Technical aspects of lithotripters and application of shock wave therapy /ESWL/ in the treatment of urinary tract stones

Danas tretman litotripsije udarnim valovima (ESWL) predstavlja prvi izbor za liječenje kamenaca u bubregu, u mokraćovodima i bubrežnim nakapnicama. U usporedbi s otvorenim i endoskopskim metodama, ESWL je neinvazivna metoda, metoda za koju nije potrebna anestezija, a postiže visoke postotke uspješnosti tretmana u bolesnika s urolitijazom. Učinkovitost ESWL leži u njegovoj osobitosti fragmentiranja konkremenata „in vivo“ koji se nakon tretmana spontano eliminiraju kroz mokraćni sustav. Današnji uređaju za litotripsiju sastoje se od četiri osnovne komponente: (1) generatora udarnih valova, (2)sustava fokusiranja, (3) mehanizma povezivanja, i (4) jedinice za sliku/lokalizaciju konkrementa. Generatori udarnih valova mogu biti: elektrohidraulični, piezoelektrični ili elektromagnetski. Mehanizam djelovanja omogućava da konkrement bude fragmentiran, onog trenutka kada snaga udarnih valova nadilazi vlačnu čvrstoću kamena. Iako nedovoljno razjašnjena, fragmentacija konkrementa nastaje kombinacijom mehanizama, pri čemu se snaga udarnih valova, uz učinak kavitacije smatra najvažnijim. U Kliničkoj bolnici Dubrava danas koristimo LITHOSKOP® multifunkcijski litotriptor tvrtke Siemens koji posjeduje prilagodljivu udarnu glavu za izvođenje litotripsije u pozicijama iznad i ispod stola te nema potrebe za repozicioniranjem pacijenta tijekom procedure. Frekvencija udarnih valova glave je 60-120 pulseva/min sa dubinom penetracije maksimalno 16 cm, a energija je podesiva u 38 razina. Rentgenski C-luk, služi za lokalizaciju i sinkrono slijedi automatsko pomicanje terapijske glave. Osim lokalizacije rentgenskim zrakama sustav je opremljen i naprednim računalnim programom za automatsko pomicanje pacijenata u terapijski fokus nakon označavanja kamena te s Color Doppler ultrazvučnim aparatom koji omogućuje "inline" ultrazvučnu lokalizaciju.Nowadays, the treatment using shock wave lithotripsy (ESWL) is becoming the first choice for the treatment of stones in kidneys, ureter, and renal pelvis. Compared with open and endoscopic methods, ESWL is a minimally invasive method which does not require anaesthesia, and achieves high success rates in patients with urolithiasis. The effectiveness of ESWL lies in its specifics of fragmenting calculi "in vivo" which are upon treatment spontaneously eliminated through the urinary tract. All lithotripsy devices consist of four basic components: (1) shock wave generator, (2) focusing system, (3) linking mechanism, and (4) units for image/localization of stones. Shock wave generators can be electrohydraulic, electromagnetic or piezoelectric. The mechanism of activity that allows stones be fragmented the moment when the power of shock waves exceeds the tensile strength of the stone. Although incompletely explained, fragmentation of stones is performed by the combination of mechanisms, while the strength of shock waves and cavitation are considered to be the most important. In Clinical Hospital Dubrava nowadays LITHOSKOP ®, a multifunctional lithotripter made by Siemens, is used. It has a flexible impact head to perform lithotripsy in positions above and below the table, and there is no need for repositioning the patient during the procedure. Frequency of the head shock waves is 60-120 pulses/min with a penetration depth up to 16 cm and the energy is adjustable to 38 levels. The X-ray C-arm is used for localization and it synchronously follows the automatic movement of the therapeutic head. In addition to the localization of X-ray system it is also equipped with advanced software to automatically move patients in therapeutic focus after selecting the stone and with Color Doppler ultrasound device that enables "inline" ultrasound localization

Effects of Clonidine Preemptive Analgesia on Acute Postoperative Pain in Abdominal Surgery

