12 research outputs found
Strano tijelo u mokraÄnom mjehuru kao ishod samokateterizacije: prikaz sluÄaja
Foreign bodies inside urinary tract are a relatively rare condition in our practice. There are several reports published and in most cases the reason for self insertion of an object was autoerotic stimulation or psychiatric illness. Self treatment by homemade instruments is a rarely seen scenario. A 62-year-old man presented to our department complaining of lower urinary tract symptoms. On examination, a foreign body was detected inside the urinary bladder. Urethral stricture was also detected for which the patient had been previously treated on several occasions. The patient stated that he had attempted self catheterization using a homemade catheter. He had succeeded in emptying his bladder; however, the catheter entered the bladder completely and was irretrievable to him. Sachse urethrotomy was performed following retrieval of the foreign body. No psychiatric illness was detected in our patient. The patientās postoperative course was uneventful.Strana tijela unutar mokraÄnog sustava su relativno rijetko stanje u naÅ”oj praksi. U veÄini objavljenih sluÄajeva razlog umetanja stranog tijela je autoerotska stimulacija ili psihijatrijska bolest. Umetanje stranog tijela kao povod za rjeÅ”avanje mokraÄne opstrukcije je rijedak dogaÄaj. Bolesnik u dobi od 62 godine javio se na naÅ”u kliniku zbog simptoma donjeg mokraÄnog trakta. Tijekom pregleda otkriveno je strano tijelo unutar mokraÄnog mjehura. Kod bolesnika je u viÅ”e navrata raÄena unutarnja uretrotomija, a jednom otvorena operacija uretre s terminoterminalnom anastomozom. Bolesnik je naveo da je pokuÅ”ao samokateterizaciju s improviziranim kateterom. Uspio je rijeÅ”iti mokraÄnu opstrukciju, no dio stranog tijela je zaostao u mokraÄnom mjehuru. Nakon dodatne obrade uÄinjena je unutarnja uretrotomija po Sachseu s ekstrakcijom stranog tijela iz mokraÄnog mjehura. Psihijatrijskih bolesti se kod bolesnika ne nalazi
Nepovoljne kliniÄko-patoloÅ”ke znaÄajke u bolesnika s izostavljenom limfadenektomijom tijekom radikalne prostatektomije
Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is the most accurate staging modality for lymph node assessment in patients with prostate cancer. It is recommended in all patients with intermediate or high-risk disease undergoing radical prostatectomy. The goal of our study was to assess unfavorable clinicopathological characteristics in patients with omitted lymphadenectomy (PLND) during radical prostatectomy based on the nomogram proposed by Briganti and colleagues. In 2011, 200 patients undertook radical prostatectomy in our institution. Among them 53 patients who fulfilled Briganti criteria and in whom we omitted lymphadenectomy based on current guidelines. Unfavorable clinicopathological features considered were: stage T3, positive surgical margins or biochemical relapse (BCR). We registered biopsy Gleason score 6 in 34 patients, and 19 patients had Gleason score 7. Stage pT2 was seen in 49 patients, and pT3 in 4. Gleason score after radical prostatectomy was upgraded from GS 6 to GS 7 in 20 patients (37%) and reduced in 1 patient (2%). After a median follow-up of 49 (44-56) months, there were 12 (22.6%) patients with BCR. Patients with biopsy Gleason score 6 (n=34) compared to biopsy Gleason 7 (n=19) patients showed no difference regarding positive margins (p=0.0738) and BCR (p=0,736) at 49 months follow-up. Thus, PLND according to current guidelines can be safely omitted in low-risk patients using Brigantinomogram.ZdjeliÄna limfadenektomija u vrijeme radikalne prostatektomije (RP) trenutno je najpouzdaniji naÄin otkrivanja metastaza u limfne Ävorove u bolesnika s rakom prostate. Cilj naÅ”eg istraživanja bio je procijeniti nepovoljne kliniÄko-patoloÅ”ke znaÄajke u bolesnika s izostavljenom limfadenektomijom tijekom radikalne prostatektomije temeljene na Briganteovom nomogramu. U 2011. godini, u naÅ”oj je ustanovi 200 