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In a mutually beneficial connection with its host, the gut microbiota affects the host’s nutrition, immunity, and metabolism. An increasing number of studies have shown links between certain types of disease and gut dysbiosis or specific microorganisms. Fecal microbiota transplantation (FMT) is strongly advised for the treatment of recurrent or resistant Clostridium difficile infection (CDI) due to its outstanding clinical effectiveness against CDI. The therapeutic potential of FMT for other disorders, particularly inflammatory bowel diseases and malignancies, is currently gaining more and more attention. We summarized the most recent preclinical and clinical evidence to show the promise of FMT in the management of cancer as well as complications related to cancer treatment after reviewing the most recent research on the gut microbiota and its relationship to cancer.

Objective: Ureteral metastasis of prostate cancer is a very rare pathology, that can be confused with an upper urinary tract urothelial carcinoma, with great implications in the surgical management and therapy of the disease. Case: A 56-years old male patient admitted to the emergency room with 2 weeks history of left flank pain without low urinary tract symptoms or hematuria. PSA level was 43,4 ng/ml. The patient underwent prostate needle biopsy and ureteral biopsy using flexible ureteroscopy, after the Lich-Gregoire ureterovesical reimplantation. In this case, renal colic as the first symptom of a ureteral metastasis secondary to prostate cancer is extremely rare which diagnosed in the patient. Conclusion: Neoureterocystostomy is a safe and effective treatment for ureteral obstruction due to prostate cancer metastasis, with low morbidity and significant benefits in terms of quality of life for patients with life expectancy more than 10 years.

Urinary tract infections (UTIs) are the most common bacterial pathologies in children, but they are difficult to spot. The diagnosis relies on urine culture in order to measure the prevalence of the infection, to identify the etiology and the sensitivity of the germs to different antibiotics. Escherichia coli (E. coli) strains are the most common uro-pathogen germs. The change in sensitivity to antibiotic of these uro-pathogen bacteria should be closely monitored because the physicians should be informed about the evolution of the antibiotic resistance of E coli, for a more effective treatment in their fight against diseases. The study aimed to determine the prevalence of UTIs and the evolution of antimicrobial sensitivity for E. coli. This retrospective study was performed over a period of 4 years, 2013-2016, and included all the patients admitted in the Children�s Hospital, aged 0-18 years, with the suspicion of UTIs; also, the standard culture techniques for urine samples, the modified Kirby-Bauer disk diffusion method for the antibiotic sensitivity testing, and the disk diffusion method to confirm the ESBL production by the clinical isolates of E. coli in urine were used. The statistical analysis was performed using the proportions of sensitive, resistant and intermediates. Descriptive statistics like the total, mean and percentage were performed using the Statistical Package for the Social Sciences (SPSS), version 15.0 and Microsoft Excel. From 15389 urine cultures processed in 4 years, 1530 were positive (9.9 %). Among these positive urine cultures, 1056 (69 %) were positive for E. coli. Testing the E. coli to a range of antibiotics, according to CLSI standard, a high resistance to Ampicillin (69-96%), Amoxicillin/Clavulanic acid (32-70%), Trimethoprim/Sulfamethoxazole (36-42%) was observed and low levels of resistance to Ceftazidime, Cefuroxime, Cefpodoxime, Gentamycin, Nalidixic acid. Among E. Coli strains, 9-9.6 % were ESBL positive. Despite the low number of positive urine cultures in a paediatric population, it is very important to perform the urine culture in order to correctly identify the etiology of UTIs, recommend the right antibiotic, and avoid the wrong use of the antibiotics in children.

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. “Masterly neglect” is a valuable option in selected cases.

Combining technological development in the laparoscopic field alongside the increase of surgeon�s experience in partial nephrectomy, have extended the indications of laparoscopic nephron sparing surgery to more complicated cases, increasing the role of suture materials in obtaining a good collecting system closure and hemostasis, with short warm ischemia time and low postoperative complications rate. Suturing materials are continuously developed combining new and unique designs with novel synthetic materials in order to fulfill surgeon�s exigence.

Stress urinary incontinence in women is a condition widely encountered in the entire world with a prevalence between 12.8% and 46.0%. Stress urinary incontinence is a public health problem causing a significant decrease in quality of life, involving social, physical, psychological, occupational and sexual suffering of patients. The minimal invasive treatment of the stress urinary incontinence (SUI) consists in fixing a suburethral polypropylene mesh (SPM) in retropubic (TVT) or transobturator (TOT) space, in order to regain the pelvic support of the urethra, with the consecutive augmentation of the pressure of urethral closing during effort. The objective of this paper is to present the advantage of SPM in the SUI treatment in the eleven years� experience of Department of Urology Sibiu.