Preemptive analgesia refers to blockade of afferent nerve fibers before a painful stimulus, which prevents or reduces subsequent pain even beyond the effect of the block. The aim of the study was to compare the effect of clonidine used before and at the end of operation on pain control in abdominal surgery. A total of 77 patients admitted for colorectal surgery were randomly classified into three groups: epidural clonidine before operation, epidural clonidine at the end of operation, and control group. After the operation on patient demand, analgesia with boluses of epidural morphine was instituted. The parameters of postoperative pain level using VAS score (visual analog scale), sedation and analgesics consumption were determined as outcome measures at 1, 2, 6, and 24 h of the operation. Clonidine administered before operation provided lowest pain scores at 6 and 24 h (p<0.05). Clonidine administered at the end of operation had low pain scores at 1 and 2 h, with a significant pain breakthrough thereafter (6.93±1.66 at 6 h and 4.04±2.39 at 24 h) compared with the group administered clonidine before operation (3.60±2.94 and 3.71±1.82). Clonidine administered before operation provided less sedation (p<0.05) and a significantly lower use of analgesics (p<0.05). Blockade of nociceptive stimulus using the centrally acting a2-adrenergic agonist clonidine before the onset of pain stimulus resulted in reduced pain levels, sedation and analgesic requirement

Pregnancy and Vaginal Delivery in Epidural Analgesia in Woman with Cerebrospinal Fluid Shunt

Hydrocephalus is a medical condition characterized by enlargement of cerebral ventricles due to abnormal cerebro- spinal fluid accumulation. Hydrocephalic women with cerebrospinal fluid (CSF) shunts are now surviving to reproduc- tive age, but still there are doubts regarding the mode of delivery, analgesia and anesthesia. Postpartal complications are more frequently described in deliveries ended by cesarean section than in spontaneous vaginal deliveries. We present a case of labor in the 32-year old woman, with congenital hydrocephalus and a preexisting ventriculoperitoneal (VP) shunt. After thorough review of current literature, we came to conclusion that without absolute neurosurgical indication or acute development of listed symptoms (headaches, irritability, light sensitivity, hyperesthesia nausea, vomiting, ver- tigo, migraines, seizures, weakness in the arms or legs, strabismus and double vision) the best way to finish the preg- nancy of woman with VP shunt is spontaneous vaginal delivery with the use of epidural analgesia, mediolateral episiotomy and vacuum extraction

EFFECT OF GENDER AND BODY MASS INDEX ON ELECTRICAL IMPEDANCE TOMOGRAPHY FINDINGS DURING SPONTANEOUS BREATHING IN SUPINE POSITION

