Diagnostic and therapeutic aspects of penis cancer in CHU Yalgado Ouédraogo

Diagnostic and therapeutic aspects of penis cancer in CHU Yalgado Ouédraogo | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic and therapeutic aspects of penis cancer in CHU Yalgado Ouédraogo Brahima Kirakoya, Oumarou Karimoune Mossi, Clotaire AM Yaméogo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6523889/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Through a retrospective study carried out over a period of 16 years. We report the diagnostic and therapeutic aspects of rod cancer in our department. During the study period, 13 cases of penis cancer were monitored. Their diagnostic aspects are essentially marked by a delay in diagnosis. Diagnosis is made at an advanced stage of pathology with limited therapeutic choices. Penectomy was the main therapeutic indication in our patients. However, a low rate of achievement of this penectomy has been found. For psychosocial reasons, achieving penectomy is always difficult in our context. Penis cancer squamous cell carcinoma lymphoma penectomy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Penis cancers are anarchic cell proliferations that develop at the expense of penis tissues. According to Globocan, around 36,068 cases were registered worldwide in 2020, an incidence of 0.8 per 100,000 people [ 1 ]. There are disparities in the geographical distribution of this cancer. The highest impacts are found in Central Africa, Latin America and Asia [ 2 ]. In South Africa of the Sahara, penis cancer can account for up to 3% of urological cancers and its diagnosis is usually late [ 3 – 7 ]. This diagnostic delay makes management complex [ 8 – 10 ]. This justifies the choice of our work aimed at reporting and analyzing the diagnostic and therapeutic aspects of penis cancer in our context. This is a relevant study, as there is very little data on this disease in the subregion. Patients and methods We conducted a retrospective and descriptive study between January 2007 and December 2022 of all cases of penis cancer diagnosed and managed at the urology-andrology department of the Yalgado Ouédraogo Hospital and University Centre (CHU-YO) in Ouagadougou. Patients with histological confirmation of their cancer whose socio-demographic, diagnostic and therapeutic data are available were included in the study. For each patient, the variables studied were: frequency, age mean, duration of progression, risk factors, clinical, paraclinical data, and therapeutic aspects. Results January 2007 to December 2022, 16 years old. Approximately 8,125 patients were followed up in the service, including 13 cases of yard cancer, or 0.81 cases per year. The average age at diagnosis of our patients is 56 years ± 12.02 with a minimum of 30 years and a maximum of 82 years. The different risk factors for our patients are summarized in Table I. All our patients had consulted for a chronic wound of the penis including an association with an inguinal wound. For 4 patients in our cohort, the penis wound was associated with acute urine retention (Fig. 1 ). The average duration of lesions prior to first urology consultation was 24 ± 18.58 months. This was a minimum of 4 months and a maximum of 60 months. The lesion was unique and widespread in all patients. It was ulcerative with a cauliflower appearance for forms located in glans (Figs. 2 and 3 ). As for the forms localized to the body, they took the appearance of an ulcerative range with sometimes necrosis for the forms localized on the body of the rod (Fig. 4 ). The majority of patients (11) had localized lesions on the distal part of the penis, only 2 patients had lesions on the penis body. At the time of diagnosis, 12 patients had an extension of their cancer to the cavernous bodies, 6 to the spongy body and urethra. No patient had perineal extension. Inguinal, bilateral and superficial lymphadenopathies were found in 11 patients, including fistulized lymphadenopathies in one patient (Figs. 1 and 3 ). Histological analysis found epidermal carcinoma in 12 patients and 1 case of plasma lymphoma (Figs. 5 , 6 and 7 ). At the therapeutic level, penectomy was indicated in all patients in our cohort, but only 2 cases of partial penectomy could be performed. A biopsy and an exeresis of the lesion were carried out in 1 patient. Biopsy and circumcision were performed in 2 patients. A total of 10 patients refused the penectomy and were subsequently lost to view. No ganglionic, chemotherapy or radiotherapy has been performed. At the