Les fistules péniennes après circoncision: A propos de 20 observations

Complications of traditional circumcision are very common. Their treatment is uneasy. We have performed a retrospective study including 20 cases of urethral fistula. Mean age was 4 years (ranged 2–12 years). They were referred to us in a mean time of 2 years. The main clinical outcome was penopreputial urethral fistula. 14 patients underwent uretrorraphy with end to end suture while 6 had a one-stage penile cutaneous stand flap. The results were good in 11 cases. 5 patients had recurrence of the fistula and 4 were suffering from dysuria. Need for more attention during homeostasis and preputial dissection owing to the difficulties of surgical treatment of such lesions.     

Les traumatismes de la verge: à propos de 23 cas

The authors report 23 cases of penile injuries based on a retrospective study of their urological practice in Senegal. The various cases were distributed as follows: fracture of the penis (19 cases), corpora cavernosa and urethral gunshot injuries (2 cases), rupture of the superficial dorsal vein of the penis (1 case) and laceration of the penile skin (1 case). The mean age of these patients was 32.4 years. Early surgical treatment of all penile fractures reduces the complication rate.     

Les tumeurs testiculaires à cellules de Leydig: à propos de quatre cas et revue de la littérature

Introduction

Leydig cell tumors of the testis are uncommon, and represent 1 to 3% of all testicular tumors, it’s the most common of sex cord stromal tumors. They can be found in all age groups, but they mainly occur in subjects aged 15 to 50 years (50%), 25% occurring in older men and a little less than 20% in children aged 5 to 9 years. The most common revealing symptom is gynecomastia in adults, whereas in children it is isosexual pseudo-precocious puberty. They pose a problem during diagnosis, nonpalpable tumors, and during the choice of surgical treatment, because it is difficult to make a clear distinction between benign and malignant tumors.

Material and methods

We describe four different presentations of this disease. The parameters studied were: age, revealing symptom, hormonal profile, type of treatment, and mode of evolution.

Results

The average age of our patients was 37.5 years. The first revealing symptom was a unilateral increasing size of purse in two cases, a bilateral increasing size of purse in one case, and gynecomastia in the last one. In all cases testosterone was normal or low, and oestradiol was normal or elevated. Our four patients underwent an orchidectomy, associated with an enucleation of the contralateral testis in only one case. A favorable evolution was observed in every case for a mean follow-up of 15 months.

Conclusion

On the basis of four different clinical observations and the analysis of the literature, the aim of this review is to present the various clinical, biological, radiological, pathological and therapeutic aspects of Leydig cell tumors of the testis.     

Les gynécomasties à Dakar (à propos de 30 cas)

Gynecomastia has been rarely studied in Dakar. The objective of this study is to analyze the socio-demographic, clinical and etiologic aspects of gynecomastia in Dakar. A retrospective survey of our patients, from 1980 to 1996, reported age, ethnic and geographic origin, clinical aspects (site, duration, pain, galactorrhea, secondary sexual characteristics, associated signs) and etiologic aspects. Thirty cases of gynecomastia were observed, representing 0.93% of all patients attending the Department of Internal Medicine. These patients had a mean age of 22 years; 36% of patients consulted during adolescence, and one half patients consulted between the ages of 21 and 30 years; the majority of patients were Ouolofs. Most patients were suburban (26/30). Gynecomastia was recent (less than 1 year) in 30% of cases, had been present for 2 to 5 years in 43% of cases and had been present for 6 to 10 years in 20% of cases. One half of patients had bilateral gynecomastia with left-sided predominance (6/16). Unilateral cases were left-sided in 26% of cases and right-sided in 20% of cases. 45.8% of cases experienced pain. Galactorrhea was observed in 5 cases. The testicular atrophy observed in two cases had no impact on secondary sexual characteristics and sexual function. Obesity was observed in 4 patients: gynoid in 3 cases and mixed in 1 case. More than one half of all cases presented during puberty and 76.66% presented during adolescence. Testicular ultrasonography, performed in 7 patients, was normal; chest x-ray and sella turcica were also normal. Our study shows that gynecomastia of adolescence represents 76% of all cases and the high frequency of suburban population indicated a possible role of environmental adaptation.     

Les gangrènes des organes génitaux externes: à propos de 102 cas

Objectives

To describe the epidemiological, clinical, biological and therapeutic features of Fournier’s gangrene and identify the prognostic factors.

Patients and methods

We conducted a retrospective study on 102 cases of Fournier’s gangrene treated at the urology department of the university teaching hospital Aristide- Le-Dantec (Dakar) between January 2001 and December 2007.