Cilj: Procijeniti korelaciju pokazatelja regionalne ventilacije pluća izmjerene električnom impedancijskom tomografi jom (EIT) spontano dišućih bolesnika u ležećem položaju indeksom tjelesne mase (BMI) i tjelesnom površinom te usporediti izmjerene pokazatelje između bolesnika s MBI ≤30 kg/m2 s bolesnicima kojima je BMI ≥30 kg/m2. Bolesnici i metode: Trideset i dva bolesnika zakazana za elektivni urološki zahvat uključena su u ovo istraživanje. Prije uvoda u anesteziju uzorkovana je arterijska krv za plinske analize te je napravljena EIT snimka. Izmjerene su vrijednosti impedancije pluća na kraju inspirija (ETI) i na kraju ekspirija (EELI) te vrijednosti centra ventilacije i indeksa inhomogenosti. Izmjereni podatci izvedeni su pomoću računalnog programa Dräger EIT data analysis tool v 6.3 te dalje analizirani pomoću računalnog programa Microsoft Excel. Koefi cijent korelacije izračunat je pomoću Pearsonovog ili Spearmanovog testa, ovisno o distribuciji, a razlike u kontinuiranim varijablama između skupina testirane su Studentovim t-testom ili Mann Whitneyevim U-testom. Statistička analiza i vizualizacija podataka provedene su pomoću programa jamovi i PAST. Rezultati: Značajna negativna korelacija nađena je između BMI i ETI i EELI u svih bolesnika (EELI-BMI ρ=-0,35, p=0,047; ETI-BMI ρ=-0,35, p=0,046), a koefi cijent korelacije bio je još izraženiji u pretilih bolesnika (ρ=-0,83, p=0,050). Dokazana je i značajna negativna korelacija između dobi i Horovitzovog kvocijenta (r=-0,36, p=0,044). Nisu dokazane statistički značajne razlike u pokazateljima izmjerenima pomoću EIT između pretilih bolesnika i bolesnika koji ne pripadaju pretiloj populaciji. Diskusija: Iako je dokazana značajna negativna korelacija između impedancije pluća i BMI, kao i smanjena površina ventiliranog područja uprosječenog tomograma u pretilih bolesnika, nisu dokazane razlike u izmjerenim pokazateljima između skupina. No, s obzirom da je vrijednost koefi cijenta korelacije značajno viša u pretilih bolesnika, izostanak statističke značajnosti treba pripisati asimetriji u distribuciji bolesnika između skupina (26 vs 6). Izostanak statistički značajnih razlika u Horovitzevom kvocijentu treba pripisati mehanizmu hipoksične plućne vazokonstrikcije te očuvanom funkcionalnom rezidualnom kapacitetu tijekom spontanog disanja. Navedeno je potrebno uzeti u obzir u interpretaciji rezultata jer je gubitak FRC zajedno s brzom desaturacijom arterijske krvi nakon uvoda u opću anesteziju dobro dokumentiran i dokazan. Zaključak: Pad ETI i EELI u spontano dišućih bolesnika u ležećem položaju korelira s porastom BMI, no nisu dokazane statistički značajne razlike u navedenim pokazateljima i vrijednostima Horovitzovog kvocijenta između pretilih bolesnika i bolesnika koje ne ubrajamo u pretilu populaciju. Potrebne su d aljnje studije koje će utvrditi promjene u EIT izmjerenim pokazateljima tijekom samog uvoda u opću anesteziju.Aim: To assess correlation of electrical impedance tomography (EIT) fi ndings in obese patients spontaneously breathing in supine position with body mass index (BMI) and body surface area and to compare measurements in obese patients (BMI ≥30 kg/m2) with those recorded in patients with BMI <30 kg/m2. Patients and Methods: Thirty-two patients scheduled for elective urologic procedure were included in this study. Arterial blood was sampled and EIT recording was made before induction of anesthesia. End tidal (ETI) and end expiratory (EELI) lung impedance were measured, as well as center of ventilation and global inhomogeneity index. Data were exported using the Dräger EIT data analysis tool v. 6.3 and further analyzed in Microsoft Excel. Correlation coeffi cient was calculated using the Pearson or Spearman test of correlation and continuous variables were tested for statistical signifi cance using Student’s t-test or Mann Whitney U test, depending on the normality of distribution. Statistical analysis and data visualization were performed using software packages jamovi and PAST. Results: A signifi cant negative correlation was found between BMI and both ETI and EELI in all patients (EELI-BMI ρ=-0.35, p=0.047; ETI-BMI ρ=-0.35, p=0.046), and the correlation coeffi cient was even more pronounced between ETI and BMI in the obese population (ρ=-0.83, p=0.050). There was also a signifi cant negative correlation between age and Horovitz quotient (r=-0.36, p=0.044). No signifi cant differences in EIT measured parameters and arterial blood gas analyses were found between obese and non-obese patients. Discussion: Although there was a signifi cant negative correlation between lung impedances and BMI, as well as markedly increased ventilated area in the averaged tomogram in the non-obese group, no difference was found between obese and non-obese patients (with BMI ≥30 kg/m2 as a differentiator according to the WHO). However, since the correlation coeffi cient was much more pronounced in the obese group, the asymmetry between the groups (26 vs. 6 patients) could explain this discrepancy. There was no signifi cant difference in Horovitz quotient between the groups either, which could be attributed to preserved hypoxic pulmonary vasoconstriction and preserved functional residual capacity in the awake state. These facts should be taken into consideration when interpreting the data, as the loss of functional residual capacity coupled with rapid desaturation of arterial blood after induction of general anesthesia has been well documented and measured. Conclusion: End-tidal and end-expiratory lung impedance loss correlates well with an increase of BMI in spontaneously breathing patients, but no signifi cant differences were found between obese and non-obese patients either in EIT fi ndings or on arterial blood gas analyses. Further studies are needed to assess EIT measured differences in obese patients after induction of anesthesia

Preoperative Clonidine or Levobupivacaine – Effect on Systemic Inflammatory Stress Response

With perioperative pain control it is possible to supervise immune system, release of inflammation mediators, and influence on treatment outcome. Use of analgetics before the pain stimulus (preventive analgesia) obstruct development of neuroplastic changes in central nervous system, and reduces pain. Investigation hypothesis was that preoperative epidural clonidine is more efficient in blockade of systemic inflammatory stress response comparing to levobupivacaine. Patients were allocated to three groups, according to preoperative epidural use of clonidine, levobupivacaine or saline (control group). Before operation, 1 h after the beginning, 1 h, 6 h, 12 h and 24 h after the operation following parameters were analyzed: interleukine-6, C-reactive protein and leukocyte count. There were no significant differences between groups in age, gender, body mass index and operation time. In preoperative clonidine group, we found significant reduction in interleukine-6 levels throughout investigation time, compared to preoperative levobupivacaine group and control group. Also, C-reactive protein was significantly lower at the end of investigation, compared to other two groups. Leukocyte count was lower, and within the normal range in all investigation times only in preoperative clonidine group. We demonstrated significant difference that support importance of clonidine central effect on pain pathways and systemic inflammatory blockade