end of the surgical treatment, 3 patients were declared cured over a period of more than 3 years. Discussion The objective of our study was to study the diagnostic aspects and therapeutic difficulties of penis cancer in the urology department of the CHU-YO. This was a retrospective study whose main weakness is related to the number of cases in our cohort, it was a sample that is far from representative of the general population. Penis cancer is rare in Burkina Faso, as evidenced by studies carried out by Kirakoya [ 3 ] and Kambou [ 10 ]. The annual frequency found in our study is 0.81 cases/year, it confirms the rarity of cancer of the penis. This rarity can be explained in our context by the practice of circumcision. According to Dembélé et al. [ 11 ], 97.2% of the men in Ouagadougou were circumcised. The frequency of non-circumcision or late circumcision was over 69%, confirming the protective role of circumcision. In our series, the average age at diagnosis of patients was 56 years ± 12.02 years. It is slightly lower than the average age at diagnosis found in the literature which is 65 years [ 12 ] and close to those found in several African studies, 60.5 years in Morocco [ 13 ], 64.7 years in Tunisia [ 14 ], 60 years in Chad [ 9 ] and 60.35 years in Congo Brazzaville [ 15 ] and Rwanda [ 16 ]. These results confirm that penis cancer is cancer of the elderly. Histologically, our series recovered epidermal carcinoma of the penis in 12 patients (91.66%) and one case of plasma lymphoma (8.34%). Different studies in Africa have found results similar to ours [ 10 , 13 , 17 , 18 ]. Our results confirm the evidence in the literature that 95% of penis tumors are epidermal carcinomas and that plasma lymphoma is a rare histological type [ 19 ]. More than 90% of patients in our series are at a stage greater than or equal to T3 which corresponds to an infiltrating tumor. Our rate of infiltrating cancer is greater than or equal to those found in several African studies [ 9 , 13 , 15 – 17 ]. The high frequency of these advanced stages in diagnosis is explained by the delay in diagnosis. Indeed, our average duration of pathology evolution before the first urology consultation is 24 ± 18.58 months. This delay in diagnosis can be explained on the one hand by the fact that it is a disease affecting their privacy. They do not consult in the hospital until they have exhausted all other therapeutic means. On the other hand, because of its rarity, the cancer of the penis is little known by many carers making the journey of the patient longer. In the face of these infiltrating cancers, a high penectomy rate of 92% was indicated. It was often a penectomy of cleanliness. Several authors also report similar rates of penectomy in their series [ 9 , 14 , 15 , 17 ] they also justify the high frequency of this indication by the rate of infiltrating cancer. Despite the frequent indication of penectomy, its refusal rate in our series is 77%. Similar proportions of refusal of penectomy have been reported since 1992 by Gueye et al in Senegal [ 6 ]. Twenty years later, several authors point to the persistence of this refusal, Kambou et al [ 17 ] in Burkina Faso, Odzébé et al. [ 18 ] in Congo Brazzaville and Sow et al. [ 17 ] in Senegal. The psychological and religious considerations of the patients remained constant in the face of this surgical gesture. Indeed, many patients consider the penis as the organ of masculinity and manhood par excellence. In this context, penectomy is equated with mutilation. Despite the introduction of psychotherapy before surgery, penectomy remains difficult to accept for patients. At this stage of treatment, many patients are lost to sight or leave against medical advice. Conclusion Penis cancer is a rare disease. In our context, its management is made complex by the late diagnosis. It is therefore necessary to improve its early detection for good management. Declarations Statements ‘Human Ethics and Consent to Participate declarations: not applicable’ ‘No organization funded this study’ ‘The authors do not declare any conflict of interest with this article’ ‘All authors have read and approved the manuscript’ ‘This study was approved by the National Ethics Committee for Health Research of Burkina Faso (CERS)’ Author Contribution BK: To contribute to the study by revising and correcting the present manuscript. He is also one of the urologists who has treated these patientsKMO: To contribute to the study by collecting data, analysing them and writing the present manuscript;CAY: To contribute by being one of the urologists who took care of these patients. He also contributed with his advice.FAK: To contribute by being one of the urologists who took care of these patients. He also contributed with his advice.