Introduction: Priapism is a urological emergency defined as a prolonged penile erection for more than 6 hours, painful and sustained, occurring without any sexual stimulation. The diagnosis is essentially clinical. Ho...Introduction: Priapism is a urological emergency defined as a prolonged penile erection for more than 6 hours, painful and sustained, occurring without any sexual stimulation. The diagnosis is essentially clinical. However, the management is often late because of the delay in consultation, which is characteristic in our context. The purpose of our study is to describe the clinical and therapeutic aspects of patients who presented with priapism at the Yaoundé Central Hospital as well as to propose a present synthesis concerning the management of priapism. Methodology: We conducted a descriptive cross-sectional study with a retrospective recruitment method in the urology department of the YCH. It extended over a period of 6 months from January 2022 to June 2022. We reviewed the files of patients seen within a period spanning 10 years from January 1<sup>st</sup>, 2011 to January 31<sup>st</sup>, December 2021. The study population consisted of patients who had been hospitalized and treated for priapism. We carried out consecutive and non-exhaustive sampling. Results: During the study, we collected data from the medical files of 13 patients. The median age was 25 years, with extremes of 12 and 82 years. Most of the patients were between 20 and 30 years old (38.5%). Most of the patients were single (69.2%). Sickle cell disease was the main comorbidity encountered during the study (76.9%). The median time from onset of symptoms to consultation was 10 [6 - 20.5] hours, with extremes of 1 and 264 hours. All patients presented with painful penile erection (100%). There was concomitant multifocal pain in 38.5% of cases suggestive of vaso-occlusive crises (VOC). The symptoms occurred in a non-traumatic context in the majority of cases (92.3%). The T-shunt was the most used surgical technique (84.6%). The median duration of surgery was 36 [35 - 40] minutes with extremes of 25 and 60 minutes, the majority being operated in less than 45 minutes (84.6%). The frequency of postoperative complications was 46.2%, dominated by weak erections/loss of erections (38.5%). The median duration of hospitalisation was 4 [3 - 5.5] days, with extremes 2 and 20 days of hospitalisation. Resumption of sexual activity was reported in 8 patients (61.5%). The time to recovery was mostly greater than 6 weeks (62.5%). Conclusion: Priapism remains a urological emergency. The prognosis depends on the patients’ promptness in consulting. The T-Shunt is an effective surgical technique in the event of failure of medical treatment.展开更多
Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabrie...Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.展开更多
Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty ...Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm<sup>3</sup> ± 39, after physiotherapy it was 203 mm<sup>3</sup> ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.展开更多
Many patients with prostate cancer for whom androgen deprivation therapy （ADT） is indicated are young and desire to remain sexually active. In such patients, the side effects of androgen therapy on sexual function c...Many patients with prostate cancer for whom androgen deprivation therapy （ADT） is indicated are young and desire to remain sexually active. In such patients, the side effects of androgen therapy on sexual function can be a source of serious reduction in overall quality of life. Providing the appropriate treatment options in this patient population is therefore essential. Nevertheless, treating such patients is challenging and an understanding of the underlying mechanisms of sexual physiology and pathophysiology is crucial to optimal patient care. In this paper, we reviewed what was known regarding the effects of ADT on sexual function in animal models and we also provided a detailed review on the effects of ADT on sexual health in humans and its treatment.展开更多
The clinical features of prostate cancer do not provide an accurate determination of patients undergoing biochemical relapse and are therefore not suitable as indicators of prognosis for recurrence. New molecular mark...The clinical features of prostate cancer do not provide an accurate determination of patients undergoing biochemical relapse and are therefore not suitable as indicators of prognosis for recurrence. New molecular markers are needed for proper pre-treatment risk stratification of patients. Our aim was to assess the value of altered expression of syndecan-1 and -2 as a marker for predicting biochemical relapse in patients with clinically localized prostate cancer treated by radical prostatectomy. The expression of syndecan-1 and -2 was examined by immunohistochemical staining in a series of 60 paraffin-embedded tissue samples from patients with localized prostate cancer. Ten specimens from patients with benign prostatic hyperplasia were used as non-malignant controls. Semiquantitative analysis was performed to evaluate the staining patterns. To investigate the prognostic value, Kaplan-Meier survival curves were performed and compared by a log-rank test. In benign samples, syndecan-1 was expressed in basal and secretory epithelial cells with basolateral membrane Iocalisation, whereas syndecan-2 was expressed preferentially in basal cells. In prostate cancer samples, the expression patterns of both syndecans shifted to granular-cytoplasmic Iocalisation. Survival analysis showed a significant difference （P〈0.05） between normal and altered expression of syndecan-1 and -2 in free prostate-specific antigen recurrence survival curves. These data suggest that the expression of syndecan-1 and -2 can be used as a prognostic marker for patients with clinically localized orostate cancer, improving the larostate-specific antigen recurrence risk stratification.展开更多
