COVID-19 and Urologic Emergencies

Zbog pandemije COVID-19 od sredine ožujka i urološka je struka neizbježno reorganizirana prostorno, medicinskom opremom, kadrovski i ciljevima. Tako su u fokus interesa dospjela hitna stanja u urologiji. Autor navodi zdravstvena stanja, njihovu simptomatologiju i terapiju u kojima je potrebna hitna urološka intervencija. Cilj je olakšati prepoznavanje takvih stanja i racionalizirati medicinski postupak uz postizanje maksimalne terapijske učinkovitosti u segmentu primarne zdravstvene zaštite. Posebnu kategoriju čine bolesnici s ranije dijagnosticiranim tumorima urotrakta u kojih je kirurška terapija odgođena. Neoplazme bubrega i prostate su gotovo uvijek sporo progresivni tumori starije dobi pa, sada nužna, odgoda operacije neće znatno utjecati na prirodno spori tijek bolesti. Bolesnici s tumorom testisa većinom brzo progresivnom neoplazmom mlađe dobi operiraju se po prioritetnom protokolu.Due to the COVID-19 pandemic, since mid-March 2020 the field of urology was also compelled to reorganize in terms of space (capacity), medical equipment, personnel and priority goals. The focus of interest thus turned to urologic emergencies. The author defines the medical conditions in which urgent urological intervention is required, as well as corresponding symptomatology and therapy. The aim is to facilitate the recognition/identification of such conditions and rationalize medical procedure while achieving maximum therapeutic efficacy. It is mainly intended to help primary medical care providers. A special category are patients with previously diagnosed tumors of the genitourinary tract, whose surgical treatment has been postponed. Renal tumors, and especially prostate tumors, are almost always slow, progressive diseases among the elderly, and therefore the postponement of urgent treatment should not significantly influence the naturally lengthy course of the disease. On the contrary, patients with testicular tumors – generally rapid, progressive and highly malignant diseases, are operated according to priority protocol

Dijagnostička vrijednost za dob specifičnog antigena specifičnog za prostatu u bolesnika s rakom prostate