“All authors have read and approved the manuscript” Acknowledgement Acknowledgment for their contributions to data collection , Ouédraogo Sosthèneand Ky Bienvenue Désiré References Bray F, Ferlay J, Soerjomataram I, Siegel R L, Torre L A and Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin 2018 Sept 12: 392–424. Fu L, Tian T, Yao K, Chen X-F, Luo G, Gao Y, et al. Global Pattern and Trends in Penile Cancer Incidence: Population-Based Study. JMIR Public Health Surveill. 2022; 8:348–74. B Kirakoya, A Ouedraogo, M Simpore, FA Kabore. Epidémiologie des cancers urologiques au centre hospitalier universitaire Yalgado Ouedraogo (Burkina Faso). Jaccr Africa fevr 2020; 4(1) : 165–170. Ouattara A, Hodonou R, Avakoudjo J, Cisse D, Zango B, Gandaho I, et al. Épidémiologie des cancers urologiques au Centre national hospitalier universitaire Hubert Koutoukou Maga Cotonou, Bénin. Analyse d’une série hospitalière de 158 cas. Prog En Urol. 2012; 22 :261–5. Ouedraogo S, Traore MT, Kambire JL, Ouedraogo S, Bere B, Kabore AF. Les cancers urologiques primitifs dans un contexte de ressources limitées: épidémiologie et traitement. Bull Cancer (Paris). 2019 ; 106 :868–74. Gueye SM, Diagne BA, Ba M, Sylla C, Mensah A. Le cancer de la verge: aspects épidémiologiques et problèmes thérapeutiques au Sénégal. Méd Afr Noire 1992; 39: 582–584. Diallo I, Diamé I, Diouf C, Faye S, Thiam A, Yaya A, et al. Les cancers urogénitaux en région périphérique de Sénégal: à propos de 156 cas. J Afr Urol. 2021; 27 : 9–16. Tseng H-FT. Risk factors for penile cancer: results of a population-based case_control study in Los Angeles County (United States), Cancer Causes and Control. 2001; 267–77. Rimtebaye K, Mahamat MA, Kimassoum FR, Nemia FM, Djekoundade A, Andjeffa V et al. Clinical Characteristics and Difficulties in the Management of Cancer of the Penis. Open J Urol. 2021; 11 : 436–42. Kambou T, Ouattara A, Zaré C, Zango B, Kaboré AF, Konségré V, et al. Le cancer de la verge à Bobo-Dioulasso (Burkina-Faso). A propos de 3 cas et revue de la littérature. J Afr Cancer Afr J Cancer. 2015; 7 : 64–8. Dembelé B. Circoncision, Enquête Démographique et de Santé -III. 2003, 13: 225–231. Savoie PH, Murez T, Neuville P, Ferretti L, Rocher L, Van Hove A, et al. French AFU Cancer Committee Guidelines - Update 2022–2024: penile cancer. Prog En Urol. 2022; 32:1010–39. Nouri A, Elkarni H, Yacoubi SE, Karmouni T, Kahder KE, Koutani A, et al. Cancer du pénis: A propos de 6 cas avec Revue de la littérature. Afr J Urol. 2012 ; 18 : 66–70. Houyem Mansouri. Cancers primitifs de la verge: à propos de 11 cas et revue de la littérature. Pan Afr Med J 2018, 311–4 Ondziel Opara SA. Cancer du pénis à Brazzaville: Analyse d’une série de 13 cas. VOL 18 N° 2. Annales de l’université Marien Ngouabi. 2018 ; 18(2) 37–43 Ngendahayo E, Nzayirambaho M, Bonane A, Gasana GA, Umurangwa F, et al. Pattern and clinical management of penile cancer in Rwanda. Afr J Urol. 2018; 24: 274–81. Sow Y, Thiam A, Fall B, Coulibali M, Sarr A, Diao B, et al. Cancer du pénis au Sénégal: aspects cliniques et thérapeutiques. Basic Clin Androl. 2012; 22: 102–7. Odzébé AWS, Bouya PA, Nkoua Mbon JB, Ngatshé A, Péko JF. Le cancer de la verge: à propos d’un cas et revue de la littérature. Basic Clin Androl. 2010 ; 20 : 273–5. Sow M, Nkégoum B, Oyono J-LE, Nzokou A. Aspects épidémiologiques et histopathologiques des tumeurs urogénitales au Cameroun. Prog En Urol. 2006; 16, 36–39 Tables Table I: Distribution of Patients by Risk Factors Risk factors Frequency (n = 13) Percentage (%) Not circumcised or delayed circumcision 9 69,23 HPV infection 2 15,38 HIV infection 3 23,08 Sexual partners Multiple and polygamy 11 84,62 Tobacco 3 23,08 Phimosis 1 7,69 Low socio-economic level 8 61,54 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6523889","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457134455,"identity":"11885e06-cd23-422c-8b38-f692898e08fe","order_by":0,"name":"Brahima Kirakoya","email":"","orcid":"","institution":"Centre Hospitalier Universitaire Yalgado Ouédraogo","correspondingAuthor":false,"prefix":"","firstName":"Brahima","middleName":"","lastName":"Kirakoya","suffix":""},{"id":457134456,"identity":"9616e4c4-95ce-4771-8df7-30c10bcb0ba3","order_by":1,"name":"Oumarou Karimoune