19 research outputs found
Ureterorenoscopic treatment of ureteral stones ā influence of operatorās experience and skill on the procedure outcome
Aim To observe the influence of operating urologistās education
and adopted skills on the outcome of ureterorenoscopy
treatment of ureteral stones.
Methods The study included 422 patients (234 men,
55.4%) who underwent ureterorenoscopy to treat ureteral
stones at the Urology Department of Clinical Hospital Center
Split, Croatia, between 2001 and 2009. All interventions
were carried out with a semi-rigid Wolf ureteroscope and
an electropneumatic generator used for lithotripsy. The
operating specialists were divided into two groups. The
first group included 4 urologists who had started learning
and performing endoscopic procedures at the beginning
of their specialization and the second group included 4
urologists who had started performing endoscopic procedures
later in their careers, on average more than 5 years
after specialization.
Results Radiology tests confirmed that 87% (208/238) of
stones were completely removed from the distal ureter,
54% (66/123) from the middle ureter, and 46% (28/61) from
the proximal ureter. The first group of urologists completed
significantly more procedures successfully, especially for
the stones in the distal (95% vs 74%; P = 0.001) and middle
ureter (66% vs 38%; P = 0.002), and their patients spent less
time in the hospital postoperatively.
Conclusion Urologists who started learning and performing
endoscopic procedures at the beginning of their specialization
are more successful in performing ureteroscopy.
It is important that young specialists receive timely and
systematic education and cooperate with more experienced
colleagues
Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs
Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy (HBOT) was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods
Karcinom in situ mokraÄnog mjehura: incidencija, lijeÄenje i kliniÄki ishod tijekom desetogodiÅ”njeg praÄenja
Bladder carcinoma in situ (CIS) is a rare, high-grade intraepithelial neoplasm with a high tendency of progression and unpredictable clinical course. The aim of this study was to evaluate the incidence, treatment and clinical outcome of patients with CIS during a 10-year period. Medical records of 1062 patients with primary bladder cancer and 847 patients with recurrent bladder cancer that underwent tumor resection at Department of Urology, Split University Hospital
Center, Split, Croatia, between January 2001 and December 2010, were analyzed. Among all treated patients with primary bladder neoplasms, 51 (4.8%) had CIS. Primary CIS was diagnosed in 18
(1.7%) and concomitant CIS in 33 (3.1%) patients. In the same period, 847 patients with recurrent tumors were treated by transurethral resection (TUR ), 12 (1.4%) of them with secondary CIS.
Clinical course was followed-up in 15 patients with primary CIS and 21 patients with concomitant (TaT1) CIS. BCG immunotherapy was applied in 12 patients with primary and 17 patients with concomitant CIS. After median follow-up of 50 months, 9 patients with primary CIS had no sign of disease, 4 progressed, 1 had recurrence and 1 died. After median follow-up of 37 months, 13 (62%) patients with concomitant CIS had complete response, 3 progressed (14%), 1 had recurrence (4%) and 4 patients died, however, only 2 (10%) of these due to bladder cancer. Of all patients receiving BCG immunotherapy, 8 (27%) had significant side effects. The incidence and treatment of patients with CIS of urinary bladder in our institution is comparable to other recent literature reports.Karcinom in situ mokraÄnog mjehura (CIS) je rijetka intraepitelijska neoplazija visokog stupnja s visokom tendencijom progresije i teÅ”ko predvidljivog kliniÄkog tijeka. Cilj ovoga istraživanja bila je evaluacija incidencije, lijeÄenja i ishoda lijeÄenja bolesnika s CIS-om tijekom 10-godiÅ”njeg razdoblja. Analizirane su povijesti bolesti 1062 bolesnika s primarnim tumorima mokraÄnog mjehura koji su podvrgnuti transuretralnoj resekciji (TUR ) na Odjelu za urologiju KBC Split izmeÄu sijeÄnja 2001. i prosinca 2010. godine. Od svih bolesnika s primarnim tumorom mokraÄnog mjehura koje smo lijeÄili, 51 (4.8%) ih je imalo CIS. Primarni CIS dijagnosticiran je u 18 (1.7%) bolesnika, a konkomitantni u 33 (3.1%) bolesnika. U istom razdoblju 847 bolesnika s recidivnim tumorima lijeÄeno je TUR -om, njih 12 (1.4%) sa sekundarnim CIS-om. Pratili smo kliniÄki tijek 15 bolesnika s primarnim CIS-om i 21 bolesnika s konkomitantnim (TaT1) CIS-om. BCG imunoterapija je primijenjena u 12 bolesnika s primarnim i u 17 bolesnika s konkomitantnim CIS-om. Nakon medijana praÄenja od
50 mjeseci 9 bolesnika s primarnim CIS-om nije imalo znakove bolesti, u 4 je zabilježena progresija, u 1 recidiv i 1 bolesnik je umro. Nakon medijana praÄenja od 37 mjeseci meÄu bolesnicima s konkomitantnim CIS-om 13 (62%) ih je bilo bez znakova bolesti, 3 je progrediralo (14%), u 1 je zabilježen recidiv (4%), 4 bolesnika su umrla, ali samo 2 zbog karcinoma mokraÄnog mjehura (10%). Od svih bolesnika lijeÄenih BCG imunoterapijom 8 (27%) ih je imalo znaÄajnije nuspojave. Incidencija i lijeÄenje bolesnika s CIS-om mokraÄnog mjehura u naÅ”oj ustanovi usporedivi su s rezultatima iz literature
Ureterorenoscopic treatment of ureteral stones: influence of operatorās experience and skill on the procedure outcome
Aim To observe the influence of operating urologistās education
and adopted skills on the outcome of ureterorenoscopy
treatment of ureteral stones.
Methods The study included 422 patients (234 men,
55.4%) who underwent ureterorenoscopy to treat ureteral
stones at the Urology Department of Clinical Hospital Center
Split, Croatia, between 2001 and 2009. All interventions
were carried out with a semi-rigid Wolf ureteroscope and
an electropneumatic generator used for lithotripsy. The
operating specialists were divided into two groups. The
first group included 4 urologists who had started learning
and performing endoscopic procedures at the beginning
of their specialization and the second group included 4
urologists who had started performing endoscopic procedures
later in their careers, on average more than 5 years
after specialization.
Results Radiology tests confirmed that 87% (208/238) of
stones were completely removed from the distal ureter,
54% (66/123) from the middle ureter, and 46% (28/61) from
the proximal ureter. The first group of urologists completed
significantly more procedures successfully, especially for
the stones in the distal (95% vs 74%; P = 0.001) and middle
ureter (66% vs 38%; P = 0.002), and their patients spent less
time in the hospital postoperatively.
Conclusion Urologists who started learning and performing
endoscopic procedures at the beginning of their specialization
are more successful in performing ureteroscopy.
It is important that young specialists receive timely and
systematic education and cooperate with more experienced
colleagues
CYSTINE UROLITHIASIS: RECOMMENDATIONS FOR DIAGNOSIS, TREATMENT AND RECURRENCE PREVENTION
Cistinska litijaza dijagnostiÄki je i terapijski izazov, a u naÅ”oj literaturi do sada nije bilo ujedinjenih prikaza kako valja postupati s ovakvim bolesnicima. Ovaj dokument rezultat je rasprava na tom sastanku uz nadogradnju nakon simpozija putem elektroniÄkih sjednica i ekspertno je miÅ”ljenje struÄnjaka. Nadamo se da Äe Älanak biti od praktiÄne koristi brojnim kolegama koji se susreÄu s problemom litijaze, a one koji to rjeÄe imaju prilike, podsjetit Äe na ovaj oblik kamenaca mokraÄnog sustava. Ovaj dokument namijenjen je primarno urolozima i nefrolozima, ali i svim opÄim internistima te lijeÄnicima obiteljske medicine jer Äe svima, vjerujemo, olakÅ”ati razmiÅ”ljanja kada se suoÄe s takvim bolesnikom.Cystine lithiasis is a diagnostic and therapeutic challenge. This consensus document has outgrown of discussion of experts in nephrology and urology. It is our hope that this document will be of use for all physicians who are facing this disturbing type of urolithiasis. So far, in our national literature there have been no comprehensive documents dealing with this entity and we believe that not only nephrologists and urologists will benefit, but also specialists in internal medicine and general practitioners
