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Prikazan je pristup neurovaskularnom snopu tijekom kirurškog liječenja karcinoma prostate.

Radikalna prostatektomija je metoda izbora za liječenje karcinoma prostate u bolesnika kod kojih je očekivana duljina života više od 10 godina i koji su niskog ili srednjeg stupnja rizika. Za bolesnike sa karcinomom prostate visokog rizika radikalna prostatektomija je legitiman izbor u sklopu multimodalne terapije. Pozitivni kirurški rubovi su neovisan prognostički faktor povrata bolesti ili biokemijskog relapsa bolesti. Ipak, ekstraprostatička propagacija bolesti se pokazuje kao bitniji faktor, a kod rubova je bitna lokalizacija (apikalno ili drugdje) te eventualna multifokalnost. Tijekom 2015 godine učinjeno je 55 radikalnih prostatektomija. Prosječna dob operiranih je bila 64 godine (53-74 god.), prosječan volume prostate je bio 45 ccm (15-100 ccm). PSA se kretao od 1.00 do 74.4 (prosjek 15.61). Preoperativni GS je bio 6 u 47%, 7 u 42% i viši od 7 u 11% slučajeva. Najčešći cTNM je bio T1c, a potom T2a. Patohistološka analiza je pokazala GS 8-9 u 14% slučajeva, 7 u 66% slučajeva i 6 u 20% bolesnika. T2c je potvrđen po patologu u 43% bolesnika, a T3b u 33% bolesnika uz 3 bolesnika sa pozitivnim limfnim čvorovima. Pozitivan kirurški rub je potvrđen u 35% bolesnika, a podjela bolesnika prema stupnju rizika (prema klinički utvrđenom stadiju bolesti) nije pokazala značajnu razliku. Analizom slijedećih faktora (grupa rizika, PSA, cGS, cTNM, pGS, pTNM, broj pozitivnih uzoraka, zahvaćenost prostate tumorom, volumen prostate) u odnosu na pozitivan kirurški rub je pokazala značajnu povezanost samo sa patohistološki utvrđenim stadijem bolesti (p=0.0001). Također ako se bolesnici ponovo raspodijele u grupe rizika, ali uz primjenu točnije utvrđenog stadija bolesti po patologu, bolesnici sa visokim rizikom imaju značajno češće pozitivne rubove (p=0.005). Utvrđivanje kliničkog stadija bolesti preciznije (primjer: u uzorcima biopsije tumor utvrđen u oba lobusa je T1c, primjena MRI u prijeoperacijskoj obradi), te time točnije svrstavanje bolesnika u grupe rizika je neophodno radi procjene potrebe daljnje terapije nakon definitivnog zahvata.

Procesom normalne mineralizacije, odnosno procesima kristalizacije u organizmu čovjeka, životinja i bilja nastaju mineralizirana tkiva kao što su kosti, zubi, zubna caklina koji daju čvrstoću te služe kao “skladište” različitih iona, posebno kalcija i fosfata. Vrlo često dolazi do depozicije minerala u mekim tkivima, procesima nastajanja teško topljivih soli unutar organske makromolekularne matrice, kao što su kamenci u bubregu, mokraćnim putevima ili mjehuru (urolitijaza, nefrolitijaza). Patološka tkiva su i zubni i žučni kamenci, te pojava uloga (gihta) u zglobovima te krvnim žilama (ateroskleroza). Sve ove patološke pojave u organizmu čovjeka uzrokuju medicinske i socijalne probleme. Da bi se upoznalo s procesima u organizmu čovjeka koji uzrokuju patološka stanja važno je istražiti sastav i strukturu biološkog materijala i organske matrice, mehanizme i promjene tijekom procesa, interakciju biološkog materijala s tjelesnom tekućinom koja ga okružuje kao i inhibiciju patološke mineralizacije čime se smanjuje i mogućnost recidivirajuće urolitijaze. Prvi korak u ovim istraživanjima su bazična istraživanja koja se najčešće izvode u modelnim sustavima (oksalatni, fosfatni, sustav mokraćne kiseline i njezinih soli (jednostavni, složeni, realni) iz kojih se može doći do saznanja o sastavu, morfologiji, transformaciji, fizikalno kemijskim karakteristikama i konstantama istraživanog spoja. Kombinacijom rezultata fizičko-kemijskih istraživanja pri čemu se koristi i mikroskopija (svjetlosna ; pretražna elektronska mikroskopija (SEM) ; mikroskopija atomskih sila (AFM)) uz spektroskopske analize (infracrvena spektroskopija, FTIR, rentgenska difrakcija na prahu, XRD, termogravimetrijska analiza, TG) omogućava učinkovit način klasifikacije mokraćnih kamenaca. Prije više od tridesetak godina u Hrvatskoj započinje suradnja više ustanova na raznim projektima (IRB, IMI, KB Osijek) u cilju rasvijetljavanja nastanka kamenca, koji su rezultirali većim brojem radova u međunarodnim i domaćim časopisima, obranjenim magistarskim i doktorskim radovima, sudjelovanjima na domaćim i međunarodnim konferencijama. U predavanju će sažeto, biti dana bazična istraživanja u modelnim i realnim sustavima kao i važnost upotrebe, uz RTG, FT-IR i TG analizu, novijih, gore spomenutih, mikroskopskih tehnika koje omogućuju pogled kemičaru i geologu u unutrašnjost kamenca.

Opisan je slučaj "zaboravljenog" JJ stenta te komplikacije koje su nastale. Izvršena je analiza liječenja i dane preporuke o spriječavanju ove komplikacije urološkog liječenja.

Angiomiolipom je dobroćudni tumor bubrega sa dvije podvarijante. U bolesnika sa tuberoznom sklerozom je uglavnom manji i bilateralan, a u drugom obliku dolazi u bolesnika bez tuberozne skleroze kada je uglavnom veći i unilateralan. Liječenje angiomiolipoma ovisi o veličini tumora i prisustvu simptoma (bolovi, krvarenje). Načelno u angiomiolipoma kod kojih su prisutni umjereni ili izraženi simptomi i/ili u angiomiolipoma većih od 4 cm može se razmatrati kirurško liječenje. Ipak, u većini slučajeva se provodi konzervativni tretman praćenjem sa redovitom procjenom veličine (UZV, CT). Zabilježene su i iznimno rijetke maligne podvarijante angiomiolipoma, uglavnom u većih tumora. Svaki angiomiolipom može potencijalno rupturirati i biti uzrokom krvarenja koje može biti i životno ugrožavajuće. Rupture su češće u većih angiomiolipoma (>10 cm), a zabilježene su i rupture angiomiolipoma povezane sa lokalnom traumom lumbalne regije. Prikazat ćemo slučaj bolesnice od 37 godina sa rupturom angiomiolipoma lijevog bubrega veličine 10 cm i posljedičnim retroperitonealnim hematomom veličine 12x9 cm. Iako anamnestički i klinički nije zabilježena trauma koja je prethodila rupturi, bolesnica navodi dizanje težeg tereta i klinički ima kontuzijski otisak u predjelu lijevog kuka. Učinjena je hitna eksploracija sa posljedičnom evakuacijom hematoma i nefrektomijom lijevog bubrega.

BACKGROUND-AIM Angiogenesis plays an important role in the development, growth and spread of solid tumors, including prostate cancer. Numerous studies link potentially functional single nucleotide polymorphisms (SNP) in genes important in prostate angiogenesis with increased risk and aggressive form of prostate cancer. The aim of our study was to investigate the influence of polymorphism in the pro- angiogenic IL-8 -251 (rs4073) cytokine genes with the prostate cancer risk and aggressiveness in eastern Croatian patients. METHODS A total of 275 subjects from eastern Croatia were included in the study, 120 prostate cancer patients (CaP), 120 benign prostate hyperplasia (BHP) patients and 35 controls. They were genotyped for IL-8 -251 (rs4073) polymorphism using real-time PCR (LightCycler Instrument, Roche Diagnostics) and melting curve analysis method. All groups were agematched (mean age 67.5 years). CaP patients were classified in two groups according to Gleason score (≤7 and >7). χ2 test was used to compare distribution of IL-8 polymorphism genotypes. Relative risk was estimated by the Odds ratio (OR). RESULTS There was no significant statistical difference in the frequency of genotypes between controls and patients with CaP and BHP (χ2=1.158, P=0.885, OR=0.862, 95%CI=0.295- 2.524). An increased frequency of IL-8 -251 AA genotype is noted in CaP patients with the Gleason score >7 (25% vs 16.7%), although with no statistical significance (χ2=1.569, P=0.456). There was no significant statistical difference in the frequency of genotypes and the presence of metastatic disease in CaP patients (χ2=2.057, P=0.3576, OR=0.933, 95%CI=0.424-2.056). CONCLUSION Our data suggest that, although, there is a tendency in increased frequency of IL-8 -251 AA genotype in CaP patients according to Gleason score, IL-8 -251 SNP-s is not associated with prostate cancer development, progression and/or presence of distant metastasis in eastern Croatian population. The limiting factor of this study was a relatively small number of patients ; therefore we suggest that a larger group might show association of AA genotype with the risk of developing more aggressive forms of prostate cancer in the population of eastern Croatian population.

U ovom radu je dan pregled spoznaja o mogućim dijagnostičkim postupcima u procjeni kliničkog stanja akutnog skrotuma. Opisana je uloga MPV u razlikovanju torziju testisa od torzije apendiksa testisa. Torzija testisa (TT) je hitno stanje u urologiji koje se odlikuje smanjenim protokom krvi unutar testisa uslijed uvijanja sjemenog snopa oko svoje osi što dovodi do venske okluzije i arterijske ishemije testisa. TT nastaje najčešće u muškaraca mlađih od 25 godina. Zahtijeva hitnu operaciju detorzije i fiksacije oboljelog testisa za unutrašnjost skrotuma ali istovremeno i fiksacije kontralateralnog zdravog testisa kako bi se spriječio mogući događaj torzije u budućnosti. Ako se operacija izvede do 4 sata od nastupa ovog stanja, testis obično može biti spašen. Operacije nakon 4 sata rezultiraju nepopravljivim oštećenjima spermija odnosno njihove produkcije što može izazvati neplodnost. Također, testis se može toliko oštetiti da mora biti uklonjen. U kliničkoj slici TT prisutna je bol, oteknuće i promjena položaja testisa. Torziju testisa treba razlikovati od drugih stanja koje se prezentiraju akutnom boli u području skrotuma, uključujući upalu epididimisa i testisa te torziju apendiksa testisa, stanja koja po razvoju bolesti i intenzitetu boli ponekad teško razlikujemo od torzije testisa. Diferencijalna dijagnoza je stoga vrlo važna i može se postići slikovnim dijagnostičkim metodama poput Doppler ultrazvuka i scintigrafije testisa a također i laboratorijskim pretragama poput analize kompletne krvne slike (KKS), mjerenja vrijednosti sedimentacije eritrocita i C reaktivnog proteina. U novije vrijeme sve veću važnost prilikom dijagnosticiranja upalnih poramećaja i poremećaja prokrvljenosti tkiva prilikom ishemije i tromboze ima srednji volumen trombocita (MPV), parametar koji pruža informacije o funkcionalnom statusu trombocita odnosno o aktivaciji trombocita. Iako je rutinski analiziran zajedno s drugim indeksima KKS, MPV se često previdi od strane kliničara prilikom diferencijalne dijagnostike. S obzirom da je prosječna veličina trombocita veća kada ih tijelo proizvodi više, MPV nam može reći o proizvodnji trombocita u koštanoj srži ili o njihovom gubljenju. Povišene vrijednosti MPV ukazuju na ubrzanu i povećanu proizvodnju nezrelih trombocita tj. megakariocita što dovodi do povećanja broja zrelih hiperkoagulabilnih trombocita. Zreli trombociti su metabolički i enzimatski više aktivni od nezrelih trombocita i imaju veći potencijal tromboze, stoga kod povećane potrošnje ili gubitka trombocita MPV je viši. Nova istraživanja su pokazala da aktivacija trombocita ima određenu ulogu prilikom ishemije testisa jer se šteta nastala ishemijom može smanjiti davanjem antitrombocitne terapije. Povećane vrijednosti MPV se smatraju faktorom rizika vaskularnog oštećenja tkiva.