bolesnika podvrgnuto radikalnoj prostatektomiji. Identificirali smo 53 bolesnika koji su ispunili Brigantijeve kriterije te su prema aktualnim smjernicama bili poÅ”teÄeni zdjeliÄne limfadenektomije. Nepovoljnim kliniÄko-patoloÅ”kim znaÄajkama smatralo se bilježenje stadija T3 bolesti, pozitivni kirurÅ”ki rubovi ili biokemijski relaps. Na patohistoloÅ”kom (PH) nalazu biopsije Gleason zbroj 6 verificiran je u 34 pacijenta, a 19 je pacijenata imalo Gleason zbroj 7. Na konaÄnom PH nalazu nakon uÄinjene radikalne prostatektomije 49 bolesnika je imalo pT2 stadiji bolesti, a 4 su bolesnika imala pT3. KonaÄni Gleason zbroj nakon radikalne prostatektomije poveÄan je u 20 bolesnika na GS 7 (37%) i smanjen kod jednog bolesnika (2%). Nakon srednjeg praÄenja od 49 (44-56) mjeseci, bilo je 12 (22,6%) bolesnika s biokemijskim relapsom (BR). Usporedba bolesnika s biopsijskim nalazom Gleason zbroja 6 (n = 34) i bolesnika s Gleason zbrojem7 (n = 19) nije pokazala znaÄajnu razliku u odnosu na pozitivne kirurÅ”ke rubove (p = 0,0738) i BR (p = 0,736) nakon 49 mjeseci praÄenja. Stoga se zdjeliÄna limfadenektomija prema aktualnim smjernicama može sigurno izostaviti u bolesnika s procijenjenim niskim rizikom koristeÄi Briganteov nomogram
Dietary habits and COVID-19 vaccination status among patients after myocardial infarction: experience from Dubrava University Hospital
Usporedba toÄnosti stupnjevanja diferencijacije raka prostate u uzorcima dobivenim ciljanom i sustavnom biopsijom prostate
All malignancies, including prostate cancer, require accurate diagnosing and staging
before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings
has raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead
of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted
biopsies should lower prostate cancer biopsy undergrading and overgrading.
To determine the incidence of prostate cancer biopsy undergrading in patients who underwent
a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy.
We identified the patients from our database who underwent a radical prostatectomy
at our institution from January 1st, 2021, to June 30th, 2021.There were 112 patients identified.
Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer.
The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate
biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We
compared the biopsy results with the final pathological results, and searched for undergrading or overgrading
in the biopsies compared to the final histological reportThe undergrading was found in 17,7 % (N=11) cases in the non-mpMRI group and in 12,0
% (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in
our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the
final specimen report. The charasteristics of patients are listed in Table 1.
In our cohort, the patients who underwent a mpMRI targeted biopsy
had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of
the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate.
Since different areas of the tumor have different areas of differentiation, only a low-grade part of the
tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole
tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate
than the analysis of prostate cores obtained by biopsy.Sve maligne bolesti, ukljuÄujuÄi rak prostate, zahtijevaju preciznu dijagnostiku prije odluke o lijeÄenju. UvoÄenjem
ciljanih biopsija na temelju nalaza MRI prostate poveÄana je toÄnost biopsije prostate. VoÄene biopsije ciljaju na sam tumor
u umjesto na najÄeÅ”Äe lokacije tumora u prostati kao Å”to je sluÄaj sa sistemskom biopsijom. Neke studije pokazuju da bi ciljane
biopsije trebale smanjiti podcjenjivanje stupnja diferenciranosti raka prostate u uzorcima dobivenim biopsijom prostate.
Odrediti incidenciju podcjenjivanje stupnja diferenciranosti raka prostate kod pacijenata koji su bili podvrgnuti
klasiÄnoj sistemskoj biopsiji u usporedbi s pacijentima koji su bili podvrgnuti mpMRI kognitivnoj ciljanoj biopsiji.