The aim of the study was to analyze age distribution in patients undergoing early diagnosis procedures within the scope of the prostate cancer program, and to compare diagnostic accuracy of total prostate specific antigen (tPSA) test and age specific PSA range test in differentiating prostate cancer from benign prostate hyperplasia in order to reduce the number of unnecessary biopsies. Age distribution was analyzed in 394 patients with negative digitorectal examination, and diagnostic accuracy was analyzed in 80 patients with negative digitorectal and tPSA of 4.0-9.9 ng/mL. All 80 patients underwent prostate biopsy under transrectal ultrasound guidance obtaining at least six cores. Statistical analysis included t-test, Mann-Whitney rank sum test, specificity and sensitivity, positive and negative predictive value, and detection rate. The patient mean age was 67.0 years. Only 22% were self referred to the early diagnosis program seeking PSA and urologist consultation while being free from any other urologic difficulties. This population was significantly younger in comparison with patients referred to urologist by general practitioner for their micturition difficulties (Mann-Whitney test, p<0.001). Total PSA differentiated significantly prostate cancer from benign prostate hyperplasia (p=0.007, t-test). Positive predictive value for tPSA and age specific PSA range test did not differ significantly (16.2 vs. 17.6%). The sensitivity and specificity of agespecific PSA range test was 92.3% and 16.41%, respectively. It is concluded that there is the need of additional public health education about prostate cancer since only 22% of the respective population seek urology consultation and PSA testing, being aware of the benefits of the early diagnosis of prostate cancer. Up to 38% of patients included in the early diagnosis program are beyond target population since no curable treatment could be offered to them even if the diagnosis of prostate cancer was established. Although age specific PSA range test reduces the rate of biopsies by 16.4%, 7.6% of prostate cancers are thus missing, whereas false positive results account for as many as 83.58% of cases, clearly calling for search for the potentially better ways of reducing the number of unnecessary prostate biopsies.Cilj rada bio je analizirati dobnu strukturu populacije u koje se provodi rana dijagnostika raka prostate te usporediti dijagnostičku vrijednost ukupnog antigena specifičnog za prostatu (tPSA) i referentnog raspona PSA specifičnog za dob u razlikovanju raka prostate i dobroćudne hiperplazije prostate, kako bi se smanjio broj nepotrebnih biopsija prostate. Dobna struktura analizirana je u 394 bolesnika s negativnim digitorektalnim nalazom, a dijagnostička vrijednost navedenih parametara uspoređena je s onima zabilježenim u 80 bolesnika s negativnim digitorektalnim nalazom i tPSA od 4,0-9,9 ng/mL. U svih 80 bolesnika učinjena je biopsija pod kontrolom transrektalnog ultrazvuka uzimajući najmanje 6 biopsijskih uzoraka. Preparati su analizirani rutinskim metodama, a prema potrebi je imunohistokemijski (p63, HMW-CK) postavljena i patohistološka dijagnoza. Prosječna dob ispitanika u programu rane dijagnostike je 67 godina. Samo 22% ispitanika samoinicijativno traži pregled i test na PSA, bez prisutnosti tegoba mokrenja, ali je ta populacija značajno mlađa u usporedbi s bolesnicima koje upućuje liječnik opće prakse zbog mikcijskih smetnja (Mann-Whitney, p<0,001). Serumska vrijednost tPSA u ispitanoj skupini značajno je razlikovala bolesnike s rakom prostate od onih s dobroćudnom hiperplazijom prostate (t-test, p=0,007). Nije bilo razlike u pozitivnoj prediktivnoj vrijednosti za tPSA i raspon za dob specifičnog PSA (16,2% prema 17,.6%). Osjetljivost raspona za dob specifičnog bila je 92,3%, a njegova specifičnost 16,41%. Zaključeno je kako treba i dalje sustavno raditi na javnozdravstvenoj izobrazbi muške populacije u Hrvatskoj, budući da samo 22% ispitanika traži pregled i PSA test svjesni potrebe za ranom dijagnostikom. Načela rane dijagnostike provode se, najvjerojatnije nepotrebno, u čak 38% ispitanika koji ne predstavljaju ciljnu populaciju za ranu dijagnostiku. Prilikom indiciranja biopsije prostate, služeći se kriterijima za raspon za dob specifičnog PSA može se smanjiti broj nepotrebnih biopsija za 16,4%, dok se dokazivanje raka prostate propušta u 7,6% slučajeva. Razmjer lažno pozitivnih nalaza raspona za dob specifičnog PSA i dalje je 83,58%, pa se drži potrebnim ispitati potencijalno bolje načine smanjenja broja nepotrebnih biopsija

Dijagnostička vrijednost za dob specifičnog antigena specifičnog za prostatu u bolesnika s rakom prostate

