Macroscopic Hematuria—A Leading Urological Problem in Patients on Anticoagulant Therapy: Is the Common Diagnostic Standard Still Advisable?

All urological standards of care are based on the past definition of the clinical importance of macroscopic hematuria. The aim of the study was to assess the phenomenon of iatrogenic hematuria in current clinical practice and analyze its origins in patients receiving anticoagulant drugs. Retrospective analysis of clinical documentation of 238 patients that were consulted for hematuria in 2007–2009 by 5 consultant urologists was performed. In the group of 238 patients with hematuria, 155 (65%) received anticoagulants. Abnormalities of urinary tract were found in 45 (19%) patients. Estimated cost of a single neoplasm detection reached the value of 3252 Euro (mean 3-day hospitalization). The strong correlation between the presence of hematuria and anticoagulant treatment was observed. Authors suggest to redefine the present and future role of hematuria from a standard manifestation of serious urological disease to a common result of a long-term anticoagulant therapy

Technique of transurethral needle core biopsy to confirm invasive bladder cancer staging

Introduction: Transurethral, cystoscopically-guided needle core biopsy (TUcoreBxBT) seems to be a less invasive diagnostic method than transurethral resection (TURBT) offering a simple way to confirm cancer infiltration of the bladder. The aim of this study was to assess the technique of TUcoreBxBT in the diagnosis of bladder cancer infiltrating the detrusor muscle. Material and methods: In every 96 pts the suspicion of invasive bladder cancer (IBC) was evaluated on the basis of radiological examinations, cystoscopy and bimanual examination. TUcoreBxBT were performed using a rigid cystoscope with a direct working channel and tru-cut automatic (COOK Quick-Core® BiopsyNeedle) 18 G/480 mm needle or self construction tru-cut 16 G/400 mm needle, adapted to work with a standard biopsy gun. At least three cores were taken in each patient, followed by regular TURBT. Results: There were no complications of the bladder biopsy procedure. The average size of cores was 15 mm (8-17 mm). In every case TUcoreBxBT revealed muscle infiltration and was in agreement with all microscopic examinations of TURBT. Conclusions: TUcoreBxBT in cases of clear suspicion of invasive bladder cancer is a simple, short and safe procedure which makes it possible to collect reliable material for microscopic examination. TUcoreBxBT is less invasive than standard TURBT only in diagnosis and staging of invasive tumours, and seems to be effective in selected cases to confirm malignancy before radical cystectom

Renal carcinoma infiltrating inferior vena cava and combined valvular heart disease - one-stage uro-cardiological procedure: a case report

Standard treatment of patients with coexisting cardiac and non-cardiac diseases includes two separate operations. We report a case of 55-year-old man with combined valvular heart disease and renal carcinoma infiltrating inferior caval vein, who underwent one-stage cardio-urologic procedure. In the first step, mitral and tricuspid valvuloplasty were performed by cardiac surgeons. Then, urologists performed radical nephrectomy and thrombectomy. The postoperative course was uneventful. In twelve months follow-up the patient shows no signs of reccurrence and he had no symptoms of cardiac disease. To the best of our knowledge such a case has never been reported before in the literature

Recommendations on the management of prostate cancer - a round table conference

Rak gruczołu krokowego jest jednym z najczęściej rozpoznawanych nowotworów u mężczyzn w wielu krajach Europy i w Ameryce Północnej. W ostatnich latach obserwuje się istotny wzrost liczby zachorowań, co w pierwszej kolejności można wiązać z wydłużeniem średniej długości życia i wprowadzeniem pod koniec lat 80. powszechnego oznaczania stężenia swoistego antygenu sterczowego (PSA) w surowicy. Podstawowymi metodami leczenia chorych na wczesnego raka gruczołu krokowego są zabieg chirurgiczny i radioterapia. U wybranych chorych o krótkim spodziewanym czasie przeżycia i niskim stopniu złośliwości histologicznej można rozważyć jedynie ścisłą obserwację. Leczenie chorych na zaawansowanego raka gruczołu krokowego polega na zmniejszeniu wpływu stymulującego działania androgenów na komórki raka w wyniku tak zwanej ablacji androgenowej. Pozwala ona na osiągnięcie poprawy subiektywnej, obniżenie stężenia PSA w surowicy oraz obiektywną regresję nowotworu (guza pierwotnego i/lub przerzutów w tkankach miękkich) u około 80% chorych. Wysoka zachorowalność na raka gruczołu krokowego i wciąż niezadowalające wyniki leczenia tego nowotworu stały się przyczyną potrzeby sformułowania jednolitych zasad postępowania diagnostyczno- -terapeutycznego opartego na dowodach o charakterze naukowym i wykorzystującego możliwość ścisłej współpracy lekarzy urologów oraz onkologów. Przedstawione w obecnym opracowaniu zalecenia stanowią wspólne stanowisko grupy ekspertów w dziedzinie urologii, onkologii i patomorfologii, które przyjęto podczas spotkania okrągłego stołu oraz uaktualniono na podstawie późniejszych doniesień.Prostate cancer is one of the most common male malignancies in most European countries and the US. A significant increase in the number of new cases has been observed over the last years, most probably due to increase in the life span and introduction of PSA in the 1980s. Two main treatment modalities of early prostate cancer are surgery and radiotherapy. In selected patients with short life expectancy and low histological grade of the tumor, watchful waiting is acceptable. Treatment of advanced prostate cancer is based on inhibition of stimulatory effect of androgens on prostate cancer cells. Androgen ablation allows for subjective improvement, PSA decrease and objective tumor regression in 80% of patients. High incidence of prostate cancer and unsatisfactory results of its treatment created a demand for uniform, evidence-based diagnostic and therapeutic guidelines. Recommendations presented in this paper were prepared during a round table meeting of experts in urology, oncology and pathology, and updated with most current literature data