Identificirali smo pacijente iz naŔe baze podataka koji su podvrgnuti radikalnoj prostatektomiji u
naÅ”oj ustanovi od 1. sijeÄnja 2021. do 30. lipnja 2021. Identificirano je 112 pacijenata. Pacijenti su podijeljeni u dvije skupine
na temelju vrste biopsije kojom je potvrÄen rak prostate. Skupina mpMRI (N=50) primila je mpMRI kognitivno voÄenu
transrektalnu ultrazvuÄnu (TRUS) biopsiju prostate, a skupina non-mpMRI (N=62) primila je klasiÄnu, sistemsku TRUS
biopsiju. Usporedili smo rezultate biopsije s konaÄnim patoloÅ”kim nalazima i tražili smo podcjenjivanje stupnja diferenciranosti
karcinoma prostate u biopsijama u usporedbi s konaÄnim histoloÅ”kim nalazom.
Podcjenjivanje stupnja diferenciranosti naÄeno je u 17,7 % (N=11) u non-mpMRI skupini i u 12,0 % (N=6)
sluÄajeva u mpMRI skupini (p=0,02, Mann-Whitney U test). U naÅ”oj kohorti nije pronaÄeno precjenjivanje stupnja diferenciranosti.
Svi sluÄajevi podcjenjivanja imali su Gradus grupu 1 na nalazu biopsije prostate i Gradus grupu 2 u konaÄnom
patohistoloŔkom nalazu.
U naŔoj kohorti, pacijenti koji su bili podvrgnuti ciljanoj biopsiji imali su nižu incidenciju podcjenjivanja
stupnja diferenciranosti Å”to je posljedica toÄnijeg uzorkovanja. Tijekom sistemske TRUS biopsije, urolog cilja na
podruÄja prostate gdje se rak najÄeÅ”Äe nalazi, Å”to je obiÄno periferna zona prostate. BuduÄi da razliÄita podruÄja tumora imaju
razliÄita podruÄja diferencijacije, ponekad se bioptira samo dio tumora koji je bolje diferenciran, Å”to rezultira pogreÅ”kom
uzorkovanja. Nakon Å”to je prostata uklonjena, analizira se cijeli tumor, tako da su rezultirajuÄi patohistololoÅ”ki rezultati uklonjene
prostate daleko toÄniji od analize uzoraka prostate dobivenih biopsijom
Razvoj parcijalne nefrektomije zbog tumora bubrega ā napuÅ”tamo li osnovna naÄela Robsonove radikalne nefrektomije?
Fifty years ago, Robson introduced radical nephrectomy (RN ) setting the gold standard for treating kidney tumors. Experience has shown that partial nephrectomy (PN) can be equally effective with the advantages of preserving kidney function and avoiding unnecessary nephrectomies for benign tumors. The purpose of this report is to demonstrate the evolution of clinical presentation and choice of treatment for patients with kidney tumors at our department, emphasizing changes in the PN utilization trends. Clinical data were abstracted for the years 2002, 2007 and 2012. We assessed annual trends for changes in the choice of operative treatment related to tumor size, pathologic stage and diagnosis. During the study, there was an increase in the share of T1 tumors, from 46.6% in 2002 to 69.8% in 2012. The rate of PN increased more than ten-fold, from 2.7% in 2002 to 31.7% in 2012. The annual rates of PN for T1 tumors increased even more, from 6.6% in 2002 to 46.7% in 2012. Opposite to RN group, there was an increase in the mean tumor size in PN group (from 1.8 cm in 2002 to 3.9 cm in 2012). The rate of RN for benign tumors was reduced impressively from 85.7% in 2002 to 23.1% in 2012. Our data argue strongly that PN should be expanded and not restricted. Robsonās principles have been partially deserted over the last decade; however, proving that PN is superior to RN still remains to be elucidated.Prije 50 godina Robson je izveo prvu radikalnu nefrektomiju (RN ) te time postavio zlatni standard za kirurÅ”ko lijeÄenje tumora bubrega. Iskustvo je pokazalo da je parcijalna nefrektomija (PN) jednako uÄinkovita s prednostima oÄuvanja bubrežne funkcije i izbjegavanjem nepotrebne nefrektomije zbog dobroÄudnih tumora. U radu se prikazuju promjene kliniÄke slike i napredak u izboru operativnog lijeÄenja tumora bubrega na naÅ”oj klinici, naglaÅ”avajuÄi razvoj indikacija za primjenu PN. Studija je obuhvatila sve bolesnike koji su operativno lijeÄeni zbog tumora bubrega na naÅ”oj klinici u 2002., 2007. i 2012. godini. Analizirali smo izbor operativne metode u danim razdobljima prema veliÄini tumora, stadiju bolesti i dijagnozi.U promatranom razdoblju porastao je udio