Introduction. Sparing kidney tissue is important because studies show that patients who have their entire kidney removed are more likely to suffer from chronic kidney disease after surgery than patients who received a kidney-sparing partial nephrectomy. The aim of study is to show the effectives of Pringle maneuver for clamping renal pedicle in order to minimize warm ischemia during open partial nephrectomy. Material and method. We retrospectively analyzed 34 patients diagnosed with cT1 renal tumors between 2012 and 2016 and underwent open partial nephrectomy in Sibiu Urology Department. During the surgery we perform clamping of renal pedicle with Satinsky clamp or with the Pringle maneuver. We analyzed the flowing parameters: operation time, blood loss, clamping time and serum creatinine before and after the surgery. Results. The mean age of patient with partial nephrectomy was 58.7±14.7 years, with 56.7±12.4 years for Satinsky group and 60.5±11.6 for Pringle group. The average duration for partial nephrectomy was 94.8±19.4 minutes. Average blood loss for all surgeries was 220±30 ml. Conclusion. Pringle maneuver is a safe and effective method with low intra and postoperative complications during open partial nephrectomy, having a good control of the renal pedical with reduced ischemia. Is a feasible method of choice in renal tumour tumor pathology on a single congenital or surgical kidney, mediorenal tumors or near the sinus and multifocal tumors.

Introduction. More than 70% of all bladder cancers are nonmuscle invasive involving only the mucosa and the submucosa. A large percentage of patients present local recurrence after endoscopic surgery, and many of them progress to muscle invasive disease necessitating radical cystectomy. The high recurrence and progression rate is the reason to use intravesical therapy to prevent recurrences. The aim of this study is to compare the efficacity and safety of intravesical immunotherapy with Bacillus Calmette Guerin (BCG) vs. chemotherapy (Pharmoribicin) after TUR-B for NMIBC. Material and methods. Following TURB and pathological analysis, NMIBC was stratified into low, intermediate and high-risk groups depending on the probability of recurrence and progression to muscle-invasive disease. Patients were treated with adjuvant intravesical therapies, BCG or Pharmorubicin. Results. Between 2008 and 2012, a total of 125 patients with NMIBC were diagnosed in the Urology Department Sibiu. Histopathological data show: pT1 G1 – 48 patients (38.4%), pT1 G2 – 69 patients (55.2%), pT1G3 and or Tis – 8 patients (6.4%). Adjuvant intravesical therapies with Pharmorubicin was administered to 83 patients (66.4%) and with BCG 42 patients (33.6%). Pharmorubicin, the recurrence rate was 22.8% in the first year and at 5 years there was a recurrence of 36.1%. For the group of patients treated with BCG recurrent rate was 14.2% in the first year and 33,3% at 5 years. For the whole group of patients tumor progression was 2.4% in the first year and 9.6% at 5 years. For the Pharmorubicin group, in the first year, the progression was 2.4% compared with 2.3% tumor progression in the BCG-treated group. Conclusions. Intravesical instillation treatment after TURB reduce the recurrence rate and tumor progresion. In our series there are no major differences between efficacity of intravesical immunotherapy (BCG) vs. chemotherapy (Pharmoribicin). Disease-free survival and progression-free survival are comparable to the two studied lots.

Antibiotherapy is the treatment of choice for the urinary tract infections in hospitalized urological patients. Antibiotic associated diarrhea (ADD) caused by the Clostridium difficile cytotoxin producer represents one of the most severe side effects of the antibiotic treatment. It is important to evaluate the risk factors for a hospitalized patient to develop a C. difficile healthcare associated infection during hospitalization in order to put in practice effective preventive measures. The aim of the study is to analyzed the risk factors associated with the demographic status: age, sex, and also risk factors related to healthcare conditions: use of antibiotics (number, type, duration of treatment), other significant medication taken prior to the onset of diarrhea (histamine-2-receptor antagonists and proton-pump inhibitors, comorbidities, possible contamination from other in-patients who developed ADD in the same period and data about in-hospital mortality.

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma, produced by gas-forming Gram-negative bacilli. Even though only few cases are reported in the literature, the disease is not so rare and can become life-threatening if the diagnose is not quick and the therapeutic messures efficient. The biochemical analysis are the first line diagnostic, indicating the severity of the infection. The aim of our study was to to evaluate the importance of biochemical parameters, as first line diagnosis and also of the microbiological parameters, as etiologic diagnosis, in severe renal infections produced by gas forming bacili mainly in diabetic patients, predominantly women, with obstructive nephrolithiasis.

