Microscopic Haematuria

Mikrohematurija je jedan od najčešćih simptoma s kojima se urolog susreće u svojoj svakodnevnoj praksi. Može biti znak bolesti bubrega i mokraćnog sustava. Pravodobnom obradom mikrohematurije postiže se maksimalni terapijski učinak uz izbjegavanje uporabe skupih i invazivnih dijagnostičkih metoda. Mikrohematuriju definiramo kao prisutnost pet ili više eritrocita u vidnom polju svjetlosnog mikroskopa svježega centrifugiranog urina, dokazanu u tri uzastopna uzorka tijekom tjedan dana. U svrhu dijagnosticiranja etiološkog čimbenika služe slikovne, radiološke pretrage gornjeg urinarnog sustava i cistoskopija. Ako su one nedostatne, radi se biopsija bubrega. Liječenje mikrohematurije ovisi o etiologiji te je ona predmet liječenja kod pedijatra, nefrologa ili urologa. Osobu smatramo zdravom ako su nalazi mokraće negativni tijekom tri godine.Microscopic haematuria is one of the most common symptoms encountered by urologists in everyday practice. It may be a sign of kidney and urinary tract diseases. The timely handling of microscopic haematuria leads to maximum therapeutic effects, while avoiding the use of expensive and invasive diagnostic procedures. Microscopic haematuria is defined as the presence of five or more red blood cells per light microscopic field of the centrifuged urine from three consecutive samples collected during one week. Imaging studies and cystoscopy are used to reveal etiological factors. If they are insufficient, we may perform kidney biopsy. Treatment depends on the etiology of microscopic haematuria, which is treated by a paediatrician, nephrologist or urologist. If urine samples are negative for three consecutive years, a person can be considered as healthy

Microscopic Haematuria

Mikrohematurija je jedan od najčešćih simptoma s kojima se urolog susreće u svojoj svakodnevnoj praksi. Može biti znak bolesti bubrega i mokraćnog sustava. Pravodobnom obradom mikrohematurije postiže se maksimalni terapijski učinak uz izbjegavanje uporabe skupih i invazivnih dijagnostičkih metoda. Mikrohematuriju definiramo kao prisutnost pet ili više eritrocita u vidnom polju svjetlosnog mikroskopa svježega centrifugiranog urina, dokazanu u tri uzastopna uzorka tijekom tjedan dana. U svrhu dijagnosticiranja etiološkog čimbenika služe slikovne, radiološke pretrage gornjeg urinarnog sustava i cistoskopija. Ako su one nedostatne, radi se biopsija bubrega. Liječenje mikrohematurije ovisi o etiologiji te je ona predmet liječenja kod pedijatra, nefrologa ili urologa. Osobu smatramo zdravom ako su nalazi mokraće negativni tijekom tri godine.Microscopic haematuria is one of the most common symptoms encountered by urologists in everyday practice. It may be a sign of kidney and urinary tract diseases. The timely handling of microscopic haematuria leads to maximum therapeutic effects, while avoiding the use of expensive and invasive diagnostic procedures. Microscopic haematuria is defined as the presence of five or more red blood cells per light microscopic field of the centrifuged urine from three consecutive samples collected during one week. Imaging studies and cystoscopy are used to reveal etiological factors. If they are insufficient, we may perform kidney biopsy. Treatment depends on the etiology of microscopic haematuria, which is treated by a paediatrician, nephrologist or urologist. If urine samples are negative for three consecutive years, a person can be considered as healthy

Diagnostic Accuracy of Ultrasound T-staging of the Urinary Bladder Cancer in Comparison with Histology in Elderly Patients