tumora T1, s 46,6% u 2002. na 69,8% u 2012. godini. Od ukupnog broja operiranih bolesnika u 2002. godini 2,7% ih je operirano metodom PN, dok je u 2012. taj udio bio 32%, Å”to predstavlja porast veÄi od 10 puta. Porast godiÅ”njeg udjela PN za stadij bolesti T1 bio je joÅ” veÄi, sa 6,6% u 2002. na 46,7% u 2012. godini. Za razliku od skupine RN , u skupini PN zabilježen je porast prosjeÄne veliÄine tumora s 1,8 cm u 2002. na 3,9 cm u 2012. godini. Impresivno je smanjenje RN kod bolesnika s dobroÄudnom patologijom koja je u 2002. godini iznosila 85,7%, a u 2012. samo 23,1%. Rezultati naÅ”ega istraživanja pokazuju da indikacije za PN treba proÅ”irivati, a ne ograniÄavati. U zadnjih 10 godina Robsonova naÄela su djelomice napuÅ”tena, ali superiornost PN nad RN tek treba dokazati
Povijest urologije u bolnici Sestara milosrdnica
The history of Croatian urology clearly shows its affiliation to the medical and civilizational circle of the Western world. The Department of Urology at the Sestre milosrdnice University Hospital Center is the oldest urology institution in the Republic of Croatia. The Department was established in 1894, when the new Sestre milosrdnice Hospital was open in Vinogradska cesta in Zagreb. It was then that doctor Dragutin MaÅ”ek founded the so-called III Department, which, in addition to treating urology patients, also treated patients with conditions of the ear, nose and throat, eye diseases and dermatologic conditions. Dragutin MaÅ”ek had already realized that medicine would soon be divided into fields and had assigned younger doctors joining the III Department to specific fields. As a result, urology was given to Aleksandar BlaÅ”koviÄ, who founded the first independent department of urology in Croatia in 1926. In 1927, he was appointed Professor of urology at the Zagreb School of Medicine, where he established the first department of urology and was giving lectures and practicals. Under his leadership, the Department of Urology was given the status of a Clinic, a teaching department, the first of its kind in Croatia. Owing to all his activities in the field of urology, the history remembers him as the āfather of modern Croatian urologyā. Over the course of the following years, department chairs had changed, but luckily for the patients, approach to work had not. Conscientiousness, trust, competence and charity. After all, charity is the idea that the hospital carries even in its name, after the Sisters of Charity who had founded it. In all the decades, the Department of Urology has been following global development paths, objectively legging behind top facilities in the world by only a few years. Overall professional and scientific urology activities culminated in 1998, when the Clinic became the Reference Center of the Ministry of Health of the Republic of Croatia for prostate cancer, and in 2011, when it became the European Board of Urology Certified Center. All that has been achieved could not have been done without wholehearted help and cooperation of the nurses, as well as every other department employee from the beginnings of urology until today. Despite its rich history, the Department does not rest on laurels. Today, it is a modern urology department together with its European role models.ProÅ”lost hrvatske urologije jasno odreÄuje njezinu pripadnost medicinskom i civilizacijskom krugu zapadnoga svijeta. Klinika za urologiju KBC āSestre milosrdniceā najstarija je uroloÅ”ka ustanova u Republici Hrvatskoj. Osnovana je 1894. kad je otvorena nova Bolnica sestara milosrdnica u Zagrebu u Vinogradskoj ulici. Te je godine dr Dragutin MaÅ”ek osnovao tzv. III Odjel na kojem su se operativno zbrinjavali osim uroloÅ”kih bolesnika, bolesnici sa bolestima uha, grla i nosa, sa oÄnim i dermatoloÅ”kim bolestima. Dragutin MaÅ”ek veÄ tada je vidio da Äe se medicina uskoro dijeliti na uža podruÄja, pa je dolaskom mlaÄih lijeÄnika na III. odjel njima prepuÅ”tao odreÄena podruÄja, tako da je urologiju preuzeo Aleksandar BlaÅ”koviÄ koji 1926. godine osniva