Introduction. Genital prolapse is a pelvic static disorder, which represents the descending of the vaginal walls and the uterus in the vaginal axis with their exteriorization through vaginal introit. It is a public health problem, with a risk of occurrence of 30-40% in women over 40 years old, of 20-30% in multiparous, of about 20% after surgeries, having as the main cause injuries to pelvic supporting and suspension structures. The objective of this paper is to compare the classic transvaginal surgical technique of mounting the prosthesis to the bilateral sacrospinous ligament with the technique of fixing the mesh to the sacrospinous ligament using the I-Stitch device. Materials and methods. Between 2010 and 2017, in the Sibiu Urology Clinic, there were diagnosed 57 patients (p) with urogenital prolapse who benefited from colpopexy by fixing the polypropylene mesh to the sacrospinous ligament using the I-Stitch device and colpopexy by classically fixing the mesh. Results. In the group using the I-Stich device, mean operative time was 48.5 minutes (between 35 and 110 minutes), mean blood loss was 140 ml (90-300 ml), postoperative pain present in 5 p (8.77%), hospitalization length between 2 and 5 days with an average of 3.2 days. Conclusion. Reconstructive surgery of pelvic floor is a combination of surgical procedures designed to correct multiple defects, is definitive and curative in the treatment of prolapse.

Prostate cancer (PCa) is the most commonly diagnosed male malignancy after 60 years old. Today, the problem is to distinguish between low-risk and agrressive cancers, especially in patients with Prostatic Specific Antigen (PSA) less than 10 ng/ml The use of PSA as a biomarkers for diagnosis and prognosis of prostate cancer has the potential to improve the clinical management of the patients. PSA levels. together with clinical examination, prostate ultrasound and histopatological examination are esential for the diagnostic of PCa, risk assessment and therapeutic decisions. The aim of our study is to evaluate the patients with PSA values less then 10 ng/mL and to determine the correct indications for tratment depending on the risk scale of the disease. The inclusion criteria for the patients are described in the paper. For improving the early diagnosis of PCa in patients with PSA below 10 ng/mL we developed an algoritm based on current opportunities.

Introduction. Vitamin D is well known for its role in calcium absorption and maintenance of healthy bones and its deficiency results in rickets. Serum 25-hydroxyVitamin D (25(OH) D) is the most abundant Vitamin D metabolite and its concentration reflects Vitamin D status in humans. The aim of this study was to analyse the level of 25(OH) D in children between 1 month and 24 months of age, admitted in Sibiu Children’s Hospital, with various pathologies, and to give scientific evidence for the prevention and treatment of rickets. Materials and methods. We made a retrospective study on 200 children, aged between 1 month and 24 months, hospitalized in different Pediatric Departments of Sibiu Children’s Hospital between 01.09.2015 and 01.11.2016, in whom we determined the level of serum 25(OH)D. The optimal level of 25(OH)D was considered to be ≥30 ng/ml; values of 25(OH) D between 20-29 ng/mL define insufficient Vitamin D and Vitamin D deficiency is characterized by levels < 20 ng/ml. Results. Overall, 111 children (55.5%), aged between 1 month and 24 months, had levels of 25 (OH) Vitamin D below 30 ng/ml, with a mean value of 28.68 ng/ml. Of these 111 patients, 87 (78%) had 25(OH)D values between 20-29 ng/ml, with a mean value of 22.61 ng/ml and only 24 children (22%) had values less 20 ng/ml, with a mean value of 17.2 ng/ml. Conclusions. Low serum 25(OH) D levels affect more than half of infants and children, aged 1 month to 24 months, suggesting that there are many children in our area who have suboptimal levels of Vitamin D and this should be a matter of concern for families with children, for medical professionals and public health authorities. Determination of 25(OH) Vitamin D is an important test for children between 1 month and 24 months of age, to be used as a starting point in efficiently preventing rickets at this age.

