UROLITHIASIS – PREVENTION, DIAGNOSIS AND TREATMENT

Broj bolesnika s urolitijazom sve je veći. Većina kamenaca nastaje kao posljedica metaboličke abnormalnosti, ali, unatoč tome, u većine pacijenata ne može se pronaći specifična metabolička abnormalnost. Stoga u većini slučajeva nije mogu}e kauzalno liječenje već samo simptomatska terapija. Iako većina bolesnika izmokri kamence, u preostalih se koriste različite, prije svega, kirurške metode uklanjanja kamenca. U prevenciji kamenaca najvažniji su čimbenici velik unos tekućine, uz posljedičnu obilnu diurezu, te dijetalne mjere.The prevalence of urinary stones is increasing. The majority of stones are caused by metabolic abnormality but, despite this, specific metabolic abnormality cannot be found in most patients. In most cases causal therapy is not possible so that the therapy of symptoms is the only option. Despite the fact that most patients spontaneously eliminate stones, different surgical methods are available. The cornerstone of stone prevention is a high fluid input with increased urine volume as well as diet

UROLITHIASIS – PREVENTION, DIAGNOSIS AND TREATMENT

Broj bolesnika s urolitijazom sve je veći. Većina kamenaca nastaje kao posljedica metaboličke abnormalnosti, ali, unatoč tome, u većine pacijenata ne može se pronaći specifična metabolička abnormalnost. Stoga u većini slučajeva nije mogu}e kauzalno liječenje već samo simptomatska terapija. Iako većina bolesnika izmokri kamence, u preostalih se koriste različite, prije svega, kirurške metode uklanjanja kamenca. U prevenciji kamenaca najvažniji su čimbenici velik unos tekućine, uz posljedičnu obilnu diurezu, te dijetalne mjere.The prevalence of urinary stones is increasing. The majority of stones are caused by metabolic abnormality but, despite this, specific metabolic abnormality cannot be found in most patients. In most cases causal therapy is not possible so that the therapy of symptoms is the only option. Despite the fact that most patients spontaneously eliminate stones, different surgical methods are available. The cornerstone of stone prevention is a high fluid input with increased urine volume as well as diet

Transrectal Sonography in Prostate Cancer Detection – 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 ultrasound1–5. 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

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

Prognostic Values of Morphological and Clinical Parameters in pT2 – pT3 Prostate Cancer in Elderly People

Prostate cancer is a disease of elderly men, hthe incidence of whic increases in an age dependent manner. This study presents the correlation of clinical and morphological parameters in locally confined (pT2) and locally advanced (pT3) prostate cancer. We analyzed a group of elderly men treated with radical prostatectomy in the period 1999–2008 in the University Hospital Rijeka. We found no statistical association between pT stage and age categories, preoperative prostate-specific antigen, digitorectal examination and biopsy Gleason score. There was a significant correlation of higher Gleason score in prostate specimens after radical prostatectomy and a higher frequency of a positive surgical margin in tumors with pT3 than in pT2 stage (p=0.003; p=0.011 respectively). Recurrence-free survival was shorter in patients with tumors with positive surgical margins as well as in patients with pT3 stage (p=0.030; p=0.001 respectively). We conclude that higher tumor grade and positive surgical margins are indicators of a worse prognosis in our patients

Epidemiology of Prostate Cancer in the Mediterranean Population of Croatia – 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