KliniÄke upute za dijagnostiku, lijeÄenje i praÄenje bolesnika oboljelih od raka mokraÄnog mjehura Hrvatskoga onkoloÅ”kog druÅ”tva i Hrvatskoga uroloÅ”kog druÅ”tva Hrvatskoga lijeÄniÄkog zbora [Clinical guidelines for diagnosing, treatment and monitoring patients with bladder cancer - Croatian Oncology Society and Croatian Urology Society, Croatian Medical Association]
Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-GuƩrin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia
CLINICAL GUIDELINES FOR DIAGNOSING, TREATMENT AND MONITORING PATIENTS WITH PROSTATE CANCER ā CROATIAN ONCOLOGY SOCIETY AND CROATIAN UROLOGY SOCIETY, CROATIAN MEDICAL ASSOCIATION
Adenokarcinom prostate druga je po uÄestalosti zloÄudna neoplazija u muÅ”karaca u Republici Hrvatskoj. KliniÄki je Äesto asimptomatski, a najÄeÅ”Äe se otkriva na osnovi poviÅ”enih vrijednosti PSA u serumu. Odluka o lijeÄenju donosi se na osnovi TNM-klasifikacije, Gleasonova gradusa (stupnja diferenciranosti) i vrijednosti PSA. KliniÄki lokalizirana bolest lijeÄi se vrlo uspjeÅ”no radikalnom prostatektomijom ili radikalnom radioterapijom s hormonskom terapijom ili bez nje. KliniÄki lokalno uznapredovala bolest najÄeÅ”Äe se lijeÄi združenom primjenom radikalne radioterapije i hormonske terapije. Metastatska bolest može se godinama kontrolirati androgenom deprivacijom, a nakon razvoja bolesti rezistentne na kastraciju opravdana je kemoterapija ili dodatni oblici hormonske terapije. U tekstu koji slijedi predstavljene su kliniÄke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, lijeÄenja te praÄenja bolesnika s rakom prostate u Republici Hrvatskoj.Prostate adenocarcinoma is the second most common solid neoplasm in male population in Croatia. It rarely causes symptoms unless it is advanced. The finding of PSA rise is the most common reason for diagnostic workout. Treatment plan is based on TNM classification, Gleason score and PSA. Clinically localized disease is successfully treated by radical prostatectomy or radiotherapy with or without hormonal therapy. Locally advanced disease is treated with radiotherapy and hormonal therapy. Metastatic disease can be controlled for many years by androgen deprivation. For castration resistant disease appropriate treatment is chemotherapy or secondary hormonal therapy. The following paper presents the clinical guidelines in order to standardize procedures and criteria for the diagnosis, management, management, treatment and monitoring of patients with prostate cancer in the Republic of Croatia
CLINICAL GUIDELINES FOR DIAGNOSING, TREATMENT AND MONITORING PATIENTS WITH BLADDER CANCER ā CROATIAN ONCOLOGY SOCIETY AND CROATIAN UROLOGY SOCIETY, CROATIAN MEDICAL ASSOCIATION
Urotelni rak najÄeÅ”Äi je rak mokraÄnog mjehura. Hematurija je najÄeÅ”Äi simptom pri prezentaciji bolesti. Dijagnoza raka mokraÄnog mjehura postavlja se uglavnom transuretralnom resekcijom nakon Äega slijedi patohistoloÅ”ka dijagnoza. Nužno je utvrditi je li rak zahvatio miÅ”iÄni sloj (miÅ”iÄnoinvazivni rak) ili nije (miÅ”iÄnoneinvazivni rak). Odluka o terapijskome modalitetu ovisi o kliniÄkom stadiju bolesti, prognostiÄkim Äimbenicima i Äimbenicima rizika. Za miÅ”iÄnoneinvazivni rak mokraÄnog mjehura uglavnom se preferira transuretralna resekcija tumora mokraÄnog mjehura s intravezikalnom instilacijom Calmette-GuĆ©rinova bacila (BCG) ili bez nje. Za invazivni je rak metoda izbora radikalna cistektomija. Radioterapija se rabi u radikalne i palijativne svrhe. Metastatska bolest najÄeÅ”Äe se lijeÄi kemoterapijom metotreksat/vinblastin/doksorubicin/cisplatinom (MVAC) ili gemcitabin/cisplatinom (GC). Svrha je ovog Älanka predstavljanje kliniÄkih uputa s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, lijeÄenja te praÄenja bolesnika s rakom mokraÄnog mjehura u Republici Hrvatskoj.Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-GuĆ©rin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia