Gustoća antigena specifičnog za prostatu može pomoći u izbjegavanju nepotrebne biopsije prostate kod razine antigena specifičnog za prostatu od 4-10 ng/mL

Elevated level of prostatic specific antigen (PSA) is an established parameter to help determine the need to perform prostate biopsy. The aim of the present study was to determine whether PSA density (PSAD) could better predict pathologic finding of 12-core prostate biopsy in men with PSA 4-10 ng/mL than PSA alone. Transrectal ultrasound guided biopsy was performed in 125 men with PSA within this range. The rate of cancer detection was 24%. Study results showed a significant difference in PSAD between the two patient groups with negative and positive biopsy findings (P=0.002), while difference in the measured PSA levels was not significant (P=0.091). Study results suggested that PSAD could serve as an additional parameter in predicting negative outcome of prostate biopsy, with a cut-off value of 0.15 ng/mL/mL within PSA range of 4-10 ng/mL (sensitivity 86.7% and negative predictive value 91.5%).Povišene vrijednosti antigena specifičnog za prostatu (PSA) su potvrđeni parametar u donošenju odluke o provođenju biopsije prostate. Cilj ove studije bio je pokazati može li određivanje gustoće PSA predvidjeti ishod biopsije prostate bolje od samog PSA kod muškaraca s vrijednostima PSA od 4-10 ng/mL. U studiju je bilo uključeno 125 muškaraca kojima je učinjena biopsija prostate zbog sumnje na karcinom prostate, s vrijednostima PSA u navedenom rasponu. Unutar toga raspona PSA otkriveno je 24% karcinoma. Rezultati studije su pokazali značajnu razliku u gustoći PSA između dviju skupina bolesnika s negativnim i pozitivnim nalazom biopsije (P=0,002), dok razlika u razini PSA nije bila značajna (P=0,091). Pokazalo se da gustoća PSA može biti pomoćni parametar u predviđanju negativnog ishoda biopsije prostate uz graničnu vrijednost od 0,15 ng/mL/mL kod raspona PSA od 4 do 10 ng/mL (osjetljivost 86,7%, negativna prediktivna vrijednost 91,5%)

URINARY TRACT DYSFUNCTION IN SPINAL CORD INJURY PATIENTS

Ozljeda kralježnične moždine (OKM) rezultira paralizom, ali i smetnjama mokrenja, zbog čega se tijekom rehabilitacije i života posebna skrb vodi o očuvanju donjeg urotrakta kako bi se spriječila patološka stanja gornjeg urotrakta s nizom komplikacija. Ta skrb uključuje pravodobnu i standardiziranu neurološku i urološku obradu te tehnike eliminacije od kojih se najviše rabi intermitentna kateterizacija. Urološka obrada uključuje uzorkovanje krvi i urina, urinokulturu, ultrazvučno i rendgensko snimanje urotrakta te cistometriju kao pretragu dinamičkih svojstava neurogenoga mokraćnog mjehura. Dokazano je da i kod bolesnika s nepotpunim OKM-om nastaje neurogeni mjehur sličnih karakteristika kao kod bolesnika s potpunom ozljedom, tj. smanjene su vrijednosti cistometrijskog kapaciteta i povišene vrijednosti intravezikalnog tlaka, ugrožavajući gornji urotrakt. Također, pokazano je da nema razlike u tim vrijednostima između pojedinih razina neurološke ozljede: cervikalne, torakalne, torakolumbalne i lumbalne, pa su takvi rizici podjednaki u svakoj od tih skupina bolesnika. Zaključno, potrebno je kod svih bolesnika s OKM-om provoditi dijagnostiku urotrakta za dobrobit kvalitete i duljine života bolesnika.Spinal cord injury (SCI) results with paralysis but also with micturition dysfunction; therefore rehabilitation management and long-term follow-up include lower urinary tract care in order to prevent upper urinary tract pathology and complications. That comprises timely and standardized neurological and urological diagnostics and eliminatory techniques with intermittent catheterisation in majority of patients. Urological diagnostics include blood and urine tests, urine culture, ultrasound and X-ray of urinary tract, and cystometry to assess dynamic properties of neurogenic bladder. It has been proven that incomplete SCI patients have neurogenic bladder with similar findings as patients with complete injuries, i.e. cystometric capacities are reduced while intravesical pressures are increased, which endanger upper urinary tract. Furthermore, it has been shown that there is no difference of these findings between particular levels of injury: cervical, thoracic, thoracic-lumbar and lumbar, so these risks are similar in every group. Conclusively, it is necessary to conduct urinary tract diagnostics in SCI patients for sake of the quality and quantity of patients’ lives

Results of the antireflux ureterocystoneostomyat the urinary bladder vertex in a 28-year-period (1978-2005)

U radu se prikazuje retrospektivna studija rezultata antirefluksne ureterocistoneostomije na verteksu mokraćnoga mjehura (AUCN) prema Bradić-Pasiniju u posljednjih 28 godina. U suradnji s pedijatrima iz Varaždina, Čakovca i Koprivnice ovom se metodom operira veliki broj djece s primarnim vezikoureteralnim refluksom 3. - 5. stupnja. U navedenom se razdoblju operiralo 316 djece, od toga 67 dječaka i 249 djevojćica. Refluks 3. - 5. stupnja bio je prisutan na obje strane u 7 djece, tako da su obavljene ukupno 323 ureterocistoneostomije. Prilikom obrade učinjen je pregled urina, urinokultura, kreatinin, urografija, MCUG i cistoskopija. Klasifikacija je obavljena na temelju MCUG prema International Reflux Study. Svi su bolesnici poslijeoperacijski hospitalizirani 6 i 24 mjeseca nakon operacije te se učinila obrada kao i prije operacije. Od 323 AUCN kod 13 bolesnika (4,02%) dokazan je recidiv refluksa, kod (1,55%) poslijeoperacijska opstrukcija. U 305 bolesnika (94,43%) operacija je bila uspješna. Uspješnom plastikom smatrali smo onu u koje se nakon dvije kliničke kontrole nije mogao dokazati refluks ili opstrukcija, a urin je bio sterilan. Od 13 recidiva, 5 je operirano kod nas sa 100% uspjehom, ostali su liječeni u drugim ustanovama.In this paper we are presenting retrospective study results of the Bradić-Pasini antireflux ureterocystoneostomy (AUCN) procedure at the bladder vertex in children in the past 28 years. In collaboration with pediatricians from Varaždin, Èakovec and Koprivnica we subjected 316 children (67 boys and 249 girls) with severe primary vesicoureteral reflux (VUR) grades 3-5 to this surgical procedure. Bilateral reflux was present in 7 children, so total of 323 AUCN was performed. A complete evaluation, including urine analysis, urine culture, serum creatinine measurement, urography, voiding cystourethrography (VCUG) and cystoscopy was done before the surgical intervention. We used VCUG classification according to International Reflux Study. After 6 and 24 months we did post surgical evaluation, including the same types of analyses mentioned before, to reveal the late postoperative complications. We established reappearance of VUR in 13 cases (4,02%) and ureterovesical junction obstruction in 5 cases (1,55%). In 305 (94,43%) out of total 323 cases the AUCN was successful. The criteria for long-term successfulness were the absence of VUR or obstruction and negative urine culture. Out of total 13 reappearances of VUR, we treated 5 patients with the same technique, all of them with long-term success. The rest of them were treated elsewhere

Usporedba cistometrijskih kapaciteta i intravezikalnih tlakova kod prokapavanja u tetraplegičnih i paraplegičnih bolesnika s ozljedom kralježničke moždine i neurogenom hiperaktivnošću detruzora

