Biomedical subjects

L Falandry

Publications and source records attributed to L Falandry.

At least 19 recordsLinked to original sources

PubMed2001

[Surgical treatment of priapism with open glans penis puncture-drainage in 26 black patients].

The surgical treatment of the priapism is complex and requires various techniques for diversion of the corpora cavernosa with significant morbidity. For the last 15 years, the author have been using a simple transglandular cavernosal spongiosum shunt technique, which satisfies the requirements of functional surgery: restoration of anatomy, reduced morbidity, facility to learn. This article is intended to precisely describe the surgical technique and to present the results based on a personal series of 26 cases of priapism operated with this technique in black patients (19 adults and seven children) in the context of sickle-cell anaemia.

Adolescent↗

PubMed2000

[Vaginal route treatment for residual urinary incontinence after closing an obstetrical fistula: apropos of 49 cases].

OBJECTIVE: Described here is a simple treatment for female urinary incontinence present and concurrent cystocele repair, if present. The objective of this technique which combines a bladder neck and a suprapubic percutaneous suspension, is to obtain by a sling effect, efficient cure of the urinary incontinence, in avoiding the common retention problem. PATIENTS AND METHODS: Between 1992 and 1998, 49 black female patients were treated with this procedure. Average age was 18 years old (the youngest 14, eldest 29 years old) 39 were primigravid while 10 were multigravid (2 to 6 childbirths). 12 (24. 4%) have undergone at least 2 operations for fistula cure, 6 of the patients showed previous incontinence surgery; Burch technique (n=1), Martius fat sling (n=3) and anterior colporraphy (n=2). 25 patients (51%) were suffering from a severe incontinence, for 17 cases the urine leak was grade 2 and 8 cases grade 3 at decubitus. RESULTS: No bladder lesion occurred on any of the 49 patients. Except for one general peritonitis which occurred on a patient who was receiving a combined recto-vaginal fistula operation, the post operative complications were minor (n =7). We observed only one direct recurrent urinary incontinence which was treated a second time with the same technique and was cured. For 46 studied cases and an average follow-up of 28.6 months, 29 patients (63%) were declared totally cured, 8 (17.3%) showed functional improvement, 9 (19.5%) remained incontinent. The global success rate (cure and improvement) was obtained in 80% of cases. The results were less satisfactory in multi-operated patients, particularly in those who suffered from extensive cervico urethral damage (Group III). In this group only one out of two patients obtained cure or improvement. CONCLUSION: Due to its real simplicity the bladder neck and vagina wall sling is easy to redo, and because its reliability we have chosen this procedure as a choice treatment for incontinence following a vesico vaginal fistula. The excellent results confirmed by a longer follow-up has led us to extend its indication to all types of female urinary incontinence. This technique is particularly well suited for use in developing countries.

Adolescent↗

PubMed2000

[Surgical treatment of priapism: experience of 56 cases in an African setting].

Since priapism is uncommon, treatment is controversial and difficult. In this article we describe a practical, well-documented approach for management of priapism in countries with a high incidence of sickle cell disease. This approach is based on our experience including a total of 56 black patients (49 adults and 7 children) as well as on the results reported in the literature. The patients in our series were examined and treated by the same physician over an 18 year period in various African countries, i.e., Burkina (n = 8), Chad (n = 12), Gabon (n = 19), and Niger (n = 17). Etiologies and pathophysiology are reviewed. In all cases, surgical treatment involved diversion from corpora cavernosa. In the 51 cases with follow-up periods of 3 months or longer, results were considered as excellent in 17 cases (33 p. 100), partial in 5 (9.8 p. 100), and unsuccessful in 29 (56.8). Since 1984, needle drainage with a unilateral transglandular cavernosal-spongiosum shunt based on the technique described by Al Ghorab's has led to better results with immediate detumescence in 80 p. 100 of cases and a long-term success rate of 52 p. 100 (13/25 cases with sufficient follow-up). Except in cases involving sickle cell anemia in which concomitant medical treatment of priapism can be useful, immediate surgical treatment is the only technique effective in avoiding secondary impotence, which was common in our series (58.6). Our p. 100 needle drainage technique appears to be the method of choice for simplified achievement of a unilateral transglandular cavernosal-spongiosum shunt.

Adolescent↗

PubMed1999

[Practice of spinal anesthesia in a developing country: usefulness of vascular preloading with a 7.5% hypertonic saline solution].