Mossi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYPACCTkGBh4QQ454LcZQLcbEW5PYQLQWfgbuxIc//likbzh+9uCDDwwG+QS1SDbwbjbmbZPI3XAmL9lwBoOBZQMhLQYHeLdJMzYAtRzIMZPmYfhjQNAWkBbJH38k0g3OvwFpMSBOiwQPm0SCwY0cIrVINkP8YjjzxhtjwxkGRGjhZ+/dCAyxOnm+8zmGDz5UEKGFgRlKKxwAu5OwBgSQbyBF9SgYBaNgFIwoAAAxZzSlPQdg4QAAAABJRU5ErkJggg==","orcid":"","institution":"Centre Hospitalier Universitaire Yalgado Ouédraogo","correspondingAuthor":true,"prefix":"","firstName":"Oumarou","middleName":"Karimoune","lastName":"Mossi","suffix":""},{"id":457134458,"identity":"aec9c6ff-e45a-4dce-aa73-7bdbfe613ff7","order_by":2,"name":"Clotaire AM Yaméogo","email":"","orcid":"","institution":"Centre Hospitalier Universitaire Yalgado Ouédraogo","correspondingAuthor":false,"prefix":"","firstName":"Clotaire","middleName":"AM","lastName":"Yaméogo","suffix":""},{"id":457134460,"identity":"151ca789-a7f2-4f39-84ee-479d3a3e8520","order_by":3,"name":"Fasnéwindé A Kaboré","email":"","orcid":"","institution":"Centre Hospitalier Universitaire Yalgado Ouédraogo","correspondingAuthor":false,"prefix":"","firstName":"Fasnéwindé","middleName":"A","lastName":"Kaboré","suffix":""}],"badges":[],"createdAt":"2025-04-24 22:53:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6523889/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6523889/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83014686,"identity":"e7cf1226-0bce-46ee-937d-f9ac2912c4c1","added_by":"auto","created_at":"2025-05-19 06:03:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85069,"visible":true,"origin":"","legend":"\u003cp\u003eRoot cancer localized in glans with inguinal lymphadenopathies in a 45-year-old patient\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6523889/v1/6039a8e21c41afdf232f2eba.jpg"},{"id":83012777,"identity":"f570a524-e527-41cc-a9d7-7980993c420f","added_by":"auto","created_at":"2025-05-19 05:39:28","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":66785,"visible":true,"origin":"","legend":"\u003cp\u003ePenis cancer located in glans in a 54-year-old patient.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6523889/v1/9e7de24ac4d6dfb0636e9e52.jpg"},{"id":83012783,"identity":"cde89c26-9ad7-4f2f-b75d-3b571ffda02f","added_by":"auto","created_at":"2025-05-19 05:39:28","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":176018,"visible":true,"origin":"","legend":"\u003cp\u003eRoot cancer located in glans with cauliflower appearance and bilateral inguinal lymphadenopathies. Right fistulized adenopathy.\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6523889/v1/176328dd21464d88920dc425.jpg"},{"id":83014693,"identity":"d1b0b357-20fe-4b9e-921e-1aa918135fa1","added_by":"auto","created_at":"2025-05-19 06:04:19","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":81824,"visible":true,"origin":"","legend":"\u003cp\u003ePenis cancer located on the penis body in a 58-year-old patient.\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6523889/v1/b009608760c8468d741b11b3.jpg"},{"id":83012790,"identity":"cd580c1a-c2db-4e4c-8763-26d91906746e","added_by":"auto","created_at":"2025-05-19 05:39:29","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":268846,"visible":true,"origin":"","legend":"\u003cp\u003ePenis lymphoma in a 48-year-old patient\u003c/p\u003e\n\u003cp\u003eA: Pre-operative image B: Image post partial penectomy\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6523889/v1/002af0959c70f19498d0241a.jpg"},{"id":83012785,"identity":"5121080c-9f46-441c-a373-07b5112646ef","added_by":"auto","created_at":"2025-05-19 05:39:28","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":80809,"visible":true,"origin":"","legend":"\u003cp\u003eIntermediate magnification (x100) showing the tumor lobules, some of which are centered by corneal globes.\u003c/p\u003e","description":"","filename":"Picture6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6523889/v1/59fb4e1e3a45863287d7002c.jpg"},{"id":83012791,"identity":"a09cee23-8b0c-4b51-ab96-51d55d1028a7","added_by":"auto","created_at":"2025-05-19 05:39:29","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":98001,"visible":true,"origin":"","legend":"\u003cp\u003eHigh magnification (x400) showing cellular details; Large polygonal or ovalary cells with slightly eosinophilic cytoplasm and voluminous nuclei, dispersed chromatin with prominent nucleole\u003c/p\u003e","description":"","filename":"Picture7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6523889/v1/823effd409a0eafd87342345.jpg"},{"id":98623019,"identity":"9456c055-113c-4423-9c11-c855bcce6d65","added_by":"auto","created_at":"2025-12-19 