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Congenital urinary obstruction is one of the most frequent conditions affecting the urinary tract in children. It may lead to significant long-term health consequences and the management of these pathologies represents a major challenge for urologists.[1] In cases where the patient presents with a complex pathology and an intricate medical and surgical history, retracing and understanding this history require a thorough anamnesis. Access to a state-of-theart Imaging department is vital in order to have the highest degree of accuracy in determining the diagnosis. The doctor-patient relationship plays a very important role and all available treatment options must be discussed. The cases should be resolved through as few surgeries as possible. When the full reconstruction of the urinary tract is not feasible, as a last resort remains total nephrectomy or partial nephrectomy - when possible. The urologist's approach should always also bear in mind the patient's quality of life and it is preferable to avoid long-term indwelling catheters. Postoperative follow-up after reconstructive surgeries must be done through high-performance imaging studies of the urinary tract. In this article we will present the case of a female patient with multiple congenital anomalies of the urinary tract and iatrogenic stenoses of the ureteropelvic junction and of the ipsilateral ureterovesical reimplantation site, following the reconstructive procedures she underwent during childhood. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Vesico-uterine fistula (VUF) represents a rare type of urogenital fistula (around 4%) and it is defined as a pathological communication between bladder and uterus. The etiology of urogenital fistulas includes surgical, obstretic, radiation necrosis or related to tumour pathologies. The main cause of VUF are low segment Caesarean sections (LSCS), which represent 83-93% of all cases. The symptoms may occur immediately after a cesarean section later after surgery or in months or even years, manifesting in the late puerperium or after repetead procedures. Based on menstrual flow routes, three types was described: type I — with amenorrhea and menouria; type II — with bidirectional flow through the vagina and urinary bladder (fistula located at isthmus) and type III — with normal vaginal menses and urinary leakage, when the fistulous tract is below the isthmus, being in fact a vesico-cervical fistula. In this paper we present a rare case of a type III VUF. Materials and Methods. A 38-year-old woman complained of periodic vaginal urinary leakage for five months, but only at the end and few days after menses. From her medical history, we mention two LSCS as risk factors, the last one correlating with the symptom’s debut. A set of investigations was performed (methylene blue test, contrast CT and MRI), but failed to reveal the fistula. We proceeded for urethrocystoscopy, that highlighted a small defect in the postero-inferior wall of the urinary bladder with lack of extravasation of the irrigating fluid through vagina. We concluded that the diagnosis was VUF type III. We used a transabdominal approach, with an infraumbilical incision. The cystotomy revealed a VUF between the postero-inferior urinary bladder wall and the lower segment of the anterior uterus wall. The fistula tract was disected and excised, as a result of a properly dissection between bladder wall and uterus. The fistula openings in the urinary bladder and uterus were closed separately in two perpendicular layers. A Foley catheter and ureteral stents were left in situ for proper urinary diversion, in order to protect the bladder sutures. Results. The postoperative course was uneventful. The Foley catheter was maintained for three weeks, while the ureteral stents were removed earlier, after two weeks. At the one year postoperative clinical evaluation, the patient was asymptomatic, with no signs of vaginal urinary leakage after menses, voiding difficulty or other irritative symptoms, all these confirmed by a post-op MRI. Conclusions. The LSCS represents the most important etiological factor for the VUF. In a VUF type III, the diagnosis can be difficult, the query should be represented by the intermittent vaginal urinary leakage related to the menses. Surgery is the definitive treatment for the VUF’s management. