56 research outputs found
Our Experiences in Treatment of Prostate Carcinoma in Patients over the Age of 70
The goal of our study was to present our long-standing experience of the treatment of prostate carcinoma in patients
over the age of 70. During the 20 years period (from 1991 to 2010) we diagnosed the prostate carcinoma in 1998 patients.
More than 58% of the patients were over 70 years old. The most frequent symptoms of the prostate carcinoma were frequent
urination and backache. At the first examination 36% of the patients had both prostate lobes involved, and 27% of
them had metastases. The most frequent ones (26%) were those in the bone system (pelvis and spine), while in only 1%
metastases were found in solid organs (lungs and liver). According to the TNM classification, T1 and T2 were diagnosed
in 818 (71%) patients. Histopathological examination discovered Gleason score 2 in 70% of patients and Gleason score 3
in 24% of them. Most often the combination of castration and antiandrogen therapy (in 68% of the patients) and the combination
of castration and Estracyt therapy (in 19% of the patients) were applied. In conclusion, intensified efforts should
be made in promoting preventive urological examinations because of the great number of patients (27%) with metastases
at the first examination
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
Radical Surgical Treatment of the Urinary Bladder Cancer in Patients Over the Age of 60 ā Our Experiences
The goal of the paper was the analysis of patients over the age of 60 suffering from the urinary bladder cancer that underwent radical surgical treatment of the urinary bladder and establishing urine derivation. In the 1972ā2008 period 2405 patients with the urinary bladder cancer were treated, 296 (12.3%) of whom underwent radical surgical treatment. The average age was between 60 and 80 years ā in 207 (70%) patients. In our patients there were 190 patients (91.6%) with transitional cell cancers. According to TNM classification, T3 stage in 92 (44.4%) patients and T2 stage in 85 (41%) patients were predominant in our study. According to histological criteria, the most common stage was G3 stage ā in 151 (73%) patients. Radical cystectomy or combined with urethrectomy was performed in 178 (86%) patients. Unfortunately, in 12% of them (T3 and T4 stages) the inner iliac blood vessels were tied off due to a progressive cancer. The outer supravesical urine derivation (Bricker, U-tubing nephrostomy, and ureterocutaneostomy) was done in 163 (78.7%) patients. The inner derivation (Coffey, ureteroileosigmoidostomy, Mainz-Pouch II) was performed in 17 (8.2%) patients and neovesica (Hautmann, Studer) in 24 (11.5%) patients. There were 74 (35.7%) patients with early postoperative complications. Among them the most dominant were the surgical complications ā in 28 (13.5%) patients and distant organ complications ā in 22 (10.6%) patients. In 75 (36%) patients with negative nodes the survival rate was 55% after five years. In 73 (35%) patients with positive nodes the survival rate was 27% after five years
NeuobiÄajeni sluÄaj akutnog zadržavanja mokraÄe
A 47-year-old male was referred to Emergency Department of our hospital for acute urinary retention. Physical examination showed electrical cable with proximal part introduced into the urethra. Plain abdominal radiograph demonstrated a metallic object in the pelvis and the patient underwent an operation. We used suprapubic cystostomy approach, and the wire was removed from the bladder and urethra.MuÅ”karac u dobi od 47 godina upuÄen je na hitni odjel naÅ”e bolnice zbog akutnog zadržavanja mokraÄe. Fizikalnim pregledom otkriven je elektriÄni kabel koji je dijelom bio uvuÄen u uretru. Radiografski pregled trbuha pokazao je metalni predmet u zdjelici, pa je bolesnik podvrgnut operacijskom zahvatu. Primijenili smo pristup suprapubiÄnom cistostomom i uklonili žicu iz mjehura i uretre
Transrectal Sonography in Prostate Cancer Detection ā 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 ultrasound1ā5. 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
Endoscopic treatment of urinary reservoir calculus
Cilj: U pacijenata u kojih je odstranjen mokraÄni mjehur neophodno je uÄiniti urinarnu diverziju. Ona podrazumijeva umetanje izoliranog dijela crijeva (najÄeÅ”Äe ileuma ili kolona) u mokraÄni sustav. Urinarna diverzija može služiti za provoÄenje urina (konduit) ili kao spremnik urina. Pacijenti s urinarnom diverzijom imaju zbog metaboliÄkih poremeÄaja, bakterijske kolonizacije i rezidualnog urina sklonost nastanku urolitijaze. U ovom radu prikazujemo pacijenticu s kamencem u urinskom spremniku i naÄin lijeÄenja. Prikaz pacijenta: U 65-godiÅ”nje pacijentice zbog recidivnog karcinoma vulve uÄinjena je prednja egzenteracija zdjelice uz derivaciju urina spremnikom urina po metodi Mainz pouch I. Zbog recidivne makrohematurije uÄinjena joj je kompjutorizirana tomografija kojom je pronaÄen kamenac u spremniku najveÄe duljine 24 mm. S obzirom na tip spremnika i veliÄinu kamenca odluÄili smo se na endoskopsku litotripsiju kamenca transstomalnim pristupom. Litotripsija je uspjeÅ”no uÄinjena s elektrokinetiÄkim litotriptorom uz eliminaciju svih fragmenata. Poslijeoperacijski tijek je protekao uredno, bez kirurÅ”kih komplikacija. Rasprava i zakljuÄak: U pacijenata s urinskom diverzijom i kamencem u spremniku preporuÄuje se endoskopsko lijeÄenje, jer je uspjeÅ”nost takvog zahvata vrlo visoka. Kod kamenca manjeg promjera, kao kod naÅ”e pacijentice, preporuÄuje se transstomalni pristup uz koriÅ”tenje uobiÄajenog uroloÅ”kog instrumentarija. Oporavak nakon ove operacije je vrlo brz, a komplikacije izuzetno rijetke.Aim: Some type of urinary diversion must be performed in patients after cystectomy, usually with an isolated part of bowel (ileum or colon) transposed into the urinary tract, serving for derivation or containment of urine. Metabolic disorders, bacterial colonization and significant residual urine are risk factors in patients with urinary diversion, which