17:04:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1213506,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6523889/v1/3dd7b39f-8490-4773-8292-61838fd790d5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic and therapeutic aspects of penis cancer in CHU Yalgado Ouédraogo","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePenis cancers are anarchic cell proliferations that develop at the expense of penis tissues. According to Globocan, around 36,068 cases were registered worldwide in 2020, an incidence of 0.8 per 100,000 people [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. There are disparities in the geographical distribution of this cancer. The highest impacts are found in Central Africa, Latin America and Asia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In South Africa of the Sahara, penis cancer can account for up to 3% of urological cancers and its diagnosis is usually late [\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This diagnostic delay makes management complex [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This justifies the choice of our work aimed at reporting and analyzing the diagnostic and therapeutic aspects of penis cancer in our context. This is a relevant study, as there is very little data on this disease in the subregion.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003eWe conducted a retrospective and descriptive study between January 2007 and December 2022 of all cases of penis cancer diagnosed and managed at the urology-andrology department of the Yalgado Ou\u0026eacute;draogo Hospital and University Centre (CHU-YO) in Ouagadougou. Patients with histological confirmation of their cancer whose socio-demographic, diagnostic and therapeutic data are available were included in the study. For each patient, the variables studied were: frequency, age mean, duration of progression, risk factors, clinical, paraclinical data, and therapeutic aspects.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eJanuary 2007 to December 2022, 16 years old. Approximately 8,125 patients were followed up in the service, including 13 cases of yard cancer, or 0.81 cases per year. The average age at diagnosis of our patients is 56 years\u0026thinsp;\u0026plusmn;\u0026thinsp;12.02 with a minimum of 30 years and a maximum of 82 years. The different risk factors for our patients are summarized in Table I. All our patients had consulted for a chronic wound of the penis including an association with an inguinal wound. For 4 patients in our cohort, the penis wound was associated with acute urine retention (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The average duration of lesions prior to first urology consultation was 24\u0026thinsp;\u0026plusmn;\u0026thinsp;18.58 months. This was a minimum of 4 months and a maximum of 60 months. The lesion was unique and widespread in all patients. It was ulcerative with a cauliflower appearance for forms located in glans (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). As for the forms localized to the body, they took the appearance of an ulcerative range with sometimes necrosis for the forms localized on the body of the rod (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The majority of patients (11) had localized lesions on the distal part of the penis, only 2 patients had lesions on the penis body. At the time of diagnosis, 12 patients had an extension of their cancer to the cavernous bodies, 6 to the spongy body and urethra. No patient had perineal extension. Inguinal, bilateral and superficial lymphadenopathies were found in 11 patients, including fistulized lymphadenopathies in one patient (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Histological analysis found epidermal carcinoma in 12 patients and 1 case of plasma lymphoma (Figs.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). At the therapeutic level, penectomy was indicated in all patients in our cohort, but only 2 cases of partial penectomy could be performed. A biopsy and an exeresis of the lesion were carried out in 1 patient. Biopsy and circumcision were performed in 2 patients. A total of 10 patients refused the penectomy and were subsequently lost to view. No ganglionic, chemotherapy or radiotherapy has been performed. At the end of the surgical treatment, 3 patients were declared cured over a period of more than 3 years.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe objective of our study was to study the diagnostic aspects and therapeutic difficulties of penis cancer in the urology department of the CHU-YO. This was a retrospective study whose main weakness is related to the number of cases in our cohort, it was a sample that is far from representative of the general population.