Klinička praksa hrvatskih urologa i usklađenost sa smjernicama u liječenju simptoma donjeg mokraćnog trakta u muškaraca

The aim of this study was to assess the Croatian urologists’ management of non-neurogenic male lower urinary tract symptoms (LUTS) and their compliance with the European Association of Urology (EAU) guidelines. A cross-sectional survey included 51/179 Croatian urologists. We developed a questionnaire with questions addressing compliance with EAU guidelines. The rate of performing recommended evaluations on the initial assessment of patients with benign prostate hyperplasia (BPH)/LUTS varied from 8.0% (serum creatinine and voiding diary) to 100.0% (physical examination, prostate specific antigen and ultrasound). The international prostate symptom score was performed by 31%, analysis of urine sediment by 83%, urine culture by 53%, and serum creatinine by 8% of surveyed urologists. Only 8% of urologists regularly used bladder diary in patients with symptoms of nocturia. Our results indicated that 97% of urologists preferred alpha blockers as the first choice of treatment; 5-alpha reductase inhibitors (5ARI) were mostly prescribed (84%) in combination with an alpha-blocker, preferably as a continuous treatment, whilst 29% of urologists used to discontinue 5ARI after 1-2 years. Half of the Croatian urologists used antimuscarinics in the treatment of BPH/LUTS and recommended phytotherapeutic drugs in their practice. In conclusion, Croatian urologists do not completely comply with the guidelines available.Cilj ovoga istraživanja bio je uvrditi kliničku praksu hrvatskih urologa u pristupu bolesnicima sa simptomima donjeg mokraćnog trakta (LUTS) i njihovo pridržavanje Smjernica Europskoga urološkog društva (EAU). Provedeno je presječno istraživanje među 51/179 (28%) hrvatskih urologa. Izradili smo upitnik koji sadrži pitanja glede poštivanja smjernica EAU. Primjena preporučenih pretraga u početnoj procjeni bolesnika s benignom hiperplazijom prostate (BPH)/LUTS varirala je od 8,0% (kreatinin i dnevnik mokrenja) do 100,0% (fizikalni pregled, antigen specifičan za prostatu (PSA) i ultrazvuk). U početnoj procjeni bolesnika s BPH/LUTS uz anamnezu i digitorektalni pregled hrvatski urolozi primjenjuju još PSA i ultrazvuk (100%). Međunarodni zbroj prostatičnih simptoma (IPSS) primjenjuje 31%, analizu sedimenta mokraće 83%, kulturu mokraće 53%, a serumski kreatinin 8% ispitanih urologa. Samo 8% urologa redovito koristi dnevnik mokrenja kod bolesnika sa simptomima nokturije. Rezultati su pokazali kako 62% hrvatskih urologa smatra da provodi dijagnostičku obradu koja je u skladu sa smjernicama EAU. U terapijskom pogledu rezultati pokazuju da 97% urologa smatra alfa blokatore lijekom prvog izbora. Inhibitori 5-alfa reduktaze (5ARI) uglavnom (84%) su propisani u kombinaciji s alfa-blokatorima, ponajprije kao kontinuirano liječenje, dok 29% prekida 5ARI nakon 1-2 godine. Polovica hrvatskih urologa rabi antimuskarinike u liječenju BPH/LUTS i preporučuje fitoterapiju u svojoj praksi. Praksa hrvatskih urologa nije u potpunosti usklađena sa smjernicama

