination of the prostate biopsy cores revealed an infiltrating prostatic adenocarcinoma, Gleason score 7 (4 + 3), ISUP (International Society of Urological Pathology) 3. Hormontherapy and blood transfusions associated with bisphosphonates were the factor essential of treatment. The outcome under this treatment was clinically favorable with an improvement in the general and biological condition with normalization of the red line at 3 months of treatment and a PSA (Prostate Specific Antigen) at nadir after 6 months of treatment. The haematological complications of prostatic neoplasia, in particular due to spinal cord invasion, are a source of diagnostic error. They deserve to be known to clinicians since they can be indicative of this cancer in the metastatic stage.

Introduction: Les troubles électrolytiques sont nombreux et complexes en raison de leurs symptômes non spécifiques et de leurs multiples étiologies. Le but de ce travail est de décrire les désordres ioniques à la Clinique Universitaire d'Urologie et d'Andrologie du Centre Hospitalier Universitaire Hubert Maga Koutoukou de Cotonou, pour en tirer des leçons afin d'élaborer un protocole pour leur prise en charge. Matériels et méthode: Il s'est agi d'une étude descriptive rétrospective avec collecte de données prospective portant sur des patients hospitalisés présentant de trouble électrolytique. Résultats: L'âge de nos patients variait de 25 à 86 ans avec une moyenne de 63,58 ans. La catégorie des retraités était la plus représentée dans 39,10% des cas suivie des fonctionnaires (24,36%). La découverte fortuite de troubles électrolytiques était plus représentée dans 86,54% des cas. L'admission était indépendante des troubles électrolytiques dans 83 % des cas. Les troubles électrolytiques étaient plus fréquents chez les patients opérés en période préopératoire dans 32,70 % des cas. La dysnatrémie prédominait dans 49,72% des cas suivie de la dyskaliémie (40,78%). Sur le plan qualitatif, l'hyponatrémie était prédominante dans 30,72% des cas suivie de l'hypokaliémie (17,33%). Dans notre série, les troubles électrolytiques étaient légers dans 72,43 % des cas avec une échelle de morbi-mortalité de 1 (retour à domicile). Conclusion: Les troubles électrolytiques sont grevés d'une morbi-mortalité non négligeable et sont principalement représentés par la dysnatrémie et la dyskaliémie. Ces troubles sont souvent la conséquence d'une uropathie obstructive vue au stade des complications. La mise au point d'un protocole standardisé dans un service d'urologie permet une prise en charge optimale des troubles ioniques en urologie.

Background: The percutaneous nephrostomy constitutes a backup remedy allowing the derivation of urine and thus cancelling the emergency, while waiting for adequate etiological treatment. The objective of this study was to determine indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of the National Centre Academic Hospital Hubert KOUTOUKOU MAGA (CNHU-HKM) of Cotonou. Methods: It was a retrospective study carried out from January 1st, 2016 to May 30, 2020. Results: The placement of nephrostomy tubes has been indicated in 15.26% of urine derivations for the obstruction of the upper urinary tract. The average age of patients was 54.85 years with extremes of 28 and 70 years. The two sexes are interested in the same proportion, 10 cases for each. The average consultation time is 31.4 days with the extremes of 5 and 90 days. The obstruction was bilateral in 19 cases on 20. The gynaecological cancers were majority with 9 cases follow-up of those of the colon (4 cases), of the bladder (3 cases) and of the prostate (3 cases). The drainage was unilateral in 18 cases out of 20. The mean blood creatinine rate is 145.52 mg/l with extremes of 10 and 436 mg/l. Blood creatinine rate was pathological in 19 of our patients; it has been ameliorated among patients having an elevated initial creatinine blood level but without reaching normal values in 18 out of 19 patients. The lowest rates of creatinine blood level have been reached after 10.33 days with extremes of 2 and 23 days. After the percutaneous nephrostomy, the surgical abstention has been decided in 13 cases, the dialysis had been done in 5 cases, the reimplantation + installation of the probe double J in 1 case and the chemotherapy in 1 case. The main reason of death of the patients having undergone the nephrostomy was the ionic disorders (13 cases out of 18) mainly the hyperkalemia and the hyponatremia followed of anemia (3 cases out of 18) and of the uremic coma (2 cases out of 18). The middle duration of hospitalization after the drainage was of 16.85 days, with extremes of 1 and 50 days. The death occurred at 18 out of 20 patients and the middle period of survival was 31.25 days with extremes of 1 to 60 days. Conclusion: The percutaneous nephrostomy remains the beneficial alternative for the derivation of the upper urinary tract instead of the double J installation. Popularization of percutaneous nephrostomy would reduce the morbidity and mortality linked to complications of obstructive syndrome of the upper urinary tract; hence the need for awareness for early urological consultation

