URETERORENOSCOPY – OUR 10 YEARS OF EXPERIENCE

Tijekom deset i pol godina učinjene su na Urološkom odjelu Kirurške klinike KBC-a Rijeka 1554 ureterorenoskopije, od kojih je većina, 1374 (88,4%), učnjena radi liječenja ureteralne litijaze. Budući da Odjel ne posjeduje aparat za ekstrakorporalno mrvljenje kamenaca, metoda izbora postao je endoskopski način liječenja litijaze, bez obzira na položaj, broj i veličinu kamenaca. U zadnjih šest godina 960 (75,5%) bolesnika liječeno je ureteroskopski, 162 (12,7%) perkutanom litotripsijom, 92 (7,2%) upućeno je na ESWL, a samo u 58 (4,6%) bolesnika je uičnjena klasična ureterolitotomija. Uspje{nost liječenja urolitijaze pomo}u ureterorenoskopa iznosi vi{e od 90%. U 8,3% bolesnika kamenci nisu potpuno odstranjeni ili su potisnuti natrag u bubreg, zbog čega su ti bolesnici upućeni na ESWL. Do perforacije uretera kao teške intraoperacijske komplikacije došlo je samo u 8 (0,5%) bolesnika. Laceracije sluznice, blaga krvarenja, febrilitet, postoperacijska bol u slabini ili renalna kolika, nešto su ve{će komplikacije koje se smatraju lakšim i jednostavno se lijče. Do sepse je do{lo samo u jednog bolesnika koji je uspješno izliječen primjenom antibiotika. Dvije manje izražene stenoze lumbalnog segmenta dilatirali smo balonom te postavili endoproteze. Zbog perforacije uretera, kamenaca pretvrdih za mrvljenje ure|ajima kojima smo u aktualnom trenutku raspolagali i kamenaca do kojih nismo uspjeli doprijeti ureteroskopom, u 20 bolesnika učnjene su otvorene operacije (ureterolitotomija, ureterolitotomiju s resekcijom stenoze i T-T anastomozom uretera, ureterolitotomija s apendektomijom zbog akutnog apendicitisa i jednom nefrektomija). U 146 (9,6%) bolesnika u~injena je dijagnosti~ka URS radi istra`ivanja uzroka unilateralnog krvarenja i dijagnosticiranja suženja ili opstrukcije uretera (benigna, odnosno maligna stenoza). U trideset četiri bolesnika (2,2%) pomo}u ureterorenoskopa odstranjena je retrahirana endoproteza iz uretera. Smatramo da URS ima posebnu važnost primarnog liječenja u bolnicama koje ne raspolažu uređajem za ESWL. Indiciran je kod svih kamenaca, bez obzira na njihov položaj, broj i veli~čnu. Za uspješan rad, uz obvezno iskusnog operatera, potreban je adekvatan, kvalitetan ureterorenoskop, s pripadajućim pomoćnim instrumentima, više različitih tipova uređaja za mrvljenje kamenaca.During the last 10 years 1.554 ureterorenoscopies were done at our department. Most of them, 1.374 (88.4 %) were applied in ureteral stone treatment. Since we do not have an instrument for extracorporeal shock wave lithotripsy (ESWL), ureteroscopic approach to the stones, regardless of the size, number and localization, becomes a method of choice in the treatment. During the last six years 960 (75.5%) patients were treated ureteroscopically (URS), 162 (12.7%) by percutaneous lithotripsy, 92 (7.2%) were directed to ESWL and only in 58 (4.6%) of them classical ureterolithotomy was done. Complete stone clearance after URS was achieved in more than 90% of patients. In 8.3% of patients the stones could not be completely removed or were pressed to the kidneys, and therefore the patients were directed to ESWL. Serious intraoperative complication, the perforation of ureters occurred only in 8 (0.5%) patients. Mucosal lacerations, mild bleeding, fever, postoperative lumbal pain or kidney colic are possible complications, but they are usually mild and simple to treat. Sepsis occurred in one patient only and was successfully treated by antibiotics. Two mild lumbar stenoses were balloon dilated and stented. In 20 patients where stones could not be reached or fragmented by available methods (US, EH) or due to a complication (perforation), open surgery was performed: ureterolithotomy, ureterolithotomy with the resection of ureteral segment stenosis and T-T ureteral anastomosis, ureterolithotomy with appendectomy due to acute appendicitis and in one case nephrectomy was indicated. In 9.6% of patients explorative URS was done with the purpose to determine the cause of unilateral bleeding, stenosis or obstruction of ureter (benign, malignant stenosis). In 34 patients retracted endoprothesis was removed by URS. In conclusion, we consider URS a primary method for hospitals without ESWL. The use of URS is indicated in all cases of ureteral stones regardless of the size, number and localisation. For a successful stone clearance, a good and adequate ureteroscope is needed, corresponding instruments, several possibilities for stone fragmentation and above all an experienced urologist