Relationship between recipient and donor factors and kidney transplant outcome

Cilj: Iako je transplantacija bubrega najbolja metoda nadomještanja bubrežne funkcije, još uvijek postoji potreba za poboljšanjem dugoročnih ishoda. Cilj rada bio je utvrditi neovisnu povezanost demografskih čimbenika primatelja i darivatelja, osnovne bubrežne bolesti, trajanja liječenja dijalizom, tkivne nepodudarnosti i senzibilizacije s ishodima transplantacije u suvremenoj kohorti pacijenata kojima je presađen bubreg. Ispitanici i metode: U istraživanje su uključeni pacijenti kojima je transplantiran bubreg u Kliničkoj bolnici Merkur od lipnja 2007. do kraja 2018. god. Ishodi transplantacije praćeni su do 31. 12. 2019. godine. Najkraće vrijeme praćenja bila je jedna godina. Podaci su prikupljeni korištenjem izvješća iz aplikacije Eurotransplant Network Information System (ENIS; www.eurotransplant.org). Preživljenje je prikazano Kaplan-Meierovim krivuljama. Povezanost preživljenja s određenim obilježjima primatelja i darivatelja analizirana je univarijatnom i multivarijatnom Coxovom regresijom. Rezultati: U razdoblju od lipnja 2007. do konca 2018. presađeno je 480 bubrega u 472 pacijenta. 10-godišnje preživljenje pacijenata iznosilo je 72 %. Desetgodišnje preživljenje bubrega cenzurirano za smrt pacijenata s bubregom u funkciji bilo je 93 %. U multivarijatnoj analizi jedino dob primatelja pri transplantaciji, šećerna bolest kao uzrok osnovne bubrežne bolesti i trajanje liječenja dijalizom ostali su neovisno povezani s preživljenjem pacijenata. Zaključak: Transplantacija bubrega rezultira odličnim dugoročnim preživljenjem bubrega. Potrebno je poboljšati dugoročno preživljenje pacijenata, prevencijom, ranim otkrivanjem i intenzivnim liječenjem kroničnih bolesti.Aim: Although kidney transplantation is the best method of replacing renal function, there is still a need to improve long-term outcomes. The aim of this study was to determine the independent association of recipient and donor demographic factors, underlying renal disease, duration of dialysis treatment, tissue typing mismatch, and sensitization with transplant outcomes in a contemporary cohort of kidney transplant patients. Patients and methods: The study included patients who had a kidney transplantation at Clinical Hospital Merkur from June 2007 to the end of 2018. Transplant outcomes were monitored until December 31, 2019. The minimum follow-up time was 1 year. Data were collected using reports from the Eurotransplant Network Information System (ENIS) application (www.eurotransplant.org). Survival is shown by Kaplan-Meier curves. The association of survival with specific recipient and donor characteristics was analyzed by univariate and multivariate Cox regression. Results: In the period from June 2007 to the end of 2018, 480 kidneys were transplanted in 472 patients. The 10-year patient survival was 72%. Ten-year renal survival censored for the death of renal function patients was 93%. In the multivariate analysis, only recipient age at transplantation, diabetes as the cause of underlying renal disease and duration of dialysis remained independently associated with patient survival. Conclusion: Long-term graft survival is excellent after kidney transplantation. Long-term patient survival can be improved by prevention, early detection and intensive treatment of chronic diseases

The effect of pretransplant dialysis modality on the outcome of renal transplantation

