Enukleacija prostate tulij:YAG laserom (Thu:LEP) - naša iskustva kod 246 operiranih bolesnika

New minimally invasive procedures to treat benign prostatic hyperplasia (BPH) have been developed in the last 20 years. With the introduction of laser enucleation techniques in prostate surgery, previous standard surgical procedures (open retropubic or transvesical adenectomy and transurethral resection of the prostate) have become less relevant, especially in case of very large prostates. The objective of this paper is to describe the experience and results of thulium:YAG laser application in BPH treatment in our department. In the last five years, 246 patients underwent thulium:YAG laser enucleation of the prostate (ThuLEP) due to BPH or lower urinary tract symptoms following complete urologic evaluation. The mean age of our patients was 73 (range 51-95) years and mean duration of surgery was 92 minutes. The mean weight of enucleated tissue was 73 grams. A low rate of intraoperative and early postoperative complications and short length of stay proved minimal invasiveness of this procedure, which results in significant improvements in urodynamic parameters and substantially reduces the postvoid residual urine volume. The most important surgical and technical characteristics (enucleation and low-power laser application) make ThuLEP a safe and efficient surgical method not limited by the prostate volume. ThuLEP has a potential to displace the current standard surgical procedures to treat BPH.Tijekom posljednja dva desetljeća bilježi se pojava novih minimalno invazivnih zahvata u liječenju benigne hiperplazije prostate (BPH). Uvođenjem enukleacijskih laserskih tehnika u kirurgiju prostate dosadašnji standardni operacijski zahvati (otvorena retropubična ili transvezikalna adenektomija, transuretralna resekcija prostate) sve više gube na značenju, osobito pri većim volumenima prostate. Cilj ovoga rada je prikazati iskustva i rezultate primjene tulij:YAG lasera u liječenju BPH. U posljednjih pet godina 246 bolesnika podvrgnuto je minimalno invazivnoj metodi laserske enukleacije prostate (ThuLEP) zbog simptoma BPH ili simptoma donjeg mokarćnog sustava. Prethodno je učinjena cjelovita urološka dijagnostika. Prosječna dob bolesnika bila je 73 godine, a prosječna duljina trajanja operacijskog zahvata 92 minute. Enukleacijom uklonjeno tkivo iznosilo je prosječno 73 grama. Nizak postotak intraoperacijskih i ranih poslijeoperacijskih komplikacija, kao i kratko vrijeme hospitalizacije potvrdile su se kao odlike minimalne invazivnosti ove operacijske metode koja rezultira značajnim poboljšanjem urodinamskih parametara i znatnom redukcijom ostatne mokraće. Može se istaknuti kako je ThuLEP sa svojim najvažnijim operacijsko-tehničkim čimbenicima (enukleacija, aplikacija male laserske energije) sigurna i djelotvorna operacijska metoda koja nije ograničena volumenom prostate te ima potencijal potisnuti ili u potpunosti zamijeniti dosadašnje standardne operacijske metode u liječenju BPH

Uloga intervencijskog radiologa u liječenju komplikacija uroloških bolesnika

Higher turnaround of urologic patients in the tertiary clinical center can lead to more accompanying complications, ranging from 1% to 55% for various procedures, with the incidence of vascular injuries varying from 0.43% up to 9.5%. In patients with impaired renal function, it is imperative to prevent the loss of normal kidney function and potential hemodialysis. Being minimally invasive, endovascular procedures such as renal artery embolization (RAE) can treat major and life-threatening complications, but good and prompt communication between urologists and interventional radiologist is necessary for fast and effective treatment. Absolute contraindications for RAE are the presence of acute infection and previously known anaphylactic reaction to the iodine contrast media, while previous mild or moderate allergic reactions to iodine contrast media are not contraindications for RAE. Currently used embolic agents can be divided into temporary and permanent embolization agents. While the temporary embolization agent available is a gelatin sponge that could be used as complementary material or stand-alone, for permanent embolization interventional radiologists use microparticles, microspheres, liquid embolic agents, coils, and microcoils. RAE procedures are considered to be safe with a low incidence of complications, with non-target embolization being the most serious one. Postembolization syndrome is considered to be the most common adverse effect and it involves around 90% of patients. The overall results show that RAE is a safe, minimally invasive procedure that can effectively treat significant complications caused by other urologic procedures, with the reported success rates of 87%-100%.Veći broj liječenih uroloških bolesnika u tercijarnom kliničkom centru može dovesti i do većeg broja popratnih komplikacija, u rasponu od 1% do 55% za različite zahvate, s incidencijom vaskularnih ozljeda od 0,43% do 9,5%. U bolesnika s oštećenom funkcijom bubrega nužno je spriječiti gubitak zdravog parenhima bubrega i moguću hemodijalizu. Minimalno invazivni, endovaskularni zahvati poput embolizacije bubrežne arterije (renal artery embolization, RAE) mogu liječiti velike i za život opasne komplikacije, no za brzo i učinkovito liječenje neophodna je dobra i brza komunikacija između urologa i interventnog radiologa. Apsolutne kontraindikacije za RAE su prisutnost akutne infekcije i prethodno poznata anafilaksijska reakcija na jodna kontrastna sredstva, dok prethodne blage ili umjerene alergijske reakcije na jodna kontrastna sredstva nisu kontraindikacija za RAE. Sredstva za embolizaciju koja se rabe mogu se podijeliti na sredstva za privremenu i trajnu embolizaciju. Dok je dostupno sredstvo za privremenu embolizaciju želatinska spužva koja se može rabiti kao dodatni materijal ili samostalno, za trajnu embolizaciju interventni radiolozi upotrebljavaju mikročestice, mikrosfere, tekuća sredstva za emboliju, zavojnice i mikrozavojnice. Postupci RAE smatraju se sigurnima s niskom učestalošću komplikacija, pri čemu je non-target embolizacija najozbiljnija. Postembolizacijski sindrom se smatra najčešćom nuspojavom i pogađa oko 90% bolesnika. Ukupni rezultati pokazuju da je RAE siguran, minimalno invazivan postupak koji može učinkovito liječiti značajne komplikacije uzrokovane drugim urološkim zahvatima s prijavljenim stopama uspjeha u rasponu od 87% do 100%