URETERORENOSCOPY – OUR 10 YEARS OF EXPERIENCE

Tijekom deset i pol godina učinjene su na Urološkom odjelu Kirurške klinike KBC-a Rijeka 1554 ureterorenoskopije, od kojih je većina, 1374 (88,4%), učnjena radi liječenja ureteralne litijaze. Budući da Odjel ne posjeduje aparat za ekstrakorporalno mrvljenje kamenaca, metoda izbora postao je endoskopski način liječenja litijaze, bez obzira na položaj, broj i veličinu kamenaca. U zadnjih šest godina 960 (75,5%) bolesnika liječeno je ureteroskopski, 162 (12,7%) perkutanom litotripsijom, 92 (7,2%) upućeno je na ESWL, a samo u 58 (4,6%) bolesnika je uičnjena klasična ureterolitotomija. Uspje{nost liječenja urolitijaze pomo}u ureterorenoskopa iznosi vi{e od 90%. U 8,3% bolesnika kamenci nisu potpuno odstranjeni ili su potisnuti natrag u bubreg, zbog čega su ti bolesnici upućeni na ESWL. Do perforacije uretera kao teške intraoperacijske komplikacije došlo je samo u 8 (0,5%) bolesnika. Laceracije sluznice, blaga krvarenja, febrilitet, postoperacijska bol u slabini ili renalna kolika, nešto su ve{će komplikacije koje se smatraju lakšim i jednostavno se lijče. Do sepse je do{lo samo u jednog bolesnika koji je uspješno izliječen primjenom antibiotika. Dvije manje izražene stenoze lumbalnog segmenta dilatirali smo balonom te postavili endoproteze. Zbog perforacije uretera, kamenaca pretvrdih za mrvljenje ure|ajima kojima smo u aktualnom trenutku raspolagali i kamenaca do kojih nismo uspjeli doprijeti ureteroskopom, u 20 bolesnika učnjene su otvorene operacije (ureterolitotomija, ureterolitotomiju s resekcijom stenoze i T-T anastomozom uretera, ureterolitotomija s apendektomijom zbog akutnog apendicitisa i jednom nefrektomija). U 146 (9,6%) bolesnika u~injena je dijagnosti~ka URS radi istra`ivanja uzroka unilateralnog krvarenja i dijagnosticiranja suženja ili opstrukcije uretera (benigna, odnosno maligna stenoza). U trideset četiri bolesnika (2,2%) pomo}u ureterorenoskopa odstranjena je retrahirana endoproteza iz uretera. Smatramo da URS ima posebnu važnost primarnog liječenja u bolnicama koje ne raspolažu uređajem za ESWL. Indiciran je kod svih kamenaca, bez obzira na njihov položaj, broj i veli~čnu. Za uspješan rad, uz obvezno iskusnog operatera, potreban je adekvatan, kvalitetan ureterorenoskop, s pripadajućim pomoćnim instrumentima, više različitih tipova uređaja za mrvljenje kamenaca.During the last 10 years 1.554 ureterorenoscopies were done at our department. Most of them, 1.374 (88.4 %) were applied in ureteral stone treatment. Since we do not have an instrument for extracorporeal shock wave lithotripsy (ESWL), ureteroscopic approach to the stones, regardless of the size, number and localization, becomes a method of choice in the treatment. During the last six years 960 (75.5%) patients were treated ureteroscopically (URS), 162 (12.7%) by percutaneous lithotripsy, 92 (7.2%) were directed to ESWL and only in 58 (4.6%) of them classical ureterolithotomy was done. Complete stone clearance after URS was achieved in more than 90% of patients. In 8.3% of patients the stones could not be completely removed or were pressed to the kidneys, and therefore the patients were directed to ESWL. Serious intraoperative complication, the perforation of ureters occurred only in 8 (0.5%) patients. Mucosal lacerations, mild bleeding, fever, postoperative lumbal pain or kidney colic are possible complications, but they are usually mild and simple to treat. Sepsis occurred in one patient only and was successfully treated by antibiotics. Two mild lumbar stenoses were balloon dilated and stented. In 20 patients where stones could not be reached or fragmented by available methods (US, EH) or due to a complication (perforation), open surgery was performed: ureterolithotomy, ureterolithotomy with the resection of ureteral segment stenosis and T-T ureteral anastomosis, ureterolithotomy with appendectomy due to acute appendicitis and in one case nephrectomy was indicated. In 9.6% of patients explorative URS was done with the purpose to determine the cause of unilateral bleeding, stenosis or obstruction of ureter (benign, malignant stenosis). In 34 patients retracted endoprothesis was removed by URS. In conclusion, we consider URS a primary method for hospitals without ESWL. The use of URS is indicated in all cases of ureteral stones regardless of the size, number and localisation. For a successful stone clearance, a good and adequate ureteroscope is needed, corresponding instruments, several possibilities for stone fragmentation and above all an experienced urologist

