Pregled komplikacija i neželjenih događaja metalnih urinarnih stentova

Urinary stents, be it urethral or ureteral, polymeric, metallic or biodegradable, are one of the most frequently used tools in urology and they have been used for decades in prophylactic and therapeutic setting. Although relatively low invasive, they are prone to complications and adverse effects so much that complication rates up to 100% have been described. Many reviews have focused either on specific groups of patients or particular stent types, materials or designs but so far, no comprehensive review on complications has been published. To tackle this issue, a working group was set up within ENIUS (European Network of multidisciplinary research to Improve Urinary Stents) tasked with literature search in order to screen for and systematically review published stent complications in urethra (male only) and ureters (polymeric and metallic ureteral stents in both sexes) when used in obstructed systems. In this paper, we review, catalogue and summarize complications published for metallic urethral and ureteral stents.Urinarni stentovi, bilo uretralni ili ureteralni, polimerni, metalni ili biorazgradivi, jedan su od najčešće korištenih alata u urologiji i u primjeni su već desetljećima u profilaksi ili kao terapija. Iako su minimalno invazivni, česte su komplikacije i neżeljeni učinci do te mjere da su u nekim studijama stope komplikacija do 100%. Mnogi pregledni radovi su orijentirani na specifičnu skupinu bolesnika ili određeni tip, materijal ili dizajn stenta, ali dosad nije objavljen pregledni rad o komplikacijama upotrebe stentova. Stoga je oformljena radna skupina unutar grupe ENIUS (European Network of multidisciplinary research to Improve Urinary Stents) sa zadatkom probira literature i sistematskog pregleda objavljenih komplikacija stentova u muškoj uretri te polimernih i metalnih ureteralnih stentova (kod oba spola) korištenih kod opstrukcije. U ovom radu iznosimo pregled objavljenih komplikacija u katalogiziranom i sażetom obliku za metalne uretralne i ureteralne stentove

The Use of Color Duplex Ultrasound and Magnetic Resonance Imaging in the Dissolution of Idiopathic Recurrent Priapism in Patient with Congenital Penile Curvature – A Case Report

Priapism, penile erection characterized as prolonged and devoid of sexual stimulation or excitement is a rare condition. It is critical to distinguish between low- and high-flow priapism, because the treatment algorithm differs markedly for these 2 conditions. The diagnosis is made clinically and confirmed with color Doppler ultrasonographic imaging (CDUS). We present a 21 year old men with high-flow priapism and left lateral congenital penile curvature. A duplex Winter shunt procedure was employed with corporeal irrigation of heparin solution and adrenalin solution instillation, but the priapism returned 12 hours after. Following several days slow instillation of phenilephrine or adrenaline solution accompanied by oral flutamide therapy resulted in complete detumescence. We used both CDUS and magnetic resonance imaging (MRI) before and after treatment of priapism. Although CDUS has been the primary modality for cross-sectional imaging of the penis, the superior soft-tissue contrast and spatial resolution afforded by MRI provide an opportunity to advance imaging evaluation of this organ

Ambulatory surgery – are there limitations?

Uvod i cilj: Pojam jednodnevne kirurgije datira iz početka 20. stoljeća. James Nicoll objavio je 1909. godine u časopisu British Medical Journal rezultate kod 8.988 djece operirane po principu jednodnevne kirurgije. Prema Međunarodnom udruženju za jednodnevnu kirurgiju (IAAS), pacijent u jednodnevnoj kirurgiji definiran je planiranim prijamom u zdravstvenu ustanovu s ciljem dijagnostičkog i/ili operativnog zahvata, gdje se po zahvatu očekuje brz oporavak te ne postoji potreba za hospitalizacijom – otpušta se kući isti dan. Razvoj kirurških metoda, anestezioloških tehnika i metoda analgezije doprinosi eksponencijalnom porastu broja pacijenata zbrinutih po principu jednodnevne kirurgije. Metode: U radu prikazujemo pregled literature putem baze podataka MEDLINE koristeći ključne pojmove. Cilj je prikaz osnovnog koncepta uspjeha jednodnevne kirurgije: kritičan preoperativni probir, odabir najbolje anesteziološke i kirurške tehnike, otpust prema važećim kriterijima. Rezultati: Izbor pacijenata s obzirom na dob, težinu, komorbiditete, ASA status te socijalni aspekt ako je sagledan individualno i praćen zahvatom koji je definiranim vremenskim trajanjem i niskom incidencijom postoperativnih komplikacija uz korištenje optimalnih anestezioloških tehnika i lijekova rezultira dobrim postoperativnim uspjehom uz ekonomske uštede. Zaključak: Prednosti jednodnevne kirurgije jasne su i dokazane: usmjerena je na pacijenta, nosi niži rizik postoperativnih komplikacija i hospitalnih infekcija, ekonomična je.Introduction and aim: The term ambulatory surgery dates from the early 20th century. It was James Nicoll who in the year 1909. published the study in British Medical Journal, which demonstrated the results in 8988 children operated by principles of ambulatory surgery. According to the International Association for Ambulatory Surgery (IAAS), a patient in ambulatory surgery is defined by admission to a healthcare facility with the purpose of diagnostic procedure and/or operation, where a speedy recovery is anticipated and there is no need for hospitalization. The development of surgical methods, anaesthesia techniques and analgesia modalities encourage the exponential growth in the number of patients treated via ambulatory surgery. Methods: A literature review was performed via MEDLINE database using key terms. In this paper we are showing the current basis of success of ambulatory surgery: strict preoperative assessment, choosing the optimal anaesthesia and surgery techniques and patient discharge by guidelines. Results: Optimal selection of patients based on age, weight, comorbidities, ASA score and social parameters is crucial. If approached on individual basis and followed by defined duration of operation and low incidence of perioperative complications by choosing the right anaesthesia techniques and medications, it results in postoperative success and significant cost savings. Conclusion: The advantages of ambulatory surgery are clear and well-defined: it is patient-oriented, economically more favourable, and poses a lower risk of perioperative complications and intrahospital infections