INTRODUCTION AND OBJECTIVE:Surgical medical missions allow for the global transfer of surgical skills, knowledge, and resources between high and low to middle-income countries to the benefit of bot...

We report a case of Conn’s adenoma in a 35-year-old female successfully managed in a poor hospital technology environment.

Persistent urachal anomalies are rare congenital lesions of the urinary tract. They result from the failed obliteration of the urachus and are classified according to persistent segment of the urachus.

Objective: To report the epidemiological, clinical and therapeutic aspects of urinary lithiasis at the university clinic of urology - andrology of Centre National Universitaire Hubert Koutoukou MAGA of Cotonou. Patients and methods: This is a retrospective study of 117 cases of urolithiasis collected over 10 years, carried out at the university clinic of urology - andrology of Centre National Universitaire Hubert Koutoukou MAGA of Cotonou. The study parameters were age, sex, profession, clinical and para-clinical characteristics, topography of urolithiasis, the treatment used and the main complications. Frequency and average calculations allowed us to analyze our results. Results: The average age in our study was 44.5 years. The age group between 40-49 years old was the most represented with 27.4% of the cases. The sex ratio was 2. The most frequent clinical manifestation was dominated by low back pain in 85.5% of cases. Cytobacteriological examination of the urine was pathological in 27 patients or 20%. The most commonly used imaging test was ultrasound of the urinary tree (89.5%) followed by Euro-CT (56.4%). Creatinine levels were disturbed in 16.2% of patients and uremia in 13.7%. Over 85% of urolithiasis involved the upper urinary tract. The JJ catheter surge (29.9%) and percutaneous nephrolithotomy (24.8%) were the main techniques used for the treatment of urolithiasis at CNHUHKM of Cotonou. Conclusion: Urolithiasis remains a problem in our environment and requires an appropriate diagnosis with a view to effective and prompt management.

Introduction: The presence of an obstacle in upper urinary tract, threatens kidneys and therapeutic arsenal includes an ureterovesical reimplantation especially in the case of lower ureteral obstacles. Ureterovesical reimplantation (UVR) techniques are numerous with each of its advantages and disadvantages. In order to review indications, techniques and the outcomes of the ureterovesical reimplantation in our context of work, we made this study. Material and Method: It was a retrospective, transversal, descriptive and analytic study conducted over a period of 10 years, in the department of urology University Hospital Center Hubert Koutoukou Maga of Cotonou. Patients over 15 years of age who have had a ureterovesical relocation had been included. Results: Thirty-six files were selected. Ureterovesical relocations accounted for 1.8% of surgical procedures. The ligatures iatrogenic ureters and vesico-vaginal fistulas were the most frequently involved in 33.4% and 27.8% respectively. The ureterovesical reimplantation was performed without anti-reflux plasty at 36.1% of patients. The technique of Politano-Leadbetter had been most accomplished, in 82.6% of the cases in which anti-reflux plasty had been made. Suites had been simple in 63.9% of patients. Postoperative complications were dominated by parietal suppurations and vesicocutaneous fistulas in respectively 6 and 4 patients. Conclusion: Ureterovesical reimplantations are interventions that require from the urologist a perfect knowledge given their complexity and the emergency context in which one may be led to practice them. They answer to general principles that reduce operative morbidity.