The aims were to compare cystometric capacities and leak-point intravesical pressures between tetraplegic and paraplegic spinal cord injury patients with neurogenic detrusor overactivity, and to assess eligibility of using suprapubic tapping voiding with external collection device in tetraplegic patients. Filling cystometry at non-physiological filling rate was performed in 122 spinal cord injury patients at rehabilitation or annual check-up using Dantec Etude urodynamic machine. Sixty-seven tetraplegic and 55 paraplegic patients were diagnosed with neurogenic detrusor overactivity, all with suprasacral level of injury. The mean cystometric capacity (CC) was 260±117 mL (range 53-500) in tetraplegic group and 289±135 mL (range 42-530) in paraplegic group. There was no significant between-group difference in CC (P=0.220). The mean leak-point intravesical pressure (Pves LPP) at CC was 72±25 cm H2O (range 25-124) in tetraplegic group and 70±27 cm H2O (range 25-140) in paraplegic group. The difference was not significant (P=0.711). The findings were equally unfavorable in both groups, suggesting the method of suprapubic tapping voiding with external collection device to be no more advisable in tetraplegic than in paraplegic patients. Neurogenic bladder should be managed with the same caution in cervical (tetraplegic) and thoracolumbar (paraplegic) patients, including intermittent catheterization as the first treatment choice, as opposed to the use of the less carer-time-consuming suprapubic tapping voiding with external collection device.Ciljevi rada bili su usporediti cistometrijske kapacitete i intravezikalne tlakove kod prokapavanja u tetraplegičnih i paraplegičnih osoba s ozljedom kralježničke moždine i neurogenom hiperaktivnošću detruzora, i ocijeniti podobnost suprapubičnog lupkanja s kondom urinal drenažom u tetraplegičnih bolesnika. Cistometrija nefiziološkom brzinom punjenja učinjena je kod 122 bolesnika s ozljedom kralježničke moždine tijekom rehabilitacije ili godišnje evaluacije stanja uporabom urodinamskog aparata Dantec Etude. Neurogenu hiperaktivnost detruzora imalo je 67 bolesnika s tetraplegijom i 55 bolesnika s paraplegijom, svi sa suprasakralnom razinom ozljede. Srednja vrijednost cistometrijskog kapaciteta (CK) za tetraplegičnu skupinu bila je 260±117 ml (raspon 53-500), a za paraplegičnu skupinu 289±135 ml (raspon 42-530). Nije nađena značajna razlika CK među skupinama (P=0,220). Srednja vrijednost intravezikalnog tlaka kod promokravanja pri CK za tetraplegičnu skupinu bila je 72±25 cm H2O (raspon 25-124), a za paraplegičnu skupinu 70±27 cm H2O (raspon 25-140). Razlika među skupinama nije bila značajna (P=0,711). Nalazi su bili podjednako loši u obje skupine, stoga se metoda suprapubičnog lupkanja s kondom urinal drenažom ne može preporučiti u tetraplegičnih bolesnika više no u paraplegičnih. Neurogeni mjehur treba pažljivo liječiti u cervikalnih (tetraplegičnih) i torakolumbalnih (paraplegičnih) bolesnika, što uključuje intermitentnu kateterizaciju kao metodu izbora naspram za asistenta manje vremenski zahtjevnim suprapubičnim lupkanjem s uporabom kondom urinal drenaže

Results\u27 analysis of 12-core and 8-core protocol in ultrasound guided transrectal prostate biopsy at the department of urology in Varaždin

Cilj. Primjenom protokola s 12 uzoraka kod transrektalne biopsije prostate željelo se poboljšati dijagnostiku karcinoma prostate. Materijal i metode. Ultrazvučno vođena transrektalna biopsija prostate urađena je kod 149 bolesnika koji su imali povišen PSA i/ili su bili klinički suspektni na karcinom prostate. Kod 76 bolesnika primijenjen je protokol s 8 uzoraka, a kod 73 protokol s 12 uzoraka. Rezultati. U skupini bolesnika s 8 uzoraka karcinom je prostate histološki dokazan u 26 bolesnika (34,2%). Od 40 bolesnika koji su imali samo povišen PSA bez suspektnoga DRP i/ili TRUS nalaza, karcinom je dokazan kod 9 (22,5%). Od 44 bolesnika koji su imali povišen PSA od 4 do 10 ng/ml, kod 10 (22,7%) je bolesnika dokazan karcinom. Od 64 bolesnika koji su imali PSA od 4 do 20 ng/ml, kod 21 (32,8%) dokazan je karcinom. U skupini bolesnika s 12 uzoraka kod 30 od 73 (41,1%) dokazan je karcinom. Među bolesnicima koji su imali samo povišen PSA, karcinom je dokazan kod 6 od ukupno 32 (18,7%). Kod 9 bolesnika od 36 (25%) s povišenim PSA 4-10 ng/ml dokazan je karcinom. U skupini bolesnika s povišenim PSA 4-20 ng/ml kod 17 od ukupno 55 (30,9%) dokazan je karcinom. Rasprava. Primjena protokola s 12 uzoraka nije signifikantno poboljšala dijagnostiku karcinoma prostate kod transrektalne biopsije prostate. Zapravo, dodatni uzorci nisu nikada samostalno bili pozitivni u bolesnika kod kojih je karcinom histološki dokazan.Aims: With implementation of 12- versus 8-core ultrasound guided transrectal prostate biopsy protocol we tried to improve prostate cancer detection. Material and methods: Transrectal ultrasound guided prostate biopsy was performed in 149 patients with PSA and/or clinical suspection on prostate cancer. 76 of them underwent 8-core biopsy protocol, and 73 underwent 12-core biopsy protocol. Results: In the group with 8-core biopsy protocol prostate cancer was histologically detected in 26 patients (34,2%). 40 patients had only PSA elevation without DRE and/or TRUS suspection, and 9 of them were positive (22,5%). 44 patients had PSA elevation 4-10 ng/ml and 10 of them were positive (22,7%). In the group of patients with elevation of PSA 4-20 ng/ml 21 of 64 (32,8%) were positive. In the group with 12-core biopsy protocol, 30 of 73 (41,1%) patients were positive. Among patients who only had elevated PSA, 6 of 32 were positive (18,7%). With PSA elevation 4-10 ng/ml, 9 of 36 patients were positive (25%). And in the group with PSA elevation 4-20 ng/ml, 17 of 55 (30,9%) patients were positive for prostate cancer. Discussion: 12-core biopsy protocol did not significantly improve prostate cancer detection. As a matter of fact, additional prostate biopsy cores were never alone positive in histologically detected prostate cancers

