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Clinical Presentation, Therapeutic Aspects and Results of Urogental Prolapse in Yaounde

Open Journal of Urology 2024年第2期14卷 83-94页

作者： junior Barthelemy mekeme mekeme Pierre Joseph Fouda Marie Josiane Ntsama Essomba Jean Cedric Fouda Marie Salome Eko’o Neme Marcel junior Yon mekeme Achille Y. Kpanou Bright Che Awondo Philip Fernandez Owon’Abessolo Marcella Biyouma Achille Aurele Mbassi Robinson Mbu Robinson Fru Angwafo III Department of Urology and Andrology Yaounde Central Hospital Yaounde Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department of Surgery Yaounde University Teaching Hospital Yaounde Cameroon Faculty of Medicine and Pharmaceutical Sciences Douala Douala Cameroon Department of Urology and Andrology Laquintini Hospital Douala Douala Cameroon Department of Obstetrics and Gynaecology Yaounde Obstetrics Gynaecology and Pediatrics Hospital Yaounde Cameroon

Introduction: Urogenital prolapse is the descent of one or more elements of the abdominal-pelvic contents into the vaginal cavity. The anterior, middle and posterior anatomical compartments may be involved giving rise to several types of genital prolapse. However, there are various therapeutic modalities ranging from observational procedures to surgery. In Yaounde, urogenital prolapse appears to be a rare clinical entity, and its treatment has not been clearly stated. There is limited data about this subject in our context. Our aim was to study the clinical and therapeutic aspects of urogenital prolapse in Yaounde. Methods: We conducted a descriptive cross-sectional study with retrospective data collection at the Yaounde Gynaecological Obstetric and Pediatric Hospital (YGOPH) and the Yaounde Central Hospital (YCH) over a period of 05 months (from February 2022 to June 2022). All women aged ≥30 years and all women with documented urogenital prolapse admitted to the maternity and urology departments of these two health facilities were included. Data were collected using a structured questionnaire. Data was analyzed using IBM SPSS (statistical package for social sciences) software version 23.0 and the data were reported as mean, standard deviation, frequencies and percentages. Results: A total of 50 patients were recruited;the mean age was 45.8 ± 17 years. The age range was from 21 to 72 years. Majority of the patients were aged more than 55 years (32%). Most of the patients attended primary education (48%). Forty percent of the patients were housewives. The majority of the patients were from West Cameroon (26%). The most common reason for consultation was pelvic heaviness (54%). The most prevalent clinical sign was cystocele (56%), followed by hysterocele (54%). According to the Baden Walker classification, one-third of the patients were classified as first degree (36%). More than half (58%) of patients had the condition located at the first stage. Surgery was performed in 68% of cases while 48% received medical tr

关键词： Urogenital Prolapse Cystocele Hysterocele Clinical Surgery

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Evaluation of the Quality of Micturition in Patients Who Underwent Anastomotic Urethroplasty at the Yaounde Central Hospital, Cameroon

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Open Journal of Urology 2024年第2期14卷 115-127页

作者： Achille Aurele Mbassi Landry Oriole Mbouche junior mekeme mekeme Jean Crepin Eloundou Nkolo Bright Che Awondo Jean Cedrik Fouda Frantz Guy Epoupa Ngalle Cyril Kamadjou Pamela Anaba Laure Pierre Joseph Fouda Fru Forbuzshi III Angwafo Higher Institute of Medical Technology Yaounde Cameroon Higher Institute of Health Sciences Bangangte Cameroon Urology and Andrology Department Yaounde Central Hospital Yaounde Cameroon Department of Surgery and Subspecialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Yaounde Gynecology Obstetrics and Pediatric Hospital Yaounde Cameroon