Results

The mean age of the patients was 50.0 ± 15.7 years (range: 20–93 years). The mean duration of hospital stay was 8.0 ± 7.1 days (range: 1–33 days). The lesions were located on the scrotum in 61.7% of cases, on the scrotum and penis in 17.6% of cases and on the penis alone in 3.9% of the cases. Perineal involvement was found in 14.7% of the cases. No etiologic factors (idiopathic) were found in 26 cases (25.5%) and 70 patients (68.6%) had Fournier’s gangrene secondary to urethral stricture. The most common predisposing factors were diabetes mellitus (13.7%), hypertension (5.9%), and renal failure (5.9%). Biological examination revealed that 79.4% of patients had a leukocytosis higher than 12,000/ml and the mean rate of haemoglobin was 9.8 ± 2.8 g/dl (range: 3.3–13.9 g/dl). The most common antibiotherapy associated a third generation cephalosporin, aminoside and metronidazole (46.1%). Twenty-one patients (20.6%) underwent extensive debridement only and eighty-one (79.4%) underwent extensive debridement and cystostomy. The death rate was 15.7%. Among the patients whose Fournier’s gangrene was idiopathic or secondary to urethral stricture, the statistically significant factors for a poor outcome were age, the secondary character of the gangrene, the extent of the lesions, and association with diabetes mellitus and/or hypertension.

Conclusion

Fournier’s gangrene is still a frequent and lethal disease. Its good management requires a multidisciplinary approach.     

Fracture de verge: à propos de 12 cas

The authors would like to report their management of 12 patients with penile fracture. Their protocol consisted of emergency surgical repair, which gave the patients the greatest chance of full recovery, i.e. normal erection and effective sexual intercourse. A review of the literature shows the relative rarity of this traumatic disease and emphasizes the value of cavernosography, MRI and sonography in the diagnosis.     

Les lésions de l’urètre associées à une fracture des corps caverneux. A propos d’une série de 4 cas et revue de la littérature

Introduction

Urethral injury associated with corpora cavernosa fracture is a relatively uncommon form of urological trauma. Early diagnosis and immediate surgical repair are essential.

Patients and methods

Between January 1990 and December 2004, a total of 4 male patients with urethral injury associated with fracture of the corpora cavernosa were retrospectively studied from a series of 96 cases of penile fracture.

Results

The mean age of the patients was 36.5 years (range: 27–45 years). Urethral bleeding was noted in all patients. Immediate surgical repair via a penile circular subcoronal incision was performed in all cases. Two partial urethral injuries associated with a unilateral corpus cavernosum lesion were identified. In the other cases, total urethral injury was associated with bilateral rupture of the corpora cavernosa. The tunica albuginea defect was closed and the urethral laceration repaired over a urethral catheter. With a mean follow-up of 2.5 years, 2 short urethral strictures were observed and were managed non-operatively with good outcome.

Comments

Secondary urethral lesions associated with corpora cavernosa fracture most frequently affect young adults. In North African countries, forced self-manipulation of an erect penis is the most frequent cause, but the associated urethral lesion is usually related to vaginal intercourse. The diagnosis can generally be made on the basis of history and physical examination alone. Blood at the meatus or haematuria or voiding difficulties suggest associated trauma to the urethra [4]. Additional imaging examinations are rarely required. The standard treatment is prompt surgical exploration, evacuation of haematoma, and primary repair of the urethral and corpora cavernosa defects. Late complications after surgical repair are penile curvature and pain during coitus. They are usually attributable to a residual fibrotic area.

Conclusion

Urethral injury associated with corpora cavernosa fracture usually has typical signs. The mechanism of trauma is very suggestive. Early surgical treatment is the only guarantee of a satisfactory functional result.     

Les kystes intraprostatiques: à propos de trois observations

Introduction

Intraprostatic cysts are considered to be rare. Some forms may be responsible for male infertility. The authors study the various clinical aspects, with the aim of defining guidelines for the exploration and treatment of different types of intraprostatic cysts.

Materials and methods

Between 2002 and 2007, we studied 3 cases of intraprostatic cyst in 3 men aged between 32 and 39 years.

Results

The clinical presentation was primary infertility (2 cases) and pelvic pain (2 cases). Digital rectal exam revealed prostate mass in 2 cases. Spermogram results were abnormal in 2 cases. The diagnosis was confirmed by prostate ultrasound. Trans-rectal ultrasound guided needle aspiration was performed in one case with secondary recurrence. Two patients had urethroscopy showing an absence of communication between the cyst and urethral channel. Transurethral incision of the cyst was made with resection of the protruding dome. Progress was favourable in all cases with improvement of semen and dissipation of symptoms without recurrence.

Conclusion

Intraprostatic cysts are benign lesions, often of congenital origin. Imaging is an essential component of diagnosis and can sometimes guide therapeutic procedures. The treatment is not yet codified, but symptomatic and/or complicated cysts can be treated by effective and minimally invasive endoscopic methods.     

La micro-lithiase testiculaire: à propos de 4 cas

Testicular microlithiasis (TMI) is a rare and little known condition. We verified its clinical and pathogenetic characteristics according to our experience. We performed testicular echography on four patients. Three of them had subfertlity and presented oligoasthenospermia in the spermiogram, while one patient had prostatitis with emospermia. Three patients had a high density TMI and one had a low density TMI. None of them showed neoplastic testicular lesions in the first echography. Anamnesis and examination revealed no outstanding data, one had been treated with calcium and Vit.D when a child for rachitis and another reported acute orchyepididymitis in his past history. Oncological markers were negative. 6–18 months follow-up with examination and echography didn’t show any testicular nodules. TMI is easy to diagnose and classify thanks to echography: Isolated TMI (the commonest, of flogistic, vascular or post-traumatic origin) Low-density TMI (<5calcifications per scan) High-density TMI (>5 calcifications per scan). Aetiology, pathogenesis of TMI and its connection to testicular cancer are not yet known. Differential diagnosis trhough echography is possible with both pathological hyperechogenic lesions of testicles (i.e. Tumors, hoematomas, partial atrophy, torsion, calcified hydatid) and non pathological ones (ilum, testicular mediastinum). The structure of the calcifications is constituted by hydroxyapatite which develop on degenerated spermatogones. They measure 1–3mm in diameter and can be found on 30–75% of the seminifer tubules. TMI is typical of patients with subfertility although the connection between this condition and male sterility is not clear. Similarly, TMI can be found in testicles’ tumours although even in this case, the connection between these conditions is not clear. That is why all authors agree in suggesting an echographical check every 6–12 months. Although the above case history can’t be considered significant due to the small number of patients, it is interesting to notice how 3 out of 4 patients had subfertility. Follow-up never showed probable neoplastic lesions. Finally what we also found worthy of notice is the possible connection between past orchyepididymitis and TML and connection between therapy for rachitis and TMI.     

L’éléphantiasis pénoscrotal, diagnostic et prise en charge: à propos de trois cas

Penoscrotal elephantiasis is a rare disease outside areas where filariasis is endemic. It is a benign disease but can become disabling in that it can make sexual relations difficult and sometimes even affect urination. We report three cases of primitive penoscrotal elephantiasis treated with complete surgical resection of pathological tissue and penoscrotal reconstruction, with good functional and aesthetic results. We update, through our own experience and a review of the literature, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis.     

La fracture de verge à Dakar. à propos de 25 cas

Objectives

To describe the epidemiological, clinical and therapeutic characteristics of penile fracture in the department of Urology-Andrology of h?pital général de Grand Yoff, Dakar, Sénégal.

Materials and methods

We reviewed the medical records of cases of penile fracture managed at the h?pital général de Grand Yoff from January 2001 to December 2011. The data of interest were: age at diagnosis, geographic origin, clinical presentation, surgical findings, treatment and outcomes.

Results

In ten years, 25 cases of penile fracture were found with an average of 2,5 cases per year and patients mean age of 36 years with 22 and 60 years as extremes. The circumstances of occurrence were mainly forced manipulation (52%) and coitus (32%). Pain associated with penile curvature, swelling localized to the penis or extending to the pubis or the perineum were the major clinical findings. A prompt emergency (mean time for providing care was 2 hours ranging from 45 minuts to 2 days) surgical explorationwith suture of the albuginea of the corpus cavernosum was the treatment in all cases.

Conclusion

Penile fracture is a relatively uncommon urological emergency in our setting. The diagnosis is easy, mostly based on clinical examination. A prompt and appropriate surgical management is the key to cosmetic and functional outcomes.     

Ectopie testiculaire croisée: à propos d’un cas

Crossed testicular ectopia, also called transverse testicular ectopia, is an uncommon congenital anomaly in which both testes migrate through a single inguinal canal toward the same hemiscrotum. More than 100 cases have been reported in the literature. This rare syndrome is commonly associated with abnormalities of genitourinary development, especially inguinal hernia and defective Müllerian regression. A conservative approach is recommended, now performed via laparoscopy. Long-term follow-up is required for assessment of fertility and early detection of testicular malignancy. The authors report a new case of crossed testicular ectopia in a 4-year-old boy who presented with right inguinal hernia and impalpable left testis.     

