Modified Extensive Anterior Vaginal Wall Repair for Cystocoele

We describe a new transvaginal technique for cystocoele repair. We prospectively evaluated patients with moderate and high-grade cystocoele who underwent repair with the new transvaginal repair between 2000 and June 2009. Preoperative evaluation included history and physical examination using the Pelvic Organ Prolapse Quantification, urine culture, residual urine measurement, urodinamycs and cystoscopy. We performed the repair in 76 patients with a mean age of 65.24 years (range, 36 to 84 years), wit anatomical cure in 72 (95%) patients. Four (5%) patients had recurrent cystocoele, 3 (4%) patients claimed residual sensory urgency and 4 (5%) stress urinary incontinence (SUI) after the operation. The operation is safe, simple, and provides good anatomic results with minimal complications

Transrectal Sonography in Prostate Cancer Detection – Our 25 Years Experience of Implementation

Prostate cancer is a leading public health problem of male population in developed countries. Gold standard for prostate cancer diagnosis is true cut biopsy guided by transrectal ultrasound1–5. Aim of this study was to determine sensitivity, specificity, accuracy, positive and negative predictive value of transrectal sonography (TRUS) in prostate cancer detection. The analysis was made for two time periods, before and after routine implementation of prostate specific antigen (PSA) in prostate cancer diagnostics. From 1984 to 1993 TRUS guided prostate biopsy was performed in 564, and from 1994 to 2008 in 5678 patients. In the second period PSA was routinely used in prostate cancer diagnostics. In the first period by TRUS we have made an exact diagnosis of prostate cancer in 18.97% of patients what was confirmed by biopsy. 4.61% ware false positive and 11.34% ware false negative. In the second period prostate cancer was recognized in 30.34% of patients, confirmed by biopsy. False positive cases ware 6.11% and false negative 29.31%. Sensitivity of transrectal sonography in the first period was 62.57%, specificity 94.2%, accuracy 86.2%, positive predictive value 80.45% and negative predictive value 87.72%. In the second period sensitivity was 50.87%, specificity 91.93%, accuracy 73.84%, positive predictive value 83.24% and negative predictive value 70.39%. Based on our experience we can conclude that prostate cancer is mostly found in the peripheral zone. Smaller tumors are hipoechoic and bigger tumors are hiperechoic. Prostate cancer lesions are impossible to differentiate from chronic prostatitis only by TRUS. Implementation of PSA has significantly decrease sensitivity, accuracy and negative predictive value of TRUS in prostate cancer detection. TRUS guided true cut biopsy is a gold standard in prostate cancer diagnostics

Influence of Insolation on Osteoporosis Progression in Androgen Deprived Nonmetastatic Prostate Cancer Patients

Prostate cancer is a major public health problem in all the developed countries. Increasing numbers of men with nonmetastatic prostate cancer are receiving long-term androgen deprivation therapy (ADT). ADT is associated the loss of bone mineral density and a increased risk of bone fractures. The standard recommendations for male bone health include above all optimizing calcium and vitamin D intake, and exercise. Vitamin D3 is an essential factor in the maintenance of bone health and calcium homeostasis. The main supply of vitamin D3 is obtained through photosynthesis in the skin. The aim of this study was to investigate the influence of insolation on osteoporosis progression in androgen deprived nonmetastatic prostate cancer patients. We divided our androgen deprived prostate cancer patients in 2 groups. The first group (A) consists of 224 patients with insolation rate less then 3h per week. The second group (B) consists of 174 patients with insolation rate greater then 10h per week. With a questionnaire we determined, that patients from both groups were 70 to 80 years old, body mass index was 25–30 kg/m2, androgen deprivation was 4–6 years and received no vitamin D supplements. In the group A 21.86% suffered pathologic fractures do to osteoporosis. In the group B 10.92% patients suffered from osteoporotic bone fractures. The risk for pathological bone fractures is significantly greater in the group A. In conclusion higher insolation in androgen deprived nonmetastatic prostate cancer patients significantly decreases the osteoporosis progression and the risk of pathologic bone fractures

