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Introduction and Objectives. Detrusor underactivity (DU) is a complex condition, characterized by decreased detrusor contractility. There are many parameters used in urodynamical practice, one of them is the Bladder Contractility Index (BCI) which is used to quantify bladder contractility using a mathematical formula based on the detrusor pressure and Qmax value. The aim of this study is to evaluate the importance of BCI value as an urodynamical parameter in the diagnosis of detrsuor underactivity. Materials and Methods. A retrospective study was performed over a period of 6 years which included 114 patients, both women and men, urodynamically investigated and diagnosed with DU in the Clinic of Urology from Târgu Mureș. Results. The mean age of the patients was 62.58 years +/- 13.23 SD. Voiding symptoms were predominant: straining in 98 cases (85.96%), slow (and or interrupted) stream in 77 patients (67.54%), increased daytime urinary frequency in 63 patients (55.26%), nocturia in 49 patients (42.98%) and the sensation of incomplete bladder emptying, in 48 patients (42.10%). Causes of DU: neurological disorders in 42 patients (36.84%), diabetes in 35 cases (30.70%), pelvic surgery in 32 cases (28.07%), psychiatric disorders under treatment in 18 patients (15.78%) and age over 70 years in 38 cases (33.33%). PVR below 100 ml was found in 36 patients (31.55%), between 100-200 ml in 38 patients (33.33%) and over 200 ml in 26 patients (22.80%). The mean PVR value was 112.69 ml +/- 96.06 SD. The results of the urodynamical parameters were: mean Qmax = 8.86 ml/s +/- 4.59 SD, mean BCI = 60.13 +/- 23.46 SD, mean pdetQmax = 14.90 +/- 5.29 SD . There is a statistically correlation between the BCI value and the diagnosis of DU, p < 0.0001. Conclusions. Quantifying detrusor contractility is a challenge but also a must in determining the proper therapeutical management. The value of BCI under 100, sustaine the diagnosis of DU and is an important factor for teraputical decision and patients’s follow up. [ABSTRACT FROM AUTHOR]

Introduction: Bladder tumors are the most common tumors of the urinary tract, accounting for about 5.5% of all cancers. In male it is on the 4th place, and in females it occupies the 7th place. TURBT is the gold standard for the initial treatment and diagnosis of bladder tumors. This intervention can be followed, in the case of non-muscle invasive tumors, by intravesical instillation, with a chemotherapeutic or with BCG. The aim of this work was to follow the evolution of patients with non-muscle invasive bladder tumors who have been treated with BCG (Bacillus Calmette-Guérin) immunotherapy. Matherial and methods: The study was a retrospective one, for a period of 5 years, between 2010 January 1 and 2014 December 31, including a number of 91 patients hospitalized in the Urology Clinic of Mureş County Clinical Hospital. Follow-up data at 24 months was present in 76 patients. Results: Of the 76 patients, 80.26% were male and 19.74% were female. The distribution of patients according to the environment of origin highlights the prevalence of the urban environment in the percentage of 72.36%, the rural area having a percentage of only 27.64%. The average age was 61.43 years. There was no statistically significant association between the gender of the patient and the rate of tumor recurrence. Of the 76 patients, 21 had tumor progression during the follow-up period. No patient was found to have progressed to invasive bladder tumor. Of the total number of 76 patients, at the end of the follow-up period, it was found that 8 discontinued treatment with BCG due to side effects such as: haematuria and tuberculous cystitis. In 3 patients, treatment with BCG failed and due to repeated recurrences required a total cystectomy. Conclusions: Instillational treatment with BCG immunotherapy remains the best option as an adjuvant in patients with non-muscle invasive bladder tumors to prevent recurrence and progression, in well-selected cases and with clear indication. [ABSTRACT FROM AUTHOR]