Izvantjelesna magnetska inervacija (extracorporeal magnetic innervation - ExMI) je neinvazivna metoda liječenja urgentne i stresne urinarne inkontinencije. Promjenjivim magnetskim poljem uzrokuje kontrakcije mišića male zdjelice, mokraćnog mjehura i mokraćne cijevi. Istražili smo učinak ove vrste liječenja u rehabilitaciji neuromuskularne kontrole kod urinarne inkontinencije. Analizirali smo 22 bolesnica s urgentnom inkontinencijom i 14 sa stresnom inkontinencijom. Postupak liječenja traje 20 minuta, provodi se 2 puta tjedno kroz 8 tjedana. Učinak smo procjenili uz pomoć upitnika kvalitete života (Kings Health Questionare), dnevnika mokrenja, testom mjerenja težine dnevnih uložaka i urodinamskim ispitivanjima. Mjerenja su urađena prije početka liječenja te 8 tjedana i 24 tjedna nakon liječenja. Izliječenje u obje grupe pacijentica je smatrano kada 24 tjedna nakon zadnjeg tretmana nije bilo inkontinencije a poboljšanje kada je smanjena učestalost inkontinencije za više od 50%. Posebno u grupi sa stresnom inkontinencijom također se smatralo poboljšanjem kada je test mjerenja težine uložaka pokazao regresiju za više od 50%. 6 bolesnica s urgentom inkontinecijom je izliječeno (27%), 9 bolesnica je imalo poboljšanje simptoma (63%), 7 bolesnica su i dalje imale iste simptome (10%). Ponovljenom procjenom u 8 tjednu događaji neželjenog mokrenja su se smanjili sa 6, 5 na 1, 8 puta dnevno. 8 bolesnica a stresnom inkontinecijom je izliječeno (57%), 5 bolesnica je imalo poboljšanje simptoma (36%), 1 bolesnica je i dalje imala iste simptome (7%). Prosječna težina dnevnog uloška je pokazala regresiju sa 17 grama na samo 3, 5 grama ponovljenom procjenom u 8 tjednu. ExMI je učinkovita u liječenju urgentne i stres inkontinencije. Potrebno je utvrditi koliko dugo traju učinci ove vrste liječenja odnosno kada liječenje treba nastaviti.

INTRODUCTION & OBJECTIVES: Aim of this prospective clinical study was to evaluate the effects of extracorporeal magnetic innervation (ExMI) therapy in the rehabilitation of neuromuscular control in female patients with urge and stress urinary incontinence. MATERIAL & METHODS: We evaluated 22 women with urge urinary incontinence and 14 women with stress urinary incontinence in the period from July 2013 to December 2014. ExMI treatment lasted for 20 minutes, it was performed twice a week through out 8 weeks. The effects of the treatment were assessed by 3 day bladder diaries, 24 hour pad weight testing, urodynamic studies, and quality of life questionnaire. Measurements were performed before treatment, at the 8th week of treatment and 24 weeks after the treatment. RESULTS: 6 patients with urge incontinence were cured (17%), 9 patients had improvement of symptoms (63%), 7 patients still had the same symptoms (10%). Estimates at the 8th week in this group of patients determined that the events of unwanted urination decreased from 6.5 to 1.8 times a day. 8 patients with stress incontinence were cured (57%), 5 patients had improvement of symptoms (36%), 1 patient still had the same symptoms (7%). 24 hour pad weight test in stress incontinence group showed regression from 17 grams to only 3.5 grams at the 8th week assessment. CONCLUSIONS: EXMI is effective in the treatment of urge and stress urinary incontinence however the data based on scientific evidence in the literature supporting the efficacy EXMI is scarce. Further studies are mandatory to determine how long the effects of ExMI therapy last and how many retreatments are required if necessary.

Cystine lithiasis is a diagnostic and therapeutic challenge. This consensus document has outgrown of discussion of experts in nephrology and urology. It is our hope that this document will be of use for all physicians who are facing this disturbing type of urolithiasis. So far, in our national literature there have been no comprehensive documents dealing with this entity and we believe that not only nephrologists and urologists will benefit, but also specialists in internal medicine and general practitioners.

In humans, one of the pathological forms of biomineralization in the body is a process in which the complex chemical systems, such as the urine, precipitated inorganic salts such as the kidney and / or urinary stones of different composition. This process is influenced by physico-chemical, genetic, endocrine, anatomic, climate, inflammatory and others factors. The disease is defined as urolithiasis and is still a serious health, social and sociological problem. Double J stent has been established as very valuable medical tool in treatment of numerous urological conditions. As such it has its advantages and drawbacks. The complications of double J stent are well documented and in the most cases are not life-treating. The most common “technical” complication is formation of stent encrustations which render stent nonfunctional. The stent encrustation is most easily prevented by stent replacement. The etiological factors of the stent encrustation, besides biofilm formation and inflammation, are not well documented. The aim of this research was to analyze selected etiological factors and their role in the stent encrustation. The secondary objective was to test the hypothesis that chemical composition of the encrustate must be same as of primary stone, with premise that alkali urine will favor the phosphate stones. Deposits on JJ stent removed from the urinary tract in selected groups of patients were characterized by thermal FT-IR spectroscopic analysis and gravimetric analysis (TG) . The composition of the encrustates on the urological stents were compared with the composition of urinary stoneand it is shown that they are not consistent. In conclusion it can be said that some of the parameters were not significantly different in patients with and without encrustates. The most common encrustate component is apatite, then struvite, and least common are calcium oxalate encrustates. The composition of the encrustates were not always identical at different levels.

Systematic reporting of surgical complications is necessary in making an objective comparison between institutions, in a single institution over time or between surgeons and to evaluate new treatment modality. Clavien-Dindo (CD) is most frequently used such classification in urology. We will present pros and cons of CD specifically for percutaneous nephrolitholapaxy (PCNL) and ureterorenoscopy (URS), followed by results from our institution. We use CD since January 2013 for 14 urological operations, including PCNL and URS. Initial retrospective dana collecting was later replaced by filling the CD form at patient discharge. Data for the last 45 PCNL and 70 URS patients will be presented. 85% of URS treated ureterolithiasis patients had no deviation from normal postoperative course. 9.4% patients were classified as CD2 and 1 patient as grade 3A, while ureterolithotomy was performed in 1 patient when URS failed. JJ stent was placed intraoperatively in 38% of patients, median stone size was 8 mm and hospital stay 3 days. 69.5% of patients had normal postoperative course after PCNL, 5 patients were classified as CD2 and 5 as grade 3A, while URS as an adjunctive treatment was done in 1 patient. Stones were mostly staghorn calculi and median hospital stay was 7 days. Data will be updated. While applicable for PCNL, CD classification does not take into account frequently present need for adjunctive treatments like second-look PCNL or URS, classifying them as complications. Because of that CD modifications for specific procedures are being developed. PULS (Postureteroscopic lesion scale) was conceived in a similar fashion for classifying ureteral lesions during URS. Systematic presentation of surgical complications objectifies and upgrades the quality of surgical scientific literature and CD, although not without limitations, currently represents most widely accepted classification of surgical complications.

Aim To investigate the possible association between the radioactive and toxic elements contamination, mainly depleted uranium (DU) from Chernobyl accident, Croatian War of Independence and Bosnian War and the increasing incidence of testicular germ cell cancers (TGCC) in the population of Eastern Croatia. Methods From 1969 to 2012, 258 testicular cancer (TC) patients were treated at Department of Urology, University Hospital Centre Osijek. Incomplete data were found in 32 patients who were excluded from the analysis and 10 patients had non-TGCC TC. Seminoma and non-seminoma groups were included out of 216 TGCC patients. The patients were assigned to one of the time periods: 1969-1995 (distant prewar and war period) and 1996-2012 (postwar period). Results In the postwar period 3.5 times higher incidence rate for non-seminomas (4.5 patients yearly vs. 1.3), seminomas (4.2 vs. 1.2) and TGCC overall (8.7 vs. 2.5) was found compared to prewar period, with non-seminoma presenting in more advanced stage III (35.5% vs. 13.9%, p=0.013). Conclusion Usage of depleted uranium in armed conflicts could lead to the development of TGCC after unknown time of latency. Exposure assessment is mandatory to determine the possible causative correlation between the depleted uranium exposure and testicular germ cell cancer.

Complications are expected at various rate and grade after surgical procedure. Rate and grade of complications are different for every procedure. Surgical complication are dependent on procedure type, patient risk and surgeon skill. Complex or novel procedures are associated with higher rate of complications. Higher rate of complications is noted in high risk patients and in surgeons with lower experience with procedure, best shown with “learning curve”. Reporting surgical complications should be mandatory, as such reports have lead to declining rate of complications for some procedures. Reporting complications is also useful tool in assessing best team or hospital for desired procedure. Clavien-Dindo (CD) modified complications report is most common method for reporting complications in urology and it's use in recent years has grown exponentially. CD has been used at our Department as of January 1st 2013 for 14 different major procedures, both open or endoscopic. Primary collection of data was done retrospectively and continued prospectively. CD report is filled by discharging physician and revised at 3 month follow-up visit by senior surgeon. Data is presented for 66 tumor nephrectomies (TNEF) and 22 radical prostatectomies (RP) done in 2013. Average age of TNEF patients was 65 years. Patient risk was assessed with ASA score: ASA I 48%, II/III 15%, III 29%, III/IV 3% and ASA IV in 5%. T Stage was as follows: T1/T1a – 23%, T1b – 36%, T2 – 32%, T3 – 3% and T4 in 6%. CD grade was I in 55%, II in 32%, IIIa in 8% and IIIb in 5%. T stage stratified CD analysis showed that CD was not associated with T stage (p=0.322). Effect of surgeon experience (junior – 10 or less years as urologist, senior > 10 years) on overall CD distribution, CD I/II vs CD III/IV, CD distribution in T1 and T2 tumors showed no statistical significance (p=0.102, p=0.66, p=0.318), with seniors performing better in T2 tumors (p=0.08). RP was performed in 22 patients and CD was as: I in 23%, II in 50%, IIIa in 18%, IIIb in 9% and IV in 5%. There was no difference in complications for all three surgeons in regard to CD overall, CD with EAU risk assessment or T stage (p=0.27, p=0.473, p=0.421). Even in short time our institutional analysis showed us some pointers at our surgical treatment of renal tumors and prostate cancer. Our complication rate is as cited and clear “learning curve” is visible for TNEF, as seniors outperform juniors in larger tumors (p=0.08). There is no difference in complication rate for three surgeons performing RP (1 senior and 2 juniors).

