Klinička praksa hrvatskih urologa i usklađenost sa smjernicama u liječenju simptoma donjeg mokraćnog trakta u muškaraca

The aim of this study was to assess the Croatian urologists’ management of non-neurogenic male lower urinary tract symptoms (LUTS) and their compliance with the European Association of Urology (EAU) guidelines. A cross-sectional survey included 51/179 Croatian urologists. We developed a questionnaire with questions addressing compliance with EAU guidelines. The rate of performing recommended evaluations on the initial assessment of patients with benign prostate hyperplasia (BPH)/LUTS varied from 8.0% (serum creatinine and voiding diary) to 100.0% (physical examination, prostate specific antigen and ultrasound). The international prostate symptom score was performed by 31%, analysis of urine sediment by 83%, urine culture by 53%, and serum creatinine by 8% of surveyed urologists. Only 8% of urologists regularly used bladder diary in patients with symptoms of nocturia. Our results indicated that 97% of urologists preferred alpha blockers as the first choice of treatment; 5-alpha reductase inhibitors (5ARI) were mostly prescribed (84%) in combination with an alpha-blocker, preferably as a continuous treatment, whilst 29% of urologists used to discontinue 5ARI after 1-2 years. Half of the Croatian urologists used antimuscarinics in the treatment of BPH/LUTS and recommended phytotherapeutic drugs in their practice. In conclusion, Croatian urologists do not completely comply with the guidelines available.Cilj ovoga istraživanja bio je uvrditi kliničku praksu hrvatskih urologa u pristupu bolesnicima sa simptomima donjeg mokraćnog trakta (LUTS) i njihovo pridržavanje Smjernica Europskoga urološkog društva (EAU). Provedeno je presječno istraživanje među 51/179 (28%) hrvatskih urologa. Izradili smo upitnik koji sadrži pitanja glede poštivanja smjernica EAU. Primjena preporučenih pretraga u početnoj procjeni bolesnika s benignom hiperplazijom prostate (BPH)/LUTS varirala je od 8,0% (kreatinin i dnevnik mokrenja) do 100,0% (fizikalni pregled, antigen specifičan za prostatu (PSA) i ultrazvuk). U početnoj procjeni bolesnika s BPH/LUTS uz anamnezu i digitorektalni pregled hrvatski urolozi primjenjuju još PSA i ultrazvuk (100%). Međunarodni zbroj prostatičnih simptoma (IPSS) primjenjuje 31%, analizu sedimenta mokraće 83%, kulturu mokraće 53%, a serumski kreatinin 8% ispitanih urologa. Samo 8% urologa redovito koristi dnevnik mokrenja kod bolesnika sa simptomima nokturije. Rezultati su pokazali kako 62% hrvatskih urologa smatra da provodi dijagnostičku obradu koja je u skladu sa smjernicama EAU. U terapijskom pogledu rezultati pokazuju da 97% urologa smatra alfa blokatore lijekom prvog izbora. Inhibitori 5-alfa reduktaze (5ARI) uglavnom (84%) su propisani u kombinaciji s alfa-blokatorima, ponajprije kao kontinuirano liječenje, dok 29% prekida 5ARI nakon 1-2 godine. Polovica hrvatskih urologa rabi antimuskarinike u liječenju BPH/LUTS i preporučuje fitoterapiju u svojoj praksi. Praksa hrvatskih urologa nije u potpunosti usklađena sa smjernicama

Dijagnostika raka prostate u 2019. - promjene u europskim smjernicama i utjecaj na svakodnevnu praksu

Changes in the diagnostic pathway for prostate cancer advised in the most recent Guidelines of the European Association of Urology bring many endeavors for everyday practice. Availability, costs and radiological expertise are still representing a challenge for the adoption of these guidelines in everyday clinical practice. In this article we discuss the current situation regarding these issues and future options.Promjene u dijagnostici karcinoma prostate preporučene u najnovijim Smjernicama Europskog udruženja za urologiju donose mnoge izazove u svakodnevnoj praksi. Dostupnost, troškovi i pouzdanost slikovnog nalaza i dalje su izazov za usvajanje ovih smjernica u svakodnevnoj kliničkoj praksi. U ovom članku raspravljamo o trenutnoj situaciji u Hrvatskoj i svijetu i o budućim opcijama