Objective:Simulation based training with training models is being increasingly used as a tool to help trainees mount the learning curve.However,validation studies of surgical simulators are often limited by small numb...Objective:Simulation based training with training models is being increasingly used as a tool to help trainees mount the learning curve.However,validation studies of surgical simulators are often limited by small numbers.We aim to evaluate the feasibility of validating simulation-training tasks in laparoscopy and flexible ureteroscopy(FURS)rapidly at a large-scale conference setting for residents.Methods:Seventy-six urology residents from various Asian countries were assessed on their laparoscopic and FURS skills during the 14th Urological Association of Asia Congress 2016.Residents performed the peg transfer task from the fundamentals of laparoscopic surgery(FLS)and completed inspection of calyces and stone retrieval using a flexible ureteroscope in an en-dourological model.Each participant’s experience(no experience,1-30 or>30 procedures)in laparoscopy,rigid ureteroscopy(RURS)and FURS was self-reported.Results:Median time taken to complete the laparoscopic task decreased with increasing laparoscopic experience(209 s vs.177 s vs.145 s,p=0.008)whereas median time taken to complete the FURS tasks reduced with increasing FURS experience(405 s vs.250 s vs.163 s,p=0.003)but not with RURS experience(400.5 s vs.397 s vs.331 s,p=0.143),demonstrating construct validity.Positive educational impact of both tasks was high,with mean ratings of 4.16/5 and 4.10/5 respectively,demonstrating face validity.Conclusion:Our study demonstrates construct and face validities of laparoscopy and FURS simulation tasks among residents at a conference setting.Validation studies at a conference setting can be an effective avenue for evaluating simulation models and curriculum in the future.展开更多
Objective： To investigate molecular alterations associating with prostate carcinoma progression and potentially provide information toward more accurate prognosis/diagnosis. Methods： A set of laser captured microdis...Objective： To investigate molecular alterations associating with prostate carcinoma progression and potentially provide information toward more accurate prognosis/diagnosis. Methods： A set of laser captured microdissected （LCM） specimens from 300 prostate cancer （PCa） patients undergoing radical prostatectomy （RP） were defined. Ten patients representing ＂aggressive＂ PCa, and 10 representing ＂non-aggressive＂ PCa were selected based on prostate-specific antigen （PSA） recurrence, Gleason score, pathological stage and tumor cell differentiation, with matched patient age and race between the two groups. Normal and neoplastic prostate epithelial cells were collected with LCM from frozen tissue slides obtained from the RP specimens. The expressions of a panel of genes, including NPY, PTEN, AR, AMACR, DD3, and GSTP1, were measured by quantitative real-time RT-PCR （TaqMan）, and correlation was analyzed with clinicopathological features. Results： The expressions of AMACR and DD3 were consistently up-regulated in cancer cells compared to benign prostate epithelial cells in all PCa patients, whereas GSTP1 expression was down regulated in each patient. NPY, PTEN and AR exhibited a striking difference in their expression patterns between aggressive and non-aggressive PCas （P=0.0203, 0.0284, and 0.0378, respectively, Wilcoxon rank sum test）. The lower expression of NPY showed association with ＂aggressive＂ PCas based on a larger PCa patient cohort analysis （P=0.0037, univariate generalized linear model （GLM） analysis）. Conclusion： Despite widely noted heterogeneous nature of PCa, gene expression alterations ofAM,4CR, DD3, and GSTP1 in LCM-derived PCa epithelial cells suggest for common underlying mechanisms in the initiation of PCa. Lower NPY expression level is significantly associated with more aggressive clinical behavior of PCa; PTEN and AR may have potential in defining PCa with aggressive clinical behavior. Studies along these lines have potential to define PCa-associated gene expression alterations and likely co-regulation of genes/pathways critical in the biology of PCa onset/progression.展开更多
Greenlight photoselective vaporisation of the prostate (GPVP) is progressively becoming an established treatment in patients with LUTS because it is a minimally invasive technique that achieves efficient haemostasis, ...Greenlight photoselective vaporisation of the prostate (GPVP) is progressively becoming an established treatment in patients with LUTS because it is a minimally invasive technique that achieves efficient haemostasis, making it the ideal technique for patients at high surgical risk. Material and Methods: To study of 133 patients with an ASA surgical risk score of 3 or 4, undergoing GPVP, with an analysis of perioperative outcome, IPSS, Qmax, IIEF-5 and complications during a five-year follow-up. Results: At 5 years the mean annual improvement in IPSS was stable, and at 5 years there was a 15.2 point improvement versus the preoperative score (p 0.05). The Qmax showed an improvement of 14.9 ml/sec and was maintained at five years after surgery (p 0.05). No patients were transfused or suffered urinary incontinence. 2.25% suffered major complications and there were no deaths. 3.1% of patients suffered de novo urgency. In the 5-year follow-up, five patients had to be reoperated. The quality of sexual health assessed by IIEF-5 before the procedure was scored at 14 points;the 5-year follow-up covering the preoperative period and all revisions did not show any worsening in the IIEF-5 score (p > 0.05). Conclusions: Due to its physical characteristics, in our opinion GPVP is now the treatment of choice in patients at high surgical risk. In our series, the risk of major/minor complications and transfusions was much lower than the same risks in conventional techniques. The objective results (Qmax and quality of life questionnaire) are equivalent to conventional techniques and persist over a 5-year follow-up.展开更多