Cistinska litijaza dijagnostički je i terapijski izazov, a u našoj literaturi do sada nije bilo ujedinjenih prikaza kako valja postupati s ovakvim bolesnicima. Ovaj dokument rezultat je rasprava na tom sastanku uz nadogradnju nakon simpozija putem elektroničkih sjednica i ekspertno je mišljenje stručnjaka. Nadamo se da će članak biti od praktične koristi brojnim kolegama koji se susreću s problemom litijaze, a one koji to rjeđe imaju prilike, podsjetit će na ovaj oblik kamenaca mokraćnog sustava. Ovaj dokument namijenjen je primarno urolozima i nefrolozima, ali i svim općim internistima te liječnicima obiteljske medicine jer će svima, vjerujemo, olakšati razmišljanja kada se suoče s takvim bolesnikom.

Recent studies suggest that chronic inflammation is crucial in the development and progression of prostate cancer (CaP). Interleukin-6 (IL-6) is a proinflammatory cytokine that plays an important role in intraprostatic inflammation and thus carcinogenesis. The –174G>C polymorphism of IL-6 gene has been associated with high IL-6 producer pheno- type and an increased risk for CaP . The aim of this study was to evaluate the association between the mentioned IL-6 polymorphism and CaP risk, as well as to compare the genotype frequency between the different tumour grades of CaP , in population of Eastern Croatia. We analyzed the IL-6 polymorphism in 120 CaP patients and 120 controls with benign prostatic hyperplasia (BPH). CaP patients and BPH controls did not statistically differ in studied IL-6 polymorphism. Furthermore, high IL-6 producer genotypes (GG or GC) were more frequent in controls than in CaP group (86.7% vs 80.8%, respectively, p=0.147). Also, no statistically significant difference in IL-6 high and low producer genotype fre- quency was noticed between well, moderately and poorly differentiated tumours. Our results, taken together with other studies on the subject, suggest that IL-6 – 174 single nucleotide polymorphism (SNP) distribution may differ between various ethnic groups and that a single cytokine gene polymorphism has probably just a minor effect on CaP susceptibil- ity. Further studies should be performed to clarify the link between SNPs of different cytokines and the risk for CaP .

Biti će prikazani rezultati zbrinjavanja ureterolitijaze ureterorenoskopijom na Klinici za urologiju u Osijeku, odnosno u Referentnom centru za urolitijazu Republike Hrvatske.

Nastajanje mokraćnih kamenaca predstavlja patološki oblik biomineralizacije kao procesa u kojem iz kompleksnog kemijskog sustava, kakav je urin, taloži anorganska sol. Tako mogu taložiti kamenci različitih sastava što je uvjetovano fizikalno-kemijskim, genetskim, endokrinim, anatomskim, klimatskim, upalnim i dr. čimbenicima. Patološko stanje kod kojeg dolazi do nastajanja mokraćnih kamenaca u bilo kojem dijelu mokraćnog sustava naziva se urolitijaza, a ona pripada skupini bolesti koje su od početka pisane ljudske povijesti prisutne u čovjekovu životu. Ureteralnim premošćivanjem moguće je ublažiti mnoge komplikacije povezane s urolitijazom. Dvostruka JJ proteza mokraćovoda je tanki gumeni, plastični ili silikonski kateter koji omogućuje protok urina pokraj istaloženih prepreka kroz mokraćni sustav. Iako su te JJ proteze izrađene od internih sintetskih biomaterijala, kod osoba koje su sklone stvaranju kamenaca, na njima se također talože anorganske naslage zbog čega je njihova dugotrajna uporaba u organizmu ograničena. U istraživanjima u ovom radu načinjene su kemijske analize sastava naslaga na JJ protezama uklonjenih iz mokraćnog sustava kod izabrane skupine ispitanika. Analize su načinjene s dvije instrumentalne analitičke metode: termogravimetrijskom analizom i FT-IR spektroskopijskom analizom. Uzorci naslaga uzimani su s tri različita mjesta na protezi: s početka, iz sredine i s kraja. Rezultati analize sastava naslaga na protezama uspoređeni su s rezultatima analize sastava kamenca.

Renalna kolika i/ili hidronefroza nije neuobicajeno stanje u trudnoci. Najcesce se radi o fizioloskoj hidronefrozi trudnoce uzrokovanoj mehanickim pritiskom fetusa i usporenim motilitetom uretera uslijed povisenih razina estrogena, no razlog moze biti i urolitijaza. Lijecenje je konzervativno, uz postavljanje JJ stenta ili nefrostome. Savjetuje se promjena JJ stenta svakih 6-8 tjedana zbog viseg postotka inkrustata. U specijaliziranim centrima moze se uciniti URS uz primjenu lasera. Uz postivanje indikacija, na Klinici postavljamo JJ stent, bez indikacije ne cinimo redovite promjene JJ stenta, a URS ne provodimo. U zadnje 4 godine kod 35 trudnica u prvoj trudnoci postavljen je JJ stent. Dijagnosticki algoritam je slijedeci: anamneza, ultrazvuk bubrega i laboratorij (CRP, CKS, urea, kreatinin, K, urin i urin bakteriološki). U slucaju perzistentne boli, temperature i/ili povišenih laboratorijskih nalaza indicirano je postaviti JJ stent. Postpartalno se provodi radioloska obrada s nativnom snimkom urotrakta i/ili intravenskom urografijom. Na temelju ucinjene obrade formirane su dvije grupe za usporedbu: Grupa 1 – potvrdena urolitijaza ; Grupa 2 – bez znakova urolitijaze. U 10 trudnica je potvrdena urolitijaza nakon poroda. Prosjek trajanja trudnoce je 28 tjedana. Prijasnja uroloska operacija je potvrdena u 3 trudnice iz Grupe 1, uz dva inkrustata JJ stenta takoder u Grupi 1. Najcesci simptomi su bol lumbalne regije (97%), te febrilitet u 38% trudnica. U većini slučajeva JJ stent je postavljen u desni bubreg (31 trudnica). Vrijednosti CRP-a i leukocita su u prosjeku bile povišene u svih analiziranih, uz urednu ureu i kreatinin. Analizom varijabli između grupa (trajanje trudnoce, temperatura, strana, prijasnja uroloska anamneza, analiza urina, laboratorij) utvrdena je znacajna razlika samo za pozitivnu prijasnju urolosku anamnezu (p=0.043). Samo 29% trudnica sa renalnom kolikom ima urolitijazu koja zahtijeva postporodajni tretman. Iako postoji znacajna mogucnost spontane ekspulzije kamenca u trudnoci, tocan postotak takvih slucajeva je tesko utvrditi. Pozitivna prijasnja uroloska anamneza je znacajan pozitivan prediktor urolitijaze kao razloga renalne kolike.

Izvantjelesna udarno-valna litotripsija kamenaca urotrakta (ESWL) neinvazivna je i sigurna metoda lijecenja urolitijaze u opcoj populaciji. Unatoc izvjestajima kako je ESWL jednako uspjesan i u lijecenju urolitijaze djecje dobi, potreba za sedoanalgezijom ili opcom anestezijom dni bitnu razliku u odnosu na odrasle bolesnike. Prikazujemo iskustva ESWL-a u djecjoj dobi Klinike za urologiju KBC Osijek u posljednjih 25 godina. Od srpnja 1988. godine do ozujka 2013. godine ESWL-om je na Klinici lijecen 101 bolesnik djecje dobi: 60 djecaka i 41 djevojcica raspona godina od 1 do 17 (prosjecna dob 10, 2 godine) imalo je ukupno 147 kamenaca urotrakta te je ucinjeno 165 ESWL tre-tmana. Analizirali smo lokaciju i velicinu kamenaca, podatke o tretmanu, vrstu sedoanalgezije/anestezije, uspjesnost i komplikacije te dodatne postupke. Uspjesnost (stone-free rate ; SFR) je definirana kao odsutnost fragmenata kamenca na kontrolnoj nativnoj snimci urotrakta i ultrazvuku 3 mjeseca nakon ESWL-a. Ucinjen je 1, 1 ESWL tretman po kamencu (1, 6 tretman po bolesniku). Kamenci su najcesce bili smjesteni u bubreznim casicama (34, 7%) i mokracovodu (23, 8%) ; u 21, 1% bolesnika kamenac se nalazio u bubreznoj nakapnici, a u 6, 8% bole-snika u pijelouretericnom segmentu, 11 bolesnika imalo je visestruke bubrezne kamence (cetiri ili vise kamenaca u istom bubregu), a u 9 bolesnika radilo se o odljevnoj litijazi. Prosjecna velicina kamenaca izndsila je 9 mm (raspon 4-40 mm). Ukupni SFR iznosio je 82, 35%, a uz dodatak bolesnika s klinicki beznacajnim fragmentima manjima od 4 mm, SFR raste na 89, 7% (biti ce prikazani azurirani podatci). Ureterorenoskopija je kao konacan modalitet lijecenja bila potrebna u 3 * bolesnika, a u jedne bolesnice ucinjena je perkutana nefrolitolapaksija. ESWL je jednostavna, sigurna i ucinkovita metoda odstranjivanja kamenaca urotrakta u djecjoj dobi. Klinicko iskustvo nase ustanove potvrduje ESWL kao metodu prvog izbora u lijecenju djecje urolitijaze.

Uvod: Klinicka slika akutnog skrotuma u vecini slucajeva se moze pripisati torziji testisa (TT) Hi torziji apendiksa testisa (TAT). Medutim, TAT po razvoju bolesti i intenzitetu boli ponekad tesko razlikujemo od TT kod koje je potrebno uraditi hitni operativni zahvat. Bolesnici i metode: Od 618 bolesnika s akutnim skrotumom lijecenih operativno na nasoj klinici od 1998. do 2013. godine retrospektivno smo analizirali 121 bolesnika s TT i 268 s TAT. Ostali bolesnici iskljuceni su iz istrazivanja zbog nepotpunih podataka ili zbog negativnog nalaza na torziju tj. dijagnoze epididimitisa. Rezultati: Prosjecna dob bolesnika s TT bila je 15, 31 godina, a bolesnika s TAT 10, 09 godina. Nije bilo statistickiznacajne razlike izmedu zahvacenih strana tijela. Samo je 30% analiziranih bolesnika posjetilo urologa unutar 10 sati od pocetka simptoma, a ostalih 70% bolesnika cekalo je duze od 10 sati (cesce bolesnici s intraoperativnim nalazom TAT). Uradeno je 25 orhidektomija zbog nepopravljivih ostecenja uzrokovanih TT koja je trajala duze od 10 sati. TT i TAT tipicno se jav- Ijaju tijekom rane djecje dobi, ali prema nasim podacima nakon 21 godine imali smo 13 slucajeva TT, a najstariji pacijent bio je 51 godinu. Od laboratorijskih nalaza (CRP, L, urin) leukocitoza je bila izrazena u 35% bolesnika. Color Doppler je uraden kod 79 bolesnika te je torn metodom u 24% bolesnika dijagnosticirana TT. Scintigrafija testisa je uradena kod 9 bolesnika kojom je u 44% bolesnika dijagnosticirana TT. Rasprava: Bolesnici s klinickom slikom akutnog skrotuma skloni su potraziti lijecnicku pomoc u kasnijem tijeku bolesti, pogotovo bolesnici kod kojih je intraoperativno ustanovljena TAT. Nepotrebne orhidektomije i ostale komplikacije moze-mo smanjiti educiranjem predpubertetske i pubertetske populacije o tijeku bolesti i potrebi da se na vrijeme pregledaju kod lijecnika u slucaju pojave simptoma.