Nepovoljne kliničko-patološke značajke 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.Zdjelična limfadenektomija u vrijeme radikalne prostatektomije (RP) trenutno je najpouzdaniji način otkrivanja metastaza u limfne čvorove u bolesnika s rakom prostate. Cilj našeg istraživanja bio je procijeniti nepovoljne kliničko-patološke značajke u bolesnika s izostavljenom limfadenektomijom tijekom radikalne prostatektomije temeljene na Briganteovom nomogramu. U 2011. godini, u našoj je ustanovi 200 bolesnika podvrgnuto radikalnoj prostatektomiji. Identificirali smo 53 bolesnika koji su ispunili Brigantijeve kriterije te su prema aktualnim smjernicama bili pošteđeni zdjelične limfadenektomije. Nepovoljnim kliničko-patološkim značajkama smatralo se bilježenje stadija T3 bolesti, pozitivni kirurški rubovi ili biokemijski relaps. Na patohistološkom (PH) nalazu biopsije Gleason zbroj 6 verificiran je u 34 pacijenta, a 19 je pacijenata imalo Gleason zbroj 7. Na konačnom PH nalazu nakon učinjene radikalne prostatektomije 49 bolesnika je imalo pT2 stadiji bolesti, a 4 su bolesnika imala pT3. Konačni Gleason zbroj nakon radikalne prostatektomije povećan je u 20 bolesnika na GS 7 (37%) i smanjen kod jednog bolesnika (2%). Nakon srednjeg praćenja 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 značajnu razliku u odnosu na pozitivne kirurške rubove (p = 0,0738) i BR (p = 0,736) nakon 49 mjeseci praćenja. Stoga se zdjelična limfadenektomija prema aktualnim smjernicama može sigurno izostaviti u bolesnika s procijenjenim niskim rizikom koristeći Briganteov nomogram

Usporedba točnosti 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, uključujući rak prostate, zahtijevaju preciznu dijagnostiku prije odluke o liječenju. Uvođenjem ciljanih biopsija na temelju nalaza MRI prostate povećana je točnost biopsije prostate. Vođene biopsije ciljaju na sam tumor u umjesto na najčešće lokacije tumora u prostati kao što je slučaj 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 klasičnoj sistemskoj biopsiji u usporedbi s pacijentima koji su bili podvrgnuti mpMRI kognitivnoj ciljanoj biopsiji. Identificirali smo pacijente iz naše baze podataka koji su podvrgnuti radikalnoj prostatektomiji u našoj ustanovi od 1. siječnja 2021. do 30. lipnja 2021. Identificirano je 112 pacijenata. Pacijenti su podijeljeni u dvije skupine na temelju vrste biopsije kojom je potvrđen rak prostate. Skupina mpMRI (N=50) primila je mpMRI kognitivno vođenu transrektalnu ultrazvučnu (TRUS) biopsiju prostate, a skupina non-mpMRI (N=62) primila je klasičnu, sistemsku TRUS biopsiju. Usporedili smo rezultate biopsije s konačnim patološkim nalazima i tražili smo podcjenjivanje stupnja diferenciranosti karcinoma prostate u biopsijama u usporedbi s konačnim histološkim nalazom. Podcjenjivanje stupnja diferenciranosti nađeno je u 17,7 % (N=11) u non-mpMRI skupini i u 12,0 % (N=6) slučajeva u mpMRI skupini (p=0,02, Mann-Whitney U test). U našoj kohorti nije pronađeno precjenjivanje stupnja diferenciranosti. Svi slučajevi podcjenjivanja imali su Gradus grupu 1 na nalazu biopsije prostate i Gradus grupu 2 u konačnom patohistološkom nalazu. U našoj kohorti, pacijenti koji su bili podvrgnuti ciljanoj biopsiji imali su nižu incidenciju podcjenjivanja stupnja diferenciranosti što je posljedica točnijeg uzorkovanja. Tijekom sistemske TRUS biopsije, urolog cilja na područja prostate gdje se rak najčešće nalazi, što je obično periferna zona prostate. Budući da različita područja tumora imaju različita područja diferencijacije, ponekad se bioptira samo dio tumora koji je bolje diferenciran, što rezultira pogreškom uzorkovanja. Nakon što je prostata uklonjena, analizira se cijeli tumor, tako da su rezultirajući patohistolološki rezultati uklonjene prostate daleko točniji od analize uzoraka prostate dobivenih biopsijom