Aim: To determine whether bladder functions deteriorate with age. Methods: Data contained in electronic medical record (INFOMED?) were used in this institutional retrospective review. Analysis was done on the urodynam...Aim: To determine whether bladder functions deteriorate with age. Methods: Data contained in electronic medical record (INFOMED?) were used in this institutional retrospective review. Analysis was done on the urodynamic studies in women over 18 years old conducted between May 2011 and November 2015. Patients with previous history of pelvic surgery or radiotherapy, neurological disease, vaginal prolapse greater than grade I, congenital urogenital malformations, urinary obstructive disease, diabetes, or the use of any medication that could interfere with bladder function were excluded from the analysis. The urodynamic parameters analyzed were the Maximum Cystometric Capacity (MCC), Voiding Volume (VV), Maximum Flow (Qmax), Bladder Compliance (BC), Detrusor Pressure at Maximum Flow (PdetQmax), Bladder Contractility Index (BCI), Bladder Voiding Efficiency (BVE) and Post-Void Residual Urine Volume (PVR). Patients were further stratified in five groups according to age (A—18 to 40;B—41 to 50;C—51 to 60;D—61 to 70;E—over 70 years old). Results: Out of 3103 urodynamic studies analyzed, 719 were eligible for the study. The average age of patients was 49.3 (+13.2) years old and in all evaluated parameters, statistically significant correlation between age and decline of bladder function was obtained (p Conclusions: This study showed a decline in bladder storage function (reduction in MCC and BC) and in bladder emptying function (reduction in Qmax, PdetQmax, VV, BCI and BVE with an increase in PVR) with age.展开更多
Epididymo-Orchitis (EO) is a disease that may affect males in all ages. Neonates and elderly patients may suffer from bacterial infection due to congenital or aging processes affecting the urinary tract. In sexually a...Epididymo-Orchitis (EO) is a disease that may affect males in all ages. Neonates and elderly patients may suffer from bacterial infection due to congenital or aging processes affecting the urinary tract. In sexually active post pubertal and young males sexually transmitted organisms may cause EO. EO is also prevalent in pre pubertal healthy boys;however in this group the etiology, the needed imaging modalities and proper management are not clearly defined yet. This manuscript will systematically review the various etiologies causing EO in pre-pubertal boys, discus about the needed proper imaging, and image interpretation, will give treatment and follow-up recommendations.展开更多
Purpose: Clinical guidelines recommend partial nephrectomy (PN) as the preferred method of surgical excision of the small renal tumor whenever feasible. PN has comparable cancer cure rates to that of radical nephrecto...Purpose: Clinical guidelines recommend partial nephrectomy (PN) as the preferred method of surgical excision of the small renal tumor whenever feasible. PN has comparable cancer cure rates to that of radical nephrectomy in this setting, and decreased risk of chronic kidney disease. A recognized devastating complication following partial nephrectomy is acute post-operative hemorrhage (APOH) from the reconstructed kidney. Risk factors for hemorrhage following partial nephrectomy remain poorly elucidated, as does the impact of hemorrhage on subsequent hospital stay. Identification of risk factors for hemorrhage may lead to a better understanding of and reduction of this complication. Material and Methods: We utilized a prospectively managed database comprised of patients undergoing open partial nephrectomy at our institution by the same surgical team from January 2006 to July 2012. Clinicopathologic factors assessed APOH for their relationships, including patient age, gender, diabetes, smoking, hypertension, coronary artery disease, American Society of Anesthesia Score (ASA), tumor size, RENAL nephrotomy score, pathologic result, cancer margin status, operative time, and intra-operative blood loss. The impact of APOH on subsequent hospital course was evaluated and compared with the entire cohort. Results: Data were analyzed from 200 consecutive patients. We identified 7 patients (3.5%) who experienced APOH. Compared with the entire cohort, APOH resulted in an increased hospital length of stay (median, 5 days;range, 2-11 days, p = 0.001), an increased transfusion requirement (median, 6 units;range, 1-16 units. p = 0.001), a greater risk of selective angiographic embolization (median, 2 procedures;range, 0-3, p = 0.001), and completion nephrectomy (n = 2, p = 0.001). One patient in the APOH group experienced cardiac arrest and was resuscitated. Clinicopathologic factors associated展开更多
Introduction: Percutaneous approach to the kidney is a very useful alternative in renal surgery which minimizes the morbidity of a variety of procedures. Objectives: To evaluate the efficacy, practicity of a reusable ...Introduction: Percutaneous approach to the kidney is a very useful alternative in renal surgery which minimizes the morbidity of a variety of procedures. Objectives: To evaluate the efficacy, practicity of a reusable system of metallic coaxial dilator coupled to a special puncture needle to perform lumbar puncture and dilation of the percutaneous tract. Methods: A randomized experimental study was carried out involving 50 individuals. These patients were randomized as follows: Group 1 had the procedure performed with the conventional disposable Amplatz set traditionally used for this procedure. Patients in Group 2 were operated utilizing the new reusable coaxial set specially designed for this purpose. The following parameters were measured to compare the 2 groups: sex Corporeal Mass Index (CMI), Pre and postoperative hematocrit and hemoglobin. Time interval between the puncture, dilation and access to the renal pelvis and insertion of the nephroscope were also analyzed. Results: There was no statistical difference between the 2 groups concerning hematocrit and hemoglobin changes when comparing prewith postoperative period. Patients in Group 2 required a significant lower time between puncture and final access to the upper collecting system. Conclusion: The new coaxial dilator set showed to be as safe as the conventional Amplatz set with the advantage of reusability and decrease of tract dilation time.展开更多