Introduction: Radiological investigation which is the gold standard to perform following anastomotic urethroplasty in order to evaluate the quality of micturition is costly. In our context, due to financial limitations, reconstructive urologists prefer to use the uroflowmetry in order to assess the micturition post-surgery. Therefore, the objective of the study was to assess the quality of micturition using the uroflowmetry after anastomotic urethroplasty. Methodology: We conducted an 11-year retrospective review (1st January 2006-31st December 2017) and a cross-sectional descriptive observational study for a period of 8 months (November 2017-June 2018) at the Urology and Andrology Department of the Yaounde Central Hospital (YCH) of patients who were diagnosed with urethral stenosis and underwent an anastomotic urethroplasty at the YCH. We excluded patients who had incomplete files, patients lost to follow-up and did not do pre-operative uroflowmetry. Quality of micturition was evaluated using a uroflowmetry. Data was analyzed using EPI info 7.0. Parametric variables were reported as means and standard deviations and percentages and counts were used to report categorical variables. Results: We had a sample of 60 patients. The mean age was 42 ± 5 years with extremes ranging from 20 to 76 years. Twenty-seven (27) patients, or 45%, had no post-operative complications, and those who did had a urinary tract infection (26.70%). In our series, we had 82% excellent results (patient satisfied with his urination with bell-shaped urinary stream and urinary flow greater than or equal to 15 ml/sec);15% good results (patient with moderate dysuria with average urinary stream and urinary flow between 10 and 14.9 ml/sec) and 3% poor results (severe dysuria with urinary flow less than 10 ml/sec, urinary retention or urinary incontinence). Based on these results we can say that the success rate in our series was 97%. 96.70% of patients were satisfied against 3.3% who were not. Conclusion: Anastomotic urethropl

关键词： Urethra Stricture Anastomotic Urethroplasty

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Traumatic Penile Amputation Post Circumcision: A Series of 3 Cases

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Open Journal of Urology 2023年第11期13卷 517-524页

作者： Orock Agbor Tanyi Mbassi Achille Aurele mekeme mekeme junior Fouda Jean Cedrick Owon Abessolo Nwatchap Jean Jacques Awoundja Christain Pierre Joseph Fouda Department of Surgery and Subspecialties Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Surgery Service Regional Hospital Ngoundere Ngoundere Cameroon Urology and Andrology Service Yaoundé Central Hospital Yaoundé Cameroon Department of Surgery and Subspecialties Higher Institute of Medical Technology Yaoundé Cameroon

Circumcision remains a frequently performed surgical procedure and could be associated with various complications, ranging from mild to catastrophic. Penile amputation is a rare and severe complication usually complex and challenging to manage. We describe three cases of penile amputation injuries following circumcision referred within a week at the urological service of the Yaoundé Central Hospital. The first case was a 5-year-old who had complete penile amputation during circumcision by a nurse assistant at a rural health center. The second was a 7-year-old boy who sustained total penile glans amputation while undergoing circumcision by a nurse under local anesthesia at a rural health facility. The third involved a 6-year-old who had total penile amputation with loss of the amputated stump during circumcision by a traditional practitioner at home. Non-microsurgical penile re-implantations were done with diverse outcomes. The preservation of the amputated stump, the ischemic time and the severity of injury are factors affecting surgical outcome. The aim of this study is to evaluate our management experience and outcome of penile amputation injuries in resource-limited settings. Microsurgical replantation remains the gold standard in the management of penile amputation injuries. However, in resource-limited settings macroscopic replantation could be used as an alternative remedy to salvage the amputated penis.

关键词： Circumcision Penile Amputation Surgical Management Complications

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Surgical Management of Adrenal Tumors: Experience of Three Tertiary Hospitals in Yaounde, Cameroon

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Open Journal of Urology 2023年第11期13卷 495-516页

