/STRU^NI RAD UDK 616.65-006.04-07 Clinically significant and non significant prostate cancer an ongoing question

One of the most important problems in urological practice is how to differentiate clinically significant and non significant prostate cancer (Pca) i.e. how to avoid over treatment of tumors with low malignant potential in one hand, and inappropriate less aggressive treatment of significant tumors, on the other hand. At the first place, one should estimate precise local clinical stage and the grade of the disease. Transrectal ultrasound – guided prostate biopsy id the golden standard, but there are few dilemmas concerning prostate biopsy: the number of biopsy cores, inter and intra-observer variations in the grading, the significance of PIN, multifocal character of Pca etc. Our opinion is that sextant or octan biopsy is quite sufficient for the exact detection of clinically insignificant cancers. An additional problem is the discrepancy in grade between biopsy and radical prosatectomy specimen. Second, the treatment should not be the same for every patient and it is guided by the age and general condition of the patient. The aggressive treatment is recommendable for younger patients, younger than 70-72 years, even for tiny area of cancer in one of the biopsy samples. On the other hand, it is an ethical question, should we insist on detection of small cancer foci at older patients, and make them anxious and unhappy in their last years of life. Key words Significant prostate cancer, prostate biopsy, number of biopsy cores, treatment options, patient age, radical prostatectomy. rezim

Prostatitis

The objective of this article is to present a detailed review of the international literature concerning both the already established and the most recent information about clinical picture, aetiology, classification, diagnosis and treatment of prostatitis. The symptomatology of the condition is non-specific and requires a wide spectrum of diagnostic tools in order the clinician be able to reach a firm conclusion. A novel classification system is outlined, with already established international reputation. The treatment of the various chronic types is often empirical and the available therapies need controlled studies in order to achieve an established status in Urologist’s armamentarium. Finally it is emphasized that continuous research addressing to aetiology, pathogenesis, diagnosis and treatment is of paramount importance in answering questions and shedding light on this obscure syndrome

Extracorporeal lithotripsy in patients with hemophilia

Two hemophiliac patients with nephrolithiasis were treated with extracorporeal lithotripsy. Both patients were followed up by the 2nd Hemophilia Center of Athens. One is registered as severe hemophilia A and the other one suffers from hemophilia B. With the cooperation of the specialized center they were prepared as for a major operation by administration of substitution therapy. The least possible number of shock waves at low voltage was administered in order to minimize renal damage. Both patients had an uneventful postoperative course