EFFECT OF GENDER AND BODY MASS INDEX ON ELECTRICAL IMPEDANCE TOMOGRAPHY FINDINGS DURING SPONTANEOUS BREATHING IN SUPINE POSITION

Cilj: Procijeniti korelaciju pokazatelja regionalne ventilacije pluća izmjerene električnom impedancijskom tomografi jom (EIT) spontano dišućih bolesnika u ležećem položaju indeksom tjelesne mase (BMI) i tjelesnom površinom te usporediti izmjerene pokazatelje između bolesnika s MBI ≤30 kg/m2 s bolesnicima kojima je BMI ≥30 kg/m2. Bolesnici i metode: Trideset i dva bolesnika zakazana za elektivni urološki zahvat uključena su u ovo istraživanje. Prije uvoda u anesteziju uzorkovana je arterijska krv za plinske analize te je napravljena EIT snimka. Izmjerene su vrijednosti impedancije pluća na kraju inspirija (ETI) i na kraju ekspirija (EELI) te vrijednosti centra ventilacije i indeksa inhomogenosti. Izmjereni podatci izvedeni su pomoću računalnog programa Dräger EIT data analysis tool v 6.3 te dalje analizirani pomoću računalnog programa Microsoft Excel. Koefi cijent korelacije izračunat je pomoću Pearsonovog ili Spearmanovog testa, ovisno o distribuciji, a razlike u kontinuiranim varijablama između skupina testirane su Studentovim t-testom ili Mann Whitneyevim U-testom. Statistička analiza i vizualizacija podataka provedene su pomoću programa jamovi i PAST. Rezultati: Značajna negativna korelacija nađena je između BMI i ETI i EELI u svih bolesnika (EELI-BMI ρ=-0,35, p=0,047; ETI-BMI ρ=-0,35, p=0,046), a koefi cijent korelacije bio je još izraženiji u pretilih bolesnika (ρ=-0,83, p=0,050). Dokazana je i značajna negativna korelacija između dobi i Horovitzovog kvocijenta (r=-0,36, p=0,044). Nisu dokazane statistički značajne razlike u pokazateljima izmjerenima pomoću EIT između pretilih bolesnika i bolesnika koji ne pripadaju pretiloj populaciji. Diskusija: Iako je dokazana značajna negativna korelacija između impedancije pluća i BMI, kao i smanjena površina ventiliranog područja uprosječenog tomograma u pretilih bolesnika, nisu dokazane razlike u izmjerenim pokazateljima između skupina. No, s obzirom da je vrijednost koefi cijenta korelacije značajno viša u pretilih bolesnika, izostanak statističke značajnosti treba pripisati asimetriji u distribuciji bolesnika između skupina (26 vs 6). Izostanak statistički značajnih razlika u Horovitzevom kvocijentu treba pripisati mehanizmu hipoksične plućne vazokonstrikcije te očuvanom funkcionalnom rezidualnom kapacitetu tijekom spontanog disanja. Navedeno je potrebno uzeti u obzir u interpretaciji rezultata jer je gubitak FRC zajedno s brzom desaturacijom arterijske krvi nakon uvoda u opću anesteziju dobro dokumentiran i dokazan. Zaključak: Pad ETI i EELI u spontano dišućih bolesnika u ležećem položaju korelira s porastom BMI, no nisu dokazane statistički značajne razlike u navedenim pokazateljima i vrijednostima Horovitzovog kvocijenta između pretilih bolesnika i bolesnika koje ne ubrajamo u pretilu populaciju. Potrebne su d aljnje studije koje će utvrditi promjene u EIT izmjerenim pokazateljima tijekom samog uvoda u opću anesteziju.Aim: To assess correlation of electrical impedance tomography (EIT) fi ndings in obese patients spontaneously breathing in supine position with body mass index (BMI) and body surface area and to compare measurements in obese patients (BMI ≥30 kg/m2) with those recorded in patients with BMI <30 kg/m2. Patients and Methods: Thirty-two patients scheduled for elective urologic procedure were included in this study. Arterial blood was sampled and EIT recording was made before induction of anesthesia. End tidal (ETI) and end expiratory (EELI) lung impedance were measured, as well as center of ventilation and global inhomogeneity index. Data were exported using the Dräger EIT data analysis tool v. 6.3 and further analyzed in Microsoft Excel. Correlation coeffi cient was calculated using the Pearson or Spearman test of correlation and continuous variables were tested for statistical signifi cance using Student’s t-test or Mann Whitney U test, depending on the normality of distribution. Statistical analysis and data visualization were performed using software packages jamovi and PAST. Results: A signifi cant negative correlation was found between BMI and both ETI and EELI in all patients (EELI-BMI ρ=-0.35, p=0.047; ETI-BMI ρ=-0.35, p=0.046), and the correlation coeffi cient was even more pronounced between ETI and BMI in the obese population (ρ=-0.83, p=0.050). There was also a signifi cant negative correlation between age and Horovitz quotient (r=-0.36, p=0.044). No signifi cant differences in EIT measured parameters and arterial blood gas analyses were found between obese and non-obese patients. Discussion: Although there was a signifi cant negative correlation between lung impedances and BMI, as well as markedly increased ventilated area in the averaged tomogram in the non-obese group, no difference was found between obese and non-obese patients (with BMI ≥30 kg/m2 as a differentiator according to the WHO). However, since the correlation coeffi cient was much more pronounced in the obese group, the asymmetry between the groups (26 vs. 6 patients) could explain this discrepancy. There was no signifi cant difference in Horovitz quotient between the groups either, which could be attributed to preserved hypoxic pulmonary vasoconstriction and preserved functional residual capacity in the awake state. These facts should be taken into consideration when interpreting the data, as the loss of functional residual capacity coupled with rapid desaturation of arterial blood after induction of general anesthesia has been well documented and measured. Conclusion: End-tidal and end-expiratory lung impedance loss correlates well with an increase of BMI in spontaneously breathing patients, but no signifi cant differences were found between obese and non-obese patients either in EIT fi ndings or on arterial blood gas analyses. Further studies are needed to assess EIT measured differences in obese patients after induction of anesthesia