prvi samostalni odjel za urologiju u Hrvatskoj. Imenovan je 1927. za profesora urologije na Medicinskom fakultetu u Zagrebu gdje osniva prvu katedru za urologiju i vodi predavanja i vježbe. Pod njegovim vodstvom Odjel za urologiju dobio 1943. godine status Klinike za urologiju, prve u Hrvatskoj. Temeljem svih tih aktivnosti na uroloÅ”kom podruÄju povijest ga pamti kao āoca moderne hrvatske urologijeā. U godinama koje slijede Äelnici urologije su se mijenjali, a svjetonazor u radu na sreÄu bolesnika ne. Savjest, povjerenje, struÄnost i milosrÄe. Uostalom, to je znamen koji bolnica nosi u svom imenu. Svih tih desetljeÄa Klinika za urologiju je pratila suvremene svjetske pravce razvoja, objektivno kasneÄi tek nekoliko godina za vrhunskim ustanovama u svijetu. Cjelokupna struÄna i znanstvena uroloÅ”ka djelatnost kulminira 1998. godine, kada Klinika postaje Referentni centar za tumore prostate Ministarstva zdravstva Republike Hrvatske i 2011. godine kada je postala Centar obuke Europskog odbora za urologiju (European Board of Urology). Sve postignuto ne bi se moglo ostvariti bez svesrdne pomoÄi i suradnje medicinskih sestara i drugih djelatnika klinike od prvih poÄetaka urologije do danaÅ”njih dana. UnatoÄ bogatojj proÅ”losti, Klinika ne živi na uspjesima svojih prethodnika. Danas je ta urologija zajedno s njezinim uzorima europska moderna urologija
Transopturatorna AdVanceĀ® suspenzija u lijeÄenju postoprostatektomijske stresne inkontinencije mokraÄe
Stress urinary incontinence (SUI) continues to present a major complication after radical prostatectomy. Suburethral slings represent one of the less invasive options for postprostatectomy SUI, and a more recent addition is a transobturator sling, the AdVanceĀ®. We report our results with the AdVanceĀ® sling for the management of postoperative SUI. The evaluation was conducted on 47 patients with AdVanceĀ® implant for SUI in our institution (November 2010 - June 2017). Measurements included age, etiology of SUI, duration of SUI, follow-up and pad use per day (PPD) pre- and postoperatively. Patients were classified as cured if they used no pads or 1 PPD for security reasons, or as improved if 1-2 PPDs were used and if there was a 50% reduction in pad use per day postoperatively. In our series we observed a reduction of mean PPD of 5.1 (2-8) to 1.7 (0-4) postoperatively. After follow-up and according to our criteria, the cure rate was 51.1% (24/47) and the improvement rate 27.5% (13/47). The overall success rate was 78.6% (37/47). No improvement was observed in 21.4% (10/47) of patients. Failure rates after sling placement for patients with additional treatments following prostatectomy were much higher (60% (3/10) for radiation therapy and 66.7% (4/10) for urethral stricture disease). Our results show favourable cure and improvement rates and are comparable to results from larger series. The most appropriate candidates for the AdVanceĀ® sling are patients with mild to moderate postprostatectomy SUI. The results may be even better in patients without additional treatment following prostatectomy, such as radiation therapy or surgery for stricture disease.UnatoÄ napretku u lijeÄenju lokaliziranog raka prostate radikalnom prostatektomijom, i dalje je prisutan dio bolesnika kod kojih perzistira stresna urinarna inkontinencija (SUI). Suburetralni, a odnedavno i transopturatorni āslingoviā zbog neinvazivnosti postaju metodom izbora u lijeÄenju ovih bolesnika. U Älanku prikazujemo kirurÅ”ku tehniku i naÅ”e rezultate lijeÄenja postoperativne SUI metodom AdVanceĀ®. Od studenog 2010. do lipnja 2017. metodom AdVanceĀ® na Klinici je operirano 47 bolesnika. Zabilježena je dob, etiologija i trajanje SUI te dnevni broj uložaka preoperativno i postoperativno. IzljeÄenje je definirano kao potpuna kontinencija ili koriÅ”tenje jednog sigurnosnog uloÅ”ka / dan. PoboljÅ”anje je definirano kao koriÅ”tenje 1-2 uloÅ”ka / dan te smanjenje u dnevnom broju uložaka veÄe od 50%. U ispitivanom razdoblju kod operiranih bilježimo znaÄajan pad