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

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

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

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

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

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

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

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

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

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