OBJECTIVE: To assess the efficacy of hypertonic saline for prevention of arterial hypotension in patients undergoing spinal anaesthesia in Niger. STUDY DESIGN: Prospective, randomized, double-blinded study. PATIENTS: Fifty adults undergoing scheduled surgery under spinal anaesthesia, allocated either to a hypertonic saline group (HSG) or a isotonic saline group (ISG). METHODS: Over the 15 min prior to anaesthesia, 100 mL of 7.5% saline were infused in patients of HSG, and 100 mL of 0.9% saline in those of ISG respectively. Spinal anaesthesia was performed at the L3-L4 or L4-L5 interspace using either lidocaine 5%, or bupivacaine 0.5% or a mixture of both supplemented with fentanyl. Arterial pressure (AP) and heart rate (HR) were measured the day before surgery, prior to and after spinal anaesthesia, thereafter every 5 min over 30 min and every 10 min thereafter until completion of surgery. Hypotension (30% decrease of systolic AP control value was treated with 500 mL of Ringer lactate solution and in case of failure with ephedrine (5-30 mg i.v.). An isolated bradycardia (HR < 60 b.min-1) was treated with atropine (0.5-1 mg i.v.). RESULTS: Hypotension occurred in two out of 24 patients of the HSG and eight out of 24 of the ISG (P < 0.05). The mean infused volumes of Ringer lactate solution were 387 +/- 218 mL vs 623 +/- 318 mL respectively (P < 0.05). Ephedrine and/or atropine were not required in HSG, however in 7 out of the 24 patients of the ISG. Adverse clinical effects did not occur. CONCLUSION: Hypertonic saline prevents efficiently the occurrence of hypotension during spinal anaesthesia. Considering its ease of preparation, the lack of adverse effects, in patients not suffering arterial hypertension or congestive heart failure, and low cost, hypertonic saline is well adapted for use in a developing country, if isotonic solutions are not available.

Adult↗

PubMed1999

[Utilization of a pedicled labial flap, single or double face, for the management of post-obstetric urethral damage].

Reported here is our experience with a single or double-face new procedure using a pedicled labial flap for urethral reconstruction in patients treated for extensive urethral damage after obstetrical injury. Between January 1992 to July 1997, 56 cases of urethral damage on African female patients, with an average age of 18 years old, were treated by pedicled labial urethroplasty. This procedure was done by using a single or double-face pedicled flap obtained from the major or minor labia. The flap was then introduced as in a tunnel beneath the vaginal epithelium reaching the damaged urethra. A variety of techniques were proposed: patch for sufficient lengthening (27 cases), tubularized flap allowing complete reconstruction of the urethra (18 cases) and the double-face urethroplasty (11 cases). Good quality urine continence was obtained by using the sub urethral Martius'sling procedure. In 11 cases, we combined the treatment with a colposuspension procedure. The average follow-up was 23 months (ranging from 5 to 47 months). The global success was 82% (52 patients treated). Recovery of normal miction and absence of urinary leak was obtained in 36 cases (69%). While 7 moderate failures occurred (13%), 9 cases were considered complete failures (17%). In view of the high success rate, we consider that the one-stage procedure by the use of a single or double face pedicled labial flap is a choice treatment and highly suitable for the management of extensive urethral cervical damage after obstetrical injury.

Adolescent↗

PubMed1999

[Priapism: treatment and results. Personal series of 56 cases].

OBJECTIVES: To define, based on the author's experience and the data of the literature, a simple and rigorous practical approach to the management of priapism in developing countries, for which the therapeutic approach is controversial and difficult due to the rarity of this condition. MATERIAL AND METHODS: The reported series is based on 56 cases of priapism in black patients (49 adults and 7 children), observed and treated by the same operator over an 18-year period in Burkina (n = 8) and then in Chad (n = 12), Gabon (n = 19) and Niger (n = 17). The pathophysiology and aetiologies are reviewed. RESULTS: All patients treated surgically underwent various surgical techniques for diversion of the corpora cavernosa. In this group of 51 reported cases, there were 17 successes (33.3%), 5 partial results (9.8%) and 29 failures (56.8%). The overall immediate success rate, resulting in detumescence, was 36/51 (70%). These initial successes almost exclusively concerned patients treated by unilateral cavernoglandular shunt within an interval not exceeding 2 days. Although the long-term results, all treatments combined, were disappointing (56.8% of patients with sufficient follow-up are impotent), creation of a unilateral cavernoglandular fistula to the glans, based on Al Ghorab's technique, appeared to provide the best results with a success rate of 52%, i.e. 13/25 cases of priapism correctly followed. CONCLUSION: Except in the context of sickle-cell anaemia, in which concomitant aetiological treatment can be proposed, only emergency surgery is effective to avoid secondary impotence. The unilateral cavernoglandular shunt is extremely simple and, according to the author, remains the best procedure.