\u003c/p\u003e \u003cp\u003ePenis cancer is rare in Burkina Faso, as evidenced by studies carried out by Kirakoya [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and Kambou [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The annual frequency found in our study is 0.81 cases/year, it confirms the rarity of cancer of the penis. This rarity can be explained in our context by the practice of circumcision. According to Demb\u0026eacute;l\u0026eacute; et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], 97.2% of the men in Ouagadougou were circumcised. The frequency of non-circumcision or late circumcision was over 69%, confirming the protective role of circumcision.\u003c/p\u003e \u003cp\u003eIn our series, the average age at diagnosis of patients was 56 years\u0026thinsp;\u0026plusmn;\u0026thinsp;12.02 years. It is slightly lower than the average age at diagnosis found in the literature which is 65 years [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and close to those found in several African studies, 60.5 years in Morocco [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], 64.7 years in Tunisia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], 60 years in Chad [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and 60.35 years in Congo Brazzaville [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and Rwanda [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These results confirm that penis cancer is cancer of the elderly.\u003c/p\u003e \u003cp\u003eHistologically, our series recovered epidermal carcinoma of the penis in 12 patients (91.66%) and one case of plasma lymphoma (8.34%). Different studies in Africa have found results similar to ours [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Our results confirm the evidence in the literature that 95% of penis tumors are epidermal carcinomas and that plasma lymphoma is a rare histological type [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMore than 90% of patients in our series are at a stage greater than or equal to T3 which corresponds to an infiltrating tumor. Our rate of infiltrating cancer is greater than or equal to those found in several African studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The high frequency of these advanced stages in diagnosis is explained by the delay in diagnosis. Indeed, our average duration of pathology evolution before the first urology consultation is 24\u0026thinsp;\u0026plusmn;\u0026thinsp;18.58 months. This delay in diagnosis can be explained on the one hand by the fact that it is a disease affecting their privacy. They do not consult in the hospital until they have exhausted all other therapeutic means. On the other hand, because of its rarity, the cancer of the penis is little known by many carers making the journey of the patient longer.\u003c/p\u003e \u003cp\u003eIn the face of these infiltrating cancers, a high penectomy rate of 92% was indicated. It was often a penectomy of cleanliness. Several authors also report similar rates of penectomy in their series [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] they also justify the high frequency of this indication by the rate of infiltrating cancer.\u003c/p\u003e \u003cp\u003eDespite the frequent indication of penectomy, its refusal rate in our series is 77%. Similar proportions of refusal of penectomy have been reported since 1992 by Gueye et al in Senegal [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Twenty years later, several authors point to the persistence of this refusal, Kambou et al [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] in Burkina Faso, Odz\u0026eacute;b\u0026eacute; et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] in Congo Brazzaville and Sow et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] in Senegal. The psychological and religious considerations of the patients remained constant in the face of this surgical gesture. Indeed, many patients consider the penis as the organ of masculinity and manhood par excellence. In this context, penectomy is equated with mutilation. Despite the introduction of psychotherapy before surgery, penectomy remains difficult to accept for patients. At this stage of treatment, many patients are lost to sight or leave against medical advice.