Introduction and objectives. Penile fractures is rare medical condition and is a major urological emergency. Surgery is considered the standard therapy. In some cases it can be applied a conservative therapy. This study aims to assess the results of the two therapies in penile fractures. Material and Methods. Between January 2007 and October 2019 in Tirgu Mures Urology Clinic a total of 6 patients were admitted with penile fracture. At 4 of these patients we performed surgery intervention for treatment of penile fracture and at 2 of them conservative therapy because they refused surgery. We followed hospitalization period, the occurrence of penile angulation during erection and erectile function at more than 3 months post therapy using International Index of Erectile Function (IIEF). Results. Mean age was 37,35 years for patients with surgical therapy vs 22 years for patients with conservative treatment. Average days of hospitalization was 8,75 days vs 9 days. Average IIEF 1-5,15 at 3 months after surgery was 23,25 for the patients who undergone surgery and 27 for the patients with conservative treatment. Average IIEF 1-5,15 at 12 months after surgery was 22 for the patients who undergone surgery and 28 for the patients with conservative treatment. 2 patients with penile fracture were not subsequently presented to the control and we do not have data about erectile function at 12 months. In 1 patient with conservative treatment there was a slight angulation of about 10 degrees. The patient who had concomitant urethral involvement with the penile fracture had erectile dysfunction prior to trauma. For all patients with penile fracture we recommended a period of sexual abstinence for 8 weeks. Conclusions. Penile fracture although it is a rare pathological entity, it must be quickly diagnosed. The indicated treatment is the surgical one, the only one that ensures a reduced rate of complications. The conservative treatment being indicated only to the patients who refuse the surgery. Even though in our study erectile function was superior for patients treated conservatively, this is due to the presence in the group of patients treated surgicaly of a patient with middle/severe erectile dysfunction. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Urinary retention in women has often been considered to be caused due to neurologic or psychogenic disorders. In spite of extensive investigations sometimes the causes of urinary retention may remain unknown. The aim of this paper is to highlight the place of post-void residual urine (PVR) evaluation and the urodynamic diagnosis of voiding dysfunctions in women. Materials and Methods. We performed a retrospective study over a period of 3 years in Mures County Hospital, Clinic of Urology. In this study we included 47 women which presented the selection criteria (voiding symptoms, PVR confirmed by abdominal ultrasound, over 50 ml and the results of urodynamic investigations: uroflowmetry and pressure-flow study). Results. The mean age of the patients was 51.97 ± 16.07 SD (standard deviation) years old with wider extremities between 20 to 78 years old. The mean value of PVR was 140 ml (50-260 ml). The mean value of Peak flow rate (Q max) was 11.70 ml/s ± 6.82 SD. The mean value of detrusor pressure (Pdet) at peak flow was 70.07 ± 32.66 SD cm H2O in detrusor sphincter dyssynergia, 64.66 ± 33.32 SD cm H2O, in obstructed cases and 11,29 ± 5,63 SD cm H2O in cases with impaired detrusor contractility. The urodynamic diagnosis (pressure flow study) revealed detrusor sphincter dyssynergia in 14 cases, 11 with underactive detrusor, 14 with noncontractile detrusor, 2 with obstruction due to genital prolapse gr III and IV, 2 with urinary retention post TOT and 4 with urethral stenosis. Statistical analysis demonstrated a correlation between the quantity of post void residual urine and value of Qmax (r= -0.32 and p=0.02) and also the existence of PVR and diagnosis of impaired detrusor contractility, p=0.02. Conclusions. Urinary retention in women is a condition that needs an adequate attention and a proper diagnosis protocol, in order to take into account the study of detrusor contractility. A significant post-void residual urine can be associated with an impaired detrusor contraction. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Overactive Bladder (OAB) is defined according to International Continence Society (ICS), as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence in the absence of urinary tract infections or other obvious pathologies. The aim of this study is to evaluate the efficacy and safety of using Uractiv Control as monotherapy in patients with Overactive Bladder (OAB). Materials and Methods. We performed a prospective study which started in May 2018 in the Clinic of Urology from Targu Mures. Of the patients enrolled, diagnosed with Overactive Bladder, wet and dry forms, and treated with Uractiv Control 2 x 1 caps/day, 23 were fully evaluated over a 12 weeks period. The evaluation was performed using urine culture, ultrasound, bladder diaries, OAB questionnaire before and after the treatment and personalized satisfaction questionnaire after 12 weeks of treatment. Results. The frequency of daily micturitions was reduced from 10.30 (2.53 SD) per day to 8.69 (1.23 SD) per day (p=1.73), nocturia was improved from 2.85 (0.57 SD) micturitions per night to 1.67 +/- 0.69 SD (p=0.97) and the incontinence episodes from 4.08 +/- 2.26 SD to 3.18 +/- 1.46 SD (p=1.46). The result of OAB questionnaire was improved from 20.64 +/- 3.18 SD to 16.26 +/- 3.72 SD points (p=0.68). The clinical outcome was assessed using a personalized satisfaction questionnaire (limits of the scores: min 4, max 20 points) which totalized an average 14.67 +/- 3.72 of points after 3 months of treatment, p=0.82. Patients did not report any significant side effects of the treatment. Conclusions. Uractiv Control represents a safe treatment option with no side effects and small improvement of the storage symptoms in patients with Overactive Bladder. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. To evaluate long-term overall survival and predictive factors after TURBT and adjuvant intravesical Bacillus Calmette-Guérin (BCG) treatment, in patients with T1 bladder cancer. Materials and Methods. We retrospectively analyzed, 53 patients who underwent transurethral resection of bladder tumor (TURBT) for intermediate and high-grade T1 non-muscle invasive bladder cancer (NMIBC) followed by BCG instillations at our clinic between 2006 and 2008. Primary end-point was overall survival (OS). Data about survival were obtained from the National insurance registry. Survival analysis was performed using the Kaplan Meyer method, and the log-rank test was used for univariate comparisons. Univariable and multivariable Cox regression models addressed the association of prognostic factors with OS. Results. Median follow-up was 79 months (IQR 58-110 months), 33 (62.3%) patients died. In our study, males were 43 (81.13%) and females 10 (18.86%), 41 (77.35%) patients had tumors over 3 cm in diameter, 37 (69.81%) with multiple tumors at diagnosis and 43 (81.13%) patients with high risk tumors (G3). In univariable analysis, clinico-pathologic factors such as age (p=0.003) and recurrence of tumors (p=0.005) were associated with worse OS. In multivariable analysis, independent predictors of OS were gender (HR1.06, 95% CI 1.02-1.11, p=0.002), multifocality (HR 3.03, 95% CI 1.15-7.92, p=0.024) and tumor grade (HR3.59, 95% CI 1.23-10.14, p=0.019). Progression rate was 11.3%%. Recurrence rate was 30.2%. Five year overall survival was 72.2% (95%CI: 58.2-82.2) and at 10-yr 37% (95%CI: 24.4-49.6). Limitations include retrospective design, mono-center study and small sample size. Conclusions. Our study supports current evidence that BCG therapy with maintenance is an effective and safe therapy for T1 bladder cancer patients and it is a viable option for long-term use in such patients. We found that age and recurrence of tumors were associated with poor overall survival. Elderly patients should be strictly monitored and in recurrence patients alternative options may be offered. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Horseshoe kidney (HSK) is the most common renal fusion anomaly, affecting about 0.25% of the newborn. Sometimes this condition is associated with the obstruction of the ureteropelvic junction, lithiasis, is not uncommon for renal infections, abdominal masses and haematuria. For these patients, treatment of urolithiasis represents a particular challenge. ESWL is considered the first-line treatment for the majority of cases. Materials and Methods. We performed a retrospective review of all patients with horseshoe kidney treated and followed at the Urology Clinic of Targu Mures, from 23 July 1991 to 31 December 2017. All patients with stones within a horseshoe kidney that met the following inclusion criteria: a clear urinary path distal of the location of the stone, a functional kidney without stasis and the stone size ≤ 20 mm who underwent ESWL were included in the analysis. We performed a total of 158 ESWL treatments, with a mean of 1.95 ESWL procedures / stone. 