<strong>Aim:</strong> According to World Health Organization, prostate cancer is one of the increasing malignancies in men worldwide. This paper aims to describe the epidemiological, clinical, diagnostic, ...<strong>Aim:</strong> According to World Health Organization, prostate cancer is one of the increasing malignancies in men worldwide. This paper aims to describe the epidemiological, clinical, diagnostic, therapeutic, and evolutionary aspects of patients with early metastatic prostate cancer in a urology center in the city of Douala in Cameroon. <strong>Materials and Methods:</strong> It is a retrospective and descriptive study of 110 patients with prostate cancer that was immediately metastatic at diagnosis over a period of six years (from January 2014 to December 2020). <strong>Results:</strong> The average age of patients at diagnosis was 67.5 years (range: 45 years to 88 years) and 53.63% of patients had body mass indexes greater than 25. Disorders of the lower urinary tract were the main presenting complaint in 55.45% of cases, followed by bone and joint pain in 46.36% of cases. Digital rectal examination was suggestive of prostate cancer in 96.36% of cases with an average total prostatic specific antigen (PSAT) level of 676.9 ng/ml (range: 21.8 to 8832 ng/ml). The diagnosis was made through prostate biopsy in 57 (51.81%) patients or after palliative endoscopic resection of the prostate indicated for lower urinary tract symptoms or even acute urinary retention in 53 (48.18%) patients. Adenocarcinoma of the prostate was the main histologic type, and in 47.27% of cases, the tumor was poorly differentiated with a Gleason’s score of greater than 7. The sites of metastasis were mainly the lymph node (87.27%), bone (56.36%), and both (44.54%). The treatment was palliative and dominated by bilateral pulpectomy in 60% of cases and luteinizing hormone-releasing hormone agonists (Triptorelin 11.25 mg every 3 months) in 44 (40%) of cases. <strong>Conclusion:</strong> Prostate cancer is a real public health problem in developed countries but also in Africa, especially in Cameroon. It is aggressive cancer that is often diagnosed when metastasis has already occurred. Its management is essentially palliative.展开更多
Introduction: The management of kidney stones has benefited from endoscopic techniques, in particular the development of flexible ureteroscopy (ureterorenoscopy). This endoscopic treatment has made it possible to trea...Introduction: The management of kidney stones has benefited from endoscopic techniques, in particular the development of flexible ureteroscopy (ureterorenoscopy). This endoscopic treatment has made it possible to treat many upper urinary tract stones, with satisfactory results and less morbidity. This innovative minimally invasive technique was introduced in our country in 2018. It is not practiced in all health structures. We report our experience. Objectives: The aim of our study was to evaluate the place of flexible ureteroscopy laser, its feasibility, and the results on stones up to 30 mm in size only in the lower calicial group, while assessing the postoperative quality of life. Patients and Methods: We conducted a monocentric observational retrospective study at the Omar Bongo Ondimba Army Training Hospital (OBO ATH) on 22 patients with symptomatic inferior caliciel stones, over a period of January 2019 and December 2020 treated by flexible ureteroscopy laser (FUR-L), once or twice depending on the size of the residual fragments. Results: All the patients had symptomatic urolithiasis, diagnosed on the clinical elements, and confirmed in 77% by urinary computed tomography. The average age was 35.47 years ± 12, with a clear female predominance (64%). All the stones sat in the lower chalice. 66.5% of stones were larger than 10 mm. 75% of patients were “stones free” after one FUR-L session, and 100% after the second session. 10% of patients still had residual pain at 01 month which was absent at 03 month. 18% of postoperative urinary tract infections were treated with antibiotics. 90% of the patients had resumed an activity prior to 1 month. At 1 month and 3 months, 82% and 100% respectively were satisfied with the mode of treatment according to self-questioning. Conclusion: FUR-L remains a therapeutic modality for stones in the lower calicial group, for stones whose diameter is close to 30 mm. A sequential approach should be considered for diameter stone up to 30 mm.展开更多
<strong>Background:</strong> IgG4-related disease is a rare autoimmune condition that presents with lymphoplasmacytic infiltrate and fibrosis in the organ affected. Isolated testicle involvement is uncommo...<strong>Background:</strong> IgG4-related disease is a rare autoimmune condition that presents with lymphoplasmacytic infiltrate and fibrosis in the organ affected. Isolated testicle involvement is uncommon and there are only a few cases reported in the literature. <strong>Case</strong> <strong>Presentation:</strong> We report a case of isolated chronic orchitis due to IgG4 hypersecretion in a 61-year-old patient that evolved with asymptomatic tumor-like mass growth and was treated with left orchiectomy. Histopathological study revealed orchitis related to IgG4 hypersecretion disease. <strong>Conclusion:</strong> IgG4-related disease can be manifested as a multi or single-organ disorder. Most diagnoses are made after surgery with histopathological analysis. Most of the cases in literature stand out the difficulty in diagnosis and necessity of high suspicion due to this condition’s similarity with neoplasm presentation.展开更多