Trenutno mjesto magnetske rezonance u probiru, dijagnostici i liječenju raka prostate

Prostate cancer is the most common cancer in men. Diagnosis of prostate cancer poses a significant challenge, due to several different key parameters that need to be evaluated, such as age, history of prostate specific antigen (PSA), clinical examination and more recently magnetic resonance imaging (MRI). The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mp-MRI) of the prostate has been identified as a test that could alleviate these diagnostic errors. Before prostate cancer treatment pathological confirmation is mandatory. Prostate biopsy is an invasive procedure with rare but not negligible potential complications. There are several methods of prostate biopsy of which most common are systemic or planar prostate biopsy and cognitive or targeted MRI-guided prostate biopsy. Multiparametric MRI has demonstrated better accuracy and reproducibility in detecting, locating and evaluating prostate cancer and also sparing some men unnecessary biopsies. Recent studies have shown a mpMRI benefit for better procedure planning regarding prostate cancer location, extent of disease and length of the urethra. There are still some challenges ahead, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. According to the latest urological clinical guidelines mpMRI became fundamental tool in management of prostate cancer. The aim of this study is to give a brief insight in use of mpMRI in prostate cancer diagnosis and treatment.Rak prostate najčešći je karcinom u muškaraca. Dijagnoza raka prostate predstavlja značajan izazov zbog nekoliko različitih ključnih parametara koje je potrebno procijeniti, kao što su dob, povijest prostata specifičnog antigena (PSA), klinički pregled i u novije vrijeme multiparametrijski MRI (mp-MRI). Trenutna dijagnostika raka prostate rezultirala je prekomjernom dijagnostikom i liječenjem, kao i poddijagnozom i propuštenom dijagnozom kod mnogih muškaraca. Multiparametrijski MRI prostate identificiran je kao test koji bi mogao ublažiti ove pogreške. Prije liječenja raka prostate obavezna je patološka potvrda. Biopsija prostate je invazivan postupak s rijetkim, ali ne i zanemarivim potencijalnim komplikacijama. Postoji nekoliko metoda biopsije prostate od kojih su najčešće sistemska ili planarna biopsija prostate i kognitivna ili ciljana biopsija prostate vođena MRI-om. Mp-MRI pokazao je bolju točnost i reproducibilnost u otkrivanju, lociranju i procjeni raka prostate, a također je poštedio neke muškarace nepotrebne biopsije. Nedavne studije pokazale su korist mpMRI-e za bolje planiranje zahvata s podacima o lokaciji raka prostate, opsegu bolesti i duljini uretre. Pred nama su još neki izazovi, poput osiguravanja visokokvalitetne izvedbe i izvješćivanja o mpMRI-u te osiguravanja da je ovaj dijagnostički put isplativ. Prema najnovijim urološkim kliničkim smjernicama mpMRI je postao temeljni alat u liječenju raka prostate. Cilj ove studije je dati kratak uvid u upotrebu mpMRI-e u dijagnostici i liječenju raka prostate