The aim of the study was to analyze age distribution in patients undergoing early diagnosis procedures within the scope of the prostate cancer program, and to compare diagnostic accuracy of total prostate specific antigen (tPSA) test and age specific PSA range test in differentiating prostate cancer from benign prostate hyperplasia in order to reduce the number of unnecessary biopsies. Age distribution was analyzed in 394 patients with negative digitorectal examination, and diagnostic accuracy was analyzed in 80 patients with negative digitorectal and tPSA of 4.0-9.9 ng/mL. All 80 patients underwent prostate biopsy under transrectal ultrasound guidance obtaining at least six cores. Statistical analysis included t-test, Mann-Whitney rank sum test, specificity and sensitivity, positive and negative predictive value, and detection rate. The patient mean age was 67.0 years. Only 22% were self referred to the early diagnosis program seeking PSA and urologist consultation while being free from any other urologic difficulties. This population was significantly younger in comparison with patients referred to urologist by general practitioner for their micturition difficulties (Mann-Whitney test, p<0.001). Total PSA differentiated significantly prostate cancer from benign prostate hyperplasia (p=0.007, t-test). Positive predictive value for tPSA and age specific PSA range test did not differ significantly (16.2 vs. 17.6%). The sensitivity and specificity of agespecific PSA range test was 92.3% and 16.41%, respectively. It is concluded that there is the need of additional public health education about prostate cancer since only 22% of the respective population seek urology consultation and PSA testing, being aware of the benefits of the early diagnosis of prostate cancer. Up to 38% of patients included in the early diagnosis program are beyond target population since no curable treatment could be offered to them even if the diagnosis of prostate cancer was established. Although age specific PSA range test reduces the rate of biopsies by 16.4%, 7.6% of prostate cancers are thus missing, whereas false positive results account for as many as 83.58% of cases, clearly calling for search for the potentially better ways of reducing the number of unnecessary prostate biopsies.Cilj rada bio je analizirati dobnu strukturu populacije u koje se provodi rana dijagnostika raka prostate te usporediti dijagnostičku vrijednost ukupnog antigena specifičnog za prostatu (tPSA) i referentnog raspona PSA specifičnog za dob u razlikovanju raka prostate i dobroćudne hiperplazije prostate, kako bi se smanjio broj nepotrebnih biopsija prostate. Dobna struktura analizirana je u 394 bolesnika s negativnim digitorektalnim nalazom, a dijagnostička vrijednost navedenih parametara uspoređena je s onima zabilježenim u 80 bolesnika s negativnim digitorektalnim nalazom i tPSA od 4,0-9,9 ng/mL. U svih 80 bolesnika učinjena je biopsija pod kontrolom transrektalnog ultrazvuka uzimajući najmanje 6 biopsijskih uzoraka. Preparati su analizirani rutinskim metodama, a prema potrebi je imunohistokemijski (p63, HMW-CK) postavljena i patohistološka dijagnoza. Prosječna dob ispitanika u programu rane dijagnostike je 67 godina. Samo 22% ispitanika samoinicijativno traži pregled i test na PSA, bez prisutnosti tegoba mokrenja, ali je ta populacija značajno mlađa u usporedbi s bolesnicima koje upućuje liječnik opće prakse zbog mikcijskih smetnja (Mann-Whitney, p<0,001). Serumska vrijednost tPSA u ispitanoj skupini značajno je razlikovala bolesnike s rakom prostate od onih s dobroćudnom hiperplazijom prostate (t-test, p=0,007). Nije bilo razlike u pozitivnoj prediktivnoj vrijednosti za tPSA i raspon za dob specifičnog PSA (16,2% prema 17,.6%). Osjetljivost raspona za dob specifičnog bila je 92,3%, a njegova specifičnost 16,41%. Zaključeno je kako treba i dalje sustavno raditi na javnozdravstvenoj izobrazbi muške populacije u Hrvatskoj, budući da samo 22% ispitanika traži pregled i PSA test svjesni potrebe za ranom dijagnostikom. Načela rane dijagnostike provode se, najvjerojatnije nepotrebno, u čak 38% ispitanika koji ne predstavljaju ciljnu populaciju za ranu dijagnostiku. Prilikom indiciranja biopsije prostate, služeći se kriterijima za raspon za dob specifičnog PSA može se smanjiti broj nepotrebnih biopsija za 16,4%, dok se dokazivanje raka prostate propušta u 7,6% slučajeva. Razmjer lažno pozitivnih nalaza raspona za dob specifičnog PSA i dalje je 83,58%, pa se drži potrebnim ispitati potencijalno bolje načine smanjenja broja nepotrebnih biopsija