Objective:The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia(BPH)treated with prostatic Aquablation.Materials and methods:We performed a litera...Objective:The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia(BPH)treated with prostatic Aquablation.Materials and methods:We performed a literature search of clinical trials using the MEDLINE,Embase,and Cochrane Library databases and retrieved published works on Aquablation for the treatment of BPH up to August 2021.Unpublished works,case reports,conference proceedings,editorial comments,and letters were excluded.Risk of bias was assessed using the ROBINS-I tool.Raw means and mean differences were meta-analyzed to produce summary estimates for pre-versus post-international Prostate Symptom Scores,maximum flow rate,and male sexual health questionnaire value changes.An inverse-variance weighted random effects model was used.Results:Seven studies were included in this review(n=551 patients)that evaluated various urological parameters.At 3 months,the International Prostate Symptom Scores raw mean difference from baseline was-16.475(95%confidence interval[CI],-15.264 to-17.686;p<0.001),with improvements sustained for 12 months.Similarly,maximum flow rate improved by+1.96(95%CI,10.015 to 11.878;p<0.001)from pre to 3 months postoperatively.In addition,the male sexual health questionnaire change pooled effect size was-0.55(95%CI,-1.621 to 0.531;p=0.321)from preintervention to postintervention at 3 months.Meta-analyses of some outcomes showed large statistical heterogeneity or evidence of publication bias.Conclusions:Aquablation seems to improve lower urinary tract symptoms in men with BPH while providing relatively preserved sexual function.Further research is required to confirm these preliminary results.展开更多
文摘Introduction: Priapism is a urological emergency defined as a prolonged penile erection for more than 6 hours, painful and sustained, occurring without any sexual stimulation. The diagnosis is essentially clinical. However, the management is often late because of the delay in consultation, which is characteristic in our context. The purpose of our study is to describe the clinical and therapeutic aspects of patients who presented with priapism at the Yaoundé Central Hospital as well as to propose a present synthesis concerning the management of priapism. Methodology: We conducted a descriptive cross-sectional study with a retrospective recruitment method in the urology department of the YCH. It extended over a period of 6 months from January 2022 to June 2022. We reviewed the files of patients seen within a period spanning 10 years from January 1<sup>st</sup>, 2011 to January 31<sup>st</sup>, December 2021. The study population consisted of patients who had been hospitalized and treated for priapism. We carried out consecutive and non-exhaustive sampling. Results: During the study, we collected data from the medical files of 13 patients. The median age was 25 years, with extremes of 12 and 82 years. Most of the patients were between 20 and 30 years old (38.5%). Most of the patients were single (69.2%). Sickle cell disease was the main comorbidity encountered during the study (76.9%). The median time from onset of symptoms to consultation was 10 [6 - 20.5] hours, with extremes of 1 and 264 hours. All patients presented with painful penile erection (100%). There was concomitant multifocal pain in 38.5% of cases suggestive of vaso-occlusive crises (VOC). The symptoms occurred in a non-traumatic context in the majority of cases (92.3%). The T-shunt was the most used surgical technique (84.6%). The median duration of surgery was 36 [35 - 40] minutes with extremes of 25 and 60 minutes, the majority being operated in less than 45 minutes (84.6%). The frequency of postoperative complications was 46.2%, dominated by weak erections/loss of erections (38.5%). The median duration of hospitalisation was 4 [3 - 5.5] days, with extremes 2 and 20 days of hospitalisation. Resumption of sexual activity was reported in 8 patients (61.5%). The time to recovery was mostly greater than 6 weeks (62.5%). Conclusion: Priapism remains a urological emergency. The prognosis depends on the patients’ promptness in consulting. The T-Shunt is an effective surgical technique in the event of failure of medical treatment.
文摘Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.
文摘Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm<sup>3</sup> ± 39, after physiotherapy it was 203 mm<sup>3</sup> ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.
文摘Many patients with prostate cancer for whom androgen deprivation therapy （ADT） is indicated are young and desire to remain sexually active. In such patients, the side effects of androgen therapy on sexual function can be a source of serious reduction in overall quality of life. Providing the appropriate treatment options in this patient population is therefore essential. Nevertheless, treating such patients is challenging and an understanding of the underlying mechanisms of sexual physiology and pathophysiology is crucial to optimal patient care. In this paper, we reviewed what was known regarding the effects of ADT on sexual function in animal models and we also provided a detailed review on the effects of ADT on sexual health in humans and its treatment.
文摘The clinical features of prostate cancer do not provide an accurate determination of patients undergoing biochemical relapse and are therefore not suitable as indicators of prognosis for recurrence. New molecular markers are needed for proper pre-treatment risk stratification of patients. Our aim was to assess the value of altered expression of syndecan-1 and -2 as a marker for predicting biochemical relapse in patients with clinically localized prostate cancer treated by radical prostatectomy. The expression of syndecan-1 and -2 was examined by immunohistochemical staining in a series of 60 paraffin-embedded tissue samples from patients with localized prostate cancer. Ten specimens from patients with benign prostatic hyperplasia were used as non-malignant controls. Semiquantitative analysis was performed to evaluate the staining patterns. To investigate the prognostic value, Kaplan-Meier survival curves were performed and compared by a log-rank test. In benign samples, syndecan-1 was expressed in basal and secretory epithelial cells with basolateral membrane Iocalisation, whereas syndecan-2 was expressed preferentially in basal cells. In prostate cancer samples, the expression patterns of both syndecans shifted to granular-cytoplasmic Iocalisation. Survival analysis showed a significant difference （P〈0.05） between normal and altered expression of syndecan-1 and -2 in free prostate-specific antigen recurrence survival curves. These data suggest that the expression of syndecan-1 and -2 can be used as a prognostic marker for patients with clinically localized orostate cancer, improving the larostate-specific antigen recurrence risk stratification.