Multiparametrijska magnetska rezonancija u procjeni karcinoma prostate

Multiparametric magnetic resonance is assuming an increasingly important role in the diagnosis, initial assessment and monitoring of patients with prostate cancer. This paper offers a more complex insight into the application of magnetic resonance imaging with prostate cancer, with a current literature overview. The focus is on the problem of initial prostate cancer evaluation which strongly affects further decision-making and therapeutic interventions. Clinical suggestions based on the current guidelines are also offered.Multiparametrijska magnetska rezonancija preuzima sve značajniju ulogu u dijagnostici, inicijalnoj procjeni, kao i praćenju pacijenata s karcinomom prostate. Ovaj rad nudi složeniji uvid u pitanje primjene magnetske rezonancije kod karcinoma prostate, uz pregled trenutne literature iz područja. Posebno težište je stavljeno na problem inicijalne procjene karcinoma prostate koje uvelike determinira daljnje odlučivanje i terapijsko postupanje. Ponuđene su i preporuke temeljene na trenutnim smjernicama

DIJAGNOSTIČKI ZNAČAJ BIOPSIJE PROSTATE VOĐENE KOGNITIVNOM FUZIJOM MULTIPARAMETRIJSKE MAGNETNE REZONANCE I TRANSREKTALNOG ULTRAZVUKA (mpmri-TRUS) KOD BOLESNIKA S PRETHODNO NEGATIVNOM TRUS VOĐENOM BIOPSIJOM

The aim of this prospective clinical study was to determine the detection rate of prostate cancers by multiparametric magnetic resonance and transrectal ultrasound (mpMRI-TRUS) cognitive fusion biopsies in patients with a previously negative TRUS-guided biopsy. Between 1 October 2016 and 1 July 2017, in 101 consecutive patients with elevated antigen (PSA) and/or positive digital rectal examination and after a negative first TRUS biopsy, a second, repeated prostate biopsy was performed. In 24 patients, cognitive fusion mpMRI-TRUS biopsy of the prostate with 8-10 system cores and 1-3 target biopsies was performed, in line with the European Association of Urology guidelines. In 77 patients, only a classic, repeated TRUS guided biopsy was performed. In patients with mpMRI, the detection rate according to PIRADS-v2 reporting system was: PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%); and PIRADS 5, n = 2/3 (67%). In the group of patients with MR-TRUS cognitive fusion biopsy, the prostate cancer detection rate was 8/24 (33%), while in the control group the detection rate was 12/77 (16%), which was statistically significant (t test, p = 0.037, CI 95% is 0.01 to 0.37). Patients with PIRADS ≤ 3 (54%) could have avoided the biopsy.U ovoj prospektivnoj kliničkoj studiji cilj je odrediti stopu detekcije raka prostate biopsije vođene kognitivnom fuzijom multiparametrijske magnetne rezonance i transrektalnog ultrazvuka (mpMRI-TRUS) kod bolesnika s prethodno negativnom TRUS vođenom biopsijom. U razdoblju od 1. 10. 2016. do 1. 7. 2017. kod 101 uzastopnog bolesnika s povišenim prostata specifičnim antigenom (PSA) i/ili pozitivnim digitorektalnim pregledom, a nakon negativne prve TRUS biopsije je učinjena druga, ponovljena biopsija prostate. Kod 24 bolesnika učinjena je, u skladu sa Smjernicama Europskog urološkog društva, prethodna mpMRI i potom kognitivna fuzijska biopsija prostate s 8-10 sistemskih cilindara i 1-3 ciljane biopsije prema mpMRI nalazu. Kod 77 bolesnika je učinjena samo klasična, ponovljena TRUS biopsija bez prethodne slikovne obrade. Kod bolesnika s mpMRI, stopa detekcije raka prema PIRADSU-v2 je PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%) i PIRADS 5, n = 2/3 (67%). U skupini bolesnika s MR-TRUS kognitivnom fuzijskom biopsijom stopa detekcije raka prostate je 8/24 (33%), dok je u kontrolnoj skupini stopa detekcije 12/77 (16%), što se pokazalo statistički značajnom razlikom (t test; p=0.037, CI 95% je 0.01 to 0.37). Bolesnici s PIRADS ≤ 3 (54%) su mogli izbjeći biopsiju