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Cystatin C is a reliable, alternative marker to creatinine in estimating glomerular filtration rate in patients with chronic kidney disease (CKD), even in those with kidney transplant. Also, cystatin C tends to be superior to serum creatinine in evaluating early stages of CKD in kidney recipients, which is critical to early detection of acute rejection. The aim of our study was to evaluate the correlation of serum cystatin C measured after transplantation with demographical, biological parameters and organ preservation time. Materials and methods. We performed a prospective observational study on 44 consecutive kidney transplant recipients, followed for 3 months after transplantation. Graft kidney function was evaluated with both serum creatinine and cystatin C and was estimated with CKD-EPI and Cystatin C formula. Cystatin C was analyzed on a latex enhanced immunoturbidimetric assay. Results. We found that cystatin C levels measured first time post-transplant was correlated with recipient age (r=0.39, p=0.008), cold ischemia time (r=0.56, p< 0.001) and warm ischemia time (r=0.35, p= 0.01). Results evaluated at 3 months after transplantation showed that serum cystatin C was also correlated with recipient age (r=0.36, p=0.001) and cold ischemia time (r=0.32, p=0.003) and more than that, with pretransplant recipient weight (r=0.34, p=0.002), tryglicerides and haemoglobin levels (r=0.40, p= 0.008 and r= -0.36, p=0.01). Conclusions. We showed that serum cystatin C measured early after kidney transplantation is correlated with demographic, biological parameters and ischemia times, in kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Despite refinements in the initial evaluation and management of patients with newly diagnosed localized high-risk prostate cancer, urologist have difficulties to counsel their patients based upon currently used pretreatment parameters. In this study, we investigate preoperative characteristics that can predict unfavorable pathological outcome in patients undergoing radical prostatectomy for clinically localized high-risk prostate cancer. Materials and Methods. We analyzed a database of 279 patients diagnosed with prostate cancer and treated with radical prostatectomy in our institute between 2014 and 2017 and identified 83 patients with high-risk characteristics because of PSA > 20 ng/ml or biopsy Gleason score ³ 8. The following postsurgical parameters were considered unfavorable pathological outcome: seminal vesicle invasion, surgical margins, perineural invasion and lymph node invasion. To identify the determinants associated with unfavorable pathologic outcomes, we performed univariate and multivariate logistic regression in two models. Results. 77.1% of patients (n=64) had unfavorable pathological outcome. In multivariate analysis, we pointed out that PSA > 20 ng/ml was an independent determinant associated with lymph node invasion ( OR: 3.7, 95 % CI: 1.02- 14.36, p=0.04), biopsy Gleason score ≥ 8 was independently associated with increased risk of perineural invasion ( OR: 6.04, 95% CI: 1.09-33.31, p=0.03) and PSA > 20 ng/ml and biopsy Gleason score ≥ 8 were independent high risk factors for seminal vesicle invasion (OR: 11.10, 95% CI: 1.30-98.44, p=0.02; OR: 11.45, 95% CI: 1.28-102, p=0.02, respectively). Moreover, in the second model, we showed that Gleason score pattern 5 increased the risk of lymph node invasion by 3.21 (OR: 3.21, 95% CI: 1.03-9.99, p=0.04). Conclusions. Newly diagnosed patients with PSA > 20 ng/ml or biopsy Gleason score≥ 8 are at increased risk of more extensive disease. Our data is important for urologist in the selection of patients with high risk characteristics proposed for radical prostatectomy and for patients to better understand their disease. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Cystatin C could be used as a reliable alternative marker to creatinine in estimating glomerular filtration rate (GFR), even in kidney transplant recipients. The aim of our study was to evaluate the clinical and biological determinants of glomerular filtration rate estimated with cystatin C (CysC) in kidney transplant recipients, at 3 months after kidney transplantation. Materials and Methods. We performed a prospective observational study on 44 consecutive kidney transplant patients, followed for 3 months after kidney transplantation. Cystatin C was measured by latex enhanced immunoturbidimetric assay (EuroLyser). Results. Thirty patients (68.2%) out of 44 had an estimated GFRCysC less than 60 ml/min/1.73m2. Patients with estimated GFRCysC < 60 ml/min/1.73m2 tended to be older (33.4 ± 11 vs 40.6 ± 12 years, p = 0.06), were more frequently males (35.7% vs 80%, p = 0.004) and presented significantly decreased levels of pretransplant