Adolescent↗

PubMed1997

[Urethroplasty using a pedicled labial flap in the treatment of urethral destruction of obstetrical origin: technics and results].

OBJECTIVES: To present a new technique for urethral reconstruction, the pedicled labial urethroplasty ULP, and describe the results obtained in patients treated for extensive urethral cervical damage after obstetrical injury. METHODS: From January 1992 to January 1996, pedicled labial urethroplasty (ULP), was performed on 31 African female patients, with an average age of 18 years old. The ULP was performed by using a pedicled skin flap obtained from the major labia. The pedicled flap is slid beneath the vaginal epithelieum until the damaged urethra is reached. Different techniques are then proposed : partial urethroplasty, by using a patch to lengthen the existing urethra, or complete reconstruction of the urethra by the use of a tubularized flap. Good quality urine continence was obtained by using the sub urethral Martius' sling procedure. In 6 cases, we combined the treatment with a colposuspension procedure. Post operation follow-up were done during a period of 13 months (6 to 32 months). RESULTS: In 19 out of 27 cases (70%) normal miction was obtained and the urinary leak cured. While 4 results were considered semi-failures, for 4 other cases failure was considered complete. CONCLUSION: The pedicled labial urethroplasty ULP has shown to be a reliable technique and highly suitable for the management of extensive urethral cervical damage after obstetrical injury.

Adolescent↗

PubMed1997

[Pediculated labial ureteroplasty: an original treatment procedure for ureteral lesions of obstetric origin].

Destruction of the urethra is the most severe complication of pregnancy-related vesicovaginal fistula. Although uncommon in Europe, pregnancy-related urethral destruction is still observed in Africa. In this study we describe our experience with a new reconstruction technique using a pedunculated skin flap raised from the labia majora. Between January 1992 and June 1996 we treated 35 patients in the Urology Department of Niamey Hospital in Niger. All patients were black. Mean age was 18 years and mean follow-up was 19 months. Two plasty techniques were used, i.e. extension (16 cases) and tubulisation (19 cases). Urinary incontinence was treated using a suburethral loop system created using a fatty flap taken from the labia majora (Martius method). Urethrocervico-suspension of the vagina was necessary in 6 cases. Normal micturition with no leakage was obtained in 24 patients (68.6%) and functional improvement in 6 cases (17.1%) Treatment failed in 5 cases (4.2%). In comparison with previously reported techniques, urethral reconstruction using a pedunculated labial flap and suburethral looping system allows successful treatment of pregnancy-related urethral destruction in 70% of cases. This technique is particularly well suited for use in developing countries where occurrence of this complication is most frequent. However even with the greatest skill, creation of a physiologically perfect closure system is currently impossible.

Adolescent↗

PubMed1996

[Urethral prolapse in young black girls. Report of 12 cases].

While this benign tumor of female urethra is relatively rare, reported here are 12 cases of complete mucusa ectropion observed in female black girls. The cases were studied from January 1987 to May 1994, first in Gabon (7 cases) then in Niger (5 cases), all the cases concerned girls below 10 yrs old. The revealing symptom was vulvar bleeding (9 cases) or blood in the urine (2 cases). The remaining case was discovered incidentally. Diagnosis was done at the vue of a pinkish orange soft mass, found in the center of the meatic opening, and which frequently bled on contact. Treatment was exclusively surgical, consisting of a tumoral resection followed by success in all of the cases. This experience while insisting on the rareness of this tumoral illness, strongly suggests a possible predisposition in black girls, where the incidence is underestimated. A more certain diagnosis can be done after analysis of the histological aspects. Although the number of cases reported here is quite limited, the good quality of the results obtained by the treatment demonstrate the value of this surgical management, likewise, certain of its technical details are described in the article. Considering the relative simplicity of the technique, its rapid, long lasting efficiency, and the absence of post operative complications, the author concludes that surgical resection is the treatment of choice for the cure of this benign tumor.

Black People↗

PubMed1996

[Urethral reconstruction by pedicled labial flap in the treatment of extensive urethral lesions after obstetrical injury. Apropos of 34 cases].