Analiza isplativosti uvođenja biopsije prostate navođene multiparametrijskom magnetskom rezonancom

Continuous increase of the cost of medical services around the world has become a major topic in the world today. Multiparametric prostate MRI has recently become a new standard in prostate cancer detection, especially in repeated biopsy settings. The method, although superior in cancer detection rates, is costly and requires additional training and equipment. The purpose of our study was to determine the costs and benefits that arise when introducing this method in prostate cancer diagnostics. Repeated prostate biopsy was performed in 101 consecutive patients in the period from 1 October 2016 to 1 July 2017. Patients were divided into two groups based on whether prostate mp-MRI was performed or not. The prices of specific procedures were obtained from the billing service of the Sestre milosrdnice University Hospital Center and patient models were created to determine financial costs and benefits. The cost of the entire diagnostic process per patient in the non-MRI group was HRK 1.931,05 and HRK 1.848,42 in the mpMRI group, or 4.28% less. Prostate mpMRI and subsequent mpMRI guided biopsies can reduce the overall cost in prostate cancer diagnostics despite the procedure itself being an additional cost. This is achieved by omitting prostate biopsies in patients with low malignancy risk.Kontinuirani rast troškova medicinskih postupaka aktualna je tema i razlog zabrinutosti u cijelome svijetu. Ciljana, multiparametrijskim magnetom (mpMRI) navođena biopsija prostate polako postaje standard u dijagnostici karcinoma prostate, pogotovo kod ponovljene biopsije. Iako superiorna klasičnoj, sistemskoj biopsiji prostate, navedena metoda zahtijeva skupu dodatnu opremu i vješte, educirane kliničare. Naš cilj je analizirati ekonomsku isplativost uvođenja multiparametrijske magnetne rezonance prostate i posljedične kognitivno mpMRI-om navođene biopsije prostate u dijagnostički protokol bolesnika sa inicijalno negativnom sistemskom biopsijom prostate, kod kojih postoji daljnja klinička sumnja na karcinom prostate. U periodu od 01.10.2016. do 01.07.2017 kod 101 uzastopnog bolesnika s povišenim PSA i/ili pozitivnim DRP, a nakon negativne prve TRUS biopsije učinjena je druga, ponovljena biopsija prostate. Bolesnici su podijeljeni u dvije skupine ovisno o tome dali je učinjen mpMRI prostate ili ne. Učinjena je analiza broja i troškova posjeta specijalisti urologu kao i broja i troškova ordiniranih pretraga za svaku skupinu. Tijek kliničkih postupaka standardiziran je na temelju prosjeka za pojedine promatrane skupine te preračunat na 100 bolesnika za svaku skupinu radi lakše usporedbe rezultata. Kalkulacije su vršene na temelju dobivenih modela. Prosječna cijena obrade bolesnika u skupini bez mpMRI-a iznosi 1931,05 HRK dok u sa mpMRI-em iznosi 1848,42 HRK tj. 4,28% manje. Iako mpMRI prostate pojedinačno predstavlja značajan dodatan trošak u dijagnostici karcinoma prostate, kod bolesnika sa inicijalno negativnom biopsijom prostate isti omogućava velikom broju bolesnika izbjegavanje biopsije te posljedično smanjenje ukupnog troška

Patohistološki nalaz nakon radikalne prostatektomije temeljene na novom sustavu ocjenjivanja