Dynamic Contrast Enhanced Study in Multiparametric Examination of the Prostate—Can We Make Better Use of It?

We sought to investigate whether quantitative parameters from a dynamic contrast-enhanced study can be used to differentiate cancer from normal tissue and to determine a cut-off value of specific parameters that can predict malignancy more accurately, compared to the obturator internus muscle as a reference tissue. This retrospective study included 56 patients with biopsy proven prostate cancer (PCa) after multiparametric magnetic resonance imaging (mpMRI), with a total of 70 lesions; 39 were located in the peripheral zone, and 31 in the transition zone. The quantitative parameters for all patients were calculated in the detected lesion, morphologically normal prostate tissue and the obturator internus muscle. Increase in the Ktrans value was determined in lesion-to-muscle ratio by 3.974368, which is a cut-off value to differentiate between prostate cancer and normal prostate tissue, with specificity of 72.86% and sensitivity of 91.43%. We introduced a model to detect prostate cancer that combines Ktrans lesion-to-muscle ratio value and iAUC lesion-to-muscle ratio value, which is of higher accuracy compared to individual variables. Based on this model, we identified the optimal cut-off value with 100% sensitivity and 64.28% specificity. The use of quantitative DCE pharmacokinetic parameters compared to the obturator internus muscle as reference tissue leads to higher diagnostic accuracy for prostate cancer detection

Distribution of Major Brain Gangliosides in Olfactory Tract of Frogs

Gangliosides are major cell-surface determinants in the central nervous system (CNS) of vertebrates, found both in neuronal and glial cell membranes. Together with cholesterol and glycosylphosphatidylinositol (GPI) – anchored proteins, gangliosides are involved in organization of plasma membrane microdomains. Based on biochemical studies, frog brain was previously described as having low quantities of gangliosides and their distribution pattern in specific brain regions was unknown. Using highly specific monoclonal antibodies generated against four major brain gangliosides (GM1, GD1a, GD1b and GT1b), we examined the distribution of these molecules in CNS of four different species of frogs (Rana esculenta, Rana temporaria, Bufo bufo and Bufo viridis). We also studied the distribution of myelin- associated glycoprotein (MAG), an inhibitor of axonal regeneration, which is a ligand for gangliosides GD1a and GT1b. Our results show that ganglioside GD1a is expressed in neurons of olfactory bulb in all studied animals. In the brain of Rana sp., GD1a is expressed in the entire olfactory pathway, from olfactory bulbs to amygdala, while in Bufo sp. GD1a is restricted to the main olfactory bulb. Furthermore, we found that most of myelinated pathways in frogs express MAG, but do not express GD1a, which could be one of the reasons for better axon regeneration of neural pathways after CNS injury in amphibians in comparison to mammals

Dynamic Contrast-Enhanced Study in the mpMRI of the Prostate—Unnecessary or Underutilised? A Narrative Review

The aim of this review is to summarise recent scientific literature regarding the clinical use of DCE-MRI as a component of multiparametric resonance imaging of the prostate. This review presents the principles of DCE-MRI acquisition and analysis, the current role of DCE-MRI in clinical practice with special regard to its role in presently available categorisation systems, and an overview of the advantages and disadvantages of DCE-MRI described in the current literature. DCE-MRI is an important functional sequence that requires intravenous administration of a gadolinium-based contrast agent and gives information regarding the vascularity and capillary permeability of the lesion. Although numerous studies have confirmed that DCE-MRI has great potential in the diagnosis and monitoring of prostate cancer, its role is still inadequate in the PI-RADS categorisation. Moreover, there have been numerous scientific discussions about abandoning the intravenous application of gadolinium-based contrast as a routine part of MRI examination of the prostate. In this review, we summarised the recent literature on the advantages and disadvantages of DCE-MRI, focusing on an overview of currently available data on bpMRI and mpMRI, as well as on studies providing information on the potential better usability of DCE-MRI in improving the sensitivity and specificity of mpMRI examinations of the prostate

Mapping European Association of Urology Guideline Practice Across Europe: An Audit of Androgen Deprivation Therapy Use Before Prostate Cancer Surgery in 6598 Cases in 187 Hospitals Across 31 European Countries

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