Novi izgledi za kronični prostatitis

Nowadays we may be overlooking an ever more common and most likely infectious disease of uncertain etiology - prostatitis. The field of chronic prostatitis was stagnant for some three decades; however, the state of affairs has changed dramatically over the last few years. Prostatitis is the most common prostate disease in the younger population, which results in more physician visits than either benign prostatic hyperplasia or prostate cancer. Despite its high prevalence, chronic prostatitis as a disease and its etiology have been understudied. This article is concentrated on the entity of chronic prostatitis, which is the most controversial, diagnostically most imprecise, and most frustrating diagnosis in medicine in general. Also, it is the most common ailment in men worldwide. The knowledge about the disease is now progressing at a higher pace, especially concerning its etiology and pathogenesis. Along with a review of the latest findings, an update is provided of the classification, diagnosis, treatment and epidemiology of chronic prostatitis. It is emphasized that the disease should be recognized more often, or at least, epidemiologically speaking, it should be paid more attention.Danas možda previđamo prostatitis, sve češću i najvjerojatnije zaraznu bolest neutvrđene etiologije. Područje kroničnog prostatitisa stagniralo je kroz nekoliko desetljeća, da bi se stanje dramatično promijenilo posljednjih nekoliko godina. Prostatitis je najčešća bolest prostate u mlađoj populaciji, koja rezultira većim brojem liječničkih pregleda nego benigna hiperplazija prostate ili rak prostate. Usprkos učestalosti kroničnog prostatitisa, premalo je istraživanja kroničnog prostatitisa kao bolesti, kao i njegove etiologije. Ovaj je članak usredotočen na entitet kroničnog prostatitisa, koji predstavlja najkontroverzniju, najneprecizniju i najviše zbunjujuću dijagnozu u čitavoj medicini. To je također najčešća bolest u muškaraca širom svijeta. Danas se sve brže poboljšavaju saznanja o ovoj bolesti, poglavito o njezinoj etiologiji i patogenezi. Prikazan je pregled najnovijih nalaza i saznanja o klasifikaciji, dijagnostici, liječenju i epidemiologiji kroničnog prostatitisa. Isto tako, smatramo kako bi ovu bolest trebalo više uvažavati ili joj barem s epidemiološkog stajališta poklanjati više pozornosti

Istodobna pojavnost primarnog karcinoma bubrežnih stanica i njegove polipoidne intraluminalne metastaze u tankom crijevu: prikaz slučaja

A case is reported of metastatic renal cell carcinoma in the wall of the small bowel. The patient presented with abdominal pain, hematuria and fever. Exploration during radical nephrectomy revealed a metastatic tumor into the small bowel, which was resected at once. Pathologic examination showed stage T4N2M1 renal cell carcinoma, nuclear grade G4, containing sarcomatoid and clear cell areas. Clinically, metastasis of renal cell carcinoma into the small bowel is a rare disease. To our knowledge, only a few cases have been reported to date.Prikazan je slučaj karcinoma bubrega koji je metastazirao u tanko crijevo. Bolesnik je došao s bolovima u abdomenu, hematurijom i povišenom temperaturom. Za vrijeme radikalne nefrektomije otkriven je metastatski tumor u tankom crijevu, koji je odstranjen. Patohistološka analiza pokazala je stadij T4N2M1 bubrežnog karcinoma koji je bio građen od vretenastih i svijetlih stanica. Metastaziranje bubrežnog karcinoma u tanko crijevo dosta je rijetko. Prema našem saznanju opisano je samo nekoliko slučajeva

Korelacija između Gleasonova stadija u uzorcima dobivenim prijeoperacijskom biopsijom prostate i tijekom prostatektomije