total cholesterol (208± 32.7mg/dl vs 175.8 ± 54.6 mg/dl, p= 0.04). By multivariate binary logistic regression, recipient male gender (OR: 5.59; 95% CI: 1.06-29.53; p= 0.04) and pretransplant total cholesterol levels (OR: 0.97; 95% CI: 0.95-0.99; p= 0.02) were independently associated with estimated GFRCysC < 60 ml/min/1.73m2 at 3 months after transplantation and recipient age had a near-significant trend (OR: 1.08; 95% CI: 0.98-1.18; p= 0.07). Conclusions. In conclusion, we found that recipient male gender and pretransplant total cholesterol levels were independent determinants of glomerular filtration rate estimated with cystatin C in kidney transplant recipients, at 3 months after kidney transplantation [ABSTRACT FROM AUTHOR]

Introduction and Objectives. estimating the quality of life in relation to the health status is a helpful tool in assessing the results and determining the efficacy of any form of treatment. The main purpose of this study is to rate the patients' quality of life after renal transplantation. The objectives of this paper are: to describe the demographic characteristics of the included patients, to compare their auto perceived quality of life before and after kidney transplant surgery, and to find and analyze correlations between the demographic characteristics and the quality of life after renal transplantation. Materials and Methods. This observational descriptive study was performed in a longitudinal and prospective manner. 106 patients that had been treated for chronic kidney disease through renal transplantation were included, and they were assessed before surgery, and 1, 3, 6 and 12 months after surgery. In order to evaluate them we used the Quality of Life Index - Kidney Transplant. Results. Most of the patients are males. The quality of life scores for the four individual sub-domains follow the overall score model, slightly dropping one month after transplantation compared to the pre surgery level, then constantly rising going through all the other three assessment moments (3, 6 and 12 months after surgery). Conclusions. This study analyzes the impact of renal transplantation on the quality of life of the chronic kidney disease patients. Our results clearly show a positive trend on the auto perceived quality of life. [ABSTRACT FROM AUTHOR]

Introduction Idiopathic retroperitoneal fibrosis (IRF) is a rare benign pathology, consisting of fibrous inflammatory tissue formation in the retroperitoneal space, surrounding main vessels and often involving nearby anatomic structures, such as the ureters, leading to obstruction and renal function impairment. Diagnosis is challenging, based upon high clinical suspicion, correct differential diagnosis and imagistic evaluation. Biopsy is required to confirm the non-malignant nature of the retroperitoneal mass. Medical immunosuppressive treatment is reasonable for moderate disease, whereas surgical treatment is indicated in advanced stage. Follow-up is mandatory but there is no consensus upon a surveillance schedule. Material and Methods We present a case of a male patient treated for a left retroperitoneal tumour destructive for the left renal unit, which was partially removed alongside the kidney, and turned up to be IRF and consequently immunosuppressive therapy was administered with 5 years normal follow-up. 8 years after the first event, IRF recurred on the right side of the retroperitoneum, obstructing the solitary kidney. Ureterolysis with omental wrapping was performed with optimal results and immunosuppressive therapy was reinitiated, with good response and normal check-ups to present day. Results and Conclusions IRF can prove to be a real challenge, as knowledge on its origin, optimal diagnostic, treatment and follow-up protocols is still building up. It is a potentially curable disease if managed correctly. Bilateral ureterolysis in unilateral disease could be taken into consideration from the start as late recurrence can occur. Follow-up should be conducted for a long period of time, maybe for the rest of the patient's life. [ABSTRACT FROM AUTHOR]