Introducere. Vitamina D are un rol bine cunoscut în absorbţia calciului şi menţinerea unui sistem osos sănătos. Deficitul de Vitamina D duce la apariţia rahitismului. 25-hidroxi-Vitamina D reprezintă cel mai important metabolit al vitaminei D şi concentraţia plasmatică a acesteia reflectă cel mai bine cantitatea de vitamină D la om. Scopul acestui studiu a fost de a analiza nivelul de 25-(OH) D la copiii între 1 lună şi 24 de luni, internaţi în Spitalul de Pediatrie din Sibiu, cu diverse patologii, pentru a analiza care este situaţia deficitului de Vitamina D la această populaţie şi, totodată, de a folosi aceste valori pentru a impulsiona prevenţia rahitismului la această categorie de vârstă . Material şi metodă. Am efectuat un studiu retrospectiv pe un lot de 200 copii, cu vârste cuprinse între 1 lună şi 24 de luni, internaţi în diferite secţii ale Spitalului Clinic de Pediatrie Sibiu în perioada 01.09.2015 - 01.11.2016, la care s-a dozat nivelul plasmatic de 25-(OH) D. Am considerat că nivelul optim de 25-(OH) D este valoarea peste 30 ng/ml, insuficienţa de Vitamina D a fost definită ca valori ale 25-(OH) D cuprinse între 20 şi 29 ng/ml, iar deficitul de vitamină D a fost definit ca valori ale 25-(OH) D sub 20 ng/ml. Rezultate. Din totalul de 200 pacienţi, 111 copii (55,5%) cu vârste cuprinse între o lună şi 24 de luni au prezentat nivele plasmatice ale 25-(OH) D sub 30 ng/ml, cu o valoare medie de 28,68 ng/ml. Din cei 111 pacienţi cu nivele ale 25-(OH) D sub 30 ng/ml, 87 de pacienţi (78%) au prezentat valori ale 25-(OH) D cuprinse între 20 şi 29 ng/ml, cu o valoare medie de 22,61 ng/ml şi doar 24 de copii (22%) au avut valori sub 20 ng/ml, cu o valoare medie de 17,2 ng/ml. Concluzii. Peste jumătate dintre copiii cu vârste cuprinse între o lună şi 24 de luni prezintă valori plasmatice scăzute ale 25-(OH) D. Acest fapt sugerează că există un număr important de copii în arealul nostru geografic care au nivele suboptimale de vitamină D, ceea ce ar trebui să ridice o problemă pentru familiile lor, pentru profesioniştii din domeniul medical, cât şi pentru autorităţile din sănătate. Pe lângă valoarea epidemiologică, determinarea nivelelor de 25-(OH) D reprezintă o analiză de laborator importantă pentru copiii cu vârste cuprinse între o lună şi 24 de luni, ce poate fi folosită ca punct de pornire în tratamentul de prevenţie a rahitismului, care trebuie instituit la această vârstă.

Despite the modern advancement in endourology, percutaneous nephrostomy play an important role in many urologic conditions, which of the most important is the relief of upper urinary tract in patients with malignancies that interests the ureter or the uretero-vesical junction. The aim of the study is to compare the complications of polyurethane and silicone catheters used for percutaneous nephrostomy in patients with unilateral or bilateral uretero-hydronephrosis secondary to locally advanced abdomino-pelvin malignancies. We have retrospective analyzed 164 patients (p), admitted between January 2013 and December 2016 in Urology Department Sibiu, who benefit from unilateral or bilateral percutaneous nephrostomy for secondary uretero-hydronephrosis with acute renal failure.

Introduction. Partial nephrectomy represent the standard of care for small renal tumor. Laproscopic approach tends to replace open surgery due to similar oncologic results, but with better eastethic outcomes and earlier socio-professional reintegration. Material and methods. Between January 2010 and February 2017, 55 patients (p) underwent partial nephrectomy at our center for clinically localized renal tumor, 21p with LPN by retroperitoneal approach and 34p with OPN. All patients had a normal contralateral kidney. The selection of patients for nephron-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. Results. The mean age of patients with partial nephrectomy was 59.6±16.4 years, with 57.9±11.6 years for laparoscopic subgroup and 61.3±12.4 for open surgery. The transfusion rate was 9.52% in LPN group, while in the OPN there was no need for transfusion. The warm ischemia time was higher in the LPN group (21.8±7.2 min) than OPN group (15.7±2.9). The postoperative complication rate is comparable between LPN and OPN (23.81% v.s. 20.58%), but the LPN had higher intraoperative complications. Conclusion. Laparoscopic partial nephrectomy for renal tumors is superior to open surgery by early mobilization of the patient, the low rate of wound complications, short duration of hospitalization, fast socio-professional reintegration of patient, despite the perioperative complication rate that is higher but of low ClavienDindo grade.

Ureteral stents represent one of the most utilized medical device in urology, as a minimally invasive alternative to preserve urine outflow. The ideal ureteral stent which combines long-term efficacy with a very low rate of side effects is still missing from the urologist armamentarium. The main material for ureteral stents production is polyurethane. In order to improve the side-effects and complications of polyurethane stents, special coatings were developed. The aim of this study is to evaluate short-term side-effects and complications of different polyurethane stents with or without coating used in urologic field.

Introducing polymer ligating clips (PLC) or Hem-o-lok clips was a useful alternative to titanium clips in order to perform a safe, efficient and rapid ligation of the vascular structures during laparoscopic and/or conventional surgical procedures. In urologic surgery they are useful during ablative laparoscopic surgery for renal tumor, urothelial tumors, non-functional kidney, bladder tumors and prostate tumors. Polymers� properties depend on the structure of molecules and vary from flexible substances to expandable rigid materials. They have a high resistance to shock, considerable abrasion resistance and precise durability. Polymers can easily take the desired shape, due to different processing modes. They also have the property of resistance to sustainable action of external forces. The aim of this paper is to evaluate the efficacy and safety of PLC used during renal pedicle ligation in retroperitoneal laparoscopic nephrectomy for renal tumors, high urothelial tumors and nonfunctional kidney.