Wytyczne profilaktyki przeciwzakrzepowej u chorych onkologicznych, ze szczególnym uwzględnieniem pacjentów leczonych operacyjnie

Żylna choroba zakrzepowo-zatorowa (ŻChZZ), mimo że często występuje na różnych etapach rozwoju procesu nowotworowego, stanowi ciągle niedoceniany problem w populacji chorych onkologicznych. Terapia przeciwnowotworowa, zabiegi operacyjne czy znacznego stopnia zaawansowanie choroby nowotworowej to tylko niektóre czynniki ryzyka ŻChZZ, stanowiącej nadal jedną z najczęstszych przyczyn zgonu w populacji pacjentów onkologicznych. Zróżnicowanie ryzyka wystąpienia zakrzepicy żył głębokich (ZŻG) oraz ryzyka powikłań, w tym powikłań krwotocznych, pomiędzy poszczególnymi grupami chorych onkologicznych sugeruje przeprowadzenie indywidualnej oceny ryzyka i postępowanie profilaktyczne zależne od sytuacji klinicznej konkretnego pacjenta. Uzasadnia to także stałą aktualizację wytycznych postępowania profilaktycznego proponowanego chorym onkologicznym. W dokumencie przedstawiono oparte na przeglądzie piśmiennictwa zasady postępowania profilaktycznego w populacji chorych onkologicznych, ze szczególnym uwzględnieniem profilaktyki przeciwzakrzepowej w dyscyplinach zabiegowych

Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question

Introduction: The development of endovision techniques and equipment miniaturization in urology make it possible to perform laparoendoscopic single-site (LESS) nephrectomy. Radical nephrectomy due to renal cancer performed with LESS is not a standard procedure in urology. Aim: To present our preliminary results and operative technique of LESS radical nephrectomy.Material and methods: The study was carried out after team experience based on LESS radical nephrectomy performed from October 2009 to June 2010 in 11 cases. A single port with 3 working channels (Triport Access System, OLYMPUS®) and a 5 mm laparoscope 30° were used. The approach was created by minilaparotomy technique on the lateral margin of the rectus muscle, 4 cm above the umbilicus. The procedure was performed using standard laparoscopic instruments, bent or articulating graspers, and scissors. During the surgery metal and plastic clips were used, and a mechanical vascular stapler in two cases. In every case bipolar coagulation was used. The postoperative specimen was removed via single-port minilaparotomy. After surgery, one suction drain 14 F was left.Results: In all patients the procedure was performed without conversion to standard, open technique. In two cases accessory port (10 and 12 mm) placement was necessary, for organ retraction or insertion of a vascular stapler. Mean surgery time was 128 min (120-160 min). Mean blood loss was 155 ml (100-250 ml). There were no complications during surgery or the postoperative period. Mean hospitalization stay was 4 days (3-5 days). Clinical stage of renal cell cancer (RCC) was pT1a in 1, pT1b in 9, and pT3a in 1 patient. The results of histopathological examination show typical RCC in 10 cases, and papillary RCC in 1.Conclusions: LESS nephrectomy is effective but technically difficult. LESS nephrectomy is a considerably less invasive procedure than standard laparoscopic nephrectomy, unless accessory port placement is necessary. LESS offers a very good cosmetic effect, which can be an attribute of the single-site approach. LESS radical nephrectomy makes it possible to perform efficient and safe kidney excision and seems to be a valuable alternative to classic surgery in properly selected cases