文摘Objective:Simulation based training with training models is being increasingly used as a tool to help trainees mount the learning curve.However,validation studies of surgical simulators are often limited by small numbers.We aim to evaluate the feasibility of validating simulation-training tasks in laparoscopy and flexible ureteroscopy(FURS)rapidly at a large-scale conference setting for residents.Methods:Seventy-six urology residents from various Asian countries were assessed on their laparoscopic and FURS skills during the 14th Urological Association of Asia Congress 2016.Residents performed the peg transfer task from the fundamentals of laparoscopic surgery(FLS)and completed inspection of calyces and stone retrieval using a flexible ureteroscope in an en-dourological model.Each participant’s experience(no experience,1-30 or>30 procedures)in laparoscopy,rigid ureteroscopy(RURS)and FURS was self-reported.Results:Median time taken to complete the laparoscopic task decreased with increasing laparoscopic experience(209 s vs.177 s vs.145 s,p=0.008)whereas median time taken to complete the FURS tasks reduced with increasing FURS experience(405 s vs.250 s vs.163 s,p=0.003)but not with RURS experience(400.5 s vs.397 s vs.331 s,p=0.143),demonstrating construct validity.Positive educational impact of both tasks was high,with mean ratings of 4.16/5 and 4.10/5 respectively,demonstrating face validity.Conclusion:Our study demonstrates construct and face validities of laparoscopy and FURS simulation tasks among residents at a conference setting.Validation studies at a conference setting can be an effective avenue for evaluating simulation models and curriculum in the future.
基金Project supported by the Center for Prostate Disease Researchthe Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
文摘Objective： To investigate molecular alterations associating with prostate carcinoma progression and potentially provide information toward more accurate prognosis/diagnosis. Methods： A set of laser captured microdissected （LCM） specimens from 300 prostate cancer （PCa） patients undergoing radical prostatectomy （RP） were defined. Ten patients representing ＂aggressive＂ PCa, and 10 representing ＂non-aggressive＂ PCa were selected based on prostate-specific antigen （PSA） recurrence, Gleason score, pathological stage and tumor cell differentiation, with matched patient age and race between the two groups. Normal and neoplastic prostate epithelial cells were collected with LCM from frozen tissue slides obtained from the RP specimens. The expressions of a panel of genes, including NPY, PTEN, AR, AMACR, DD3, and GSTP1, were measured by quantitative real-time RT-PCR （TaqMan）, and correlation was analyzed with clinicopathological features. Results： The expressions of AMACR and DD3 were consistently up-regulated in cancer cells compared to benign prostate epithelial cells in all PCa patients, whereas GSTP1 expression was down regulated in each patient. NPY, PTEN and AR exhibited a striking difference in their expression patterns between aggressive and non-aggressive PCas （P=0.0203, 0.0284, and 0.0378, respectively, Wilcoxon rank sum test）. The lower expression of NPY showed association with ＂aggressive＂ PCas based on a larger PCa patient cohort analysis （P=0.0037, univariate generalized linear model （GLM） analysis）. Conclusion： Despite widely noted heterogeneous nature of PCa, gene expression alterations ofAM,4CR, DD3, and GSTP1 in LCM-derived PCa epithelial cells suggest for common underlying mechanisms in the initiation of PCa. Lower NPY expression level is significantly associated with more aggressive clinical behavior of PCa; PTEN and AR may have potential in defining PCa with aggressive clinical behavior. Studies along these lines have potential to define PCa-associated gene expression alterations and likely co-regulation of genes/pathways critical in the biology of PCa onset/progression.
文摘Greenlight photoselective vaporisation of the prostate (GPVP) is progressively becoming an established treatment in patients with LUTS because it is a minimally invasive technique that achieves efficient haemostasis, making it the ideal technique for patients at high surgical risk. Material and Methods: To study of 133 patients with an ASA surgical risk score of 3 or 4, undergoing GPVP, with an analysis of perioperative outcome, IPSS, Qmax, IIEF-5 and complications during a five-year follow-up. Results: At 5 years the mean annual improvement in IPSS was stable, and at 5 years there was a 15.2 point improvement versus the preoperative score (p 0.05). The Qmax showed an improvement of 14.9 ml/sec and was maintained at five years after surgery (p 0.05). No patients were transfused or suffered urinary incontinence. 2.25% suffered major complications and there were no deaths. 3.1% of patients suffered de novo urgency. In the 5-year follow-up, five patients had to be reoperated. The quality of sexual health assessed by IIEF-5 before the procedure was scored at 14 points;the 5-year follow-up covering the preoperative period and all revisions did not show any worsening in the IIEF-5 score (p > 0.05). Conclusions: Due to its physical characteristics, in our opinion GPVP is now the treatment of choice in patients at high surgical risk. In our series, the risk of major/minor complications and transfusions was much lower than the same risks in conventional techniques. The objective results (Qmax and quality of life questionnaire) are equivalent to conventional techniques and persist over a 5-year follow-up.