3-months follow-up data were available for 60 patients. Results. From our patients 43 (53.08%) were men and 38 (46.92) were women. The average age was 46.32 years. The average size of the stone was 10.316 mm. Major complications after ESWL treatment were subcapsular renal hematoma in one case (1.23%) which only needed supportive care and observation, acute pyelonephritis in one case (1.23%), treated with appropriate antibiotics, hematuria with vesical globe in two cases (2.46%) which needed bladder washouts and catheterization with a three way catheter, with irrigation. Additional pathologies were present in 38 patients (46.91%), 16 had urinary tract infections (treated with the appropiate antibiotics before the ESWL), 12 patients had hypertension, 3 patients had type II diabetes and 16 suffered from obesity. Stone-free at 3 months was 70.31%. Conclusions. We can safely say that ESWL is a good and safe option of treatment in patients with horseshoe kidney if it is performed by a physician with extensive experience in this field. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Urinary retention in women has often been considered to be caused due to neurologic or psychogenic disorders. In spite of extensive investigations sometimes the causes of urinary retention may remain unknown. The aim of this paper is to highlight the place of post-void residual urine (PVR) evaluation and the urodynamic diagnosis of voiding dysfunctions in women. Materials and Methods. We performed a retrospective study over a period of 3 years in Mures County Hospital, Clinic of Urology. In this study we included 47 women which presented the selection criteria (voiding symptoms, PVR confirmed by abdominal ultrasound, over 50 ml and the results of urodynamic investigations: uroflowmetry and pressure-flow study). Results. The mean age of the patients was 51,97 ± 16,07 SD (standard deviation) years old with wider extremities between 20 to 78 years old. The mean value of PVR was 140 ml (50-260 ml). The mean value of Peak flow rate (Q max) was 11,70 ml/s ± 6,82 SD. The mean value of detrusor pressure (Pdet) at peak flow was 70,07 ± 32,66 SD cm H2O in detrusor sphincter dyssynergia, 64,66 ± 33,32 SD cm H2O, in obstructed cases and 11,29 ± 5,63 SD cm H2O in cases with impaired detrusor contractility. The urodynamic diagnosis (pressure flow study) revealed detrusor sphincter dyssynergia in 14 cases, 11 with underactive detrusor, 14 with acontractile detrusor, 2 with obstruction due to genital prolapse gr III and IV, 2 with urinary retention post TOT and 4 with urethral stenosis. Statistical analysis demonstrated a correlation between the quantity of post void residual urine and value of Qmax (r = -0,32 and p = 0,02) and also the existence of PVR and diagnosis of impaired detrusor contractility, p = 0,02. Conclusions. Urinary retention in women is a condition that needs an adequate attention and a proper diagnosis protocol, in order to take into account the study of detrusor contractility. A significant post-void residual urine can be associated with an impaired detrusor contraction. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Extracorporeal shock wave lithotripsy (ESWL), a non-invasive treatment used in the treatment of renal-ureteral lithiasis, was introduced in medical practice in 1980 in Germany. It can be successfully practiced even in case of patients with single kidney lithiasis. Matherials and Methods. We performed a prospective / retrospective study of all patients with lithiasis on a solitary kidney, treated and followed-up in Urology Clinic in Târgu Mureş from 23 July 1991 until 31 December 2015. All single kidney lithiasis patients who met the following criteria were included in the research: functional kidney without stasis and calculus ≤ 20 mm. A total of 203 patients were enrolled in the study. Results. The number of patients assigned by gender is approximately similar: 101 males (49.75%) and 102 (50.25%) females. In terms of age, the mean age was 56.75 +/- 13 years. Most calculi were found in inferior calves (34.49%), pelvic (20.91%) and lumbar ureter (16.72%). There have also been renal units with multiple lithiasis. Some patients required autostatic ureteral stenting or percutaneous nephrostomy prior