Results of the antireflux ureterocystoneostomyat the urinary bladder vertex in a 28-year-period (1978-2005)

U radu se prikazuje retrospektivna studija rezultata antirefluksne ureterocistoneostomije na verteksu mokraćnoga mjehura (AUCN) prema Bradić-Pasiniju u posljednjih 28 godina. U suradnji s pedijatrima iz Varaždina, Čakovca i Koprivnice ovom se metodom operira veliki broj djece s primarnim vezikoureteralnim refluksom 3. - 5. stupnja. U navedenom se razdoblju operiralo 316 djece, od toga 67 dječaka i 249 djevojćica. Refluks 3. - 5. stupnja bio je prisutan na obje strane u 7 djece, tako da su obavljene ukupno 323 ureterocistoneostomije. Prilikom obrade učinjen je pregled urina, urinokultura, kreatinin, urografija, MCUG i cistoskopija. Klasifikacija je obavljena na temelju MCUG prema International Reflux Study. Svi su bolesnici poslijeoperacijski hospitalizirani 6 i 24 mjeseca nakon operacije te se učinila obrada kao i prije operacije. Od 323 AUCN kod 13 bolesnika (4,02%) dokazan je recidiv refluksa, kod (1,55%) poslijeoperacijska opstrukcija. U 305 bolesnika (94,43%) operacija je bila uspješna. Uspješnom plastikom smatrali smo onu u koje se nakon dvije kliničke kontrole nije mogao dokazati refluks ili opstrukcija, a urin je bio sterilan. Od 13 recidiva, 5 je operirano kod nas sa 100% uspjehom, ostali su liječeni u drugim ustanovama.In this paper we are presenting retrospective study results of the Bradić-Pasini antireflux ureterocystoneostomy (AUCN) procedure at the bladder vertex in children in the past 28 years. In collaboration with pediatricians from Varaždin, Èakovec and Koprivnica we subjected 316 children (67 boys and 249 girls) with severe primary vesicoureteral reflux (VUR) grades 3-5 to this surgical procedure. Bilateral reflux was present in 7 children, so total of 323 AUCN was performed. A complete evaluation, including urine analysis, urine culture, serum creatinine measurement, urography, voiding cystourethrography (VCUG) and cystoscopy was done before the surgical intervention. We used VCUG classification according to International Reflux Study. After 6 and 24 months we did post surgical evaluation, including the same types of analyses mentioned before, to reveal the late postoperative complications. We established reappearance of VUR in 13 cases (4,02%) and ureterovesical junction obstruction in 5 cases (1,55%). In 305 (94,43%) out of total 323 cases the AUCN was successful. The criteria for long-term successfulness were the absence of VUR or obstruction and negative urine culture. Out of total 13 reappearances of VUR, we treated 5 patients with the same technique, all of them with long-term success. The rest of them were treated elsewhere