Uvod: Kronična bubrežna bolest je globalna bolest koja prvenstveno zahvada stariju populaciju te predstavlja veliki financijski trošak za svaki zdravstveni sustav. Liječenje kronične bubrežne bolesti se provodi putem dijalize ili transplantacijom bubrega. Cilj istraživanja je vidjeti povezanost tipa dijalize prije transplantacije na ishod transplantacije bubrega. Ispitanici i metode: U ovu retrospektivnu studiju su uključeni svi primatelji bubrega, odnosno pankreasa i bubrega, u razdoblju od 2007. do 2013. godine u KB Merkur, Zagreb. Rezultati: U istraživanje je uključeno 280 bolesnika (106 muškaraca i 174 žene). Od ukupnog broja transplantacija je učinjeno 229 transplantacija bubrega te 51 simultana transplantacija bubrega i gušterače. Prije transplantacije vedina bolesnika je bila na HD (207) dok ih je 63 bilo na PD. Prema Kaplan Meier krivulji preživljenja petogodišnje preživljenje svih bolesnika iznosi 82.9 % dok preživljenje grafta iznosi 78.5%. U odnosu na tip dijalize prije transplantacije nije bilo statistički značajne razlike u preživljenju bolesnika (p=.09), preživljenju bubrega (p=.19) te u preživljenju grafta cenzuriranom za smrt bolesnika (p=.16). Incidencija svih infekcija u prva tri mjeseca nakon transplantacije je iznosila 58.9% od čega su urinarne infekcije činile gotovo 50% svih infekcija. U odnosu na tip dijalize prije transplantacije nije bilo statistički značajne razlike u incidenciji infekcija. Iako je u univarijatnoj analizi tip dijalize prije transplantacije bio jedan od čimbenika koji su utjecali na vrijednost glomerularne filtracije isto se izgubio u multivarijatnoj analizi gdje su samo dob primatelja i darivatelja ostale statistički značajne varijable koje utječu na funkciju bubrega 6 i 12 mjeseci nakon transplantacije. Prosječna cijena transplantacije bubrega je iznosila 85.85±41.67 tisuda kuna, dok je za SPKT iznosila 111.84±89.20 tisuda kuna (p= .02). Nije bilo statistički značajne razlike u cijeni transplantacije u odnosu na tip dijalize prije transplantacije. Odgođena funkcija grafta, smrt bolesnika, vrsta transplantacije te preživljenje grafta cenzuriranog za smrt bolesnika su statistički značajne varijable povezane s cijenom transplantacije. Zaključak: Vrsta dijalize prije transplantacije ne utječe na preživljenje bolesnika i grafta, pojavnost infekcija i vrijednost glomerularne filtracije nakon transplantacije te na cijenu same transplantacije. Peritonejska dijaliza je jeftinija od hemodijalize te je manje financijsko opteredenje za javnozdravstveni sustav. Zbog toga se PD treba promovirati u metodu prvog odabira, kada je u pitanju liječenje dijalizom, u svih bolesnika koji nemaju kontraindikaciju za njezino provođenje.Introduction: Chronic renal disease is a global disease that primarily affects the elderly population and represents a major financial expense for all healthcare systems. Chronic renal disease is treated by dialysis or kidney transplantation. The goal of the research is to discover the connection between the type of dialysis before the transplantation and the outcome of the kidney transplantation. Test subjects and methods: This retrospective study includes all kidney recipients or pancreas and kidney recipients in the period from 2007. to 2013. at the University Hospital Merkur, Zagreb. Results: The research included 280 patients (106 male and 174 female). Of the total number of transplantations, there were 229 kidney transplantations and 51 simultaneous kidney and pancreas transplantations. Before the transplantation most of the patients were on HD (207), while 63 of them were on PD. According to the Kaplan-Meier survival curve, the five year survival of all the patients is 82.9 % while the graft survival is 78.5%). Considering the type of dialysis before the transplantation, there was no statistically significant differences in the survival of the patients (p=.09), kidney survival (p=.19), and graft survival censored for death of the patient (p=.16). The incidence of all infections in the first three months after transplantation was 58.9%, and 50% of all the infections were urinary infections. Considering the type of dialysis before transplantation, there were no statistically significant differences in the incidence of infections. Even though the type of dialysis before the transplantation was one of the factors that affected the value of glomerular filtration in the univariate analysis, it was lost in the multivariate analysis, where only the ages of the recipient and the donor remained as statistically significant variables that affect the function of the kidneys 6 and 12 months after the transplantation. The average price of a kidney transplantation was HRK 85.85±41.67 thousand, and for SPKT it was HRK 111.84±89.20 thousand (p= .02). There was no statistically significant difference in the price of the transplantation considering the type of dialysis before the transplantation. Delayed graft function, death of the patient, type of transplantation, and graft survival censored for death of the patient are statistically significant variables connected to the price of the transplantation. Conclusion: The type of dialysis before transplantation does not affect the survival of the patient and the graft, the incidence of infections, the value of glomerular filtration after the transplantation, or the price of the transplantation itself. That is why PD should be promoted as the first choice method for dialysis treatment of all the patients that do not have contraindications for its use

The effect of pretransplant dialysis modality on the outcome of renal transplantation