作者： junior Barthelemy mekeme mekeme Etoa Ndzie Agbor Orock Tanyi Jean Cedrick Fouda Achille Aurele Mbassi Philip Owon Abessolo Bright Che Awondo Marcel junior Yon mekeme Pierre Ongolo Zogo Pierre Joseph Fouda Eugene Sobngwi Zachary Sando Angwafo III Fru Department of Surgery and Subspecialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Urology and Andrology Department Yaounde Central Hospital Yaounde Cameroon Endocrinology Department Yaounde Central Hospital Yaounde Cameroon Radiology Department Yaounde Central Hospital Yaounde Cameroun Anatomy Cytopathology Department Yaounde Gynecology Obstetrics and Pediatrics Hospital Yaounde Cameroon

Introduction: Surgical management of adrenal tumors has greatly improved over the past years, with laparoscopic adrenalectomy being the gold standard. However, Open adrenalectomy is indicated in large adrenal tumors, malignant tumors and large phaeochromocytomas. We report surgical outcomes of 18 cases of functional adrenal tumors from 2007 to 2022. Methods: We conducted a retrospective cross-sectional and descriptive study in three tertiary hospitals in Yaounde, Cameroon. We reviewed files of patients who underwent adrenalectomy over a period of 15 years from July 2007 to July 2022. Clinical and diagnostic components of adrenal tumors, indications and surgical outcomes were analyzed. Results: A total of 18 patients were included in our study. The average age of patients was 38.33 years, with a female-to-male sex ratio of 2:1. Weight gain (72.2%) was the most represented clinical sign. The secretory nature of tumor and malignancy represented 55.5% and 33.3% of the operative indications and all 18 (100%) of the patients had open adrenalectomy. Vascular injury was the most common intraoperative complication with 5.63%, while acute adrenal insufficiency (16.7%) was the most common post-operative complication. The average tumor size was 6.22 cm and the mean duration of hospitalization was 11.61 days. Adenoma 7 (38.9%) and adrenocortical carcinoma 5 (27.8%) were the frequent histological types. One patient died two months post-surgery from anemia-related complications. Conclusion: The success of adrenal surgery is linked to multidisciplinary patient care and the experience of the surgeon. Conventional surgery still has indications with satisfactory short- and medium-term results in our context.

关键词： Adrenal Tumors Surgical Management Outcome Yaounde

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Testicular Burkitt’s Lymphoma: A Case Report and Literature Review

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Open Journal of Urology 2023年第9期13卷 327-336页

作者： junior Bathelemy mekeme mekeme Jean Cedrick Fouda Philip Fernandez Owono Abessolo Axel Nwaha Makon Marcella Delboise Biyouma Georges Kemegni Atenguena Christian Awoundja Marcel junior mekeme Yon Ngapagna Paul Adrien Atangana Pierre Ongolo Zogo Etoundi Paul Owono Pierre Joseph Fouda Angwafo III Fru Faculty of Medicine and Biomedical Sciences of the University of Yaoundé 1 Yaoundé Cameroon Urology and Andrology Unit Yaoundé Central Hospital Yaoundé Cameroon Faculty of Medicine and Pharmacological Sciences University of Douala Douala Cameroon Laboratory of Anatomy and Cytologic Pathology of Yaoundé Centre Paster Yaoundé Cameroon

Background: Burkitt’s lymphoma of the testis (TBL) is a rare and extremely aggressive malignant usually diagnosed in front of a testicular mass. We describe an interesting single case of TBL managed by a combined multimodal approach with a review of the literature. Case Report: A patient aged 69-year-old male, newly hypertensive, who presented with a twelve-month history of right testis progressive painful scrotal swelling, which worsens following a motorbike accident. Clinical examination revealed a large tender mass in an erythematous right scrotal bursa. A scrotal ultrasound showed a right heterogenous intra-testicular mass. The patient underwent unilateral (right) radical orchiectomy. Histopathological examination revealed presence of monomorphic lymphoid cells, with moderate to increased size, dissociated inconstantly by macrophages consistent with a Burkitt’s-like non-Hodgkin Lymphoma. After surgery, the patient was transferred to oncologist for adjuvant chemotherapy. Conclusion: A testicular mass is a usual circumstance for the discovery of a primary tumour of the testicle. Burkitt’s testicular lymphoma is a rare tumour whose diagnosis is based on histological findings. There are non-consensual etiological or predisposing factors. The treatment depends imperatively on the stage of the disease. Therapeutic modalities relay on in surgical excision, chemotherapy and radiation therapy but the accurate procedures are not standardized.