Introduction. Delayed graft function (DGF) is one of the most commonadverse event affecting kidney allografts immediately after transplant surgerywith detrimental effect upon short and long graft survivaland several risk factors were associated with its presence. However, data concerning the impact of warm ischemia time on DGF are contradictory. The aim of this study was to analyse the influence of warm ischemia time for DGF and to determine whether simultaneously prolonged cold ischemia time and warm ischemia time were associated with DGFin recipients of kidneys from deceased donors at our center. Materials and Methods. This prospective observational study included a series of 143 consecutive deceased donor renal transplants performed in our center beetwen 1st of January 2014 and 30th of September 2015. The study endpoint was DGF, defined as the requirement of dialysis in the first week after transplantation. Results. DGF occured in 21 kidney recipients from deceased donors (14.7%). Univariate analysis showed that recipient dialysis time before transplantation and recipient comorbidities were associated with DGF, whereas recipient age at transplantation, donor age and donor serum creatinine were not. As for the post renal transplant factors, prolonged cold ischemia time and the intensive care support time prior to aortic cross-clamping were associated with an increased risk of DGF, while prolonged warm ischemia time was not. The simultaneously prolonged cold ischemia time and warm ischemia time were associated with DGF (p <0.001), suggesting some cumulative effects on postoperative renal graft function. Conclusions. In our study, warm ischemia time was not associated with increased risk of DGF. However, simultaneously prolonged cold ischemia time and warm ischemia time were associated with DGF. Despite improvements in kidney transplantation, DGF remains an important medical problem and more risk factors should be investigated to help clinicians to decrease its incidenceand minimize clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction and objectives. Kidney transplantation improves survival and quality of life for the recipients and although not a direct concern of the patient it is the most cost-effective treatment for end-stage renal disease compared to chronic dialysis. Lymphocele is one of the most common complications in kidney transplant recipients and may affect as many as 26% of them. Materials and methods. We evaluated retrospectively the occurrence of lymphocele in a series of 1542 consecutive kidney transplants performed in our center between 1st of July 1997 and 31st of December 2014. Lymphocele were diagnosed by ultrasonography and computed tomography. Results. The incidence of lymphoceles after kidney transplantation in our center was 1.23% (19 cases). The indication for treatment ware local symptoms, graft dysfunction or both. In eight cases percutaneous drainage guided by ultrasonography and sclerotherapy with povidone-iodine was an efficient therapy. In 11 cases open surgery was the therapy of choice and consisted in large fenestration into the peritoneal cavity in six cases or associated with ureterocystoneostomy in five cases. Conclusions. Lymphoceles after kidney transplantation can be treated by ultrasound-guided drainage associated with sclerotherapy with the inconvenience of a longer hospital stay and a recurrence rate up to 40%, or by open or laparoscopic surgical intervention with large fenestration into the peritoneal cavity, associated or not with ureterocystoneostomy. Taking into account that we did not notice any recurrence or complication after open surgery, we consider that open fenestration into the peritoneal cavity is the method of choice for the treatment of lymphoceles after renal transplantation. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplantation is considered the "gold-standard" replacement therapy for patients with end stage renal disease because it offers a better quality of life and longer survival compared to dialysis. The rate of chronic graft loss is still considerable despite significant improvements in short and long term graft survival and patients may be suitable candidates for retransplantation. However, retransplantation is a high-risk procedure because of limited surgical options performed on highly sensitized patients, and higher rate of graft failure. The aim of this study was to evaluate urological complications of renal retransplantation in our center. Materials and Methods: We evaluated retrospectively the outcomes of kidney retransplantation performed in our center between 1st of July 1997 and 31st of December 2014. A total of 1542 consecutive kidney transplantation were performed and 78 patients were candidates for a second transplant. Renal grafts were obtained in 34 cases (43.5%) from cadaveric and in 44 cases (56.5%) from living-related donors. Among these 78 cases of retransplantation, the most common identified causes of end-stage renal disease were chronic glomerulonephritis (30.7%), diabetic nephropathy (16.7%) and systemic lupus erythematosus (6.4%). In 20.5% of retransplanted cases (N=16) recipients were at high immunologic risk compared with 3.89% (N=60) from the first kidney transplantation group (p < .05). Receptor average age was 37.2±9.8 y. o. with a male to female ratio 1.51/1. Donors mean age 48.2±16.4 y. o. with a ratio 1.17/1. Results: The overall incidence of urological complications in kidney retransplanted patients was 6.4% (five cases). Ureteral leakage was the most common complication recorded in three cases (3.8%), all in the first month postoperatively. Other urological complications identified in the retransplanted group were ureteral stenosis (one case - 1.3%) and lymphocele (one case - 1.3%). Conservative treatment (prolonged vesical catheterization) was successful in one case with a small anastomotic fistula. In the other cases of ureteral leakage and stenosis open surgery was needed, consisted in resection of the affected segment and stented ureterocystoneostomy. Lymphocele was successfully treated by US guided percutaneous drainage. Conclusions: Urological complication rate for kidney retransplantation was acceptable and comparable with the first transplant group (p>.05). Although the number of patients retransplanted in our center was low, results from this study encourage us to consider retransplantation as the best choice for patients after previous graft failure. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Cumulative incidence of metacronous renal tumors is 0.8% at a 20 year follow-up, higher in younger patients (approximately 1.8% within 10 years). In the case of a solitary kidney, NSS is imperative in order to avoid dialysis. The difficulty of NSS is related to the position of the tumor rather than its dimensions. The objective of this paper is to present the usefulness of intraoperative ultrasonography in a case of centrally located solitary renal tumor. Materials and methods: We present the case of a 62 year old male patient with a history of a right renal tumor operated 10 years prior (radical nephrectomy), who came with an incidental diagnosis of central left renal tumor. The tumor had a diameter of 3.5 cm, and the CT scan found it to be closer to the posterior aspect of the renal sinus. Considering all the angles we decided a NSS was best suited, in order to preserve the renal function. The surgical technique involved a lombotomy and perirenal fat dissection. Because we were not able to identify the expression of the tumor on the renal surface (it did not bulge the renal cortex), we decided to perform an intraoperative ultrasound to distinguish the limits of the tumor (using a Siemens Acuson X300 with a 13 MHz linear array transducer), instead of going directly for a radical nephrectomy and dialysis. We then marked these limits on the surface of the kidney with an electrocautery. We afterwards performed an enucleoresection using ligasure sealing system on the main intrarenal vessels and tumor bed compression with a perirenal fat flap. Short term (5 minutes) renal artery clamping was needed, to reduce the blood loss while suturing the pyelocaliceal concomitant lesions and conducting the hemostasis. Results: A temporary rise of creatinine to 2 mg/dl was observed, which later subsided. Postoperative urine drainage was registered and consequently a double J stent was inserted. The histopathological report revealed a clear cell carcinoma Fuhrman grade 3, stage pT1a. 6 months after surgery the patient developed pulmonary nodes suggestive for metastasis and underwent Sunitinib treatment. At the 1 year follow-up the patient is alive, without oncologic progression and a normal renal function. Conclusions: NSS is the treatment of choice that avoids dialysis in cases of renal tumors with solitary kidney. Centrally located renal tumors are the most difficult cases for NSS. Intraoperative ultrasonography is mandatory for determining the borders of a tumor without an expression on the kidney surface. [ABSTRACT FROM AUTHOR]