文摘Aim: To determine whether bladder functions deteriorate with age. Methods: Data contained in electronic medical record (INFOMED?) were used in this institutional retrospective review. Analysis was done on the urodynamic studies in women over 18 years old conducted between May 2011 and November 2015. Patients with previous history of pelvic surgery or radiotherapy, neurological disease, vaginal prolapse greater than grade I, congenital urogenital malformations, urinary obstructive disease, diabetes, or the use of any medication that could interfere with bladder function were excluded from the analysis. The urodynamic parameters analyzed were the Maximum Cystometric Capacity (MCC), Voiding Volume (VV), Maximum Flow (Qmax), Bladder Compliance (BC), Detrusor Pressure at Maximum Flow (PdetQmax), Bladder Contractility Index (BCI), Bladder Voiding Efficiency (BVE) and Post-Void Residual Urine Volume (PVR). Patients were further stratified in five groups according to age (A—18 to 40;B—41 to 50;C—51 to 60;D—61 to 70;E—over 70 years old). Results: Out of 3103 urodynamic studies analyzed, 719 were eligible for the study. The average age of patients was 49.3 (+13.2) years old and in all evaluated parameters, statistically significant correlation between age and decline of bladder function was obtained (p Conclusions: This study showed a decline in bladder storage function (reduction in MCC and BC) and in bladder emptying function (reduction in Qmax, PdetQmax, VV, BCI and BVE with an increase in PVR) with age.
文摘Epididymo-Orchitis (EO) is a disease that may affect males in all ages. Neonates and elderly patients may suffer from bacterial infection due to congenital or aging processes affecting the urinary tract. In sexually active post pubertal and young males sexually transmitted organisms may cause EO. EO is also prevalent in pre pubertal healthy boys;however in this group the etiology, the needed imaging modalities and proper management are not clearly defined yet. This manuscript will systematically review the various etiologies causing EO in pre-pubertal boys, discus about the needed proper imaging, and image interpretation, will give treatment and follow-up recommendations.
文摘Purpose: Clinical guidelines recommend partial nephrectomy (PN) as the preferred method of surgical excision of the small renal tumor whenever feasible. PN has comparable cancer cure rates to that of radical nephrectomy in this setting, and decreased risk of chronic kidney disease. A recognized devastating complication following partial nephrectomy is acute post-operative hemorrhage (APOH) from the reconstructed kidney. Risk factors for hemorrhage following partial nephrectomy remain poorly elucidated, as does the impact of hemorrhage on subsequent hospital stay. Identification of risk factors for hemorrhage may lead to a better understanding of and reduction of this complication. Material and Methods: We utilized a prospectively managed database comprised of patients undergoing open partial nephrectomy at our institution by the same surgical team from January 2006 to July 2012. Clinicopathologic factors assessed APOH for their relationships, including patient age, gender, diabetes, smoking, hypertension, coronary artery disease, American Society of Anesthesia Score (ASA), tumor size, RENAL nephrotomy score, pathologic result, cancer margin status, operative time, and intra-operative blood loss. The impact of APOH on subsequent hospital course was evaluated and compared with the entire cohort. Results: Data were analyzed from 200 consecutive patients. We identified 7 patients (3.5%) who experienced APOH. Compared with the entire cohort, APOH resulted in an increased hospital length of stay (median, 5 days;range, 2-11 days, p = 0.001), an increased transfusion requirement (median, 6 units;range, 1-16 units. p = 0.001), a greater risk of selective angiographic embolization (median, 2 procedures;range, 0-3, p = 0.001), and completion nephrectomy (n = 2, p = 0.001). One patient in the APOH group experienced cardiac arrest and was resuscitated. Clinicopathologic factors associated
文摘Introduction: Percutaneous approach to the kidney is a very useful alternative in renal surgery which minimizes the morbidity of a variety of procedures. Objectives: To evaluate the efficacy, practicity of a reusable system of metallic coaxial dilator coupled to a special puncture needle to perform lumbar puncture and dilation of the percutaneous tract. Methods: A randomized experimental study was carried out involving 50 individuals. These patients were randomized as follows: Group 1 had the procedure performed with the conventional disposable Amplatz set traditionally used for this procedure. Patients in Group 2 were operated utilizing the new reusable coaxial set specially designed for this purpose. The following parameters were measured to compare the 2 groups: sex Corporeal Mass Index (CMI), Pre and postoperative hematocrit and hemoglobin. Time interval between the puncture, dilation and access to the renal pelvis and insertion of the nephroscope were also analyzed. Results: There was no statistical difference between the 2 groups concerning hematocrit and hemoglobin changes when comparing prewith postoperative period. Patients in Group 2 required a significant lower time between puncture and final access to the upper collecting system. Conclusion: The new coaxial dilator set showed to be as safe as the conventional Amplatz set with the advantage of reusability and decrease of tract dilation time.