Paraganglioma of the Urinary Bladder – Clinicopathological, Immunohistochemical and Electron Microscopy Analysis – A Case Report

Tumors that grow within the adrenal medulla are called pheochromocytoma; when located extra-adrenal, they are called paraganglioma. Paraganglioma of the bladder are very rare, with only 180 reported cases. Less than 30 were malignant. We report a case of a 72-years old man with bladder paraganglioma who presented with painless hematuria. Urgent transurethral resection (TUR) was performed. Definitive pathohistological diagnosis was confirmed to imunohistochemical and electron microscopy. Clinical diagnostic showed normal value of epinephrine and norepinehrine in the urine. Scintigraphy of entire body and targeted pictures of pelvis where taken 24, 48 and 72 hours after administration of RI. No loci of pathologic accumulation of 131-I MIBG where found. Computer tomography (CT) of pelvis and abdomen were normal. Considering staging and pathohistological analysis, we treated our patient with TUR and longtime follow-up afterworth

Sex or Surgery – Erectile Dysfunction after Radical Treatment of Localized Prostate Cancer

The maintenance of satisfactory quality of life is major concern in majority of patients who elect treatment for localized prostate cancer. We conducted a cross-sectional study to determine sexual function after radical prostatectomy (RP) and external beam radiotherapy (EBRT). Study population consisted of series of 57 patients with early-stage adenocarcinoma of the prostate, treated in our institution in the period from January 2003 till December 2003. Thirty three patients underwent radical retropubical prostatectomy and 24 patients were treated by primary radical radiotherapy. Patients have been given the full international index of erectile function (IIEF) questionnaire two to four and six months after the treatment. Post treatment sexual function in patients treated by EBRT is significantly better than in patients treated by RP (48,5% vs. 21.57%, p<0,0001). Subgroup analysis reveals that satisfaction with erectile function, maintaining of sexual intercourse and possibility of ejaculation is better in patients treated by EBRT than in patients treated by RP (44.67% vs. 11.57%, p <0,0001) as well as general satisfaction with quality of sexual life (48.5% in EBRT group vs. 21.57% in RP group, p <0,0001). On the other hand, sexual desire remains the same in both groups of patients (63.75% in EBRT group vs. 60.61% in RP group, p = 0.71). Six months after surgical or radiotherapy treatment erectile function is almost as twice as worse in patients treated by surgery than in patients treated by radiotherapy