ORTHOTOPIC KIDNEY TRANSPLANTATION – A CASE REPORT

Transplantacija bubrega najbolji je oblik liječenja bolesnika u završnom stadiju kroničnoga bubrežnog zatajenja. Najčešće se radi heterotopna transplantacija bubrega s implantacijom presatka u ilijakalnu ložu. U nekih bolesnika, zbog prethodnih transplantacija ili izražene ateroskleroze ilijakalnih krvnih žila, heterotopna transplantacija nije moguća. Prikladna alternativa za te pacijente jest ortotopna transplantacija. U članku izvješćujemo o bolesniku s jako izraženom aterosklerozom ilijakalnih arterija, kojemu smo učinili uspješnu ortotopnu transplantaciju bubrega.Kidney transplantation is the treatment of choice in patients with end-stage renal disease. Heterotopic kidney transplantation is the most common technique used. Some patients with severe vascular pathology of iliac vessels or retained iliac fossae after previous transplantations are no more candidates for heterotopic kidney transplantation. In these patients, the orthotopic kidney transplantation represents an appropriate alternative. We present a patient with end-stage renal disease and severe atherosclerosis of iliac vessels which preclude heterotopic transplantation. In our patient a successful orthotopic kidney transplantation was done

Transrectal Sonography in Prostate Cancer Detection – Our 25 Years Experience of Implementation

Prostate cancer is a leading public health problem of male population in developed countries. Gold standard for prostate cancer diagnosis is true cut biopsy guided by transrectal ultrasound1–5. Aim of this study was to determine sensitivity, specificity, accuracy, positive and negative predictive value of transrectal sonography (TRUS) in prostate cancer detection. The analysis was made for two time periods, before and after routine implementation of prostate specific antigen (PSA) in prostate cancer diagnostics. From 1984 to 1993 TRUS guided prostate biopsy was performed in 564, and from 1994 to 2008 in 5678 patients. In the second period PSA was routinely used in prostate cancer diagnostics. In the first period by TRUS we have made an exact diagnosis of prostate cancer in 18.97% of patients what was confirmed by biopsy. 4.61% ware false positive and 11.34% ware false negative. In the second period prostate cancer was recognized in 30.34% of patients, confirmed by biopsy. False positive cases ware 6.11% and false negative 29.31%. Sensitivity of transrectal sonography in the first period was 62.57%, specificity 94.2%, accuracy 86.2%, positive predictive value 80.45% and negative predictive value 87.72%. In the second period sensitivity was 50.87%, specificity 91.93%, accuracy 73.84%, positive predictive value 83.24% and negative predictive value 70.39%. Based on our experience we can conclude that prostate cancer is mostly found in the peripheral zone. Smaller tumors are hipoechoic and bigger tumors are hiperechoic. Prostate cancer lesions are impossible to differentiate from chronic prostatitis only by TRUS. Implementation of PSA has significantly decrease sensitivity, accuracy and negative predictive value of TRUS in prostate cancer detection. TRUS guided true cut biopsy is a gold standard in prostate cancer diagnostics

Operative technique and urological complications in kidney transplantation

Between January 30, 1971 and January 30, 2004, 767 kidney transplants were performed at our center, 348 (45.37%) from living related donor and 419 (54.63%) from cadaver. During first eight years an ureteroureterostomy was routinely used. The notable incidence of urological complications (fistula 12%, complications of stenting 10.7%, stenosis and lithiasis 4%) was observed after 140 transplants. Majority of these complications (60%) were treated conservatively. A significant reduction in this incidence (P <0.001) was achieved (fistula 1.12%, complications of stenting 0.32%, lithiasis 0.16%) by introducing an extravesical ureteroneo-cystostomy by Lich-Gregoire. Stenosis had the highest incidence (3.67%). Unfortunately two patients with urinary fistula died in the early phase of its application, before the routine use of ultrasound. Majority of complications (82%) were treated surgically. A native ureter was commonly used in replacing the transplant ureter. In majority of patients an end-to-end pyelo(uretero)stomy was performed. Two patients were reoperated because of fistula, and the third had a prolonged healing. In last five patients with urological complicatons an end-to-side pyelo(uretero)stomy was done. There was no urinary leakage. The safety of method results probably from an intact native ureter which has normal blood irrigation

Transrectal Sonography in Prostate Cancer Detection – Our 25 Years Experience of Implementation