The aim of the study was to compare Gleason scores obtained from sextant preoperative prostate biopsy and radical prostatectomy specimens in patients with localized prostate cancer. Seventy-three patients with prostate biopsy and operated on at our hospital from 2000 till 2002 were included in the study. Definitive postprostatectomy Gleason score was accurately predicted by preoperative biopsy in 43.8% and undergraded by 1 grade in 39.7% of study patients. Although a fairly good concordance was recorded between Gleason scores obtained on biopsy and prostatectomy specimens, the problem of undergrading remains to be improved. The web-based free tutorial can improve the accuracy of Gleason grading by practicing pathologists. It is available at: www.pathology.jhu.edu/prostate.Cilj ove studije bio je usporediti Gleasonov zbroj dobiven prijeoperacijskom sekstant biopsijom i konačan nalaz nakon radikalne prostatektomije u bolesnika s lokaliziranim karcinomom prostate. U ispitivanje su bila uključena 73 bolesnika koji su podvrgnuti biopsiji i radikalnoj prostatektomiji u našoj ustanovi između 2000. i 2002. godine. Prijeoperacijska biopsija prostate točno je predvidjela konačan Gleasonov zbroj nakon prostatektomije u 43,8% bolesnika, dok je u 39,7% bolesnika Gleasonov zbroj bio podcijenjen za 1. Premda je nađena prilično dobra usuglašenost nalaza stupnja diferenciranosti tumora na bioptičkom i definitivnom materijalu, problem podcjenjivanja stupnja diferenciranosti jo. treba biti riješen. Točnija procjena Gleasonova zbroja može se postići uporabom i vježbom na besplatnoj Internet stranici: www.pathology.jhu.edu/prostate

Korelacija između Gleasonova stadija u uzorcima dobivenim prijeoperacijskom biopsijom prostate i tijekom prostatektomije

The aim of the study was to compare Gleason scores obtained from sextant preoperative prostate biopsy and radical prostatectomy specimens in patients with localized prostate cancer. Seventy-three patients with prostate biopsy and operated on at our hospital from 2000 till 2002 were included in the study. Definitive postprostatectomy Gleason score was accurately predicted by preoperative biopsy in 43.8% and undergraded by 1 grade in 39.7% of study patients. Although a fairly good concordance was recorded between Gleason scores obtained on biopsy and prostatectomy specimens, the problem of undergrading remains to be improved. The web-based free tutorial can improve the accuracy of Gleason grading by practicing pathologists. It is available at: www.pathology.jhu.edu/prostate.Cilj ove studije bio je usporediti Gleasonov zbroj dobiven prijeoperacijskom sekstant biopsijom i konačan nalaz nakon radikalne prostatektomije u bolesnika s lokaliziranim karcinomom prostate. U ispitivanje su bila uključena 73 bolesnika koji su podvrgnuti biopsiji i radikalnoj prostatektomiji u našoj ustanovi između 2000. i 2002. godine. Prijeoperacijska biopsija prostate točno je predvidjela konačan Gleasonov zbroj nakon prostatektomije u 43,8% bolesnika, dok je u 39,7% bolesnika Gleasonov zbroj bio podcijenjen za 1. Premda je nađena prilično dobra usuglašenost nalaza stupnja diferenciranosti tumora na bioptičkom i definitivnom materijalu, problem podcjenjivanja stupnja diferenciranosti jo. treba biti riješen. Točnija procjena Gleasonova zbroja može se postići uporabom i vježbom na besplatnoj Internet stranici: www.pathology.jhu.edu/prostate

Istodobna pojavnost primarnog karcinoma bubrežnih stanica i njegove polipoidne intraluminalne metastaze u tankom crijevu: prikaz slučaja

A case is reported of metastatic renal cell carcinoma in the wall of the small bowel. The patient presented with abdominal pain, hematuria and fever. Exploration during radical nephrectomy revealed a metastatic tumor into the small bowel, which was resected at once. Pathologic examination showed stage T4N2M1 renal cell carcinoma, nuclear grade G4, containing sarcomatoid and clear cell areas. Clinically, metastasis of renal cell carcinoma into the small bowel is a rare disease. To our knowledge, only a few cases have been reported to date.Prikazan je slučaj karcinoma bubrega koji je metastazirao u tanko crijevo. Bolesnik je došao s bolovima u abdomenu, hematurijom i povišenom temperaturom. Za vrijeme radikalne nefrektomije otkriven je metastatski tumor u tankom crijevu, koji je odstranjen. Patohistološka analiza pokazala je stadij T4N2M1 bubrežnog karcinoma koji je bio građen od vretenastih i svijetlih stanica. Metastaziranje bubrežnog karcinoma u tanko crijevo dosta je rijetko. Prema našem saznanju opisano je samo nekoliko slučajeva