to ESWL sessions either due to septic conditions or obstructive anuria. In 185 patients (91.13%), total calculus disintegration was obtained after one or more lithotripsy sessions. A total of 173 patients (85.22%) returned to the regular control at 3 months or later, showing a rate of stone free of 86.75%. Conclusions. Although the discussion regarding the optimal treatment modality in renal ureteric lithiasis in case of single kidney is still open and new treatment options are becoming numerous, given good efficacy, low incidence of complications, and high rate of stone-free (86.75 %), we consider ESWL to be the appropriate therapy in these patients if the indication is properly established and is performed by a urologist with extensive experience in this field. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Congenital anomalies occur more often in the kidney than in any other organ. The association of abnormalities with stones has important clinical relevance. Our goal was to determine the clinical success and stone-free rates for patients with renal anomalies treated with ESWL. Materials and Methods. We performed a retrospective review of patients with renal anomalies treated at the Urology Clinic of Targu Mures, since January 2004 to December 2014. The inclusion criteria were: a clear urinary path distal of the location of the stone, a functional kidney without stasis and the stone size ≤ 25 mm ( 118 patients). We performed a total of 184 ESWL treatments (a mean of 1.559 ESWL procedures/stone). 3-month follow-up data were available for 88 patients. Results. Of the total ESWL procedures performed, 35 (29%) were horseshoe kidneys, 48 (41%) duplex kidneys, 15 (13%) malrotated kidneys, 13 (11%) ectopic kidneys and 7 (6%) hypoplastic kidneys. From the total of patients, 57 were women and 61 men. The mean age was 43.26 years. The average size of the stone was 10.228 mm. The average pacient stay was 4.77 days. Complications were subcapsular renal hematoma in two (1.69%) cases, acute pyelonephritis in two (1.69%) pacients, hematuria with vesical globe in another two (1.69%) cases and stone-street formation in 10 (8.47%). In 3 cases (2.54%) the procedure was unsuccessful and retrograde ureteroscopy was needed. Associated pathology was pressent in 61 pacients (51.69%): 21 (17.79%) presented urinary tract infection, 17 (14.41%) pacients were diagnosed with hipertension, 2 (1.69%) with diabetes and 21 (17.79%) suffered by obesity. Stone-free rate was 71.77%. Conclusions. In our oppinion ESWL is the treatment of choice for reno-ureteral lithiasis in renal malformations because is a non invasive treatment, no need for anestesia, the pacient stay is short, complications occure rarely and stone free rate is high. [ABSTRACT FROM AUTHOR]

Introduction and objectives. The aim of this study is to highlight predictors or predisposing factors of stress urinary incontinence (SUI) in order to help clinicians during their treatment decisions and establish a preventive strategy to decrease the incontinence rate among women. Materials and methods. We performed a retrospective study over a period of 3 years (January 2012-December 2014) in Mure? County Hospital, Clinic of Urology. We examined 113 women with urinary incontinence and we established the following diagnosis: stress urinary incontinence in 68 cases (60%), urge urinary incontinence in 26 cases (23%) and mixed urinary incontinence in 19 cases (17%). The selection criteria for this study were female patients diagnosed with stress urinary incontinence having indication of surgical treatment (transobturator tape-TOT). We included in this study 24 patients admitted in the hospital. Results. Regarding the distribution of the patients depending on age group we observed that SUI was predominant in the 60-69 years age group (12 cases), followed by 70-79 years (6 cases), 50-59 years (4 cases) and 40-49years (2 cases). The mean age was 64,25+/-8,25 (standard deviation) years old with extremities between 41 to 46 years old. For the statistical analysis we applied Fisher's test, Chi-square test and unpaired test and we compared the group having SIU with a group of 47 patients without the disease. We analyzed the data and we observed that increased age, pregnancies, vaginal delivery, menopause, body mass index (BMI), diabetes and hysterectomy represents risk factors for SUI and that there is a significant relation between SUI and those factors, p<0,05. Statisticaly, we found no relation between caesarian, urinary tract infections, genital prolapse, neurological diseases and SUI, p was insignificant. Conclusions. Stress urinary incontinence is frequent in middle age women. Multiple predictors like age, pregnancy, vaginal delivery, menopause, high body mass index, hysterectomy had been found to be associated with SUI. Recognizing these predisposing factors, we can develop in time prevention techniques which can reduce the development and progression of symptomatology in SUI. [ABSTRACT FROM AUTHOR]