Introduction: Renal cell carcinoma is one of the most common tumors in adults, accounting for approximately 3% of all cancers. Association of renal tumors and other neoplasia is a rare event. Surgical treatment strategy of synchronous bilateral renal tumors and the value of lymph node dissection are subjects of debate. Objective: To present the management of a complex case of synchronous bilateral kidney tumors associated with Hodgkin lymphoma. Materials and method: We present the case of a 64 years-old woman admitted for abdominal pain, loss of appetite and weight. Abdominal CT showed a massive left kidney tumor with lateroaortic, interaoticocaval and laterocaval lymph node enlargement and extension in the subhepatic inferior vena cava, and a 4 cm upper pole tumor of the right kidney. No distant metastases were revealed on the thoracic CT. The surgical strategy involved a left radical nephrectomy, caval thrombectomy and extensive lymph node dissection as the first step. We made an anterior transperitoneal triradiate incision with bilateral coloparietal dissection. First we went on the right side in order to approach the thrombosed inferior vena cava. The left renal artery is ligated near the aorta. We applied a tourniquet on the suprarenal caval vein just above the tumor thrombus, on the infrarenal cava vein and on the right renal vein. Next we incised the inferior vena cava at the ostium of the left renal vein with the extraction of the thrombus and caval wall suture. Then we moved to the left side and standard perifascial nephrectomy and en bloc thrombectomy was performed. After that we performed an extensive periaortocaval lymph node dissection. Considering that we had no restant tumor tissue, and there was a wide exposure of the right kidney, we decided to perform a right superior polar nephrectomy in the same intervention, with electrothermal bipolar sealing system and a fat flap compression of the tumor bed. Results: Postoperative creatinine rose to 2.5 mg/dl and then slowly decreased to a normal value. Histopathological examination sowed bilateral clear cell carcinoma Fuhrman II and III and Hodgkin lymphoma in the LND specimen. Consequently specific treatment for Hodgkin lymphoma (chemotherapy with an EVA protocol - etoposide, vinblastine and doxorubicin) was initiated. Favorable response and oncological outcome were registered at 1 year follow-up. Conclusions: Although synchronous bilateral renal tumors surgical strategy usually involves two consecutive operations, first addressed to the largest tumor, a concomitant operation is possible in selected cases. LND in RCC has a double role, diagnostic and therapeutic and must be performed. Proper treatment of two simultaneous neoplasia could provide healing or increase the patients' survival. [ABSTRACT FROM AUTHOR]

Introduction: Penile verrucous carcinoma is a type of well differentiated scuamos carcinoma, with a slow invasive growth rate. It represents 5% to 24% of all penile malignant tumors and 5% to 16% of all penile scuamos cell carcinomas[ 1]. Macroscopically, verrucous carcinoma presents itself as an exophytic, cauliflower-like tumor, with broadbased implantation. In most cases the tumor is sized between 1 and 3 cm, although giant destructive forms have been described. Pacient, Method and Results: Patient IL, aged 31 years, with a history of pulmonary TB, had a penile tumor that appeared about 11 years ago, it slowly progressed, it included the entire penis and part of the scrotum, without any medical evaluation history prior Local clinical examination revealed a bulky tumor, sessile, with a cauliflower-like aspect, ranging from the region of the glans, near the urethral meatus, to the rest of the entire circumferential length of the penis, with extension to the scrotum. There were no detectable inguinal lymph nodes on palpation. In the first stage he underwent excisional biopsy with partial amputation of the penis and resection of the affected scrotal skin. The reconstruction was postponed because of the important skin defect, therefore we buried the penile stump in a scrotal pouch with a cutaneous urethrostomy. The histopathological result was medium differentiated verrucous carcinoma (G2). For the second stage, the patient underwent penile reconstructive surgery with split skin graft, 3 months after the first operation. Results: The 2 years follow-up revealed good mictional status, the wound healed normally and he resumed normal sexual activity with satisfactory erection. No local or distant clinical and imagistic recurrences were registered. Conclusions: Verrucous carcinoma of the penis has a good prognosis and should be managed by conservative surgery when possible. Penile reconstruction after major oncologic surgery, when possible, insures a god quality of life after a mutilating procedure and should only be attempted in specialized centers. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: TURB remains the standard in non muscle invasive bladder tumour treatment but sometimes the transurethral access is difficult or impossible because of long penile urethral strictures. In this paper we are trying to draw attention on perineal urethrostomy as an easy and fast access for TURB in patients with associated long penile urethral strictures. Materials and methods: Between 2008- 2013 we performed 36 perineal urethrostomies for different urethral pathology : penile or urethral carcinoma, recurrent long anterior urethral strictures associated with adverse conditions like periurethritis or lichen sclerosus . In 4 cases perineal urethrostomy was performed for allowing the access for TURB in cases with bladder tumors and long penile urethral strictures. With the patient in a lithotomy position, a vertical incision through the perineum is made, and after the fat tissue is being dissected, the bulbocavernous muscle is being incised. The bulbar urethra is being exposed and a 2-3 cm vertical incision on its ventral surface is made. When maturating the urethrostomy, 3 layers are being incorporated in the suture: the urethral mucosa, the adventitia of the spongiosus corpus and the skin, without suturing the muscle body of the spongiosum in order to preserve the lateral blood flow through the corpus spongiosus. After the maturation of the perineal urethrostomy a TURB is performed in a standard manner with a 26 Fr resectoscope. Results: Through the perineal urethrostomy a good access for TURB has been obtained. The operating time was 20 min. An uretral reconstruction with BMG and the closure of the urethrostomy can be attempted 6 months after two consecutive cystoscopic negative controls. Conclusions: Perineal urethrostomy is a fast and safe access for TURB in patients with non muscle invasive bladder tumour and associated recurrent long penile urethral strictures and it should be present in the standard armamentarium of any urologist. Through this approach an open surgery on the bladder tumor, with the consecutive risk of tumoral spread, is avoided and a second intervention for urethral reconstruction can be considered after the oncological control of the bladder tumour. [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.)

Introduction and objective: Renal cystic formations are generally included in two categories, simple renal cysts and complicated renal cysts. The management of these two categories is completely different, and diagnostic confusions can lead to mistreatment and can impair patients' life. Our purpose is to present the management of a cystic RCC referred to our clinic as a simple cyst and to discuss different medical aspects related to this case. Patient, Method and Results: The patient D.I., aged 63 years, was investigated in a different unit for left flank pain and was referred to our clinic for a left simple renal cyst diagnosed through ultrasound (12 cm in diameter). The abdominal ultrasound in our department revealed a medial renal cyst with some irregularities and partially thickened walls, about 12 cm in diameter. In addition to the ultrasound, we decided a CT scan (with contrast material administered IV) was needed, which found a renal cystic mass, classified Bosniak III, without adenopathy or distant metastases. Consequently we performed a left radical nephrectomy with regional lymph node dissection by anterior transperitoneal approach. Histopathological result showed a clear cell renal carcinoma Fuhrman I. The 2 year follow-up was without regional recurrence or distant metastasis on the CT scan. Conclusions: The ultrasound evaluation of the patients with renal cystic lesions is closely related to the investigator's experience and the quality of the equipment available in each unit, which makes necessary the careful reassessment of the patients. Although the simple cyst could be diagnosed by ultrasound we consider mandatory to perform a contrast CT scan before the surgery. Surgical treatment of complicated cysts should be similar to that of renal tumors to avoid diagnostic errors that could lead to poor treatment and could impair the prognosis for the patient. [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. Bleeding, urinary fistula and acute renal failure are the most frequent complications of nephron sparing surgery for renal tumors, and the ideal technique for reducing them is still to be found. [1-6] Our objective is to present the results in decreasing the complication rate by using a non-clamping open nephron sparing surgery (NSS) technique which combines the use of an electrothermal bipolar vessel sealing system and tumor bed compression with a perirenal fat flap. Material and Methods. Between 1975-2011 over 5000 cases of renal tumors were operated in our center of which 485 underwent different techniques of NSS. In this study we compare the results of two similar