prosjeÄnog broja uložaka / dan s 5.1 (2-8) na postoperativno 1.7 (0-4). Prema naÅ”im kriterijima, postoperativno je kontinentno 51.1% (24/47), a poboljÅ”anje kontinencije nalazimo kod 27.5% (13/47) operiranih. Kod 78.6% (37/47) operiranih broj dnevno koriÅ”tenih uložaka smanjio se za viÅ”e od 50% i/ili je kontinentno. Stope neuspjeha znatno su veÄe kod bolesnika koji su nakon prostatektomije tretirani radioterapijom (60% (3/10)) ili uretrotomijom (66.7% (4/10)). Rezultati lijeÄenja postoperativne SUI suspenzijom AdVanceĀ® u naÅ”oj ustanovi usporedivi su s rezultatima do sada objavljenih studija. Suspenzija AdVanceĀ® indicirana je kod bolesnika s blagom do umjerenom postoperativnom SUI te oÄuvanom ostatnom funkcijom sfinktera potvrÄenom uretrocistoskopijom. OÄekivano, a zbog periuretralne fibroze, uspjeÅ”nost metode upitna je kod bolesnika koji su nakon prostatektomije tretirani radioterapijom ili endouroloÅ”kim zahvatima
20 godina Referentnog centra za tumore prostate Ministarstva zdravstva u Klinici za urologiju KBC Sestre milosrdnice
Department of Urology at the Sestre milosrdnice University Hospital Center is the oldest urological institution in the Republic of Croatia and this part of Europe. Today, the Department is a modern tertiary healthcare institution, where the most complex methods of urological practice are performed using modern medical devices and highly sophisticated technology. In 2011, our urology specialist education program was certified by the European Board of Urology (EBU) as the only one of its kind in Croatia. The program was recertified in 2017. The Department runs a program for the early detection of prostate cancer and performs more than 240 radical prostatectomies annually, which is the highest number of such interventions in Croatia. The aim of this study is to present the work and the activities of the Reference Center for Prostate Tumors of the Ministry of Health at the Department of Urology in Sestre milosrdnice University Hospital Center over the last 20 years. The database of the Reference Center for Prostate Tumors of the Ministry of Health at the Department of Urology in Sestre milosrdnice University Hospital Center was reviewed. During the twenty-year period, approx-imately 15,000 prostate interventions were performed due to benign and malignant diseases. Of this, 7,374 transrectal ultrasound guided prostate biopsies, 2,632 radical prostatectomies with open retropubic access, 3,988 transurethral prostate resections and 1,097 open suprapubic adenomectomies were performed. With the achieved scientific and professional results in monitoring, studying and improving the prevention, diagnosis and therapy of prostate tumors, as well as with the professional conditions and personnel, the Department of Urology in Sestre milosrdnice University Hospital Center truly justifies the title of the Reference Center for Prostate Tumors of the Ministry of Health of the Republic of Croatia awarded to it in 1998Klinika za urologiju KliniÄkog bolniÄkog centra Sestre milosrdnice najstarija je uroloÅ”ka ustanova u Republici Hrvatskoj, a i u ovom dijelu Europe. Danas je Klinika za urologiju moderna medicinska ustanova tercijarne zdravstvene zaÅ”tite gdje se najsloženije metode uroloÅ”ke prakse izvode pomoÄu suvremenih medicinskih ureÄaja i visoko sofisticirane tehnologije. Program edukacije specijalizanata je 2011. godine certificiran od strane European Board of Urology (EBU) kao jedini takav u Hrvatskoj, a recertificiran je 2017. godine. U naÅ”oj se Klinici provodi program ranog otkrivanja raka prostate, a godiÅ”nje se obavlja preko 240 radikalnih prostatektomija Å”to je ujedno i najveÄi broj takvih zahvata u Hrvatskoj. Cilj rada je prikazati rad i aktivnost Referentnog centra Ministarstva zdravstva za tumore prostate u Klinici za urologiju KBC āSestre milosrdniceā u posljednjih 20 godina. UÄinjen je pregled baze podataka Referentnog centra za tumore prostate Ministarstva zdravstva u Klinici za urologiju KBC āSestre milosrdniceā. Tijekom