Urinary bladder cancer (UBC) is dominantly the cancer of the elderly occurring primarily in the 6th, 7th and 8th decade of life. The aim of this study was to evaluate diagnostic accuracy of ultrasound T-staging (UTS) of UBC in the group of elderly patients. In 152 elderly patients referred to transabdominal ultrasound examination in two different facilities (76 each) due to various symptoms (primarily painless gross or microscopic haematuria) UBC was diagnosed. Initial UTS at the moment of detection was performed and compared with fi nal histological T-staging (HTS). A high level of conformity between UTS and HTS was detected. In a total of 152 patients with UBC there were 115 (75.66%) patients with complete match between the UTS and HTS, 24 (15.79%) patients with minimal variation within one stage, and 13 (8.55%) patients with one stage difference between the UTS and HTS. The best result was established for the stage T1, where the accuracy was 94.5%. In other stages the accuracy was between 84.9% and 91.8%. The Youden’s index for all the stages was over 0.6. UTS has a high diagnostic accuracy, especially for stages T1 and T2. It is extremely useful tool in differentiating the superfi cial UBC from the muscle-invasive one, being of signifi cant importance in planning the further treatment of elderly patients and having important role in choosing appropriate surgical approach

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

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

Mini percutaneous nephrolithotripsy as treatment modality for kidney stones

Cilj: Prikazati naše rezultate u liječenju pacijenata s bubrežnim kamencima metodom miniperkutane nefrolitotripsije (miniPCNL). Pacijenti i metode: Retrospektivnim istraživanjem obuhvatili smo pacijente Klinike za urologiju, Kliničkog bolničkog centra u Rijeci koji su između 1. kolovoza 2015. i 31. prosinca 2016. godine zbog bubrežnih kamenaca liječeni metodom miniPCNL-a. Rezultati: U promatranom razdoblju u našem centru operirano je 6 pacijenata ovom metodom, od kojih je jedan bio s transplantiranim bubregom. U svih pacijenata uspješno je učinjena litotripsija s holmium-laserom. Na kontrolnom RTG-u nije bilo ostatnih fragmenata. U četvoro pacijenata poslijeoperativno je došlo do razvoja febriliteta koji je uspješno liječen antibiotskom terapijom. Niti u jednog pacijenta nije bila potrebna reoperacija, dodatne procedure niti potreba za davanjem krvi. Zaključak: Miniperkutana nefrolitotripsija je minimalno invazivna metoda koja se pokazala uspješnom i sigurnom u liječenju nefrolitijaze.Aim: To present our results in the treatment of nephrolithiasis using mini percutaneous nephrolithotripsy (miniPCNL). Patients and methods: We retrospectively analyzed all patients with nephrolithiasis treated with miniPCNL in Department of Urology, University Hospital Rijeka from August 1st 2015 to December 31st 2016. Results: In observed period 6 patients were operated with this novel method and one has transplanted kidney. In allpatients lithotripsy was successfully performed with holmium laser. On the control x-ray the residual fragments were not found in any patients. Postoperatively, in four patients febrility was noticed and successfully treated with antibiotics. Neither the one patient need reoperation, auxiliary procedures or blood transfusion. Conclusion: Mini percutaneous nephrolithotripsy is a minimally-invasive method which is successfull and safe method in the treatment of kidney stones

Surgical Treatment of Kidney Cancer in Elderly

The aim of this study was to analyze our patients over the age of 70 suffering from kidney cancer that had undergone surgical treatment. During the 2000–2012 period 634 patients with kidney cancer were treated, 197 of whom were over the age of 70. In this group there were 117 (59.4%) men and 80 (40.6%) women. In most of these patients (156 patients – 79.2%) the clear cell type of renal carcinoma was diagnosed. According to TNM classifi cation the dominant stages were T1b in 62 patients (31.8%) and T1a in 48 patients (24.6%). The most common grade was G2 (73 patients – 37%). Radical nephrectomy was performed in 103 (52.3%) patients, simple nephrectomy in 86 patients (43.7%), enucleation of the tumor and resection of the kidney in 6 (3.1%) patients, while in 2 patients the tumor was inoperable. Early postoperative complications developed in 21 (10.8%) patients. They included complications in distant organs in 11 (5.6%) patients and surgical complications in 10 (5.4%) patients. Five patients (2.6%) died during early postoperative period. Surgery is recommended treatment for elderly patients with kidney cancer with complications comparable with those in younger patients

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