Uvod: Kronična bubrežna bolest je globalna bolest koja prvenstveno zahvada stariju populaciju te predstavlja veliki financijski trošak za svaki zdravstveni sustav. Liječenje kronične bubrežne bolesti se provodi putem dijalize ili transplantacijom bubrega. Cilj istraživanja je vidjeti povezanost tipa dijalize prije transplantacije na ishod transplantacije bubrega. Ispitanici i metode: U ovu retrospektivnu studiju su uključeni svi primatelji bubrega, odnosno pankreasa i bubrega, u razdoblju od 2007. do 2013. godine u KB Merkur, Zagreb. Rezultati: U istraživanje je uključeno 280 bolesnika (106 muškaraca i 174 žene). Od ukupnog broja transplantacija je učinjeno 229 transplantacija bubrega te 51 simultana transplantacija bubrega i gušterače. Prije transplantacije vedina bolesnika je bila na HD (207) dok ih je 63 bilo na PD. Prema Kaplan Meier krivulji preživljenja petogodišnje preživljenje svih bolesnika iznosi 82.9 % dok preživljenje grafta iznosi 78.5%. U odnosu na tip dijalize prije transplantacije nije bilo statistički značajne razlike u preživljenju bolesnika (p=.09), preživljenju bubrega (p=.19) te u preživljenju grafta cenzuriranom za smrt bolesnika (p=.16). Incidencija svih infekcija u prva tri mjeseca nakon transplantacije je iznosila 58.9% od čega su urinarne infekcije činile gotovo 50% svih infekcija. U odnosu na tip dijalize prije transplantacije nije bilo statistički značajne razlike u incidenciji infekcija. Iako je u univarijatnoj analizi tip dijalize prije transplantacije bio jedan od čimbenika koji su utjecali na vrijednost glomerularne filtracije isto se izgubio u multivarijatnoj analizi gdje su samo dob primatelja i darivatelja ostale statistički značajne varijable koje utječu na funkciju bubrega 6 i 12 mjeseci nakon transplantacije. Prosječna cijena transplantacije bubrega je iznosila 85.85±41.67 tisuda kuna, dok je za SPKT iznosila 111.84±89.20 tisuda kuna (p= .02). Nije bilo statistički značajne razlike u cijeni transplantacije u odnosu na tip dijalize prije transplantacije. Odgođena funkcija grafta, smrt bolesnika, vrsta transplantacije te preživljenje grafta cenzuriranog za smrt bolesnika su statistički značajne varijable povezane s cijenom transplantacije. Zaključak: Vrsta dijalize prije transplantacije ne utječe na preživljenje bolesnika i grafta, pojavnost infekcija i vrijednost glomerularne filtracije nakon transplantacije te na cijenu same transplantacije. Peritonejska dijaliza je jeftinija od hemodijalize te je manje financijsko opteredenje za javnozdravstveni sustav. Zbog toga se PD treba promovirati u metodu prvog odabira, kada je u pitanju liječenje dijalizom, u svih bolesnika koji nemaju kontraindikaciju za njezino provođenje.Introduction: Chronic renal disease is a global disease that primarily affects the elderly population and represents a major financial expense for all healthcare systems. Chronic renal disease is treated by dialysis or kidney transplantation. The goal of the research is to discover the connection between the type of dialysis before the transplantation and the outcome of the kidney transplantation. Test subjects and methods: This retrospective study includes all kidney recipients or pancreas and kidney recipients in the period from 2007. to 2013. at the University Hospital Merkur, Zagreb. Results: The research included 280 patients (106 male and 174 female). Of the total number of transplantations, there were 229 kidney transplantations and 51 simultaneous kidney and pancreas transplantations. Before the transplantation most of the patients were on HD (207), while 63 of them were on PD. According to the Kaplan-Meier survival curve, the five year survival of all the patients is 82.9 % while the graft survival is 78.5%). Considering the type of dialysis before the transplantation, there was no statistically significant differences in the survival of the patients (p=.09), kidney survival (p=.19), and graft survival censored for death of the patient (p=.16). The incidence of all infections in the first three months after transplantation was 58.9%, and 50% of all the infections were urinary infections. Considering the type of dialysis before transplantation, there were no statistically significant differences in the incidence of infections. Even though the type of dialysis before the transplantation was one of the factors that affected the value of glomerular filtration in the univariate analysis, it was lost in the multivariate analysis, where only the ages of the recipient and the donor remained as statistically significant variables that affect the function of the kidneys 6 and 12 months after the transplantation. The average price of a kidney transplantation was HRK 85.85±41.67 thousand, and for SPKT it was HRK 111.84±89.20 thousand (p= .02). There was no statistically significant difference in the price of the transplantation considering the type of dialysis before the transplantation. Delayed graft function, death of the patient, type of transplantation, and graft survival censored for death of the patient are statistically significant variables connected to the price of the transplantation. Conclusion: The type of dialysis before transplantation does not affect the survival of the patient and the graft, the incidence of infections, the value of glomerular filtration after the transplantation, or the price of the transplantation itself. That is why PD should be promoted as the first choice method for dialysis treatment of all the patients that do not have contraindications for its use