Reported here is our experience with a new procedure using a pedicled labial flap for urethral reconstruction in patients treated for extensive urethral damage after obstetrical injury. From January 1992 to January 1996, 31 cases of urethral damage in African female patients, with an average age of 18-years-old were treated by pedicled labial urethroplasty. This procedure was done by using a pedicled flap obtained from the major labia. The flap was then introduced as in a tunnel beneath the vaginal epithelium reaching the damaged urethra. A variety of techniques were used: the patch to lengthen sufficiency (13 cases), or the tubularized flap following complete reconstruction of the urethra (21 cases). Good quality urine continence was obtained by using the suburethral Martius' sling procedure. In 6 cases, we combined the treatment with a colposuspension procedure. The average follow-up is 14 months (ranging from 6 to 37 months). Recovery of normal micturition with absence of urinary leak was obtained in 21/30 cases (70%). While 5 moderate failures occurred, 4 cases were considered complete failures. In view of the high success rate, the authors consider that the one-stage procedure by the use of a pedicled labial flap is a choice treatment and highly suitable procedure for the management of extensive urethral cervical damage after obstetrical injury.

Adolescent↗

PubMed1995

[A simple alternative technic in the treatment of idiopathic hydrocele in adults: vaginal "fenestration"].

The author describes a new, simple technique for the treatment of idiopathic hydrocele according to a "fenestration" procedure designed to correct the imbalance of intravaginal hydrostatic exchanges. The operation consists of initially hemming separately the deep fibrous layer and the parietal leaflet of the tunica vaginalis to form the margins of the "window", which is then applied by its fibrous layer to the dartos, continuous with the subcutaneous connective tissue, a site of rich lymphatic drainage. In a series of 108 patients treated by this technique since September 1982, with a follow-up of 6 years, the anatomical and functional results were excellent in 98 cases (90.7%), moderate in 6 cases (5.5%) and poor in 4 cases (3.7%). Compared to classical techniques, the fenestrated opening of the tunica vaginalis with preservation of the tunica vaginalis and limited opening of the serosa, preserves the testicular support and the protective role of the serosa on the testis. Lastly, suture of the margins of the window to the dartos, by facilitating deep lymphatic drainage towards the superficial connective tissue, reconstitutes a physiological equilibrium in the constant exchanges of intravaginal serous fluids. Experience has demonstrated the anatomical and functional efficacy and reliability of this extremely simple procedure, which is essentially indicated in adult patients with idiopathic hydrocele and a healthy tunica vaginalis.

Adult↗

PubMed1995

[A simple alternative method in the treatment of idiopathic hydrocele in adults: vaginal "fenestration"].

Adolescent↗

PubMed1995

[Intragastric foreign bodies. Apropos of an unusual case].

The following report describes a personal experience of an extremely rare case of sharp metal foreign bodies discovered in the stomach of a 22 year old adult African in good health. The authors underline the strange character of the case observed, not only because of the patient's perfect tolerance towards the foreign bodies, mainly sharp metal objects, but also considering the very large amount of objects found and it's corresponding weight (1 kg 400 g). Extraction of the foreign bodies was done by gastrotomy. Basing on our experience and following a review of the literature, the authors discuss the different problems which may occur due to the presence of foreign bodies in the gastrointestinal tract.

Adult↗

PubMed1994

[Prolapse of the urethra in black girls. Personal experience in 11 cases].

The author describes 11 cases of prolapse of the urethral meatus observed in black girls between January 1987 and July 1993 first in Gabon (n = 7) and subsequently in Niger (n = 4). All patients were under the age of 10 years. The revealing symptom was vulvar bleeding (n = 8) or blood in urine (n = 2). In the remaining case prolapse was discovered incidentally. In all cases diagnosis was achieved by physical examination revealing a soft mass that bled on contact. Treatment consisted in surgical resection which was always followed by an uneventful recovery. This experience confirms a predisposition to this uncommon disorder in black children in whom the incidence is probably underestimated. The clinical presentation is consistently the same and the mass can be mistaken for a malignant tumor or for injuries related to sexual abuse. The results of this study demonstrate that the treatment of choice for prolapse of the urethra is surgical resection which is simple, safe, and immediately and lastingly effective.

Black People↗

PubMed1993

[Stenosis of the male urethra: single-stage canal reconstruction using a mobile, vascular, pedicled skin graft. 245 personal cases].