Introduction and objectives. Multiparametric MRI of the prostate is considered the most efficient imaging technique for prostate cancer diagnosis, with overall detection rates of up to 60%. Diffusion Weighted Imaging (DWI) is a functional sequence that gained the dominant role in the prostate MRI protocol, as stated in the second version of the Prostate Imaging - Reporting and Data System (PI-RADS). We aimed to perform a systematic review of the literature concerning DWI, its technique, pitfalls, clinical efficiency and future perspectives. Materials and methods. We performed a systematic review of the PubMed database using specific keywords both directly and using the Medical Subject Headings (MeSH) system. Priority was given to systematic reviews and clinical trials published in the last 5 years. Results. DWI is clearly depicted in both versions of the PI-RADS system, and is universally deployed as an Echo-Planar Imaging technique. Classic DWI has a dual interpretation system: qualitative (direct signal intensity assessment) and quantitative (thru the Apparent Diffusion Coefficient - ADC and the ADC maps) that is used simultaneously. However, the poor spatial resolution (mainly at high b values of 1000 and 2000 s/mm2) can be a serious impediment for lesion identification thus enhancing techniques like DWI/T2 image fusions and computed DWI images were developed. A novel interpretation system for DWI data is Diffusion tensor Kurtosis Imaging that assesses kurtosis in the distribution of water molecules across the lesion. All these techniques provided promising results in the feasibility studies. Conclusions. DWI is a multivalent technique, with a complex interpretation system and an improved clinical efficiency that could facilitate the progression to contrast-free multiparametric MRI. [ABSTRACT FROM AUTHOR]

The etiological role of HPV infection in the pathogenesis of bladder tumors remains uncertain. Case-control study, NMIBC patients answered a 37 items questionnaire regarding knowledge of HPV, were compare with a healthy control group. Group A started earlier the sexual life than the group B (18 vs. 19 years), but the first cohabitation took place later (37 vs. 24 years, p = 0. 03).Group A had more sexual partners than group B (>10, 32% respectively 17.6%). 56% of patients with NMIBC heard about HPV infection and only 47% of controls and 32% of group A respectively 41% of group B didn't know if HPV infection represents a risk for their health. From this study results a lack of knowledge about HPV infection in NMIBC patients. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Natural killer cells (NK) represent the first line of defense against infections and tumors by direct cytotoxicity but also modulating an existing immune response by secretion of soluble factors such as cytokines. The functions of NK cells are regulated through a complex repertoire of molecules expressed on their surface, receptors specific for HLA class I molecules. Material and methods: The study was performed on 80 kidney transplanted patients in 2009. Before transplantation, viral screening in both, donors and receptors, was performed using serological tests and posttransplant, quantitation of CMV-DNA in patients was done by molecular biology technique (Real-Time PCR). PCR methods were used, also, for HLA and KIR genotyping. Results: In the first three months posttransplant, the incidence of CMV infection in our study was 36.3% (29 patients). Viral load values were between 76 and 200,000 genome copies/ml but most of them were below 10,000 genome copies/ml. Among patients with "missing KIR ligands" only two (9.5%) was detected with CMV infection compared with the others patients where the percentage was much higher (45.8%). Conclusion: Analysis of the KIR and HLA genotyping in these patients suggested that absence of HLA ligands for KIR inhibitory receptors and a high number of KIR activating receptors could be associated with a significant reduction of CMV infection. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Complications after failed hypospadias surgery could be severe including anterior urethral strictures with obstruction in urine and semen elimination, urethral fistula, urethral lithiasis, urethritis, recurrent UTI, the treatment of these cases being extremely difficult. The urethral reconstruction requires complete excision of the scared local tissues and use of extragenital tissues for repair. Material and Methods. Between January 2003 and January 2009 we have performed 54 urethroplasties for hypospadias cripple. In 22 cases the urethral plate and local tissues were scarred, poor vascularized, infected or with hair growth and lithiasis requiring complete excision and two stage urethroplasty. All the cases had between 4-12 failed operations (scrotal and prepuce flaps or Snodgrass operation). We used buccal mucosa harvested from the check for the first stage. After a minimum 6 months interval we performed the second stage - graft tubularization. Ventral or dorsal dartos flaps were mobilized for waterproofing the suture line. Results. The first stage complications were graft shrinkage or graft necrosis requiring partial re-grafting in 4 cases (18.2%). The second stage complications were skin necrosis with fistula and glans dehiscence in 6 cases (27.3%). The solving of these cases required another one, two, three or more operations. Final results after complication management were good from functional point of view, all patients voiding easily without postvoiding residual urine. The cosmetic results were good in 18 cases and satisfactory in 4 cases. Conclusions. Despite of a high rate of complications (∼45%), in our experience the staged approach represents a salvage surgery with good functional and cosmetic outcome in the treatment of severe forms of hypospadias cripples. For the best results the patients must be referred to the centers experienced in urethral reconstructive surgery. [ABSTRACT FROM AUTHOR]

Treatment of stress urinary incontinence consists of a wide range of options, from conservative therapies like lifestyle changes, medication, pelvic floor muscles exercises, electrostimulation, to minimally invasive proceduresinjection of collagen, suburethral slings TVT / TOT and last but not least, invasive surgical treatment reserved for recurrent and complex cases. Among the latest minimally invasive procedures reported in literature, the injection of intra-and perisfincterian of autologous stem cell (mioblasts and /or mature fibroblasts grown and multiplied in the laboratory from biopsy samples taken from the pectoralis muscles). The Clinical Institute of Uronephrology and Renal Transplantation Fundeni was performed the first stem cell implantation procedure in the urethral sphincter, in Romania. Assessment at 6 weeks, the quality of life questionnaires, micturition diary and clinical examination revealed a stunning decrease of urine loss from 6 pads / day at one per day, which significantly improved the patient's quality of life. Clinical and urodynamic evaluations will continue and will be future scientific topics. [ABSTRACT FROM AUTHOR]

Background: Varicocele represents the most common cause of male infertility. Open surgical approach and minimally invasive procedures have been performed for varicocelectomy with significant difference in the postoperative complications and pregnancy rates. Many reports suggest that microsurgical varicocelectomy has the advantages of no hydrocele formation, lower incidence of varicocele recurrence, and better improvement in sperm quality compared with other treatments modalities. Purpose: To evaluate the effects of microscopic assisted subinguinal varicocelectomy (MSV) on sperm quality and pregnancy rate. Design: Prospective longitudinal study. Materials and Methods: In a 2-year period (2008 - 2010) a standard MSV was performed in 104 patients with palpable varicocele. Inclusion criteria were: unilateral or bilateral clinical palpable varicocele, normal reproductive blood hormones levels (FSH, LH and Testosterone) and at least one abnormal semen parameter. The single exclusion criteria was vasectomy. At