Uloga limfadenektomije u bolesnika s karcinomom prostate

Prostate cancer is one of the most important men’s health issues in developed countries. For patients with prostate cancer a preoperative staging of the disease must be made. Involvement of lymph nodes could be assessed using imaging methods (CT or/and MRI), however, newer methods also exist (PET/CT, PSMA PET/CT). For some patients during radical prostatectomy a pelvic lymphadenectomy is recommended. Pelvic lymphadenectomy is indicated in intermediate- and high-risk group patients and with increased probability of lymph node invasion. The most used prediction tools for preoperative assessment of lymph nodes are Briganti and MSKCC nomograms and Partin tables. Pelvic lymphadenectomy can include different lymph nodes group, but extended lymphadenectomy is the recommended procedure. In 1-20% of patients, the lymph node invasion is present. Pelvic lymphadenectomy is primarily a diagnostic and staging method, and in minority of patients with positive lymph nodes it can be a curative method, too. In other patients with positive lymph nodes adjuvant therapy (radiotherapy and androgen deprivation therapy) can be beneficial.Karcinom prostate je jedan od značajnijih zdravstvenih problema muškaraca u razvijenom dijelu svijeta. U bolesnika s dijagnosticiranim karcinomom prostate neophodno je učiniti prijeoperacijsko stupnjevanje bolesti. Zahvaćenost limfnih čvorova se standardno određuje uz pomoć slikovnih metoda (CT i/ili/ MR) iako postoje i novije metode (PET/CT, PSMA PET/CT). U određenog broja bolesnika prilikom radikalne prostatektomije treba učiniti i zdjeličnu limfadenektomiju. Odluka o potrebi za zdjeličnom limfadenektomijom se donosi na osnovu svrstavanja bolesnika u umjerenu odnosno grupu visokoga rizika i ako je vjerojatnost za zahvaćenost limfnih čvorova povećana. Najčešće danas korišteni nomogrami za prijeoperacijsku procjenu zahvaćenosti limfnih čvorova su Briganti i MSKCC nomogram te Partinove tablice. Zdjelična limfadenektomija može obuhvaćati različite skupine limfnih čvorova ali se preporuča učiniti proširenu zdjeličnu limfadenektomiju. U 1-20% bolesnika nalaze se pozitivni limfni čvorovi. Iako zdjelična limfadenektomija ima prvenstveno dijagnostički i prognostički značaj, u manjeg broja bolesnika s pozitivnim limfnim čvorovima može biti i definitivna terapijska metoda. U ostalih bolesnika s pozitivnim limfnim čvorovima adjuvantna terapija (radioterapija i androgen deprivacijska terapija) može biti od terapijskog značaja

Različiti pristupi u liječenju urolitijaze u bolesnika s transplantiranim bubregom - prikaz slučaja

Urolithiasis is a rare urologic complication after kidney transplantation, and its diagnosis and treatment can be challenging for clinicians. In our 52-year-old male patient, graft hydronephrosis was found six months after transplantation. The patient had recurrent urinary tract infections followed by macrohematuria and an increase in creatinine levels. Computerized tomography revealed a 13-mm diameter stone in the ureter of the transplanted kidney as the cause of obstruction. Percutaneous nephrostomy was placed in the graft to solve the obstruction. Initial endoscopic treatment with a retrograde approach failed. An antegrade approach through a previously placed nephrostomy was not successful either. By a repeated retrograde approach, laser lithotripsy was performed successfully. The patient has been monitored for six months and has stable graft function without hydronephrosis or stones. As in our patient’s case, the diagnosis and treatment of urolithiasis in kidney transplant patients is challenging, and minimally invasive procedures are the treatment of choice.Urolitijaza je rijetka urološka komplikacija nakon transplantacije bubrega dijagnosticiranje i liječenje koje predstavlja izazov za kliničare. Kod našeg 52-godišnjeg bolesnika uočena je hidronefroza grafta šest mjeseci nakon transplantacije. Bolesnik je imao ponavljajuće uroinfekcije praćene makrohematurijom, a došlo je i do porasta vrijednosti kreatinina. Kompjutorizirana tomografija pokazala je kako je uzrok opstrukcije kamenac promjera 13 mm u distalnom dijelu uretera transplantiranoga bubrega. Za rješavanje opstrukcije bolesniku je postavljena perkutana nefrostomija u presadak. Inicijalno endoskopsko liječenje retrogradnim pristupom bilo je neuspješno. Anterogradni pristup preko ranije postavljene nefrostomije također nije bio uspješan. Ponovljenim retrogradnim pristupom uspjela se učiniti uspješna laserska litotripsija. Bolesnik se prati šest mjeseci i nema kamenaca niti hidronefroze, a funkcija grafta je stabilna. Dijagnosticiranje i liječenje urolitijaze u bolesnika s transplantiranim bubregom je, kao i u našeg bolesnika, izazovno, a minimalno invazivne metode predstavljaju metodu izbora u liječenju ovih bolesnika