Visual laser ablation of the prostate - results after nine years

Cilj: prikazati rezultate VLAP-a nakon devet godina Bolesnici i metode: ispitanici su prije operacije ispunjavali IPSS i QL, učinili urofloumetriju te im je UZV određena veličina prostate i ostatni urin. Kontrole su rađene nakon 3 i 6 mjeseci te 1, 3, 5 i 9 godina. Rezultati: Bolesnici (n=42) su prosječno bili stari 68 godina (53-87). Veličina prostate prije zahvata iznosila je 26,8 grama (20-50). Rezultati pokazuju vrijednosti prije operacije te nakon 1, 3, 5 i 9 godina: IPSS - 25,2; 8,2; 9,2; 19,8; 26. QL - 4,8; 1,4; 1,9; 3,6; 4,8. Uroflou - 8,9 ml/sec.; 18,2; 17,6; 12,1; 8,2. Rezidualni urin - 60 ml; 20; 30; 70; 120. 12 bolesnika smo reoperirali (TURP). Zaključak: rezultati su postojani samo tri godine, zato metodu preporučujemo jedino bolesnicima s visokim operacijskim rizikom.Aim: to present postoperative results of ELAP in 42 patients after nine years. Patients and methods: preoperative evaluations consisted of IPSS, QL, uroflowmetry and abdominal sonography (prostatic volume and postvoiding urine volume). Follow-up controls werw performed after three and six months; then after 1, 3, 5 and 9 years. Results: The average age of patients (n=42) was 68 years (53-87). Preoperatively, the volume of prostate was 26,8 grams (20-50). The results show preoperative values and values after 1, 3, 5 and 9 years respectively: IPSS - 25.2; 8.2; 9.2; 19.8; 26. QL - 4.8; 1.4; 1.9; 3.6; 4.8. Uroflowmetry (peak flow) - 8.9; 18.2; 17.6; 12.1; 8.2. The postvoiding urine - 60 ml; 20 ml; 30 ml; 70 ml; 120 ml. Twelve out of 42 patients underwent reoperation (TURP). Conclusion: ELAP should be recommended only to the high-risk patients because the benefits of the procedure lasted only 3 years postoperatively

Results of treatment for patients with carcinoma in situ of the upper urinary tract

Cilj: prikazati rezultate liječenja tri bolesnika s karcinomom "in situ" gornjeg dijela urinarnog sustava (dva bolesnika sa solitarnim bubregom i jedan bolesnik s obostranim karcinomom) instilacijom otopine Bacillus Calmette-Guerin (BCG). Bolesnici i metode: dijagnoza karcinoma "in situ" gornjeg dijela urinarnog sustava postavljena je na temelju pozitivne citologije urina, pozitivne citologije urina iz pijelokalicealnog sustava, negativnog nalaza IV urografije i negativne nasumiène biopsije mokraćnog mjehura. Nakon postavljanja JJ proteze (6 Chariere), u mokraćni je mjehur instilirana otopina BCG (80mg) u 40 ml 0,9% NaCl jednom tjedno kroz 6 tjedana. Citologija urina kontrolirana je svaka 3 mjeseca u prvoj godini, a potom svakih 6 mjeseci. Rezultati: u jednog bolesnika pozitivan nalaz citologije urina nađen je nakon 9 mjeseci. U drugog je bolesnika citološki nalaz urina još uvijek negativan 30, a u trećeg 42 mjeseca nakon terapije. Zaključak: instilacija BCG-a predstavlja prihvatljiv modalitet liječenja karcinoma "in situ" gornjeg dijela urinarnog trakta, posebice u bolesnika sa solitarnim bubregom.Aim: to present the results of treatment for three (3) patients with transitional cell carcinoma "in situ" of the upper urinary tract (one patient with bilateral carcinoma and two patients with solitary kidney carcinoma) by using Bacillus Calmette-Guerin instillation. Material and methods: diagnostic criteria of upper urinary tract carcinoma "in situ" were positive urinary cytology, positive urinary cytology in urine sample from the pyelocaliceal system, negative intravenous pyelography, as well as negative multiple random biopsy of the urinary bladder. After placing a 6-Chariere JJ prothesis, Bacillus Calmette-Guerin (80mg) in 40ml 0.9% NaCl solution was instilled into the urinary bladder once a week over a 6-week-period. Urinary cytology was done every 3 months during the first year and later on every 6 months. Results: Urine cytological findings were found positive in one (1) patient after 9 months. The findings were still negative in the second patient after 30 and in the third patient after 42 months. Discussion: Bacillus Calmette-Guerin instillation presents an acceptable method of treatement for transitional cell carcinoma "in situ" of the upper urinary tract, particullary in patients with solitary kidney