Clear cell variant of urothelial carcinoma in urinary bladder; a clinicopathological and immunohistochemical study - a case report [Urotelni karcinom svjetlih stanica mokraćnog mjehura; kliničko-patološka i imunohistokemijska analiza - prikaz slučajeva]

The clear cell variant urothelial carcinoma of urinary bladder is very rare and unusual neoplasm defined histologically by clear cell pattern and glycogen-rich cytoplasm. Our case of clear cell carcinoma was diagnosed with immunohistochemistry stain. A 72-year-old man, presented with painless macroscopic hematuria in November 2007. Evaluation revealed papillary tumor in urinary bladder. A transurethral resection of the bladder tumor (TUR-Bt) was performed. Histopatologic evaluation showed superficial transitional cell carcinoma and carcinoma in situ. On three month follow-up, a solitary pedunculated tumor was detected again in the left wall of the urinary bladder. A repeated transurethral resection of the bladder tumor (reTUR-Bt) was performed in February 2008. The pathological diagnosis was difficult due to diffuse clear cell appearance. Immunohistochemistry stain showed urothelial carcinoma and finally it was diagnosed as clear cell variant. Urothelial carcinoma has many variants that show a variety of appearances and characteristics. These should be well known for evaluation and optimal treatment

Clear Cell Variant of Urothelial Carcinoma in Urinary Bladder; a Clinicopathological and Immunohistochemical Study – A Case Report

The clear cell variant urothelial carcinoma of urinary bladder is very rare and unusual neoplasm defined histologically by clear cell pattern and glycogen–rich cytoplasm. Our case of clear cell carcinoma was diagnosed with immunohistochemistry stain. A 72-year-old man, presented with painless macroscopic hematuria in November 2007. Evaluation revealed papillary tumor in urinary bladder. A transurethral resection of the bladder tumor (TUR-Bt) was performed. Histopatologic evaluation showed superficial transitional cell carcinoma and carcinoma in situ. On three month follow-up, a solitary pedunculated tumor was detected again in the left wall of the urinary bladder. A repeated transurethral resection of the bladder tumor (reTUR-Bt) was performed in February 2008. The pathological diagnosis was difficult due to diffuse clear cell appearance. Immunohistochemistry stain showed urothelial carcinoma and finally it was diagnosed as clear cell variant. Urothelial carcinoma has many variants that show a variety of appearances and characteristics. These should be well known for evaluation and optimal treatment

Urotelni karcinom svjetlih stanica mokraćnog mjehura; kliničko-patološka i imunohistokemijska analiza - prikaz slučajeva