Epidemiološka istraživanja pokazala su da incidencija karcinoma testisa (KT) u zemljama Zapadnog svijeta u proteklih 50 godina raste, ali razlog tome nije jasan. Najčešći pato- histološki tipovi KT (90 do 95%) su karcinomi zametnih stanica testisa (KZST). Cilj ovog rada je istražiti moguću povezanost porasta incidencije KZST u populaciji Istočne Hrvatske i radioaktivnih elemenata, uglavnom osiromašenog urana (OU) i ostalih toksičnih elemenata nastalih kontaminacijom okoliša nakon nuklearne nesreće u Černobilu, Domovinskog rata i Rata u Bosni. Od 1969 do 2012 godine na našoj Klinici liječili smo 258 bolesnika s KT. 32 bolesnika s nepotpunim podacima i 10 bolesnika koji su imali drugi oblik KT isključili smo iz analize. 216 bolesnika s KZST podijelili smo u skupine seminoma i neseminoma. Kako bi usporedili mogući utjecaj navedenih elemenata s promjenama u incidenciji KZST promatrali smo dva razdoblja: 1969-1995 (predratno i ratno razdoblje) i 1996- 2010 (poslijeratno razdoblje). Ovisno o datumu dijagnoze KZST pacijenti su podijeljeni u jednu od tih dviju skupina, . U poslijeratnom periodu ustanovili smo 3, 5 puta veću incidenciju za neseminome, seminome i općenito KZST, a pacijenti s dijagnozom neseminoma imali su uznapredovali stadij bolesti. OU korišten u oružanim sukobima mogao je dovesti do razvoja KZST nakon nepoznatog perioda latencije. Potrebna je procjena izloženosti kako bi se utvrdila uzročna veza između izloženosti OU i porasta incidencije KZST.

Urolitijaza je treće naučestalije stanje u urologiji, nakon uroinfekata i bolesti prostate. Prevalencija urolitijaze je 10-12% u muškaraca i oko 5% u žena. Na svjetskoj razini prevalencija varira od 2% do 20%. Učestalost cistinske litijaze je 1-2% u odraslih i 6-8% u djece (po nekima autorima do 10%). Cistinska urolitijaza je jedina klinička manifestacija cistinurije. Cistinurija je autosomno recesivna bolest obilježena defektom bubrežnog i crijevnog transporta dibazičnih aminokiselina cistina, metionina, ornitina i arginina. Na temelju genetske analize Međunarodni konzorcij za cistinuriju (International Cystinuria Consortium – ICC) predložio je podjelu u tri tipa ovisno o zahvaćenom genu: A – zahvaćen gen SLC3A1 (tip I), B – zahvaćen gen SLC7A9 (tip non-I) i AB – zahvaćena oba gena. Kod svih opisanih oblika cistinurije je povećano izlučivanje cistina urinom koje dovodi do kristalizacije cistina i formiranja cistinskih kamenaca. Normalne vijednosti cistina u urinu su 40-80 mg/24 sata, a cistinurija je definirana kao vrijednosti više od 250 mg u 24- satnom urinu. Liječenje cistinske litijaze je doživotno. Bez adekvatne profilakse recidiv cistinskog kamenca je neizbježan. Profilaksa se sastoji od dijetalnih mjera, adekvatne hidratacije, alkalizacije urina i medikamentoznog liječenja. Dijetalnim mjerama je potrebno postići smanjen unos proteina životinjskog porijekla. Preporuča se dijeta siromašna s metioninom, iako je suradljivost bolesnika na takvu dijetu niska. Dnevni unos soli potrebno je ograničiti na manje od 2 grama. Dnevni unos tekućine bi trebao biti od 3.5 do 4 litre (250 ml po satu), a potrebno je piti prije spavanja i prije svakog mokrenja. Ciljani i održivi pH urina u bolesnika sa cistinurijom je 7.5. Za alkalizaciju urina koriste se natrij-bikarbonat (soda-bikarbona), natrij- kalij-bikarbonat i acetazolamid (250 mg 3x dnevno). Medikamenozno liječenje se provodi lijekovima koji sadrže slobodne tiolne grupe: D- penicilinamin i alfamerkaptopropionilglicin (tiopronin, značajno niža toksičnost i udio nuspojava).

Uvod Izvantjelesna udamo-valna litotripsija kamenaca urotrakta (ESWL) neinvazivna je i sigurna metoda liječenja urolitijaze u općoj populaciji. Unatoč ranijim izvještajima kako je ESWL uspješan i siguran modalitet liječenja urolitijaze u bolesnika starije životne dobi, posljednje studije opisuju slabije rezultate u navedenoj populaciji. Cilj istraživanja je bio usporediti uspjeh i komplikacije ESWL-a u tri skupine bolesnika starijih od 60 godina. Bolesnici i metode 444 bolesnika starijih od 60 godina liječeni su ESWL-om na Klinici za urologiju KBC Osijek od svibnja 2001. godine do svibnja 2008.g. Bolesnici su podijeljeni u tri starosne skupine: 60-65, 66- 70 i stariji od 70 godina. Bilo je 175, 151 i 118 bolesnika u pojedinoj skupini, sa središnjom dobi od 67.7 ± 5.4 godina. Analizirali smo demografske podatke, komorbiditete, bubrežnu funkciju, karakteristike kamenaca, podatke o tretmanu, komplikacije i uspješnost (stone-free rate ; SFR). Rezultati Po bolesniku smo uradili 1.7 ± 1.12 ESWL postupaka, s 3166 ± 571.3 impulsa po tretmanu i prosječnom primijenjenom energijom od 18.78 ± 0.64 kV. Tri skupine bolesnika nisu se razlikovale po broju ESWL tretmana (p=0.78), broju impulsa (p=0.34), razini primijenjene energije (p=0.5), veličini kamenca (p=0.3) i vrijednosti kreatinina prije postupka (p=0.88). Srednja veličina kamenaca iznosila je 12.18 ± 6.8 mm. Najčesća lokacija kamenaca je bila bubrežna nakapnica (37.41%), donje bubrežne čašice (17.99%) i distalni ureter (15.11%). 55% bolesnika je imalo komorbiditete, a gotovo svaki treći bolesnik imao ih je dva ili više prisutnih. Komplikacije su uočene u 6% bolesnika, bez statistički značajne razlike među skupinama. Ukupni SFR bio je 67.98%. Među skupinama nije bilo značajne razlike u SFR-u niti nakon podjele bolesnika na one s bubrežnim i ureteralnim kamencima. Zaključak Uspješnost ESWL-a i mali broj komplikacija mogu biti postignuti dobrim odabirom bolesnika, neovisno o dobi i komorbiditetima, a jedini pretkazatelji uspješnosti ESWL-a su bili veličina i lokacija kamenca.

A single nuclear polymorphisms (SNPs) in the promoter region of the tumor necrosis factor-alpha (TNF-α) gene are involved in regulation of expression levels of TNF-α and therefore are associated with oncogenesis of several cancers. Aim of our study was to investigate the effect of G→A polymorphism at –308 position in the promoter region of the TNF-α gene on prostate cancer (CaP) susceptibility in a subset of patients from Eastern Croatia. Study population consisted of 240 patients (120 with CaP, 120 controls). They were genotyped for TNF-α G-308A polymorphism using real-time PCR (LightCycler Instrument, Roche Diagnostics) and melting curve analysis method. 2 test was used to compare distribution of TNF-α polymorphism genotypes between patients and control group. Relative risk was estimated by the odds ratio (OR). There was no significant statistical difference (2=0.000, DF=1, p=1, OR=1, 95%CI=0.5537-1.8059) between patients and control group. Besides, data of CaP patients were stratified by pathohistological diagnosis (PHD) and Gleason score and groups were compared according to TNF- genotypes. Also, all patients and CaP patients were grouped according to prostate volume (V) into three groups: V100ml. These groups were also compared according to TNF- genotypes. There were no significant statistical differences between any of groups. Our findings suggest that TNF-α –308 SNP is not associated with CaP in Eastern Croatia population.

Renal colic is not a uncommon event during pregnancy. Colic can be provoked with passage of stones, but there is more common physiological right hydronephrosis in pregnancy. Elevated levels of progesterone as suppressor of ureter contractility and crude mechanical pressure of fetus on ureter are suggested mechanisms. Diagnosis of stone disease is achieved with ultrasound, although with low detection rates. Treatment is conservative with placement of double J stent or nephrostomy and double J stent should be changed every 6-8 weeks due to higher incrustation rate. Recently, ureterorenoscopy (URS) is being advocated with excellent results, only in cases if stone is confirmed. At our Department we place double J stent on indication in pregnant women and we don't perform URS in pregnant women. Total of 25 women were treated with stent placement in last 4 years. All attempts of stent placement were successful, no nephrostomy was performed, nor stents were changed during pregnancy on regular basis, since stents were placed in advanced pregnancy. Diagnostic algorithm included anamnesis, ultrasound and laboratory. If persistent pain, fever, vomitus, hydronephrosis or elevated laboratory markers were found or progressed, double J stent was placed. Radiological workup was performed after delivery and, if needed, definitive treatment was done. Two groups were constructed based on confirmed stone after delivery: Group 1. - patients in whom lithiasis was found after delivery ; Group 2. - no lithiasis was found. Stone disease was confirmed in only 8 patients after delivery. Median week of gestation during presentation was 26 (15-37). Previous urological operation or stone disease was found in 3 patients, all in Group 1., also in two patients incrustation of stent occurred, also both in Group 1. Most common symptom was loin pain (in 24/25 patients) followed with fever in 10/25 patients. Right side was predominant (in 21 cases), inflammation was found in 18 cases in urine analysis and positive urine culture was found in 7 cases. In laboratory average elevated CRP was found (52.1 mg/L) and leukocyte count (12.4xl09/L), while blood urea and creatinine were normal. Stent incrustation was found in two patients, both in Group 1. Positive previous urological history was found only in Group 1. (lithiasis group) and this is significant when compared to Group 2. (p=0.050). No difference was determined between groups for other analyzed variables. Only 32% of our patients presented with renal colic during pregnancy had confirmed stone disease after delivery. Some uncertainty in spontaneous passage after delivery is present, but this is still low, when compared to published data. Previous urological surgery or stone disease in medical history is found to be a good predictor of stone disease as reason for renal colic in pregnant women.