dvadesetogodiÅ”njeg razdoblja uÄinjeno je oko 15 000 zahvata na prostati zbog benignih i malignih bolesti. Od toga je uÄinjena 7 374 biopsija prostate voÄene transrektalnim ultrazvukom, 2 632 radikalnih prostatekomija otvorenim retropubiÄnim pristupom, 3 988 transuretralnih resekcija prostate i 1 097 otvorenih suprapubiÄnih adenomektomija. Postignutim znanstvenim i struÄnim rezultatima u praÄenju, prouÄavanju i unaprjeÄenju prevencije, dijagnostike i terapije tumora prostate kao i struÄno-kadrovskim uvjetima, Klinika za urologiju KBC Sestre milosrdnice opravdava naslov Referentnog centra za tumore prostate Ministarstva zdravstva Republike Hrvatske koji nosi od 1998. godine
Unfavorable Clinicopathological Features in Radical Prostatectomy Patients Who Were Spared Pelvic Lymphadenectomy
Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is the most accurate staging modality for lymph node assessment in patients with prostate cancer. It is recommended in all patients with intermediate or high-risk disease undergoing radical prostatectomy. The goal of our study was to assess unfavorable clinicopathological characteristics in patients with omitted lymphadenectomy (PLND) during radical prostatectomy based on the nomogram proposed by Briganti and colleagues. In 2011, 200 patients undertook radical prostatectomy in our institution. Among them 53 patients who fulfilled Briganti criteria and in whom we omitted lymphadenectomy based on current guidelines. Unfavorable clinicopathological features considered were: stage T3, positive surgical margins or biochemical relapse (BCR). We registered biopsy Gleason score 6 in 34 patients, and 19 patients had Gleason score 7. Stage pT2 was seen in 49 patients, and pT3 in 4. Gleason score after radical prostatectomy was upgraded from GS 6 to GS 7 in 20 patients (37%) and reduced in 1 patient (2%). After a median follow-up of 49 (44-56) months, there were 12 (22.6%) patients with BCR. Patients with biopsy Gleason score 6 (n=34) compared to biopsy Gleason 7 (n=19) patients showed no difference regarding positive margins (p=0.0738) and BCR (p=0,736) at 49 months follow-up. Thus, PLND according to current guidelines can be safely omitted in low-risk patients using Brigantinomogram
Transobturator AdvanceĀ® Sling Suspension for the Treatment of Postprostatectomy Stress Urinary Incontinence
Stress urinary incontinence (SUI) continues to present a major complication after radical prostatectomy. Suburethral slings represent one of the less invasive options for postprostatectomy SUI, and a more recent addition is a transobturator sling, the AdVanceĀ®. We report our results with the AdVanceĀ® sling for the management of postoperative SUI. The evaluation was conducted on 47 patients with AdVanceĀ® implant for SUI in our institution (November 2010 - June 2017). Measurements included age, etiology of SUI, duration of SUI, follow-up and pad use per day (PPD) pre- and postoperatively. Patients were classified as cured if they used no pads or 1 PPD for security reasons, or as improved if 1-2 PPDs were used and if there was a 50% reduction in pad use per day postoperatively. In our series we observed a reduction of mean PPD of 5.1 (2-8) to 1.7 (0-4) postoperatively. After follow-up and according to our criteria, the cure rate was 51.1% (24/47) and the improvement rate 27.5% (13/47). The overall success rate was 78.6% (37/47). No improvement was observed in 21.4% (10/47) of patients. Failure rates after sling placement for patients with additional treatments following prostatectomy were much higher (60% (3/10) for radiation therapy and 66.7% (4/10) for urethral stricture disease). Our results show favourable cure and improvement rates and are comparable to results from larger series. The most appropriate candidates for the AdVanceĀ® sling are patients with mild to moderate postprostatectomy SUI. The results may be even better in patients without additional treatment following prostatectomy, such as radiation therapy or surgery for stricture disease