Utjecaj tipa dijalize prije transplantacije na ishod transplantacije bubrega [The effect of pretransplant dialysis modality on the outcome of renal transplantation]

Introduction: Chronic renal disease is a global disease that primarily affects the elderly population and represents a major financial expense for all healthcare systems. Chronic renal disease is treated by dialysis or kidney transplantation. The goal of the research is to discover the connection between the type of dialysis before the transplantation and the outcome of the kidney transplantation. Test subjects and methods: This retrospective study includes all kidney recipients or pancreas and kidney recipients in the period from 2007. to 2013. at the University Hospital Merkur, Zagreb. Results: The research included 280 patients (106 male and 174 female). Of the total number of transplantations, there were 229 kidney transplantations and 51 simultaneous kidney and pancreas transplantations. Before the transplantation most of the patients were on HD (207), while 63 of them were on PD. According to the Kaplan-Meier survival curve, the five year survival of all the patients is 82.9 % while the graft survival is 78.5%). Considering the type of dialysis before the transplantation, there was no statistically significant differences in the survival of the patients (p=.09), kidney survival (p=.19), and graft survival censored for death of the patient (p=.16). The incidence of all infections in the first three months after transplantation was 58.9%, and 50% of all the infections were urinary infections. Considering the type of dialysis before transplantation, there were no statistically significant differences in the incidence of infections. Even though the type of dialysis before the transplantation was one of the factors that affected the value of glomerular filtration in the univariate analysis, it was lost in the multivariate analysis, where only the ages of the recipient and the donor remained as statistically significant variables that affect the function of the kidneys 6 and 12 months after the transplantation. The average price of a kidney transplantation was HRK 85.85±41.67 thousand, and for SPKT it was HRK 111.84±89.20 thousand (p= .02). There was no statistically significant difference in the price of the transplantation considering the type of dialysis before the transplantation. Delayed graft function, death of the patient, type of transplantation, and graft survival censored for death of the patient are statistically significant variables connected to the price of the transplantation. Conclusion: The type of dialysis before transplantation does not affect the survival of the patient and the graft, the incidence of infections, the value of glomerular filtration after the transplantation, or the price of the transplantation itself. That is why PD should be promoted as the first choice method for dialysis treatment of all the patients that do not have contraindications for its use

The effect of pretransplant dialysis modality on the outcome of renal transplantation