The clear cell variant urothelial carcinoma of urinary bladder is very rare and unusual neoplasm defined histologically by clear cell pattern and glycogen-rich cytoplasm. Our case of clear cell carcinoma was diagnosed with immunohistochemistry stain. A 72-year-old man, presented with painless macroscopic hematuria in November 2007. Evaluation revealed papillary tumor in urinary bladder. A transurethral resection of the bladder tumor (TUR-Bt) was performed. Histopatologic evaluation showed superficial transitional cell carcinoma and carcinoma in situ. On three month follow-up, a solitary pedunculated tumor was detected again in the left wall of the urinary bladder. A repeated transurethral resection of the bladder tumor (reTUR-Bt) was performed in February 2008. The pathological diagnosis was difficult due to diffuse clear cell appearance. Immunohistochemistry stain showed urothelial carcinoma and finally it was diagnosed as clear cell variant. Urothelial carcinoma has many variants that show a variety of appearances and characteristics. These should be well known for evaluation and optimal treatment.Oblik urotelnog karcinoma mokraćnog mjehura svijetlih stanica vrlo je rijetka i neobična neoplazma definirana histološki svijetlim stanicama s citoplazmom bogatom glikogenom. Naš slučaj karcinoma svijetlih stanica dijagnosticiran je imunohistokemijski. Muškarac, u dobi od 72 godine, klinički prezentiran s bezbolnom makroskopskom hematurijom u studenom 2007. godine. Evaluacijom mokraćnog mjehura nađena je papilarna tvorba. Učinjena je transuretralna resekcija tumora mokraćnog mjehura (TUR). Histopatološka evaluacija pokazala je da se radi površnom karcinomu prijelaznog epitela i karcinomu in situ. Nakon 3 mjeseca praćenja, ponovno je otkriven solitarni pedunkularni tumor s lijeve lateralne strane mokraćnog mjehura. Ponovna transuretralna resekcija tumora mokraćnog mjehura (reTUR) učinjena je u veljači 2008. godine. Patološka dijagnoza je bila otežana zbog difuznog prisustva svijetlih stanica. Imunohistokemijska analiza je dokazala urotelni karcinom, te je postavljena konačna dijagnoza kao oblik urotelnog karcinoma svijetlih stanica. Urotelni karcinom ima mnogo varijanti koje pokazuju različite oblike i karakteristike. To bi trebalo uzeti u obzir kod evaluacije i izbora optimalnog liječenja

Clear Cell Variant of Urothelial Carcinoma in Urinary Bladder; a Clinicopathological and Immunohistochemical Study – A Case Report

The clear cell variant urothelial carcinoma of urinary bladder is very rare and unusual neoplasm defined histologically by clear cell pattern and glycogen–rich cytoplasm. Our case of clear cell carcinoma was diagnosed with immunohistochemistry stain. A 72-year-old man, presented with painless macroscopic hematuria in November 2007. Evaluation revealed papillary tumor in urinary bladder. A transurethral resection of the bladder tumor (TUR-Bt) was performed. Histopatologic evaluation showed superficial transitional cell carcinoma and carcinoma in situ. On three month follow-up, a solitary pedunculated tumor was detected again in the left wall of the urinary bladder. A repeated transurethral resection of the bladder tumor (reTUR-Bt) was performed in February 2008. The pathological diagnosis was difficult due to diffuse clear cell appearance. Immunohistochemistry stain showed urothelial carcinoma and finally it was diagnosed as clear cell variant. Urothelial carcinoma has many variants that show a variety of appearances and characteristics. These should be well known for evaluation and optimal treatment

Jednodnevna kirurgija – postoje li granice?

Uvod i cilj: Pojam jednodnevne kirurgije datira iz početka 20. stoljeća. James Nicoll objavio je 1909. godine u časopisu British Medical Journal rezultate kod 8.988 djece operirane po principu jednodnevne kirurgije. Prema Međunarodnom udruženju za jednodnevnu kirurgiju (IAAS), pacijent u jednodnevnoj kirurgiji definiran je planiranim prijamom u zdravstvenu ustanovu s ciljem dijagnostičkog i/ili operativnog zahvata, gdje se po zahvatu očekuje brz oporavak te ne postoji potreba za hospitalizacijom – otpušta se kući isti dan. Razvoj kirurških metoda, anestezioloških tehnika i metoda analgezije doprinosi eksponencijalnom porastu broja pacijenata zbrinutih po principu jednodnevne kirurgije. Metode: U radu prikazujemo pregled literature putem baze podataka MEDLINE koristeći ključne pojmove. Cilj je prikaz osnovnog koncepta uspjeha jednodnevne kirurgije: kritičan preoperativni probir, odabir najbolje anesteziološke i kirurške tehnike, otpust prema važećim kriterijima. Rezultati: Izbor pacijenata s obzirom na dob, težinu, komorbiditete, ASA status te socijalni aspekt ako je sagledan individualno i praćen zahvatom koji je definiranim vremenskim trajanjem i niskom incidencijom postoperativnih komplikacija uz korištenje optimalnih anestezioloških tehnika i lijekova rezultira dobrim postoperativnim uspjehom uz ekonomske uštede. Zaključak: Prednosti jednodnevne kirurgije jasne su i dokazane: usmjerena je na pacijenta, nosi niži rizik postoperativnih komplikacija i hospitalnih infekcija, ekonomična je