Introduction By analyzing data from our department ranging from 1969 to 2010 and latest reports by the Croatian National Cancer Registry (2001-2008), we have noticed increase in the incidence of testicular germ cell carcinoma (TGCC) in the population of Eastern Croatia. Our hypothesis is based on the assumption that Chernobyl accident in 1986, Croatian War of Independence (1991-1995) and Bosnian War (1992- 1995) are causative agents that best depict this phenomenon. Recent studies have shown that testicular cancer incidence is also rising among North European countries, especially in Balkan War veterans, consisting of military personel involved in the Kosovo War (1998-1999), hence the term “Balkan War Syndrome”. Suggested culprit for the development TGCC, not only in our population but in these veterans, is associated stress and contamination of the environment with depleted uranium (DU) from ammunitions used in the above mentioned armed conflicts. Adverse effects of Chernobyl accident are also very well known. The aim of our study was to show possible connection between war- related stress, exposure to DU, change in the pattern of the frequency of TGCC and presentation of the disease in terms of histology and stage. Patients and Methods We had 188 patients operated at our department from 1969 to 2010. Mean age of patients was 32, 5 year ± SD 10, 6. For purposes of analysis, patients were assigned to one of two periods, depending on the date of diagnosis of the GCT, i.e. 1969-1995 and 1996-2010. These two periods were compared statistically to identify possible changes in the presentation of the TGCC. Seminoma was found in 41, 5% (78) of all cases, non-seminoma germinal cell tumors (NSGCT) in 53, 2% (100) cases while other types including some benign forms, lymphoma and metastasis in 5, 3% (10). Period from 1969 to 1995: 32 seminoma (19 stage I, 10 stage II, 3 stage III), 37 non- seminoma (18 stage I, 14 stage II, 5 stage III), 2 other, total 71. Period from 1996 to 2010: 46 seminoma (33 stage I, 11 stage II, 2 stage III), 63 non-seminoma (27 stage I, 15 stage II, 21 stage III), 8 other, total 117. Results There is 2, 8 times higher incidence rate for seminomas after 1995, 3, 2 times higher incidence rate for non-seminomas after 1995, and 3, 2 times higher incidence rate for all types of tumors after 1995. There is significant change in histology appearance of NSGCT in this two selected periods. Discussion This study gives support for the hypothesis that war-related stress and especially exposure to the DU in the Eastern Slavonia could lead to testicular malignancies after prolonged latency. However, for the latter mentioned, no exposure assessment was performed and future follow up is necessary for evaluation of DU long term risks.

Introduction It is well known that, beside age, race and familiar factor, dietary factors play big role in epidemiology of prostate cancer (CaP). The Western lifestyle, particularly the higher intake of fat, meat, and dairy products, is also associated with risk for CaP. Obesity is also linked to CaP, mainly with mortality rather than incidence. We wanted to see and show if there is difference in body mass index (BMI) in patients with biopsy diagnosed CaP and patients in control group. Patients and methods We have included 235 patients in our research was (age 42-84 yrs.). In all patients transrectal biopsy of prostate was done. In 117 patients out of 235 is diagnosed CaP, in rest of 118 patients patohistological finding did not show CaP (control group). BMI and PSA level were determinated to all patients. Student t-test was used to assign difference between BMI in our 2 groups. Results Mean BMI in group of patients with CaP was 27.625 kg/m2 (SD 5.680), mean BMI in control group was 27.692 kg/m2 (SD 3.987). There was no statistical significant difference in BMI in out two groups. When we grouped our patients according to their BMI (underweight < 18, 5 kg/m2 ; normal 18, 5-25 kg/m2 ; overweight 25-30 kg/m2 and obese >30 kg/m2), we noticed decrease of PSA level with increase of BMI. In our research there was no underweight patients, 64 of them were with normal BMI and mean PSA 69.48 ng/ml ; 120 of them were overweight with mean PSA 55.15 ng/ml and 51 of them were obese patients with mean PSA 33.16 ng/ml. Discussion General adiposity, as measured by BMI, is not in relationship with CaP incidention in our research, but obese is connected with lower PSA level with possible hemodilution in background. Question is – should we decrease the threshold of PSA in obese patients for prostate biopsy?

Introduction Recent studies suggest that chronic inflammation is crucial in the development and progression of prostate cancer (CaP). Inflammatory response depends upon differential production of cytokines, which is correlated with single- nucleotide polymorphisms (SNPs) of cytokine genes. So far, the studies of cytokine genes’ SNPs have shown contradictory results and propose ethnical dependency of SNPs. Interleukin-10 (IL10) has dual properties: it can reduce tumor angiogenesis, but can also enable tumor cells to «escape» the immune response with its anti-inflammatory action. We here investigated the association of two IL10 SNPs (IL10-819 C>T and IL10-592 C>A) with CaP risk in Eastern Croatian population. Patients and Methods 120 CaP patients and 120 benign prostatic hyperplasia (BPH) controls treated at the Clinic for Urology, University Hospital Centre Osijek were included in this study, after giving informed consent. Groups were age-matched. Two subgroups were formed according to Gleason score (≥4+3 and ≤3+4). To determine the IL10 SNPs, genomic DNA was extracted from 200 µl ethylenediaminetetraacetic acid (EDTA) whole blood using commercially available kits. IL10 gene polymorphism was assessed by real-time PCR method with melting curve analysis. Descriptive statistical analysis was performed with SPSS 19.0 statistical program (SPSS Inc., Chicago, Ill, USA) ; x2 test was used to determine the differences between the groups and Kendall’s tau-b test for linear-by-linear association. Results For the IL10-819 and -592 SNPs there were no significant differences between cases and controls. The -819 TT variant was associated with a 2-fold decreased risk for CaP, but the trend was not significant (OR = 0.5, 95% CI 0.16-1.54, p trend = 0.6). The -592 allele distribution was identical in cases and controls. When comparing the subgroups, the -819 TT variant showed a slightly increased risk for higher scores (OR = 1.23, 95% CI 0.19-7.84, p trend = 0.88). The two IL10 SNPs were also tested according to PSA levels (20 and ≥20) but again the groups did not differ. Discussion Although there are studies that report the association between the IL10 SNPs and CaP risk, recent meta-analysis of 10 studies on the subject found no significant association. Our analysis also shows lack of such an association for Eastern Croatian Population. These findings, taken together with contradictory results of other cytokine genes’ SNPs imply the ethnical dependency of such polymorphisms. Also, combinations and interactions of SNPs might have a greater impact on CaP risk than just one SNP. Future studies will define true importance of cytokine genes’ SNPs in the development and progression of CaP.

Introduction Prostate biopsy is procedure for acquiring definite diagnosis of prostate cancer. If inconclusive, indications for repeated prostate biopsy are not so clear. Free to total PSA ratio, PSA velocity, PSA density, transition zone PSA density and some new markers are tested (PCA3 as most promising and widely used), but still waiting conformation as best add-on to PSA and rectal examination in decision when to repeat prostate biopsy. All mentioned plus extended biopsy, saturation biopsy or even prostate biopsy under MRI is recommended for repeated biopsy, with significant morbidity and black shadow of (over)diagnosing insignificant prostate cancer. Our study investigated results of our patients undergoing repeated biopsy. Patients Of 2583 prostate biopsies done from 2000 to 2010 in this study we included 102 patients from 2008 to 2010 in whom first or repeated prostate biopsy was done (241 biopsies total, up to 5 biopsies). Inclusion criteria were normal rectal examination and elevated PSA (age adjusted, family history considered). 12 core prostate biopsy was used for all biopsies, no MRI guidance, no saturation biopsies, and all biopsies as outpatient procedure without anesthesia. We analyzed PSA, PSA velocity, presence of high grade PIN (HgPIN), ASAP, presence of inflammation (chronic prostatitis - CP) and correlation of this variables to outcome of prostate biopsy. Results Prostate biopsy followed with repeated prostate biopsy was done in 103 patients, making total of 241 biopsies, or 2.3 biopsies per patient, up to 5 biopsies in 3 patients. In initial biopsy average PSA was 8.13 ng/ml, HgPIN was present in 54% of cases, ASAP in 9, 7% of cases and CP in 55% of cases. Results for second biopsy are as follows: of 103 patients 82 had benign prostate hyperplasia (BPH) with average PSA of 9.68 ng/ml, HgPIN in 26%, ASAP in 4% and CP in 65% of cases. PSA velocity for this group was 2.51 ng/ml/year. Prostate cancer was found in 20 patients (20% detection rate) with average PSA 9.13 ng/ml, PSA velocity 2.08 ng/ml/year. HgPIN was found in 43%, ASAP in 5%, no CP and 8 cases of prostate cancer were insignificant. Significantly more patients with BPH had CP (p=0.001), with no difference in rate of HgPIN (p=0.193) or ASAP (p=0.608). Third biopsy was done in 26 patients, with prostate cancer in 8.3% and fourth biopsy in 6 patients. Conclusion In our clinical experience from prostate biopsy patients referred to our Department we found that neither PSA, PSA velocity, nor presence of HgPIN or ASAP at first biopsy is associated with higher detection rate of prostate cancer on repeated biopsy. Chronic inflammation is present in higher proportion in BPH patients, as recent proposal on inflammation theory in evolution of BPH suggested, and could be predictor of BPH at repeated biopsy.

Introduction VUR is a common urological anomaly in children, defined as adverse return of urine from the bladder to ureter or the renal pelvis and the calyces. Primary reflux (PVUR) is congenital anomaly of ureter and bladder junction with genetic background while secondary reflux (SVUR) is usually associated with anatomical and functional obstruction in the urinary bladder. Besides conservative treatment, VUR can be dealt surgically, in recent years increasingly using endoscopic techniques. The purpose of this retrospective study is to analyze our patients, clinical presentation, diagnostic procedures and results of treatment. Patients and Methods From 1984 to 2009 a total of 140 patients with VUR have been treated at our clinic, 129 female and 11 male patients. PVUR was found in 127 patients (age 6 months-16 years) while secondary in 13 patients (age 17-49 years). In 27 patients with PVUR other morphological or functional abnormality of lower and upper urinary tract was found, most common were: double ureter (16), ureter stenosis (4) and neurogenic bladder (3). Positive family history was found in 11 patients. Most commonly used operation technique in PVUR was Lich-Gregoir and for SVUR Politano-Leadbetter. From 2002 we started with endoscopic treatment with instillation of bulking agents. VUR had been unilateral in 116 patients (44 on the right side, 72 on the left), and bilateral in 24 patients. Recurrent acute pyelonephritis was detected in 99 patients and bacteria were isolated from urine culture in 51 patients. Other patients with clear clinical symptoms of pyelonephritis had sterile urine, but all were under antibiotic therapy before taking a urine sample. Voiding cystography was done in the all patients. In 59 patients we found active VUR and in the remaining 81 patients cystography revealed passive VUR. Results Of all treated patients 128 had excellent results and were discharged on the 11th to the 13th day after surgery, or the 2nd to 3rd day after the installation of bulking agents. In 2 patients with PVUR secondary operation had to be done due to ureteral fistulas and in 1 due to ureteral obstruction. In 2 patients with bulking agents instillation, another installation was needed. The success rate for open surgery is 97, 6% and the success rate of endoscopic surgery was 80%. Discussion The diagnosis of VUR should be set as early in childhood with PVUR and in the adult population that is often associated with SVUR, in order to avoid damage of renal function. The VUR should always be suspected in recurrent pyelonephritis and pathologic findings of urine in children. The success rate of surgical and endoscopic procedures in our institution was comparable to success rate of previously published studies.