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePenis cancer is a rare disease. In our context, its management is made complex by the late diagnosis. It is therefore necessary to improve its early detection for good management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e‘Human Ethics and Consent to Participate declarations: not applicable’\u003c/p\u003e\n\u003cp\u003e‘No organization funded this study’\u003c/p\u003e\n\u003cp\u003e‘The authors do not declare any conflict of interest with this article’\u003c/p\u003e\n\u003cp\u003e‘All authors have read and approved the manuscript’\u003c/p\u003e\n\u003cp\u003e‘This study was approved by the National Ethics Committee for Health Research of Burkina Faso (CERS)’\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBK: To contribute to the study by revising and correcting the present manuscript. He is also one of the urologists who has treated these patientsKMO: To contribute to the study by collecting data, analysing them and writing the present manuscript;CAY: To contribute by being one of the urologists who took care of these patients. He also contributed with his advice.FAK: To contribute by being one of the urologists who took care of these patients. He also contributed with his advice.\u0026ldquo;All authors have read and approved the manuscript\u0026rdquo;\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAcknowledgment for their contributions to data collection , Ou\u0026eacute;draogo Sosth\u0026egrave;neand Ky Bienvenue D\u0026eacute;sir\u0026eacute;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Ferlay J, Soerjomataram I, Siegel R L, Torre L A and Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin 2018 Sept 12: 392\u0026ndash;424.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu L, Tian T, Yao K, Chen X-F, Luo G, Gao Y, et al. Global Pattern and Trends in Penile Cancer Incidence: Population-Based Study. JMIR Public Health Surveill. 2022; 8:348\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB Kirakoya, A Ouedraogo, M Simpore, FA Kabore. Epid\u0026eacute;miologie des cancers urologiques au centre hospitalier universitaire Yalgado Ouedraogo (Burkina Faso). Jaccr Africa fevr 2020; 4(1) : 165\u0026ndash;170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOuattara A, Hodonou R, Avakoudjo J, Cisse D, Zango B, Gandaho I, et al. \u0026Eacute;pid\u0026eacute;miologie des cancers urologiques au Centre national hospitalier universitaire Hubert Koutoukou Maga Cotonou, B\u0026eacute;nin. Analyse d\u0026rsquo;une s\u0026eacute;rie hospitali\u0026egrave;re de 158 cas. Prog En Urol. 2012; 22 :261\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOuedraogo S, Traore MT, Kambire JL, Ouedraogo S, Bere B, Kabore AF. Les cancers urologiques primitifs dans un contexte de ressources limit\u0026eacute;es: \u0026eacute;pid\u0026eacute;miologie et traitement. Bull Cancer (Paris). 2019 ; 106 :868\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGueye SM, Diagne BA, Ba M, Sylla C, Mensah A. Le cancer de la verge: aspects \u0026eacute;pid\u0026eacute;miologiques et probl\u0026egrave;mes th\u0026eacute;rapeutiques au S\u0026eacute;n\u0026eacute;gal. M\u0026eacute;d Afr Noire 1992; 39: 582\u0026ndash;584.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiallo I, Diam\u0026eacute; I, Diouf C, Faye S, Thiam A, Yaya A, et al. Les cancers urog\u0026eacute;nitaux en r\u0026eacute;gion p\u0026eacute;riph\u0026eacute;rique de S\u0026eacute;n\u0026eacute;gal: \u0026agrave; propos de 156 cas. J Afr Urol. 2021; 27 : 9\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTseng H-FT. Risk factors for penile cancer: results of a population-based case_control study in Los Angeles County (United States), Cancer Causes and Control. 2001; 267\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRimtebaye K, Mahamat MA, Kimassoum FR, Nemia FM, Djekoundade A, Andjeffa V et al. Clinical Characteristics and Difficulties in the Management of Cancer of the Penis. Open J Urol. 2021; 11 : 436\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKambou T, Ouattara A, Zar\u0026eacute; C, Zango B, Kabor\u0026eacute; AF, Kons\u0026eacute;gr\u0026eacute; V, et al. Le cancer de la verge \u0026agrave; Bobo-Dioulasso (Burkina-Faso). A propos de 3 cas et revue de la litt\u0026eacute;rature. J Afr Cancer Afr J Cancer. 2015; 7 : 64\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDembel\u0026eacute; B. Circoncision, Enqu\u0026ecirc;te D\u0026eacute;mographique et de Sant\u0026eacute; -III. 2003, 13: 225\u0026ndash;231.