A series of 269 patients treated for male urethral stenoses by the same operator using the same management technique from september 1984 to november 1992, inspired the author to describe an original one-stage canal reconstructive technique, using a mobile, nourished pedicled skin graft. The particularity of the technique resides on the large versatility of the pedicle, well vascularised, carved out from the subcutaneous cell tissue and the dartos. The scrotal or penile skin flap remains attached to the mobile pedicle, giving a much wider facility for use, both for penile urethra or perineal urethra repair. The technique allows a choice of two methods of plasty repair: the widening patch which aims at widening the urethral canal, and the tubularized graft, which aims at replacing part or an entire segment of the urethra. Analysis is made on 245 urethroplasties done for the cure of difficult urethral strictures which made up 80% of the total number of cases observed (fistulated in 56 cases, multi-operated in 47 cases), affecting the penile urethra for 47 cases, the pelvian urethra for 159 cases, and the membraneous bulb for 39 cases, associated lesions where found in 15.9% of the patients. 187 patients where treated by the widening patch process whereas 58 underwent neourethral reconstruction by the tubularized graft process. Post operative follow-up for over half of the total number of cases was 4 years. While 224 of the cases treated obtained good results (91.4%), for 15 patients, the results were considered intermediary (6.1%). Immediate cure was obtained for 87.2% of the cases. Lastly, 5 patients presented bad results (2.3%). Discussion and analysis are made on the execution of the technique as well as the post operative complications encountered: infection (8.9%), urine leakage (6.9-0), urethrocele (2%). Experience acquired from the use of this management technique, showed that it is particularly valuable for the cure of wide, recurrent, infected and fistulated stenoses. Its efficiency and reliability underline the value of this technique, whose particularity lies on the wide manageability of the graft, attached to the pedicle. Its particularity also lies on the eclectic choice offered as to the site where the graft is carved off (scrotal or penile) and the appropriate plasty to be used (widening patch or tubular graft), increasing considerably the favorable chances for surgical repair. Finally, the technique's particularity is in its wide indication, independently of the characteristics and the cause of the stenoses.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1993

[Mucous prolapse of the urethra in female children. Nine new cases in children of Negroid race].

Nine recent cases of prolapse of the urethral meatus mucosa in female children treated from january 1987 to october 1992 are reported. Analysed in the article are the principal clinical, etiopathogenic and therapeutic aspects concerning this tumoral formation rarely found in pediatric pathology, yet exceptionally more frequent in African female children. While underlining certain technical details, the author insists on the interest of surgical exerese as a choice treatment for the cure of this benign tumor, because of its technical simplicity, its immediate and durable efficiency, as well as the absence of complications.

Black People↗

PubMed1992

[Idiopathic hydrocele in adults. Cure by vaginal fenestration].

Among the treatments of idiopathic hydrocele cutting a window in the tunica vaginalis testis stands out as the choice treatment, the procedure being simple and the results of good quality. In the first stage, the two layers, visceral and parietal, of the tunica are folded separately to form the edges of the window. In the second stage the parietal layer of the window is attached to the dartos which remains united with the underlying subcutaneous layer, forming an excellent tract for lymph drainage. Thus, the anatomical and physiological objectives of the operation are reached: the testicular "cockpit" and the protective function of the tunica vaginalis are preserved. In a series of 83 patients operated upon and followed up for up to 5 years, 9 out of 10 were cured by this method without unwanted sequelae.

Adolescent↗

PubMed1992

[Vesicovaginal fistula in Africa. 230 cases].

The author reports 230 cases of vesico-vaginal fistula taken from a series of 271 obstetrical fistulae treated by the same operator. The fistula was obstetrical in most cases (93 percent), occurring in young women and primiparas. Associated lesions (urethro-vaginal, recto-vaginal and perineal) were observed in 23.4 percent of the patients. Also studied were 7 pure urethro-vaginal fistulae and 2 urethro-vesical fistulae. Surgical treatment, usually (85.6 percent) through the lower route, consisted of closing the orifice of the fistula by simple separate sutures performed on the bladder and the vagina (Chassar Moir) in 95 cases. A filler tissue, a muscular and fatty pedicle flap (Martius technique), was used in 55 cases. Complementary techniques were considered indispensable in 49 cases. Eighteen patients underwent palliative surgery. Among 230 fistula patients whose postoperative follow-up ranged from 6 months to 1 year, 180 (80 percent) were considered cured (no incontinence and recovery of mictional function), and 17 were considered partially cured (sphincteral leakage during efforts); there were 29 failures. Far from being eradicated in Africa, vesico-vaginal fistulae continue to be one of the major public health problems, with an average annual prevalence of 2 percent. This critical situation is due to different social, economic, traditional and cultural factors which stay firmly inalterable. There is a need for a fistula management strategy based on a classification of the lesions encountered to increase the chances of success. The author describes the main prognostic and therapeutic groups: simple fistulae where success was obtained as a rule (group I, 33 percent of the cases in this series); difficult fistulae (group II, 43 percent), with the dual problem of attaining watertightness and healing, where the support of a well-vascularized filler tissue has proved necessary (Martius); complex fistulae (group III, 23.9 percent), where the associated lesions call for several urological, genital and gastrointestinal operations. Complete anatomical destruction of the urethra, accompanied by sclerous atresia of the genital tract, marks the limit of surgical possibilities of repair, beyond which palliative surgery has to be accepted.

Adolescent↗