But: Explorer les aspects diagnostiques du cancer de la prostate a Cotonou et plus specifiquement les aspects epidemiologiques, cliniques, paracliniques et anatomopathologiques.Patients et methode: Il s’agissait d’une etude retrospective a visee descriptive sur une duree de huit ans colligeant tous les cas de cancer de la prostate diagnostiques au service d’urologie-andrologie du CNHU HKM de Cotonou.Resultats: 109 cas ont ete colliges au total. L’incidence du cancer de la prostate sur les 8 ans etait de 4,7%. L’âge moyen des patients etait de 69,5 ans. Seulement 7% des patients diagnostiques sont venus spontanement consultes. La majorite des patients ont consulte environ 2 ans apres l’apparition des premiers symptomes. Les motifs les plus rencontres sont la dysurie et la nycturie. Le taux moyen de PSA etait de 830,2 ng/ml. Le seul type histologique retrouve apres examen histologique des pieces de biopsie etait l’adenocarcinome. Dans 28% des cas le score de Gleason etait 6.Conclusion: Le cancer de la prostate est une pathologie du sujet âge de plus de 50 ans souvent vu tardivement dans notre milieu. Le toucher rectal, le dosage du PSA et l’anatomie pathologique des pieces de biopsie prostatique ou d’evidement cervicoprostatique sont indispensables au diagnostic.Mots-cles: cancer, prostate, epidemiologie, BeninEnglish Title: Diagnosis of prostate cancer in Cotonou: about 109 casesEnglish AbstractPurpose: To explore the diagnostic aspects of prostate cancer in Cotonou and moreover the epidemiological, clinical, paraclinical and pathological aspects.Patients and methods: This was a retrospective and descriptive study over an eight-years period, covering all cases of prostate cancer diagnosed in the urology-andrology department of the CNHU HKM in Cotonou.Results: 109 cases were collected in total. The incidence of prostate cancer over the 8 years was 4.7%. The average age of the patients was 69.5 years. Only 7% of diagnosed patients consulted spontaneously. The majority of patients have consulted 2 years after the onset of symptoms. The most common complaints are dysuria and nocturia. The average level of PSA was 830.2 ng / ml. The only histological type found after histological examination of biopsy specimens was adenocarcinoma. In 28% of cases, the Gleason score was 6.Conclusion: Prostate cancer is a pathology of the subject aged over 50 years and often seen late in our environment. Rectal examination, PSA measurement and histology of prostate biopsy specimens or cervico-prostatic recess are essential for diagnosis.Keywords: cancer, prostate, epidemiology, Benin

Introduction: Undescended testis is a genital pathology of pediatric age. But it is not rare that the diagnosis of this pathology is made in adults, especially in low income countries with management problems as Benin Republic. The purpose of this study was to describe the epidemiology and therapeutic aspects of this congenital malformation in adults, in HKM University Teaching Hospital of Cotonou. Material and Method: It was a retrospective, cross-sectional and descriptive study, conducted from January 1, 2007 to December 31, 2016. Patient files served as data collecting support. All the patients aged 16 years and older were included in this study, treated and followed in the urology clinic department for undescended testis. Results: Twenty-three files were selected. The most represented age group was 16 to 20 years of age. The average consultation time from the observation of the anomaly was 213.6 months. The vacuity of the scrotum was the main reason for consultation. The absence of an intra-scrotal testis was the most clinical finding. The testis was found in the inguinal canal in 15 patients. Surgical re-positioning testis in scrotal location had been conducted for all patients and the open surgery was the only modality. Orchiectomy was performed in presence of atrophic testis. Any complication was reported in postoperative time. Later, two retractions of the testis and two testicular hypotrophies were seen. Semen control (spermograms) revealed persistence of azoospermia in three patients and astheno-zoospermia in another. Conclusion: Cryptorchidism is a pathology of the child but can still be seen in adults in our context. The main reason for consultation is the vacuity of scrotum but also paternity desire. Surgical lowering is the rule. In adults, its main purpose is the surveillance for the easy and early detection of a testicular tumor.

The authors report 4 different cases of giant hydronephrosis in the urology department of the national university healthcare, CNHU HKM of Cotonou. The frequency of the items, the etiologies and the different treatments carried out were elucidated. The patients were all females. The hydronephrosis affected the left kidney. The most frequent etiology was pyelouretral junction syndrome seconded by obstructive nephrolithiasis in the upper urinary tract. One of the last etiologies was lower pole vascular plexus. Three nephrectomies and one KUSS-HEYNES-ANDERSON pyeloplasty were carried out. Conclusion: Giant hydronephrosis is a rare condition. The etiologies were organic-based and malformed. The therapeutic attitude adopted shows the interest of an antenatal diagnosis for early care.