Prostate cancer is a leading public health problem of male population in developed countries. Gold standard for prostate cancer diagnosis is true cut biopsy guided by transrectal ultrasound1–5. Aim of this study was to determine sensitivity, specificity, accuracy, positive and negative predictive value of transrectal sonography (TRUS) in prostate cancer detection. The analysis was made for two time periods, before and after routine implementation of prostate specific antigen (PSA) in prostate cancer diagnostics. From 1984 to 1993 TRUS guided prostate biopsy was performed in 564, and from 1994 to 2008 in 5678 patients. In the second period PSA was routinely used in prostate cancer diagnostics. In the first period by TRUS we have made an exact diagnosis of prostate cancer in 18.97% of patients what was confirmed by biopsy. 4.61% ware false positive and 11.34% ware false negative. In the second period prostate cancer was recognized in 30.34% of patients, confirmed by biopsy. False positive cases ware 6.11% and false negative 29.31%. Sensitivity of transrectal sonography in the first period was 62.57%, specificity 94.2%, accuracy 86.2%, positive predictive value 80.45% and negative predictive value 87.72%. In the second period sensitivity was 50.87%, specificity 91.93%, accuracy 73.84%, positive predictive value 83.24% and negative predictive value 70.39%. Based on our experience we can conclude that prostate cancer is mostly found in the peripheral zone. Smaller tumors are hipoechoic and bigger tumors are hiperechoic. Prostate cancer lesions are impossible to differentiate from chronic prostatitis only by TRUS. Implementation of PSA has significantly decrease sensitivity, accuracy and negative predictive value of TRUS in prostate cancer detection. TRUS guided true cut biopsy is a gold standard in prostate cancer diagnostics

Modified Extensive Anterior Vaginal Wall Repair for Cystocoele

We describe a new transvaginal technique for cystocoele repair. We prospectively evaluated patients with moderate and high-grade cystocoele who underwent repair with the new transvaginal repair between 2000 and June 2009. Preoperative evaluation included history and physical examination using the Pelvic Organ Prolapse Quantification, urine culture, residual urine measurement, urodinamycs and cystoscopy. We performed the repair in 76 patients with a mean age of 65.24 years (range, 36 to 84 years), wit anatomical cure in 72 (95%) patients. Four (5%) patients had recurrent cystocoele, 3 (4%) patients claimed residual sensory urgency and 4 (5%) stress urinary incontinence (SUI) after the operation. The operation is safe, simple, and provides good anatomic results with minimal complications

Modified Extensive Anterior Vaginal Wall Repair for Cystocoele

We describe a new transvaginal technique for cystocoele repair. We prospectively evaluated patients with moderate and high-grade cystocoele who underwent repair with the new transvaginal repair between 2000 and June 2009. Preoperative evaluation included history and physical examination using the Pelvic Organ Prolapse Quantification, urine culture, residual urine measurement, urodinamycs and cystoscopy. We performed the repair in 76 patients with a mean age of 65.24 years (range, 36 to 84 years), wit anatomical cure in 72 (95%) patients. Four (5%) patients had recurrent cystocoele, 3 (4%) patients claimed residual sensory urgency and 4 (5%) stress urinary incontinence (SUI) after the operation. The operation is safe, simple, and provides good anatomic results with minimal complications

Operative technique and urological complications in kidney transplantation

Between January 30, 1971 and January 30, 2004, 767 kidney transplants were performed at our center, 348 (45.37%) from living related donor and 419 (54.63%) from cadaver. During first eight years an ureteroureterostomy was routinely used. The notable incidence of urological complications (fistula 12%, complications of stenting 10.7%, stenosis and lithiasis 4%) was observed after 140 transplants. Majority of these complications (60%) were treated conservatively. A significant reduction in this incidence (P <0.001) was achieved (fistula 1.12%, complications of stenting 0.32%, lithiasis 0.16%) by introducing an extravesical ureteroneo-cystostomy by Lich-Gregoire. Stenosis had the highest incidence (3.67%). Unfortunately two patients with urinary fistula died in the early phase of its application, before the routine use of ultrasound. Majority of complications (82%) were treated surgically. A native ureter was commonly used in replacing the transplant ureter. In majority of patients an end-to-end pyelo(uretero)stomy was performed. Two patients were reoperated because of fistula, and the third had a prolonged healing. In last five patients with urological complicatons an end-to-side pyelo(uretero)stomy was done. There was no urinary leakage. The safety of method results probably from an intact native ureter which has normal blood irrigation