OUR EXPERIENCE IN PROSTATE CARCINOMA TREATMENT

Karcinom prostate danas je najčešći maligni tumor u muškaraca u SAD-u i zapadnoj Europi i treći po učestalosti u Hrvatskoj. Razmjerno malo bolesnika otkriva se u početnom stadiju bolesti i podvrgava radikalnom liječenju, a većna bolesnika pokazuje znakove uznapredovale bolesti i udaljenih metastaza. Tijekom trinaest godina (1991.–2003.) na Urološkom odjelu KBC-a Rijeka u 933 bolesnika je dijagnosticiran karcinom prostate. Više od 55% bolesnika bili su u dobi iznad 70 godina. Najče{ći simptomi karcinoma prostate bili su učestalo mokrenje i križobolja. Pri prvom pregledu, oko 32% bolesnika imalo je zahvaćena oba lobusa prostate, a u 31,8% bolesnika nađene su metastaze. Najčeće su metastaze (26%) u koštanom sustavu (kosti zdjelice i LS kralježnica), a samo u 5,8% bolesnika nađene su u solidnim organima (plu}a i jetra). Prema TNM klasifikaciji, stadiji T3 i T4 dijagnosticirani su u 302 bolesnika. Patohistološkim pregledom u 48,7% bolesnika nađen je Gleason score 2, a Gleason score 3 u 25,9%. U samo 10,6% bolesnika učnjena je radikalna prostatektomija. Najče{će se primjenjivala kombinacija kastracije i antiandrogena (54,2% bolesnika) te kombinaciju kastracije i Estracyta (19,7%). Progresija bolesti javljala se če{šće u bolesnika s vi-š{im gradusom i stadijem bolesti i to obično unutar prve godine od početka liječenja (13% bolesnika). Od ukupno umrlih 130 bolesnika, karcinom prostate bio je uzrokom smrti 84 bolesnika (9%).Prostate carcinoma is the most common malignancy facing men in the USA and Western Europe and the third by incidence in Croatia. A relatively small number of cancer patients is detected in the early stage of the disease and submitted to radical treatment. A larger number of patients show signs of the advanced disease stage and metastases. During 13 years (1991-2003) we diagnosed prostate cancer in 933 patients. More than 55% of patients were over 70 years old. At the first examination in 32% of patients we found cancer in both prostate lobes and 31.8% of them had metastases (26% in bones). According to TNM classification stages T3 and T4 were found in 302 patients. Gleason score 2 was diagnosed in 48.7 % of cases and Gleason score 3 in 25.9%. Radical prostatectomy was performed in 10.6% of patients. The most commonly used treatment method was the combination of castration and antiandrogene drugs. The progression of the disease is faster in higher histological grade

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

Neuobičajeni slučaj akutnog zadržavanja mokraće

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.Muškarac u dobi od 47 godina upućen je na hitni odjel naše bolnice zbog akutnog zadržavanja mokraće. Fizikalnim pregledom otkriven je električni kabel koji je dijelom bio uvučen u uretru. Radiografski pregled trbuha pokazao je metalni predmet u zdjelici, pa je bolesnik podvrgnut operacijskom zahvatu. Primijenili smo pristup suprapubičnom cistostomom i uklonili žicu iz mjehura i uretre

Comparison of Results of Surgical Treatments of Primary Inguinal Hernia with Flat Polypropylene Mesh and Three-Dimensional Prolene (Phs) Mesh – One Year Follow Up

The aim of this study was to compare the results of the surgery of inguinal hernias using flat polypropylene mesh and three-dimensional prolene (PHS) mesh. The study included two groups of 40 male patients, aged 18–50 years, with the diagnosis of inguinal hernia. One group was operated with a flat polypropylene mesh, while the second group was operated with three-dimensional prolene (PHS) mesh. The study has shown that the operation with three-dimensional prolene mesh lasted 15 minutes longer and that the patients had stronger inflammatory response. Statistically, there was no significant difference in post-operative pain intensity, post-operative use of analgesics, length of hospitalization, return to daily activities, early and late post-operative complications. No recurrence was registered in any of the groups. The analysis of results indicates that there is no difference in treatment of inguinal hernia with flat polypropylene and three-dimensional prolene (PHS) mesh

The Role of Negative Pressure Wound Therapy in Patients with Kidney Transplantation

Kidney transplantation is the best treatment modality for patients with end-stage renal disease. Wound healing is impaired in these patients, and factors such as immunosuppression, older age and comorbidities have a negative impact on wound healing. Recently, negative pressure wound therapy has become an important wound management technique. We present two patients with wound healing issues in the early posttransplant period. In both patients, an immunosuppressive treatment was administered, which included tacrolimus, mycophenolate mophetil and high-dose corticosteroids with anti-IL-2 induction therapy. Postoperatively, the wounds became infl amed with dehiscence. Negative pressure wound therapy was successfully applied to aid the wound healing. The treatment duration period was two weeks for one patient and three weeks for the other. After the treatment period, the wounds were signifi cantly improved and were closed. After the secondary wound closures, the posttransplant course was uneventful in both patients. Presently, one and three years after the transplantations, both patients have well functioning kidneys. According to our limited experience, negative pressure wound therapy is a feasible and effective dehiscence wound treatment following kidney transplantation