Introduction Vesicovaginal fistula (VVF) is an abnormal opening between the bladder and the vagina that results in continuous and unremitting incontinence. The etiology of VVFs in developed countries is associated with surgical injury to the bladder during hysterectomy. The objective of this study was to review management of the VVF with an emphasis on cause, clinical presentation, treatment, outcomes and complications. Patients and Methods We operated 22 patients in the period from 1984 to 2008. Medical charts were analyzed retrospectively. The most common cause of a fistula was after transabdominal hysterectomy for benign conditions in 13 cases, for malignancy in 5 cases and 5 other cases The median age of patients was 47.00 years (range 32-62 years) and the median follow-up period was 10 months (range 2-18 months). After vaginal examination and intravesical methilene blue instillation, cystoscopy was preformed in all cases to determine the site, number and size of the fistula and its relationship with the ureteric orifice. Cystography was done in ten cases and no more information was received except extravasation of contrast media in the vagina. To determine concomitant ureteric injury, intravenous pyelography was done in all cases except in subjects with a history of iodine allergy. Results Most cases of VVFs presented with early urinary leakage (72, 72% within first and 27, 27% in the second week). 7 cases were treated with late (>3 months) and 14 with early (1-3 months) surgical repair. In three cases we discovered lesion of prevesical ureter and ureterocystoneostomia was preformed with intraoperative positioning of JJ stent. The VVFs were mainly midvaginal (60%). The VVF was repaired in all patients using the traditional techniques of tissue separation, circumscription of fistula, closure of bladder in 1 layer using 2-0 Vicryl sutures without tension, and closure of the anterior vaginal wall in 1 layer over the repaired VVF site with interposition of omentum. VVFs were successfully closed at first attempt in 18 patients, and after second procedure in 4 patients, as evidenced by the continence dye test in the operating room and from history taking at discharge and at the follow-up visits. Urethral catheters were used for urinary drainage in all cases and removed after 7- 28 days. There were no major surgical complications. Discussion VVF is a serious iatrogenic consequence, frequently associated with transabdominal hysterectomy. Successful closure of the fistula requires an accurate and timely repair, preoperative evaluation, good exposure, excision of surrounding fibrous tissue, tension- free closure and adequate postoperative urinary drainage.

Correlation of IL-6 gene polymorphism and development of prostate cancer is analyzed in this article. Since recently published data propose ethnic background in this gene polymorphism, we analyzed population of Eastern Croatia.

Introduction Primary penile carcinoma is one of the rarest male genital tract tumors, with a reported incidence of 1 per 100000 males in Western European countries. More than 95% of penile cancers are squamous cell carcinomas (SCCs). It usually arises in the epithelium of the inner prepuce, coronal sulcus and glans. Social and cultural habits influence the incidence of the disease, which is related to the exposure to Human papilloma virus, poor hygiene, phimosis, chronic irritation and smoking. Penile carcinoma most commonly occurs in the fifth and sixth decade of life, with peak incidence in the eight decade. The aim of this retrospective study was to present our results of penile carcinoma surgical treatment, with emphasis on staging and complication rate. Patients and Methods From 1998-2010 we treated 25 penile carcinoma patients. Median age of the patients at the time of diagnosis was 62 years, range 45-92, with highest incidence in the sixth and seventh decade of life. Diagnostic procedures included detailed physical examination, patient history, and pelvic CT in patients with enlarged inguinal lymph nodes. Procedures performed included circumcision, partial/total penectomy, lymphadenectomy and adjuvant oncologic treatment. In most cases we performed intraoperative biopsy and cryosection procedure of the suspected lesion. Median follow up was 14 months, range 1-79 months. Results Of the total number of penile cancer patients 48% had palpable inguinal lymph nodes at the time of the diagnosis. Final pathological evaluation revealed 96% of SCCs and 4% of Kaposi sarcoma. Most commonly performed procedures were partial/total penectomy in 72%, inguinal lymphadenectomy in 48% and circumcision in 36% of the patients. In one patient we performed immediate total penectomy due to severe life- threatening hemorrhage. 52% of the patients were treated with adjuvant oncological treatment, while one patient received neoadjuvant radiotherapy only. In 2 patients the disease has recurrence locally. We had no major complications, wound dehiscence was noted in two and prolonged lymphorrea in five patients treated with regional lymphadenectomy. Discussion Due to the relatively rare occurrence, age at the time of diagnosis and poorly educated population, majority of our patients have neglected early lesions for more than one year until they make first visit to their physician, which caused the delay of diagnosis and, subsequently, often inadequate treatment.

Introduction Transrectal ultrasound-guided prostate needle biopsy is one of the mandatory diagnostic tests in detecting prostate cancer (CaP) and obtaining its histological confirmation. The procedure, which is mostly indicated when there is elevated serum PSA level and/or abnormal DRE, is generally not pleasant for the patient. Although intrarectal lidocaine application or periprostatic nerve block seem to reduce the pain during prostate biopsy, pathological finding of prostatitis brings a question whether the procedure is more painful when there is inflammation present. We evaluated and compared pain scores at the end of the biopsy between patients with histologically confirmed CaP and benign prostatic hyperplasia (BPH) and those with evidence of prostatic inflammation. Patients and Methods In 2009 we performed 340 consecutive transrectal prostate biopsies. The procedure was performed in an outpatient setting, with 500 mg of ciprofloxacin given orally one hour before the biopsy, no anesthesia and 12-core protocol. At the end of the procedure we measured patients' assessment of pain on a 10-point visual analogue scale (VAS). Hystological data were retrospectively analyzed, and the patients were divided into those with BPH, CaP and those with prostatitis (chronic/active). Descriptive statistical analysis was performed with an online statistical program (Kirkman, T.W. (1996) Statistics to Use. www.physics.csbsju.edu/stats/ (25 June 2010)), using Kolmogorov-Smirnov test for comparing datasets between the groups. P < 0.05 was considered statistically significant. Results Out of 340 prostate biopsies 83 patients had BPH, 114 CaP and 143 patients had evidence of prostatic inflammation on pathological analysis. Median age of all patients was 68 (range 42-84) ; all groups were age-matched. Median pain score on VAS was 3 for all groups. When comparing pain scores between prostatitis and CaP and BPH group, we found no statistically significant difference, with p=0.398 and p=0.980, respectively. Also, when CaP and BPH groups were joined, the difference in comparison with prostatitis group was nonsignificant (p=0.555). Discussion Although one would expect that prostate biopsy is more painful when there is histological evidence of prostatic inflammation present, recent studies suggest that chronic inflammation is a precursor in the development of CaP. Therefore, our results that the VAS pain score did not differ between the groups seem appropriate. Nevertheless, according to the evidence from randomized controlled trials, periprostatic nerve block is effective and safe in reducing pain from transrectal ultrasound biopsy of the prostate, even without taking pathological findings into account.

This article deals with correlation of tumor necrosis factor and it's polymoprhism to the development and progression of prostate cancer.

Aim Prostate cancer (PC) is most common cancer in men and benign prostate hyperplasia (BPH) is condition affecting majority of elder men with great impact on everyday life. Both genetic and environmental factors are involved in development of PC. Epidemiological studies have shown that inflammation, toxins, hormonal changes or trauma are risk factors of PC, suggesting that chronic inflammation can lead to PC. IL-6 is a cytokine expressed in inflammation processes. Polymorphisms in gene for IL-6 are responsible for different production of IL-6. Aim of our prospective study was to analyze correlation of inflammation and IL- 6 high producer (GG or GC genotype) with presentation and symptoms of PC and BPH. Methods 120 PC and 120 BPH patients, age matched groups, were included after giving informed consent. In all patients history was taken and urological exam was done before biopsy was performed. Genomic DNA was extracted from whole blood and genotype polymorphism was assessed by real-time PCR. Results PC in family history was more common in PC group (8, 3% vs. 5.8%, p=0.169), prostate were larger in BPH group (76 ccm vs. 51 ccm, p=0.0001) and inflammation on histology was more common in BPH group (91.3% vs. 49.1%, p=0.001). There was no difference in mean IPSS score between groups (14 vs. 13, p=0.488). High producer genotype (GG or GC) of IL-6 was present in 86.7% of BPH patients and 80.8% of PC patients (p=0.147) and there was uniform distribution of high producers between PC groups (by differentiation, p=0.601). There was no difference in high producer genotype in patients with or without inflammation on histology in both groups (p=0.209 and p=0.300), but high producers are more common in BPH then in PC patients with inflammation (87, 3% vs. 77.6%, p=0.09). High producer genotype is evenly distributed when prostate size was accounted (volume 81 ccm) in BPH group, but more high producers are noted in larger prostates of PC patients (73%, 79%, 85%). However, this difference is not significant when prostate of same size are compared between groups. Discussion We found no difference in IL- 6 producers between PC and BPH patients in our population. Inflammation is more common in BPH and ratio of IL-6 high producers is much higher in BPH patients with inflammation, suggesting limited role in PC. Higher ratio of high producers in patients with larger prostate can be explained with higher growth promotion by mediators of inflammation. Although some studies have not found a positive role of high producer IL-6 in PC development, contradictory results of published results have lead to proposed explanation of ethnic differences in IL-6 producers and effect on population.

Bladder osteosarcoma is extremely rare tumor. There are about 30 cases described in the literature. Poor prognosis with lethal outcome within one year could be expected, although successful treatments were reported. We present a case of primary bladder osteosarcoma successfully treated with cystectomy, free of the disease for two years. A 63 years old man was admitted with history of blood in urine during the last month. CT showed 5 cm bladder mass and suspected infiltration of rectum. Transurethral resection was performed and after histology revealed osteosarcomma a cystectomy was done. Histology found a mesenhimal malignant tumor made from spindle like cells, areas of osteoid surrounded with malignant osteoblast type cells showing trabeculae resembling structures, cartilage with atypical forms of hondrocytes and osteoclasts. Areas of urothelium were of normal structure and without atypical or malignant cells. Immunochemistry staining was positive for vimentin, S-100, CD31, CD99, CD68 and Ki67, but negative for cytokeratin, epithelial membrane antigen (EMA) and desmin. Bone forming bladder tumors can be divided into the three groups: carcinosarcoma, transitiocellular carcinoma with osseous metaplasia and osteosarcoma. Historically four origin theories were proposed: mesenchymal remains of Wolfian body, blood transfer of cells, metaplasia and theory of alkaline-phosphatase rich mucosa triggering osteogenic differentiation into neoplastic mesenchymal cells has been held for true. Our case showed that with good coordination of pathologist and urologist combined with prompt and aggressive therapy even a locally advanced disease can be treated.