One of the main reasons for the introduction of a new grading system was Gleason sum 7, which differed significantly in the prognosis of the disease depending on the primary Gleason. The aim of this study was to compare grade group 2 and grade group 3, and the impact of cancer percentages in final pathology reports after radical prostatectomy on the occurrence of T3 stage of the disease after radical prostatectomy of clinically localized prostate cancer. The study covered 365 patients with clinically localized prostate cancer who underwent radical retropubic prostatectomy (RRP) over the period of two years. The average percentage of carcinomas found in pathology reports after RRP was 20.1%. With the increase in the grade group, the average percentage of carcinomas in pathology reports increased significantly, p<0.001. With regard to grade groups 2 and 3, irrespective of cancer percentages in pathology reports, more cases of T3 stage were found in grade group 3 when compared to grade group 2, which was statistically significant (p<0.001). However, grade group 2 and grade group 3 patients with ≤10% cancer occurrences in final pathology reports after RRP did not show any statistical significance in the occurrence of T3 stage, p=0.96. Prognostic differences in grade group 2 and grade group 3 patients after RRP are significant, but not in all cases, because of their dependence on the percentage of cancer in the final pathology report after RRP of clinically localized prostate cancer.Kao jedan od glavnih uzroka uvođenja novih gradus skupina bio je Gleasonov zbroj 7, koji se bitno razlikovao u prognozi bolesti ovisno o primarnom Gleasonu. U ovom istraživanju usporedili smo gradus skupinu 2 (GZ 3+4) i gradus skupinu 3 (GZ 4+3) u pojavnosti T3 stadija kod pacijenata s ≤10% karcinoma u patohistološkom nalazu nakon retropubične radikalne prostatektomije, klinički lokaliziranog karcinoma prostate. Studijom je obuhvaćeno 365 pacijenata s klinički lokaliziranim karcinomom prostate koji su podvrgnuti radikanoj retropubičnoj prostatektomiji između 1. siječnja 2015. i 31. prosinca 2016. godine. Najzastupljenije gradus skupine bile su gradus skupina 2 s 50,41% i gradus skupina 3, s udjelom od 36,16%. Postotak karcinoma u PHD nalazu nakon RRP bio je u rasponu od 5 do 80%, prosjek 20,1%. Kod gradus skupina 2 i 3, neovisno o postotku karcinoma prostate u konačnom PHD nalazu, bilo je statistički značajno više T3 stadija u gradus skupini 3 u odnosu na gradus skupinu 2, p=0,001. Međutim, pacijenti gradus skupina 2 i 3 s postotkom karcinoma ≤10% u konačnom PHD nalazu nakon RRP nisu pokazali razliku u pojavnosti T3 stadija, p=0,96. Razlike u prognozi za pacijente gradus skupine 2 i gradus skupine 3 nakon RRP su značajne, ali ne uvijek. Svakako pri procjeni rizika moramo uzeti u obzir i značajnost postotka karcinoma prostate nakon RRP, u ovom istraživanju niži postotak karcinoma (≤10%)

Annual educational expenses of European urology residents and the role of sponsorship in urology training: a survey-based analysis.

Introduction The aim of this article was to evaluate the personal monetary costs associated with the urology residency. Material and methods The European Society of Residents in Urology (ESRU) designed a 35-item survey and distributed it via email and social media to urology residents in Europe.Monthly net salary and educational expenses (general expenses, literature, congresses and courses) and opinions regarding sponsorship and expenditure were evaluated. Comparisons between different countries and salary cut-offs were made. Results A total of 211 European urology residents completed the survey from 21 European countries. The median interquartile range (IQR) age was 30 (18-42) years and 83.0% were male. A total of 69.6% receive less than €1500 net per month and 34.6% spent ≥€3000 on education in the previous 12 months. Sponsorships came mainly from the pharmaceutical industry (57.8%), but 56.4% of trainees thought that the ideal sponsor should be the hospital/urology department. Only 14.7% of respondents stated that their salary is sufficient to cover training expenses, and 69.2% agreed that training costs have an influence on family dynamics. Conclusions Personal expenses during training are high, are not sufficiently covered by the salary and impact family dynamics for a majority of residents in Europe. The majority thought that hospitals/national urology associations should contribute to the educational costs. For homogeneous opportunities across Europe, institutions should strive to increase sponsorship.post-print1388 K