文摘<strong>Aim:</strong> According to World Health Organization, prostate cancer is one of the increasing malignancies in men worldwide. This paper aims to describe the epidemiological, clinical, diagnostic, therapeutic, and evolutionary aspects of patients with early metastatic prostate cancer in a urology center in the city of Douala in Cameroon. <strong>Materials and Methods:</strong> It is a retrospective and descriptive study of 110 patients with prostate cancer that was immediately metastatic at diagnosis over a period of six years (from January 2014 to December 2020). <strong>Results:</strong> The average age of patients at diagnosis was 67.5 years (range: 45 years to 88 years) and 53.63% of patients had body mass indexes greater than 25. Disorders of the lower urinary tract were the main presenting complaint in 55.45% of cases, followed by bone and joint pain in 46.36% of cases. Digital rectal examination was suggestive of prostate cancer in 96.36% of cases with an average total prostatic specific antigen (PSAT) level of 676.9 ng/ml (range: 21.8 to 8832 ng/ml). The diagnosis was made through prostate biopsy in 57 (51.81%) patients or after palliative endoscopic resection of the prostate indicated for lower urinary tract symptoms or even acute urinary retention in 53 (48.18%) patients. Adenocarcinoma of the prostate was the main histologic type, and in 47.27% of cases, the tumor was poorly differentiated with a Gleason’s score of greater than 7. The sites of metastasis were mainly the lymph node (87.27%), bone (56.36%), and both (44.54%). The treatment was palliative and dominated by bilateral pulpectomy in 60% of cases and luteinizing hormone-releasing hormone agonists (Triptorelin 11.25 mg every 3 months) in 44 (40%) of cases. <strong>Conclusion:</strong> Prostate cancer is a real public health problem in developed countries but also in Africa, especially in Cameroon. It is aggressive cancer that is often diagnosed when metastasis has already occurred. Its management is essentially palliative.
文摘Introduction: The management of kidney stones has benefited from endoscopic techniques, in particular the development of flexible ureteroscopy (ureterorenoscopy). This endoscopic treatment has made it possible to treat many upper urinary tract stones, with satisfactory results and less morbidity. This innovative minimally invasive technique was introduced in our country in 2018. It is not practiced in all health structures. We report our experience. Objectives: The aim of our study was to evaluate the place of flexible ureteroscopy laser, its feasibility, and the results on stones up to 30 mm in size only in the lower calicial group, while assessing the postoperative quality of life. Patients and Methods: We conducted a monocentric observational retrospective study at the Omar Bongo Ondimba Army Training Hospital (OBO ATH) on 22 patients with symptomatic inferior caliciel stones, over a period of January 2019 and December 2020 treated by flexible ureteroscopy laser (FUR-L), once or twice depending on the size of the residual fragments. Results: All the patients had symptomatic urolithiasis, diagnosed on the clinical elements, and confirmed in 77% by urinary computed tomography. The average age was 35.47 years ± 12, with a clear female predominance (64%). All the stones sat in the lower chalice. 66.5% of stones were larger than 10 mm. 75% of patients were “stones free” after one FUR-L session, and 100% after the second session. 10% of patients still had residual pain at 01 month which was absent at 03 month. 18% of postoperative urinary tract infections were treated with antibiotics. 90% of the patients had resumed an activity prior to 1 month. At 1 month and 3 months, 82% and 100% respectively were satisfied with the mode of treatment according to self-questioning. Conclusion: FUR-L remains a therapeutic modality for stones in the lower calicial group, for stones whose diameter is close to 30 mm. A sequential approach should be considered for diameter stone up to 30 mm.
文摘<strong>Background:</strong> IgG4-related disease is a rare autoimmune condition that presents with lymphoplasmacytic infiltrate and fibrosis in the organ affected. Isolated testicle involvement is uncommon and there are only a few cases reported in the literature. <strong>Case</strong> <strong>Presentation:</strong> We report a case of isolated chronic orchitis due to IgG4 hypersecretion in a 61-year-old patient that evolved with asymptomatic tumor-like mass growth and was treated with left orchiectomy. Histopathological study revealed orchitis related to IgG4 hypersecretion disease. <strong>Conclusion:</strong> IgG4-related disease can be manifested as a multi or single-organ disorder. Most diagnoses are made after surgery with histopathological analysis. Most of the cases in literature stand out the difficulty in diagnosis and necessity of high suspicion due to this condition’s similarity with neoplasm presentation.
基金sponsored by the Australian-America Fulbright Commission administered through a 2021-2022 Fulbright Future Scholarship funded by the Kinghorn Foundation.
文摘Objective:The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia(BPH)treated with prostatic Aquablation.Materials and methods:We performed a literature search of clinical trials using the MEDLINE,Embase,and Cochrane Library databases and retrieved published works on Aquablation for the treatment of BPH up to August 2021.Unpublished works,case reports,conference proceedings,editorial comments,and letters were excluded.Risk of bias was assessed using the ROBINS-I tool.Raw means and mean differences were meta-analyzed to produce summary estimates for pre-versus post-international Prostate Symptom Scores,maximum flow rate,and male sexual health questionnaire value changes.An inverse-variance weighted random effects model was used.Results:Seven studies were included in this review(n=551 patients)that evaluated various urological parameters.At 3 months,the International Prostate Symptom Scores raw mean difference from baseline was-16.475(95%confidence interval[CI],-15.264 to-17.686;p<0.001),with improvements sustained for 12 months.Similarly,maximum flow rate improved by+1.96(95%CI,10.015 to 11.878;p<0.001)from pre to 3 months postoperatively.In addition,the male sexual health questionnaire change pooled effect size was-0.55(95%CI,-1.621 to 0.531;p=0.321)from preintervention to postintervention at 3 months.Meta-analyses of some outcomes showed large statistical heterogeneity or evidence of publication bias.Conclusions:Aquablation seems to improve lower urinary tract symptoms in men with BPH while providing relatively preserved sexual function.Further research is required to confirm these preliminary results.