Uvod: Kronična bubrežna bolest je globalna bolest koja prvenstveno zahvada stariju populaciju te predstavlja veliki financijski trošak za svaki zdravstveni sustav. Liječenje kronične bubrežne bolesti se provodi putem dijalize ili transplantacijom bubrega. Cilj istraživanja je vidjeti povezanost tipa dijalize prije transplantacije na ishod transplantacije bubrega. Ispitanici i metode: U ovu retrospektivnu studiju su uključeni svi primatelji bubrega, odnosno pankreasa i bubrega, u razdoblju od 2007. do 2013. godine u KB Merkur, Zagreb. Rezultati: U istraživanje je uključeno 280 bolesnika (106 muškaraca i 174 žene). Od ukupnog broja transplantacija je učinjeno 229 transplantacija bubrega te 51 simultana transplantacija bubrega i gušterače. Prije transplantacije vedina bolesnika je bila na HD (207) dok ih je 63 bilo na PD. Prema Kaplan Meier krivulji preživljenja petogodišnje preživljenje svih bolesnika iznosi 82.9 % dok preživljenje grafta iznosi 78.5%. U odnosu na tip dijalize prije transplantacije nije bilo statistički značajne razlike u preživljenju bolesnika (p=.09), preživljenju bubrega (p=.19) te u preživljenju grafta cenzuriranom za smrt bolesnika (p=.16). Incidencija svih infekcija u prva tri mjeseca nakon transplantacije je iznosila 58.9% od čega su urinarne infekcije činile gotovo 50% svih infekcija. U odnosu na tip dijalize prije transplantacije nije bilo statistički značajne razlike u incidenciji infekcija. Iako je u univarijatnoj analizi tip dijalize prije transplantacije bio jedan od čimbenika koji su utjecali na vrijednost glomerularne filtracije isto se izgubio u multivarijatnoj analizi gdje su samo dob primatelja i darivatelja ostale statistički značajne varijable koje utječu na funkciju bubrega 6 i 12 mjeseci nakon transplantacije. Prosječna cijena transplantacije bubrega je iznosila 85.85±41.67 tisuda kuna, dok je za SPKT iznosila 111.84±89.20 tisuda kuna (p= .02). Nije bilo statistički značajne razlike u cijeni transplantacije u odnosu na tip dijalize prije transplantacije. Odgođena funkcija grafta, smrt bolesnika, vrsta transplantacije te preživljenje grafta cenzuriranog za smrt bolesnika su statistički značajne varijable povezane s cijenom transplantacije. Zaključak: Vrsta dijalize prije transplantacije ne utječe na preživljenje bolesnika i grafta, pojavnost infekcija i vrijednost glomerularne filtracije nakon transplantacije te na cijenu same transplantacije. Peritonejska dijaliza je jeftinija od hemodijalize te je manje financijsko opteredenje za javnozdravstveni sustav. Zbog toga se PD treba promovirati u metodu prvog odabira, kada je u pitanju liječenje dijalizom, u svih bolesnika koji nemaju kontraindikaciju za njezino provođenje.Introduction: Chronic renal disease is a global disease that primarily affects the elderly population and represents a major financial expense for all healthcare systems. Chronic renal disease is treated by dialysis or kidney transplantation. The goal of the research is to discover the connection between the type of dialysis before the transplantation and the outcome of the kidney transplantation. Test subjects and methods: This retrospective study includes all kidney recipients or pancreas and kidney recipients in the period from 2007. to 2013. at the University Hospital Merkur, Zagreb. Results: The research included 280 patients (106 male and 174 female). Of the total number of transplantations, there were 229 kidney transplantations and 51 simultaneous kidney and pancreas transplantations. Before the transplantation most of the patients were on HD (207), while 63 of them were on PD. According to the Kaplan-Meier survival curve, the five year survival of all the patients is 82.9 % while the graft survival is 78.5%). Considering the type of dialysis before the transplantation, there was no statistically significant differences in the survival of the patients (p=.09), kidney survival (p=.19), and graft survival censored for death of the patient (p=.16). The incidence of all infections in the first three months after transplantation was 58.9%, and 50% of all the infections were urinary infections. Considering the type of dialysis before transplantation, there were no statistically significant differences in the incidence of infections. Even though the type of dialysis before the transplantation was one of the factors that affected the value of glomerular filtration in the univariate analysis, it was lost in the multivariate analysis, where only the ages of the recipient and the donor remained as statistically significant variables that affect the function of the kidneys 6 and 12 months after the transplantation. The average price of a kidney transplantation was HRK 85.85±41.67 thousand, and for SPKT it was HRK 111.84±89.20 thousand (p= .02). There was no statistically significant difference in the price of the transplantation considering the type of dialysis before the transplantation. Delayed graft function, death of the patient, type of transplantation, and graft survival censored for death of the patient are statistically significant variables connected to the price of the transplantation. Conclusion: The type of dialysis before transplantation does not affect the survival of the patient and the graft, the incidence of infections, the value of glomerular filtration after the transplantation, or the price of the transplantation itself. That is why PD should be promoted as the first choice method for dialysis treatment of all the patients that do not have contraindications for its use