groups (GR) of 24 patients with non-clamping NSS operated between 2008-2010. In the first group we used the standard hemostasis technique by ligation of the main peritumoral vessels, sutured the identified urinary tract lesions and applied hemostatic materials on the tumor bed. In the second group we performed hemostasis of the main peritumoral vessels with and electrothermal bipolar sealing system, sutured the identified urinary tract lesions and applied a wide base perirenal fat flap on the tumor bed with approximation sutures of the superficial parenchyma and renal capsule. Mean age of the patients was 54 in the 1st group and 58 in the 2nd group. Mean tumor size was 3 cm (1.5-4.5 cm) in both groups. The procedures in the second group were more complicated, involving 1 versus. 3 polar nephrectomies, and 3 versus. 6 central or sinus tumors. Results. Median surgery time was 116 min (group 1, 80-200 min) versus 90 minutes (group 2, 65-140 min). The median intraoperative blood loss was 400 ml (100-1500 ml) in the first group versus 250 ml (100-600 ml) in the second group. Postoperative bleeding requiring reintervention and/or blood transfusion was encountered in 4 patients (16.7%) in the first group compared to no patients in the second group. Persistent urinary fistula requiring JJ stent was encountered in 5 patients (20.8%) and 1 case (4.2%) respectively, and nephrectomy was needed in 2 patients (8.3%) versus 0 cases. Septic complications were encountered in 3 (12.5%) versus 1 (4.2%) patients. Acute renal failure was observed in 3 (12.5%) versus 0 (with solitary kidney). Postoperative median hospital stay was 10 days (5-64 days) in the first group versus 6 days (5-15 days) in the second group. There was no postoperative mortality in any of the groups. Conclusions. Using an electrothermal bipolar vessel-sealing device on the main vessels of the tumor bed provides a fast and reliable intraoperative hemostasis control. Tumor bed compression with a perirenal fat flap under approximation sutures of the renal capsule provides a mechanical hemostasis of the small vessels and a trophic support for the healing of the suboptimal sutured or undetected urinary tract lesions, preventing urinary fistula, secondary bleeding and subsequent complications. [ABSTRACT FROM AUTHOR]

Introduction. We performed an univariate analysis in order to identify prognostic factors for long term cancer specific survival. Materials and methods. Patients were enrolled between December 2005 - July 2007, at Fundeni Urological Surgery Clinic in Bucharest. Patients were followed prospectively, the clinical data was stored on electronic records. Kaplan Meier survival plots and log rank test revealed prognostic factors involved in five year cancer specific survival. Results. Median follow-up of patients (N = 293) was of 54.2 months. Perioperative mortality was 1.7%. There were 101 deaths including 59 disease related (58.4%). Correlational analysis highlighted significant recorded variables; log rank analysis showed statistically significant differences for the T, N, M staging system, histologic type, Fuhrman grade, sarcomatoid differentiation, tumor size and age. In our study cancer specific survival was 92.8% for pT1 (N = 48), pT2 83.3% (N = 3), pT3 68.2% (N = 145), zero for pT4 (n = 4) (p <0.0001, Χ2 = 144). We could not find any difference in survival for T1a and T1b stages (TNM 2002): T1a (n = 46) 92.4%, T1b (n = 14) 92.9%. Lymph nodes involvment and presence of distant metastasis at diagnosis revealed a dramatic decrease in five year cancer specific survival (20% for M1, 44% for PN1 (N = 17), 13.9% for PN2 (N = 12) (c2 = 107). The study showed statistically significant differences for specific survival at five years between clear cell variant, 71% (N = 200), papillary 62.5% (N = 16), cromophobe 100% (N = 20), unclassifiable 50% (N = 5), another 55%. (p = 0.006 log rank test). Fuhrman grade was proved to be a major prognostic factor, cause specific survival being 78.3% (N = 54), 75.1% (N = 122) 39.7% (N = 23) zero for G4 (N = 1). (p <0.0001) Conclusions. Our study validates TNM elements, histological type, Fuhrman grade, sarcomatoid differentiation, tumor size and age at diagnosis as prognostic factors in renal cancer. The values for five years cause specific survival obtained in our study confirms european therapeutic attitude in our Department. [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. 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]

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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.)