Introduction & Objectives The aim of this study was to compare the incidence of incidental prostatic carcinoma in two hospitals in Croatia according to the procedure of choice, together with incidence and its clinical caracteristics. Materials and methods The hospital medical records of all patients who have undergone prostatectomy for BPH in two hospitals, namely University Hospital Osijek and General Hospital Varazdin, in the period between January 2002 and December 2006 were reviewed. In 202 cases retropubic prostatectomy was performed and in 842 transurethral resection was done. Results The histopathology reports obtained from 1044 patients who presented with BPH were available. Incidental carcinoma was found in 71 specimens (representing 6.80% of all patients). The mean age was 70.6 years (44 to 90). Gleason score ranged between 3 and 6 with a mean value of 4.1. In 43 cases (60.56%) postoperative PSA values were stable and ranged between 0.0 to 0.5 ng/ml. In 28 cases after the postoperative rise in the PSA levels patients underwent bilateral orchydectomy and in 13 of those patients after the further rise in the PSA levels we deceided to include flutamid in the therapy. Five of those patients (7.04%) died because of concomitant diseases. Two patients (2.81%) developed osseous metastases of the prostatic carcinoma. Conclusions Considering the operative technique there were 9 cases (4.45%) of incidental prostatic carcinoma following open prostatectomy and 62 cases (7.36%) following TURP (p=0.05). The reason for such discrepancies in the results could be that during the open procedures only the adenomatous tissue of transitional zone is removed, while during transurethral procedure there is presence of the tissue that is resected from the peripheral zone which is more prone for development of prostatic carcinoma.

Introduction. Sarcomatoid carcinoma or sarcomatoid variant of urothelial carcinoma is the term that should be used for all biphasic malignant neoplasm's exhibiting morphologic and/or immunochistochemical evidence of epithelial and mesenchymal differentiation with or without heterologous elements. Case report. In this paper we described a case of biphasic malignant neoplasm of the ureter. The patient was 68-years-old woman admitted to the clinic because of painless hematuria, cystoscopically visible tumor protruding from right ureteral orifice, CT documented hydronephrosis and affunction of the right kidney. She underwent right nephroureteroctomy. The tumor consisted of four polypoid intraluminal masses that fulfill distal part of the ureter, and infiltrate ureteral wall. Microscopically, the majority of the tumor was composed of epithelial elements that show squamous or glandular differentiation, and only focal urothelial differentiation. Stroma was abundant fibro-mixoid or highly cellular composed of atypical mesenchymal spindle cells with high mitotic rate evidence. By immunohistochemistry, epithelial elements react with cytokeratin 10/13 and focally with cytokeratins 7, 8, 18 and 20. The epithelial elements were strongly NSE positive while Synaptophyisn and Chromogranin A showed only focal positivity. Atypical mesenchymal spindle cells showed immunoreactivity for Vimentin while Desmin and Actin were negative. The tumor infiltrated ureter wall and spread into periureteral fat tissue as well as into vascular spaces. Conclusion. Sarcomatoid carcinoma of the ureter is a rare aggressive neoplasm with unknown biology. Even terminology for biphasic urothelial neoplasm's is confused. Molecular studies suggest a monoclonal origin for both tumor components. In our case, epithelial component consisted of various epithelial cell types while stroma consisted of undifferentiated mesenchyma.

Cilj Klinički i epidemiološki podaci potvrđuju da je kronična upala bitan čimbenik razvoja karcinoma prostate. Oksidativni stres, izazvan aktivnošću upalnih stanica, djeluje na DNA proliferirajućeg epitela te dovodi do trajnih genomskih promjena. Regulacija imunološkog odgovora je stoga uključena u razvoj i progresiju karcinoma prostate. Parakrina sekrecija citokina, koja može biti pojačana («high producer»), srednje izražena («intermediate producer») ili snižena («low producer»), rezultat je različite ekspresije citokinskih gena. Svrha istraživanja je odrediti izražaj polimorfizama gena za citokine IL-10 i TGF-β kod oboljelih od karcinoma prostate, s ciljem konstrukcije mape polimorfizama gena za citokine u različitim stadijima bolesti. Metode U ovo je prospektivno istraživanje trajanja 3 godine uključeno 120 ispitanika s karcinomom prostate i 120 kontrola (BHP). DNA analiza polimorfizama gena za IL-10 i TGF-β učinjena je iz tkiva prostate ili krvi ispitanika. Rezultati Prikazati ćemo preliminarne rezultate analize polimorfizama citokinskih gena IL-10 i TGF-β na uzorku od 20 bolesnika. Dobiveni rezultati poslužiti će kao osnova za predikciju očekivane raspodjele navedenih polimorfizama u daljnjem istraživanju, zajedno s ostalim proučavanim citokinima. Zaključak TGF-β regulira rast stanice potičući diferencijaciju i apoptozu stanice. TGF-β pokazuje dvojako djelovanje, zaustavljajući rani razvoj karcinoma, ali potičući progresiju kasnijih stadija te razvoj metastaza. IL-10 je protuupalni medijator koji smanjuje prezentaciju MHC antigena na površini makrofaga i na taj način antigen specifični odgovor T limfocita. Djelovanje IL-10 je također dokazano dvojako: visoke razine IL-10 djeluju promotorski na rast tumora zbog imunosupresivnog djelovanja na T limfocite, omogućujući tumorskim stanicama «bijeg» od imunološkog odgovora ; u drugim studijama niske razine IL-10 djeluju pozitivno na rast karcinomskih stanica

Introduction Initial treatment options for patients with ureteral stones who require active stone removal are both extracorporeal shock-wave lithotripsy (SWL) and ureterorenoscopy (URS). SWL is usually described as less invasive and safer, but URS has lower retreatment rate. The aim of this retrospective study was to present our results of URS in treating ureteral calculi and to analyze stone-free and complication rates, along with auxiliary procedures performed. Patients and Methods We present the analysis of 210 URS treatments, the first portion of a larger scale study of 587 URS procedures performed at our Department from 1987 to 2008. URS was performed with Storz semirigid ureterorenoscope, using mostly electrokinetic and rarely ultrasonic lithotripsy. Mean age of the patients was 54 ± 13.4 years (age ± SD), range 12-82 years, with male to female ratio of 0.93. Location of the stones was proximal in 21.9%, mid-ureteric in 29.5% and distal in 48.6% of the cases. Median stone size was 10 mm (range 2-90 mm). Comorbidities were present in 58% of the patients, among which arterial hypertension was most common (74.6%). 51% of the patients had previously undergone SWL treatment of observed ureteral calculi. Stone-free rate (SFR) was determined as complete abscence of stone fragments on plain abdominal film and ultrasonography after URS treatment. Results Overall SFR was 77.14%, with 58.7% for proximal, 79% for mid-ureteric and 84.3% for distal calculi. JJ stent placement during procedure was required in 41% of the patients. In 58.3% of non stone-free patients additional SWL session was sufficient for complete stone clearance, with modified overall SFR of 90.5%. The rest of the non stone-free patients had clinically insignificant residual fragments and were monitored in later follow-up, failed to show at the check-up or had undergone several SWL sessions. Complications were noted in 23 patients: 13 patients had fever, 6 required percutaneous nephrostomy and 4 open surgery. Discussion We perform primary URS in younger patients and the high percentage of pre-URS SWL treatments of ureteral calculi is due to patients' age, comorbidities and avoidance of anesthesia. Nevertheless, URS showed to be safe and effective in removing ureteral stones, with additional SWL session when no spontaneous passage of the residual fragments occured. We also reduced the number of stenting after uncomplicated URS and the trend is for URS to become the initial modality of ureteral stones removal because of its low retreatment and complication rate.

Cilj Etiologija karcinoma prostate je djelomično poznata, a kronična upala je uzročno povezana sa razvojem karcinoma. Upala dovodi do pojave prostatične intraepitelne atrofije, sa posljedičnom hiperplazijom stanica prostate koja se događa u okolini bogatoj radikalima kisika. Takav okoliš je izuzetno pogodan za razvoj mutacija i defekata na genskom materijalu stanice koji mogu dovesti do pojave karcinomskih stanica. Citokini su regulatori i posrednici u upalnom procesu. Polimorfizmi gena za citokine su razlogom različite fenotipske ekspresije citokina: povećana produkcija („high producer“) ili smanjena produkcija („low producer“), koja dovodi do razlika u upalnom procesu među pojedincima. Cilj našeg istraživanja je utvrditi postoje li razlike u polimorfizmima gena za citokine u bolesnika sa karcinomom prostate u odnosu na bolesnike sa benignom hiperplazijom prostate. Metode Istraživanje je prospektivnog tipa sa 240 bolesnika uključenih (120 sa BPH i 120 sa karcinomom prostate), ukupnog trajanja istraživanja 3 godine. Anamneza, urološki pregled i uzorci krvi za DNA analizu su prikupljeni od svakog bolesnika. Analizirali smo polimorfizme za IL-6, TNF-α i INF-γ. Rezultati Prve rezultate polimorfizama gena za citokine smo učinili na uzorku od 20 bolesnika sa krcinomom prostate: IL-6 povećana produkcija u 87, 5%, smanjena produkcija u 12, 5%, a za TNFalpha povećana produkcija u 31%, a smanjena produkcija u 69%. Zaključak TNF-α, IL-6 i INF-γ su upalni citokini sa antivirusnim i antikarcinomskim djelovanjem koje ostvaruju kroz poticanje upale i mobilizaciju T limfocita, a u do sada objavljenim istraživanjim je dokazano da manja produkcija, tj. prisutnost polimorfizama koji određuju fenotip manje produkcije, može ubrzati razvoj ili čak djelovati povoljno za pojavu više oblika karcinoma.

Introduction Cryptorchidism is the most common congenital anomaly of male genitalia, with incidence of about 3, 4% full-term babies and 30 % of premature babies. Retractile testicles is a related condition where the testes can be at times found within the scrotum and at times not. The primary management of cryptorchidism and retractile testicles is surgery and its purpose is not only to produce a good cosmetic appearance or positive psychological effect, but to reduce the risk of infertility. It is usually performed in infancy, if inguinal testes have not descended after 4-6 months. Hormonal therapy is sometimes attempted and occasionally successful. The aim of this retrospective study was to present our results of cryptorchidism and retractile testicles surgery, with emphasis on operative technique, age of the patient at the time of surgery, anatomic position of cryptorchid testes, were the testes palpable upon physical examination and presence of associated anomalies and conditions. Patients and Methods In a ten-year span (1999-2009) a total of 490 patients were operated upon for maldescent of testes. Median patient age at first orchyopexy was 7, 5 years (range 13 months to 44 years). Maldescent had been unilateral in 401 patients (227 on the right side, 174 on the left), bilateral in 81, retractile testicles were found in 82, nonpalpable in 73, canalicular in 376, beyond the external ring in 21 and atrophic or absent in 20 patients. Of associated anomalies and conditions most common were cardiovascular anomalies (5), neurological anomalies (4), hypospadia (3), ipsilateral inguinal hernias (150), adhesions of the foreskin (104), phimosis (15). Of techniques Schoemaker type procedure was most commonly used with 479 procedures. Nine patients underwent exploration of the inguinal canal due to the finding of unilateral absent testicle, eleven patients underwent semicastration due to the finding of atrophic testicle. Results Out of 490 operated patients 485 had excellent results and were released to house care after 3 to 7 days. Complications were noted in 5 patients, including hematoma and/or oedema in 2 and other complications in 3 patients. Success was defined as scrotal position and lack of atrophy. Success rates by anatomical testicular position were 86, 4 percent for peeping and 98 percent for canalicular testes and for those located beyond the external ring. Success rate for Schoemaker orchiopexy procedure was 95, 7 percent. Discussion Diagnosis of cryptorchidism should usually be made at birth and treatment optimally performed between 6 to 18 months of age. Our data suggest that the majority of cryptorchidism are diagnosed at pre-puberty physical examination. Surgery success rates found in this study were similar to previously publicized data. Combining our experience in Schoemaker procedure with education of population will result in further increase of success rate after orchiopexy.