increase risk of urolithiasis. In this case report we present a patient with pouch stone and treatment modality. Case report: Anterior pelvic exenteration with urinary diversion (Mainzpouch I) was performed in a 65-years-old woman because of recurrent vulvar cancer. Due to recidual macrohematuria, the patient underwent computerised tomography, which revealed a stone in the pouch. Maximum stone length was 24 mm. Considering the pouch type and stone length, we chose endoscopic lithotripsy with trans-stomal approach. Lithotripsy was successfully performed with the electrokinetic lithotripter and all stone fragments were removed. Postoperative course was uneventful, without surgical complications. Conclusion: Endoscopic treatment is recommended in patients pouch stones due to its efficacy. Trans-stomal approach is suitable when the stone diameter is relatively small and all standard urologic equipment can be used, as demonstrated in our patient. Recovery after such operation is fast and complications are rare
Primary testicular necrotizing vasculitis clinically presented as neoplasm of the testicle: a case report
We present a case of necrotizing vasculitis with the testicle as the isolated affected organ. A 25-year-old man, pretreated for epididymo-orchitis, presented with a presumed testicular neoplasm. Radical orchiectomy was performed and diagnosis of necrotizing vasculitis was established. In the absence of any other sign of systemic disease, the diagnosis of isolated necrotizing vasculitis of the testis was confirmed. Two years after the operation, the patient showed no symptoms of systemic disease
Our Experiences in Treatment of Prostate Carcinoma in Patients over the Age of 70
The goal of our study was to present our long-standing experience of the treatment of prostate carcinoma in patients
over the age of 70. During the 20 years period (from 1991 to 2010) we diagnosed the prostate carcinoma in 1998 patients.
More than 58% of the patients were over 70 years old. The most frequent symptoms of the prostate carcinoma were frequent
urination and backache. At the first examination 36% of the patients had both prostate lobes involved, and 27% of
them had metastases. The most frequent ones (26%) were those in the bone system (pelvis and spine), while in only 1%
metastases were found in solid organs (lungs and liver). According to the TNM classification, T1 and T2 were diagnosed
in 818 (71%) patients. Histopathological examination discovered Gleason score 2 in 70% of patients and Gleason score 3
in 24% of them. Most often the combination of castration and antiandrogen therapy (in 68% of the patients) and the combination
of castration and Estracyt therapy (in 19% of the patients) were applied. In conclusion, intensified efforts should
be made in promoting preventive urological examinations because of the great number of patients (27%) with metastases
at the first examination
Epidemiology of Prostate Cancer in the Mediterranean Population of Croatia ā A Thirty-Three Years Retrospective Study
Prostate cancer is a major public health problem of the male population in all the developed countries1. This non-skin
cancer is the foremost one facing man today. Prostate cancer has become the second leading cause of cancer death2. In
this study we investigated changes in the prostate carcinoma incidence and manifestation during a thirty-three years period.
The study included 1,226 cases of prostate cancer diagnosed from 1972 to 2005 in the Primorsko-Goranska County,
Croatia. The age-adjusted incidence of prostate cancer increased from 1.69 per 100,000 men annually in 1972 to 137.58
per 100,000 men annually in 2005, which is an 81.4-fold increase. The percentage of patients with bone metastases on the
first medical examination decreased from 1972 (75%) to 2005 (15%). The most of the patients with bone metastases at the
first medical examination were between 30 and 50 years old. Early detection measures, such as prostate specific antigen
testing and transrectal ultrasound guided prostate biopsy combined with the raised public awareness of the disease, most
probably resulted in an increase of incidence
The Etiological Relation between Serum Iron Level and Infection Incidence in Hemodialysis Uremic Patients
Through the treatment of anaemia in dialysis patients part of the iron ions remain free in the serum which is at the
bacterias disposal for growth and the strengthening of their virulence. The linear relation of the increased serum iron
level and tissue iron stores in the body and the infection incidence in dialysed patients has become more emphasised. The
need of a clearly defined upper threshold of the serum iron concentration limit has been mentioned in scientific journals
intensely, and consequently the demand for more precise professional instructions for anaemia treatment. For the purpose
of participating in these professional and scientific discussions, we have observed the relation between the iron overload
of the organism and complication incidence in 120 of our haemodialysis uremic patients, with special emphasis on
infections. It has been established that the sepses incidence is much higher in patients with a serum ferritin concentration
above 500 mg/L, than in those patients with a ferritin level lower than the mentioned value (c
2=7.857, p=0.005). The
incidence of vascular access infection is significantly higher in those patients with a serum ferritin level above 500 mg/L
than in those patients with a ferritin level lower than the mentioned value (c
2=23.186, p=0.001). Furthermore, it has
been determined that the incidence of total infection in patients is 3.8 episodes per 100 patients months, which is in accordance
to the referral values of other authors. Conclusion ā In the analysis of the achieved results, it has been determined
that the infection incidence is significantly higher in dialysed patients with a serum iron level higher than 500 g/L, than
in those patients with lower values
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