Le cancer de la verge : à propos d’un cas et revue de la littérature

Cancer of the penis is rare. It often raises the issue of acceptability of the amputation of penis. We report a case of cancer of the penis following a late circumcision. The treatment consisted of amputation of two-thirds of the penis. The patient is alive without any local recurrence 2 years after surgery. Literature review suggests that this type of cancer is very rare. The factors associated with such cancer include lack of circumcision and infection with human papilloma virus.     

Problématique des anéjaculations psychogènes au Sénégal : à propos de quatre cas

In Senegal, sexual disorders are a real diagnosis and support problem, which is due to the lack of information of patients, sexual taboos and the little number of these affections. Patients with an anejaculation without organic or iatrogenic etiology were sent to psychiatry in psychological support consultation. The individual sessions have identified common psychosocial factors over the circumstances leading up to and sustaining the psychogenic anejaculation. The first common factor is early sexual intercourse prior to puberty for all patients. In addition, we have noted the fear of a potential incest with guilt feelings, and a sort of over-appraisal of the anejaculation by partners, all these factors may contribute to the strengthening of the disorder Provision of a listening space associated with adjustments based on the behavioral cognitive approach could bring relief to patients.     

Les carcinomes papillaires de la thyroïde révélés par examen TEP/TDM au 18F-FDG : à propos de deux cas et revue de la littérature

The authors report the cases of two patients followed up for Hodgkin lymphoma, whose control PET/CT during chemotherapy revealed incidental papillary thyroid carcinoma as hypermetabolic thyroid foci. These incidental uptakes of ¹⁸F-FDG in the thyroid gland are rarely encountered in day-to-day practice of oncological PET/CT. However, they deserve an exploration to determine their etiology.     

Auto-amputation récidivante du pénis sur terrain schizophrène: à propos d’un cas

Penile amputation is a rare form trauma, usually occurring in psychotic patients, mostly with a diagnosis of schizophrenia. The management of self-mutilation of the genitalia is primarily psychiatric, designed to ensure acceptance of surgical repair by the patient.     

Diagnostic d'une anéjaculation: à propos de 72 patients

Introduction

Anejaculation is the inability to ejaculate through the urethral meatus despite the presence of adequate erection and sexual stimulation.

Material and Methods

From January 1997 to July 2002, 72 patients (age: 17 to 72 years, mean age: 43 years, 65% under the age of 50) consulted the same urologist because of anejaculation.

Results

Forty seven patients (65%) were unable to achieve orgasm (anorgasmia). Twenty five patients were able to achieve orgasm: retrograde ejaculation (9 cases) or dry ejaculation (7 cases) (depending on the presence or absence spermatozoa in the urine after orgasm), indeterminate anejaculation (7 cases) and sluggish ejaculation (2 cases). Psychological risk factors were detected in 30 patients (42%), neurological risk factors were detected in 34 patients (47%) (especially peripheral neuropathy after pelvic or retroperitoneal surgery or diabetes mellitus) and pharmacological risk factors were detected in 16 patients (22%) (especially selective serotonin reuptake inhibitors). Men with anorgasmia presented psychological risk factors in 57% of cases, neurological risk factors in 36% of cases and pharmacological risk factors in 34% of cases. The percentages of these risk factors in patients with other forms of anejaculation were 12%, 68% and 0%, respectively. Twenty five patients (35%) presented several risk factors with a psychological predominance in 14 of them. No risk factors were detected in 11 patients (5 with retrograde ejaculation and 6 with anorgasmia), but a psychological aetiology appeared likely in 6 patients with anorgasmia, as they were able to achieve orgasm during masturbation. 70% of cases of anorgasmia therefore presented psychological risk factors or aetiologies (primary anorgasmia: 100%, secondary anorgasmia: 63%) versus 12% of patients with other forms of anejaculation.

Conclusion

1. The diagnosis of anejaculation must include the type of anejaculation.
2. The aetiological diagnosis is based on clinical interview.
3. Risk factors and aetiologies are often psychological, but sometimes neurological or pharmacological in patients with anorgasmia, and often neurological in other forms of anejaculation.
4. The term “psychological anejaculation” should be reserved for cases of primary anorgasmia.
5. Anorgasmia requires psychological assessment.