Introduction Percutaneus nephrolihotomy (PCNL) is recognized as treatment option for staghorn stones, large stones, multiple stones, stones in inferior calyx or after failed ESWL therapy1, 2, 3. It is a very specific procedure that requires special equipment, instruments and training, all greatly affected with technological development. We will present our results as presentation that such procedure is well done and can be a part of a small-volume center „menu“. Methods First PCNL was performed at our department in 1986, but from 1994 till present day we usually perform about a 15 PCNL per year and so far 239 patients were treated with PCNL, within that number are 22 cases of patients with multiple PCNL. We do a single channel PCNL, with rigid instruments and we use electrokinetic as modality for fragmentation (rarely ultrasound probe). Only 165 medical histories were present for analysis since some medical histories were lost (war damage to archives) or patients were from another state. Average age of our patients was 53, 9 years (min:23, max:78) and was almost same for both sexes. Males were slightly predominant (ratio to female 1.13), and left side was affected in 52, 4%, with one case of bilateral PCNL. Average diameter of stones was 3.48 cm, but 51 stones were staghorn stones affecting at least 2/3 of collecting system. Mean anesthesia time was 130 minutes (min:45, max:360). Significant co- morbidity was present in 60.4% of patients, and 19, 5% of them had previous pyelolithotomy or nephrolithotomy (detailed in Table 1.) Results Placement of JJ stent was found to be necessary in 40.5% of patients and stents were removed at first control check-up. ESWL prior to PCNL was done in 50.6% (we do have tendency to do a bimodal- therapy) and in 45.7% of patients after PCNL. Numbers for ureterorenoscopy were much smaller: prior to PCNL in 4.8% and after in 13.4% (mostly as salvage procedure for urethral fragments). Complications were noted in 31, 7% cases: fever (more than 1 day) in 52 patients (32.1%), transfusion in 11 patients (6.8%), stein-strasse (treated with URS) in 4 patients, conversion to open-procedure in 3 patients and one nephrectomy (due to AV fistula, unable to do sclerosation). Rate of complication was correlated only to staghorn stones (Table 2.). No injury to adherent organs or mortality was recorded. Overall stone free rate was 73.8% (modified 83, 1% in those in whom a bimodal therapy was done) (detailed in Table 3.). Conclusion Although our SFR is slightly smaller, one must bear in mind a large number of staghorn stones4. Also we do have limited resources, so we don’t use laser or flexible instruments, but we do like a bimodal-therapy1, 2. However, our complication rates were as reported or even better, with practically no major complications1, 5, 6. This shows that with careful selection of patients even in small volume centers a PCNL can be offered as valid treatment option.

Cilj Karcinom prostate je najčešći oblik raka kod muškaraca, ali još uvijek nije potpuno objašnjen razvoj karcinoma prostate. Kronična upala je važan čimbenik u razvoju karcinoma prostate, a uloga upale u razvoju benigne hiperplazije prostate od nedavno je u žarištu istraživanja. Istraživanja gena, izražaja te zastupnjenosti i polimorfizama gena koji su važni u upalnom procesu, prvenstveno citokina, je važan korak u razumijevanju uloge upale u razvoju karcinoma prostate. Cilj našeg istraživanja je da utvrdimo zastupljenost i ralike izražaja gena za citokine u naših bolesnika sa karcinomom prostate. Materijali i metode Istraživanje je prospektivnog tipa sa prvom odrednicom od 240 bolesnika uključenih (120 sa BPH i 120 sa karcinomom prostate), dok je ukupno trajanje istraživanja 3 godine. Opće zdrastvene informacije, urološki pregled i uzorci za DNA analizu (tkivo ili krv) su prikupljeni od svakog bolesnika. Analizirali smo polimorfizme za: IL-6, IL-10, TGF-β , TNF-α i INF-γ . Rezultati Prikazati ćemo prve rezultate polimorfizama gene za cytokine prikupljene od početka istraživanja. Rasprava TGF- β je važan upravljač staničnim ciklusom sa dvojakim djelovanjem: u početnim stadijima karcinoma prostate zaustavlja razvoj, dok je kod uznapredovalog karcinoma prostate dokazano da potiče pojavu metastaza. TNF-α , IL-6 i INF-γ su upalni citokini sa antivirusnim i antikarcinomskim djelovanjem koje ostvaruju kroz poticanje upale i mobilizaciju T limfocita, dok je za IL-10 u nekim radovima dokazano da ima promotorski efekt na rast karcinoma. Sve od sada zamijećene razlike, dosada objavljene, u polimorfizmima gena citokina su kontradiktorne, te je čak pretpostavka o etničkoj razlici aktualna. Naše istraživanje koje će prikazati izražaj gena za citokine u bolesnika sa karcinomom prostate je prvo u Hrvatskoj.

We will present our results in treating benign prostate hyperplasia with open prostatectomy, a operation that is slowly beeing forgotten in Europe.

Introduction Extracorporeal shockwave lithotripsy (ESWL) is successful method for treatment of urinary calculi with low complication rate in general population. Less favorable outcome was reported in elderly population. The aim of the study was to investigate success and complication rate of ESWL in patients older then 65 years. Patients and methods Study included 292 patients older then 65 years treated by step-wise ESWL (Siemens Lithostar Plus) during the seven year period (2001-2008). The data were retrieved from prospectively collected medical records and analyzed retrospectively. Demographic data, comorbidities, kidney function, stone characteristics, treatment details, complications (pain, bleeding, uretheric obstruction) and stone free rate (SFR) were analyzed. SFR was determined as complete resolution of stone or presence of asymptomatic residual fragments within kidney less then 4 mm in diameter. Descriptive statistical analysis was performed by SPSS statistical program. Results Patients older than 65 years presented 14.1% of the total of 2067 patients treated by ESWL. The mean age of the patients was 70± 5.33 years (max. 84 years), equally for both genders. Patients were treated by the total of 505 ESWL sessions (mean 1.73± 1.19 per patient, max. 8 sessions). The patients received 3166± 569 impulses per session (min. 1000, max. 5000) with mean energy of 2.8± 0.69 SU (SU- Siemens standard unit) with min. 1.0 and max. 5.0. Most common stone site was in kidney pelvis (38.8%), followed by lower calices in 16.4% and distal ureter in 15.3%. Stones were largest in upper calices (19.4± 10.9 mm), kidney pelvis (16.8± 7.46 mm) and lower calices (11.7± 5.71 mm). In 29.8% of patients JJ stent placement was required prior or after the procedure. Ureterorenoscopy or percutaneus lithotripsy were needed in 6.6% of patients in later follow-up. Comorbidity was present in 69.3% of the patients. Arterial hypertension was the most common (22.5%), diabetes mellitus was found in 9.3%, multiple kidney cysts in 9.3% and malignancy in 4.9%. Overall complication rate was 11.4%. Steinstrasse developed in 8 patients, strong pain needing prolonged hospitalization in 6 and renal subcapsular haematoma in 3 patients. Renal haematomas were treated conservatively. Complication rate was related to older age (p

Introduction & objectives: Hypospadias are one of the most common congenital anomalies in industrialized countries, with incidence of 1 in 125 male births. Currently, the only treatment of hypospadias is surgery and its purpose is not only to produce a good cosmetic appearance or positive psychological effect, but to reduce the risk of infertility in severe forms of hypospadias. The aim of this retrospective study was to present our results of hypospadia repair, with emphasis on operative technique, timing of surgery and complication rate. Material & methods: From 1997 to 2007 we performed 94 primary hypospadias repairs. Median patient age at first hypospadia surgery was 6 years (range 2 to 15). The location of the urethral meatus was glanular in 49 patients (52%), subcoronal in 38 (40%), distal penile in 1, mid-penile in 1 and penoscrotal in 3 patients. One patient had hypospadia sine hypospadia and the urethral meatus remained undetermined in one patient. Of techniques Meatal Advancement and Glanuloplasty (MAGPI) and Mathieu repair were most commonly used, with 48 and 37 procedures, respectively. Three patients with penoscrotal hypospadia underwent two-stage urethroplasty using a buccal mucosa inlay graft. Results: Out of 94 operated patients 78 (83%) had excellent results and were released to house care after 2 to 7 days. Complications were noted in 16 patients, including fistula in 12 patients (13%), hematoma and/or oedema in 2 and other complications in 2 patients. The majority of fistulas occurred after Mathieu repair and were subsequently treated, with good results after single reoperation. Two patients had to undergo up to 4 reoperations due to recurrence of fistula. For MAGPI procedure there was only one fistula (complication rate 2%). Conclusions: Although the diagnosis of hypospadias should usually be made at birth and treatment optimally performed between 6 to 18 months of age, our data suggest that the majority of hypospadias are diagnosed at pre-school physical examination. Such delay may be due to poor education of the parents. However, complication rate found in this study was similar to previously publicized data. Combining our experience in MAGPI and Mathieu procedures with education of population will result in further decrease of complication rate after hypospadias surgery.

The objective of our study was to investigate the prevalence of prostate disease in general male population. Also, an extended analysis of medical history, behavior and hormonal analysis was performed. 1000 candidates were randomly selected out of voluntary male population. 977 of those were included in the study, and 23 were rejected because of incomplete data, unwillingness to be subjected to examination and other reasons. Blood samples were taken from all participants, and a questionnaire and physical examination (with rectal exam) were performed. Based on the results, answers and the examination all participants were divided in four groups. The prevalence of benign prostate hyperplasia was 23.1 %, of prostatitis 5.1 % and of prostate cancer 3.7 %, which is within expected reported values. Family history data provided little specific data. Significant lower urinary tract symptoms were found in both subjects with benign prostate hyperplasia and prostatitis, showing a strong overlap of symptoms. The results indicate that alcohol abuse is strongly related to subjects with prostate cancer, although this relation is not confirmed by all authors. On the hormonal scale we found higher levels of binned testosterone in our subjects with prostate cancer, what is disproved by some authors. Estrogen is found in higher levels and recent reports are showing higher levels of estrogen metabolites in prostate cancer subjects. Also we found lower levels of vitamin D in subjects with benign prostate hyperplasia and prostate cancer. Since vitamin D is known to inhibit cellular proliferation, lower levels are confirmatory, with its loss of protective role against prostate cancer. Our results suggest that male population in Croatia (at least in Slavonia) with prostate diseases is, with all findings taken into account, within limits as compared to populations in developed European countries, but on a lower border. Since the prevalence of investigated diseases is rising throughout Europe we could expect the same trends in our country.