关键词： Burkitt’s Lymphoma Orchidectomy Testis

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Comparison of Transrectal Prostate Digital and Ultrasound-Guided Core Biopsies in 400 Men in a Low-and-Middle Income Country

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Open Journal of Urology 2023年第10期13卷 418-432页

作者： junior Barthelemy mekeme mekeme Oriol Landry Mbouche Figuim Bello Bright Che Awondo Aurele Achille Mbassi Cedrick Jean Fouda Tax Liendi Marcella Biyouma Guillaume Gayma Marcel junior Yon mekeme junior Ngue Ngue Mabah Paul Adrien Atangana Pierre Ongolo Zogo Pierre Joseph Fouda Noel Coulibaly Angwafo III Fru Maurice Aurelien Sosso Faculty of Medecine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department and Urology and Andrology Yaounde Central Hospital Yaounde Cameroon Higher Institute Medical Technology Yaounde Cameroun Anatomy and CytoPathology Laboratory “Centre Pasteur” Yaounde Cameroon Felix Houphouet Boigny University of Cocody Abidjan Ivory Coast

Background: The diagnosis of prostate cancer (PCa) relies on clinical assessment with digital rectal examination, serum PSA and histological examination. Limitations in our technical facilities, high financial cost of ultrasound-guided biopsy often prevent us from implementing the guidelines on the practice of prostate biopsy. Methods: We conducted a retrospective and cross-sectional descriptive study comparing digital-guided and ultrasound-guided transrectal prostate biopsy of 400 patients over a period of 12 years in the Yaounde Central Hospital. We reviewed files of patients who underwent digital and ultrasound guided biopsy procedures. Data was analyzed using EPI info 7.0. Parametric variables were reported as means and standard deviations and percentages and counts were used to report categorical variables. Results: Out of the 400 patients, 292 digital-guided transrectal biopsies (73%) and 108 ultrasound-guided transrectal biopsies (27%) were performed in patients who were suspected of having prostate cancer (PCa). Patients were aged between 39 to 90 years. Both procedures were effective in identifying prostate cancer. Gleason score between 2 to 10 detected prostate adenocarcinoma for 301 patients (75.2%). The complications included anal pain, rectal bleeding, hematuria and urinary tract infections, with an occurrence rate similar for both ultrasound-guided (2.25%) and digitally-guided techniques (2.5%). Seven patients (1.75%) required hospitalization for management of complications. The mortality rate was null. Conclusion: Both techniques are effective in detecting PCa with the similar complication rates. Digital-guided trans-rectal prostate biopsy still has its place in a resource-limited setting like ours.

关键词： Prostate Biopsy Digital Guided Ultrasound Guided Adenocarcinoma Gleason Score

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Retrospective and Prospective Study on Injuries during Coital Accidents at the Central Hospital of Yaounnde: A Study of 23 Cases

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Open Journal of Urology 2023年第2期13卷 55-63页

作者： Philip Fernandez Owon’Abessolo Fouda Jean Cedrick mekeme mekeme junior Barthelemy Nwaha Makon Axel Stephane Etobe Pondy Cecile Beling Abanda Ivon Nyanit Bob Dorcas Mendouga Menye Coralie Reine Essomba Armel Quentin Fouda Pierre Joseph Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Urology Unit Central Hospital of Yaounde Yaounde Cameroon Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon

Introduction: A penile fracture is the traumatic rupture of the turnica albuginea of one of both cavernous bodies of an erect penis. It is a urologic emergency in young adults. The objective of our study is to determine the epidemiologic, clinical, and therapeutic aspects and evaluate the complications at the Yaounde Central Hospital (YCH). Methodology: It was a cross-sectional retrospective and descriptive study, carried out for a period of five years, from 2015 to 2020, followed by a prospective phase for a period of 1 year, from December 2020 to 2021 at the Urology Unit of Yaounde Central Hospital. Results: Our study involved 23 patients. The mean age was 34 ± 4 years with extremes of 23 - 65 years. Married men were the most involved, with 16 cases (69.6%). The majority of patients presented for consultation within the first 6 hours (60.9%). The mean delay time before the consultation was 5 [3 - 24] hours, with extreme values of 1 - 72 hours. Sitting position during sexual intercourse was mainly found (56.5% of cases), while alcohol consumption was the main environmental risk factor found (47.8% of cases). Penile pain (100.0%) and deformation of the penile shaft (91.3%) were the most encountered symptom during admission. The frequency of cavernosa involement was 87.0%. The injury was partial in the majority of cases (95.0%), involving both corpus cavernosa (55.0%) and mostly on the right (60.0%). The mean management delay was 5 hours standard deviation [5 - 7], with extremes of 2 - 48 hours. The intra-cavernous hematoma was the essential per-operative finding in all the operated cases (100.0%). Most patients resumed sexual intercourse 2 - 3 months following management (65.3% of cases). After one year of treatment, 78.3% of patients declared satisfactory sexual activity. Conclusion: Penile fracture is an anthological emergency in young adults. The management is essentially surgical. Functional prognosis depends on the promptitude of surgical intervention.

关键词： Penile Fractures Young Adults Sexual Activity

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Twisting of the Spermatic Cord in an Elderly Subject at the Yaounde Central Hospital: About a Case

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Open Journal of Urology 2022年第7期12卷 394-400页

作者： Jean Cedrick Fouda junior Bartthelemy mekeme mekeme Philip Fernandez Owon’Abessolo Marcella Derboise Christelle Biyouma Ranibel Allo Axel Stephane Nwaha Makon Frantz Guy Ngalle Epoupa Landry Oriole Mbouche Cedric Mayopa Dongmo Achille Aurèle Mbassi Medjo Hell Pierre Joseph Fouda Arthur Essomba Yaounde Central Hospital Yaounde Cameroon University of Yaounde I Yaounde Cameroon University of Douala Douala Cameroon Private Hospital Cameroon

Introduction: Twisting of the spermatic cord is part of urological emergencies. It can occur at any age with a predilection for children and adolescents. There is no literature on spermatic cord torsion in octogenarians, probably due to its rarity. The majority of recent studies show spermatic cord torsion in patients under 55 years of age. This is why we present a case of spermatic cord torsion in an 80 years old subject. Case Presentation: We present a case of torsion of the spermatic cord in an 80-year-old subject. The diagnosis was made on anamnestic and clinical grounds. The patient presented with scrotal pain, unilateral, of sudden onset, violent intensity without urinary signs with an ascended testicle. The urine dipstick was unremarkable. Management was done surgically and as an emergency. The postoperative course was satisfactory. Conclusion: Spermatic cord torsion in octogenarians is exceptional and should be suspected in the first instance in the presence of any sudden onset, severe testicular pain without urinary signs with an ascended testicle and a negative urine dipstick.

关键词： Twisting of the Spermatic Cord 80-Year-Old Subject Diagnostic Emergency

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Nephrectomy in a Patient with Medullary Sponge Kidney Associated with Severe Nephrocalcinosis and Nephrolithiasis: A Rare Condition

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Open Journal of Urology 2021年第9期11卷 332-341页

作者： Landry Oriole Mbouché Achille Aurèle Mbassi junior mekeme mekeme Axel Stéphane Nwaha Makon Pierre Joseph Fouda Fru Fobuzshi Angwafo III Department of Surgery and Specialities Faculty of Medicine and Biomedical Sciences Yaoundé Cameroon Department of Uro-Andrology Yaoundé Central Hospital Yaoundé Cameroon Department of Surgery Higher Institute of Medical Technology Yaoundé Cameroon

