Abundant information is available on West African drought and its hydrological and environmental impacts. Land-use and climatic changes have greatly modified the conditions of Sudanian and Sahelian hydrology, impacting the regime and discharge of the main rivers. Human pressure on the environment (significant increase in crops and disappearance of natural bushes and landscapes, for example) has led to severe soil crusting and desertification throughout Sahelian regions. Despite recent increases in rainfall, the drought has not ended, resulting in two different hydrological evolutions. In the Sudanian areas, stream flows have been reduced, sometimes as much as twice the rainfall reduction rate. In the Sahelian regions, runoff coefficients have increased to such a degree that discharges are increasing, in spite of the reduced rainfall. The main goal of this paper is to synthesize the recent advances in the Sahelian and Sudano-Sahelian West African hydrology. The other objectives are two fold: First, to discuss the “Sahelian Paradox” (the increase in runoff in most of the Sahel during the drought, at least during the 1968–1995 period, as described in the 1980s) and paradox of groundwater highlighted in the square degree of Niamey (the rise in water table levels in some endorheic areas during the same drought, evidenced in the 1990s), and second, to attempt to define the application of their respective geographical areas. The land-use changes act as a general factor of hydrological evolution of soils and basins, while some spatial factors explain the great variability in the response to environmental evolution, such as endorheism, geological context, latitudinal climate gradient, and local hydrodynamic behaviour of environment. This paper is literature-based, and incorporates current research advances in the field, as well as a prospective focused on resources and socio-economic impacts.