least 2 sperm analysis were obtained both preoperatively and at follow up visit. The main outcome measures were sperm count, total motile sperm count, sperm morphology and pregnancy rate. The follow-up visit was scheduled at 3, 6 and 12 months postoperatively. Statistical analysis was performed using the paired t test to compare mean preoperative with postoperative sperm parameters and p value < 0.05 was considered significant. A postoperative increase of sperm count, TMSC and sperm morphology with at least 50% of preoperative value was considered success. The patients were divided into 4 groups according to pre and postoperative sperm count: group 1 (0-1milion/ml) and group 2 (1-5 million/ml) - indication for in vitro fertilization, group 3 (5-20 million/ml) - indication for intrauterine insemination, and group 4 (>20 million/ml) - indication for natural pregnancy. Results: 70 patients completed at least one follow up visit. The mean sperm count, TMSC and sperm morphology increased from 19 to 35.6 million/ml, from 41.7 to 44 million and from 53.1% to 76.7%. The difference was statistically significant for sperm count (p = 0.0001). The success of varicocelectomy to increase each sperm parameter with at least 50% of preoperative sperm count, TMSC and sperm morphology were 57.1%, 27.1% and 32.8%. 70.3% of patients from group 1 and 2 migrated postoperative into groups 3 and 4; 64.2% of patients from group 3 migrated postoperative in group 4. Conclusions: Microscopic assisted subinguinal varicocelectomy (MSV) is very effective in increasing sperm count and offer a good natural pregnancy rate; depending on the sperm count, couples can benefit of less invasive techniques for achieving pregnancy after MCV.A systematic preoperative check of genetic abnormalities of male patients and fertility potential of female partner would improve the overall results. [ABSTRACT FROM AUTHOR]

Background. Renal angiomyolipomas are rarely associated with tuberous sclerosis. Occasionally, their spontaneous rupture can be life-threatening and require immediate medical care. Objective. To analyze the cases of renal angiomyolipoma with cutaneus phenotype treated in our center. Design, Settings and Participants. A retrospective evaluation was made of 12 patients with renal angiomyolipomas with cutaneus phenotype treated in our center, between June 2000 and June 2010. Measurements. We assessed the size of the tumors and the biological constants at the admission, the treatment chosen in each case and their evolution during the therapy. Results and limitations. Average age at diagnosis: 34.2 year, 4 men and 8 women. Mean follow-up: 71.8 months. Initial symptoms, tumor size, treatment and evolution of these patients were evaluated. 8 patients (66.6%) were symptomatic at admission, complaining gross hematuria, mild abdominal pain and meteorism; 2 emergency admittance for acute abdominal pain with muscular defense. On physical examination, all patients presented bulky plaquelike lesions consistent with sebaceous adenoma, mainly on the face, forehead and upper extremities. Laboratory results at admissions displayed a mean Hb level of 7.2 g/dL and a mean creatinine level of 1.8 mg/dL (0.6-3.1 mg/dL). Contrast enhanced abdominal CT was performed at all patients, who revealed bilalteral AML in 8 cases (66.6%), Wunderlich's syndrome in 3 cases (25%). Mean tumor size was 8.3 cm (2.4-21.4 cm). None of the patients with renal lesions <3.4 cm were symptomatic at admittance. All the patients had severe mental retardation and presented on the CT scan calcified densities in cerebral ventricles. The treatment consisted in conservatory approach in 6 cases (50%), total unilateral nephrectomy in 2 cases, partial nephrectomy in 2 cases and selective arterial embolization in 2 cases. Conclusions. Because of the severe mental retard, the history was difficult to obtain and the treatment could be delayed. The correlation with the paraclinic parameters is usually the most important in these cases. We suggest a regular monitoring in cases with small and asymptomatic lesions. Both surgery and SAE offer good results when performed on an elective basis, but the surgical approach is to first line of treatment in cases with Wunderlich's syndrome. Multiplicity, bilaterality and an increased size of the lesions appear to be high risk factors for renal rupture. [ABSTRACT FROM AUTHOR]