Background: Medullary sponge kidney (MSK) is a disturbance of renal development characterized by cystic dilation and diffuse precalyceal duct ectasia. The disease affects both genders in equal proportions and is generally diagnosed in adulthood, as a result of recurrent calcium nephrolithiasis and nephrocalcinosis. The most frequently encountered manifestations being renal colic, microscopic or macroscopic hematuria, and fever. The intravenous pyelogram is standard for diagnosis and metabolic workup is required to identify the underlying cause. The main goal of treatment is to prevent recurrence and disease progression. Though considered a benign condition, a nephrectomy may often be required in patients presenting late with irreversible complications and end-stage renal disease. Aim: To highlight and discuss the presentation and management of a rare case of nephrocalcinosis and nephrolithiasis secondary to the medullary sponge kidney. Case presentation: We report herein the case of a 56-year-old male with long-standing hematuria in whom a diagnosis of medullary sponge kidney disease was made and he underwent a left total nephrectomy. The postoperative course was uneventful. Conclusion: Nephrocalcinosis and nephrolithiasis are complications of MSK and can result in irreversible renal damage. A high index of suspicion is necessary for patients presenting with renal colic, recurrent urinary tract infections, or hematuria for prompt diagnosis and management.

关键词： Medullary Sponge Kidney Nephrolithiasis Nephrocalcinosis Nephrectomy

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Results of Adults Laparoscopic Varicocelectomy in a Limited Setting: A Study in Yaoundé(Cameroon)

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Open Journal of Urology 2021年第12期11卷 443-451页

作者： Landry Oriole Mbouché Guy Aristide Bang Axel Stéphane Nwaha Makon Frantz Guy Epoupa Ngallé Eric Patrick Savom Roland Metomo junior mekeme mekeme Achille Aurèle Mbassi Justin Kamga Blondel Nana Oumarou Department of Surgery and Specialities Faculty of Medicine and Biomedical Sciences Yaoundé Cameroon The National Insurance Fund Health Center of Essos Yaoundé Cameroon

Background: Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus veins draining the testicle. The principle of varicocele treatment is to block the reflux in the internal spermatic vein while preserving the internal spermatic artery, lymphatics and vas deferens. Treatment can be performed through percutaneous venous embolization or surgical correction, either open or laparoscopic approach. The purpose of the study was to review our experience in the management of laparoscopic varicocele repair and to assess the outcomes after operation. Methods: We retrospectively reviewed files of patients who underwent laparoscopic varicocelectomy from January 2010 to December 2009 in three health center of Yaoundé (Cameroon). Clinical and diagnosis features of varicocele, indication for surgery, operative procedure and outcomes, as well as long-term follow-up of were analyzed. Results: A total of 74 file of patients were collected. The average age of patients was 36.93 years old. Among them, 43 (58.11%) had varicocele grade 1, 21 (28.38%) grade 2, and 2 (2.70%) grade 3. Fifty-four (72.97%) cases had bilateral varicocele, 17 (22.97%) and 3 (4.05%) patients had left and right varicocele respectively. 42(56.7%) patients complained for fertility problem. Scrotal pain was found in 26 (35.13%) cases. The pneumoperitoneum was achieved in all cases through a supra-umbilical open coelioscopy with the insertion of a 10 mm-optic port. Two 5 mm working ports were used in all cases. Dilated veins were clipped without section simple in 56 cases (75.68%). the mean operative time was 31.9 min ± 8.6 min. With a mean follow-up period of 27 months, we recorded 4.05% of recurrence and hydrocele in 1 case (1.35%), symptoms’ regression in 87% of cases and pregnancy in 65.9% of cases of infertility. Conclusion: Laparoscopic varicocelectomy is feasible and safe in our setting, with good results. We e

关键词： Varicocele Laparoscopy Fertility Pain

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