Troškovi transplantacije bubrega u Kliničkoj bolnici Merkur, Zagreb

The aim was to determine the cost of hospitalization for a transplant procedure and identify the independent variables associated with the cost of transplantation. The investigation was designed as a retrospective single-center cohort study conducted at a tertiary university hospital transplant center in Zagreb, Croatia. The study included 219 consecutive kidney recipients transplanted during the 2007-2013 period at the Merkur University Hospital. There were 141 male and 78 female patients having undergone kidney transplantation during the study period. The majority of kidney transplants were from a deceased donor (n=179), while 40 were from a living donor. The mean cost of a transplantation was 86,140±42,240 HRK (11,460±5,600 €), ranging from 29,000 HRK (3,860 €) to 408,000 HRK (54,000 €). In the bivariate analysis, the variables associated with the cost of transplantation were the length of hospital stay, delayed graft function, death of the patient, graft loss, use of steroids, and death-censored graft loss. In the multivariate analysis, delayed graft function was the only statistically significant variable for the cost of transplantation. Since only delayed graft function had an impact on the cost of transplantation in this study, certain steps such as shortening of the cold ischemia time (better organization of organ transport), better education of family members for living donors, and higher percentage of patients on peritoneal dialysis should be taken to lower the percentage of delayed graft function.Cilj istraživanja bio je odrediti troškove hospitalizacije za postupak presađivanja bubrega i identificirati nezavisne varijable povezane s troškovima transplantacije. Istraživanje je provedeno kao retrospektivna kohortna studija u jednom kliničkom centru. Studija je obuhvatila 219 uzastopnih transplantacija bubrega u razdoblju od 2007. do 2013. godine u Kliničkoj bolnici Merkur, odnosno 219 bolesnika (141 muškaraca i 78 žena). Većina transplantiranih bubrega je bila od preminulog (n=179) donora, dok ih je 40 bilo od živog davatelja. Prosječni trošak transplantacije iznosio je 86.140±42.240 HRK (11.460±5.600 €). U bivarijatnoj analizi varijable povezane s cijenom transplantacije bile su trajanje hospitalizacije, odgođena funkcija presatka, smrt bolesnika, gubitak presatka, upotreba steroida i cenzurirani gubitak presatka. U multivarijatnoj analizi samo je odgođena funkcija presatka bila statistički značajna varijabla za troškove transplantacije. Budući da je samo odgođena funkcija presatka u ovom istraživanju utjecala na troškove transplantacije, potrebno je poduzeti određene korake kao što su skraćivanje vremena hladne ishemije (bolja organizacija transporta organa), bolje obrazovanje članova obitelji za žive donore i veći postotak bolesnika na peritonejskoj dijalizi kako bi se smanjila incidencija odgođene funkcije presatka

Croatian urologists' clinical practice and compliance with guidelines in the management of non-neurogenic male lower urinary tract symptoms

The aim of this study was to assess the Croatian urologists’ management of non-neurogenic male lower urinary tract symptoms (LUTS) and their compliance with the European Association of Urology (EAU) guidelines. A cross-sectional survey included 51/179 Croatian urologists. We developed a questionnaire with questions addressing compliance with EAU guidelines. The rate of performing recommended evaluations on the initial assessment of patients with benign prostate hyperplasia (BPH)/LUTS varied from 8.0% (serum creatinine and voiding diary) to 100.0% (physical examination, prostate specific antigen and ultrasound). The international prostate symptom score was performed by 31%, analysis of urine sediment by 83%, urine culture by 53%, and serum creatinine by 8% of surveyed urologists. Only 8% of urologists regularly used bladder diary in patients with symptoms of nocturia. Our results indicated that 97% of urologists preferred alpha blockers as the first choice of treatment; 5-alpha reductase inhibitors (5ARI) were mostly prescribed (84%) in combination with an alpha-blocker, preferably as a continuous treatment, whilst 29% of urologists used to discontinue 5ARI after 1-2 years. Half of the Croatian urologists used antimuscarinics in the treatment of BPH/LUTS and recommended phytotherapeutic drugs in their practice. In conclusion, Croatian urologists do not completely comply with the guidelines available