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavoie PH, Murez T, Neuville P, Ferretti L, Rocher L, Van Hove A, et al. French AFU Cancer Committee Guidelines - Update 2022\u0026ndash;2024: penile cancer. Prog En Urol. 2022; 32:1010\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNouri A, Elkarni H, Yacoubi SE, Karmouni T, Kahder KE, Koutani A, et al. Cancer du p\u0026eacute;nis: A propos de 6 cas avec Revue de la litt\u0026eacute;rature. Afr J Urol. 2012 ; 18 : 66\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHouyem Mansouri. Cancers primitifs de la verge: \u0026agrave; propos de 11 cas et revue de la litt\u0026eacute;rature. Pan Afr Med J 2018, 311\u0026ndash;4\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOndziel Opara SA. Cancer du p\u0026eacute;nis \u0026agrave; Brazzaville: Analyse d\u0026rsquo;une s\u0026eacute;rie de 13 cas. VOL 18 N\u0026deg; 2. Annales de l\u0026rsquo;universit\u0026eacute; Marien Ngouabi. 2018 ; 18(2) 37\u0026ndash;43\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgendahayo E, Nzayirambaho M, Bonane A, Gasana GA, Umurangwa F, et al. Pattern and clinical management of penile cancer in Rwanda. Afr J Urol. 2018; 24: 274\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSow Y, Thiam A, Fall B, Coulibali M, Sarr A, Diao B, et al. Cancer du p\u0026eacute;nis au S\u0026eacute;n\u0026eacute;gal: aspects cliniques et th\u0026eacute;rapeutiques. Basic Clin Androl. 2012; 22: 102\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOdz\u0026eacute;b\u0026eacute; AWS, Bouya PA, Nkoua Mbon JB, Ngatsh\u0026eacute; A, P\u0026eacute;ko JF. Le cancer de la verge: \u0026agrave; propos d\u0026rsquo;un cas et revue de la litt\u0026eacute;rature. Basic Clin Androl. 2010 ; 20 : 273\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSow M, Nk\u0026eacute;goum B, Oyono J-LE, Nzokou A. Aspects \u0026eacute;pid\u0026eacute;miologiques et histopathologiques des tumeurs urog\u0026eacute;nitales au Cameroun. Prog En Urol. 2006; 16, 36\u0026ndash;39\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable I:\u003c/strong\u003e Distribution of Patients by Risk Factors\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"626\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n = 13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot circumcised or delayed circumcision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69,23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHPV infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15,38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHIV infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23,08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSexual partners Multiple and polygamy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84,62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTobacco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23,08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePhimosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7,69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow socio-economic level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61,54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Penis cancer, squamous cell carcinoma, lymphoma, penectomy","lastPublishedDoi":"10.21203/rs.3.rs-6523889/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6523889/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThrough a retrospective study carried out over a period of 16 years. We report the diagnostic and therapeutic aspects of rod cancer in our department. During the study period, 13 cases of penis cancer were monitored. Their diagnostic aspects are essentially marked by a delay in diagnosis. Diagnosis is made at an advanced stage of pathology with limited therapeutic choices. Penectomy was the main therapeutic indication in our patients. However, a low rate of achievement of this penectomy has been found. For psychosocial reasons, achieving penectomy is always difficult in our context.\u003c/p\u003e","manuscriptTitle":"Diagnostic and therapeutic aspects of penis cancer in CHU Yalgado Ouédraogo","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 05:39:24","doi":"10.21203/rs.3.rs-6523889/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9d2ef1c-84e6-4e52-a441-bbda9a765901","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-14T00:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-19 05:39:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6523889","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6523889","identity":"rs-6523889","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}