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Introducere: Sindromul nefrotic (SN) este asociat cu o incidenţă crescută a complicaţiilor tromboembolice datorită multiplelor anomalii ale sistemul coagulării şi al hemostazei întâlnite la aceşti pacienţi. Ne-am propus sa evaluăm prospectiv riscul evenimentelor venoase tromboembolice (ETV) intr-o cohorta mare de pacienţi cu sindrom nefrotic şi să identificăm factorii predictivi pentru apariţia evenimentelor tromboembolice venoase, în special parametrii legaţi de hemostază. Material si metode: Am efectuat un studiu prospectiv observaţional incluzând consecutiv pacienţi adulţi cu nefropatie membranoasă idiopatică confirmata bioptic şi sindrom nefrotic. Diagnosticul de sindrom nefrotic a fost confirmat prin prezenţa unei proteinurii de peste 3,5 g/ zi. Datele clinice şi biologice, inclusiv parametrii legaţi de sistemul coagulării şi cel fibrinolitic, au fost monitorizate la fiecare 6 luni de-a lungul perioadei de urmărire. Apariţia evenimentelor tromboembolice venoase a fost end-point-ul primar al studiului. Rezultate: Am înrolat 56 de pacienţi (52±11 ani, 64% bărbaţi). Perioada medie de urmărire a fost de 12 [IQR: 12, 33] luni. De-a lungul perioadei de urmărire am înregistrat 11 ETV, 91% din ele apărând în primele şase luni de urmărire. Proteinuria de baza şi albumina serică au fost asociate cu ETV (p

Introduction and Objectives. In 1983, prostate cancer patients were treated for the first time by Holm et al with permanent placement of 125I seeds inserted transperineally directly into the prostate. The objective of this study was to assess the efficacy of brachytherapy with permanent 125I seed implantation for the treatment of localized prostate cancer -- long-term results. Materials and Methods. Between October 2006 and December 2011, a total of 177 patients with prostate cancer were treated with permanent 125I implantation brachytherapy. This technique was applied as monotherapy for 168 patients, who had favorable prognosis according with ABS recommendations (stage T1c-T2a, Gleason < 7, PSA < 10 ng/ml). Results. Procedure time of 1.5 hours to 3 hours. Indwelling urinary catheter was withdrawn in the second day. Hospitalization period was no longer than 24 hours. PSA values at 6 weeks post-implant decreased with 40% in all patients. At 6 weeks and then at 3 months showed urinary morbidity grade I and II in 30% patients without any rectal toxicity. At the 36-months follow-up, 5 patients reported late rectal toxicity. In 85% of cases the erectile function was acceptable. Conclusions. Prostate brachytherapy using permanent I-125 seed implantation is a viable alternative to radical prostatectomy or external beam radiation therapy for the treatment of localized prostate cancer. [ABSTRACT FROM AUTHOR]

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

Introduction and Objectives. Prostate-specific antigen levels after brachytherapy may fluctuate and increase temporarily without a clear reason in some of the successfully treated men. The phenomenon is called "PSA bounce" and it was first described in 1997 by Wallner et al. The purpose of the study is to evaluate PSA levels at the 60 month follow-up after prostate brachytherapy - permanent prostate implant with 125I, for patients with and without PSA bounce phenomenon. Materials and Methods. Between October 2006 and December 2011, a total of 168 patients with prostate cancer were treated with permanent 125I implantation brachytherapy, in stage T1c-T2a. PSA bounce is defined as a temporary increase in PSA value followed by a consecutive decrease recorded with the same value before the increase or a lower value. Results. The average magnitude of the bounce was 0.8 ng/ml with values between 0.1 and 4.1 ng/ml. Mean time to bounce was 17 months. At the 60-month follow-up, 83% of patients had PSA values lower than 1 ng/mL and 17% higher than 1 ng/mL. Conclusions. A bounce definition of a rise ≥ 0.2 ng/mL is a reliable definition, to use as a threshold. PSA bounce is a common phenomenon after prostate brachytherapy and should be always considered whenever we have a patient with rising PSA after implant. [ABSTRACT FROM AUTHOR]

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

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

Introduction: Since the beginning, when proteomics has demonstrated it's ability to characterize a large number of proteins, their measurement and post-translational modifications, this has been applied in various fields of science. Objective: The objective of the present work is to demonstrate the prognostic value of biomarkers and to select those biomarkers with an impact on the evolution of patients after prostatectomy with radical intent Protocol design: A total number of 218 patients were considered, prospectively, from June 2011 - January 2014, this group fully respecting the inclusion and exclusion criteria. Data extracted from the selected patient records were organized first in an Excel date base. Through successive filtering and sorting were identified and completed the missing or incorrectly transcribed data. After ensuring data consistency, they were imported into SPSS Statistics 17.0.program Results: We can observe that for Telomerase and Hepsin confidence intervals for the odds ratio are between 0,490 and 1,964 between 0,570 and 3,549 respectively. Containing the value 1, the two parameters have no prognostic power. Interleukin 6 has the highest prognostic power, when exceeding the threshold value with an odds ratio of 3.269 , then with close values, the Vascular Endothelial Growth Factor with Odds Ratio of 2.24 and Transforming Growth Factor beta fraction 1 with Odds Ratio of 2.21. By removing the two prognostic powerless biomarkers the correct classification model of this capsular penetration is improved from 68.3% to 69.3%. Conclusions: We found a strong link between increasing the value of a single biomarker above the cuoff value and the presence of capsular penetration and a very strong link between increasing values above the cutoff of 3 parameters, the Odds Ratio being equal with 10.65 and an interval between 3.62 and 31.31. We consider that this paper has a consistent dose of originality, the scientific context being favorable to the development of predictive models and concept of "individual medicine". Acknowledgement: This paper is supported by the Sectorial Operational Programme Human Resources Development (SOP HRD) 2007-2013, financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/107/1.5/S/82839. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Post-implantation dosimetric evaluation after prostate brachytherapy performed at 1 month after procedure is recommended as the standard assessment of the quality of permanent interstitial implantation used for the treatment of prostate cancer, conform ESTRO-EORTC guidelines. This study makes a comparative analysis of dosimetric outcome of 129 patients with clinically localized prostate cancer treated with I-125 permanent implantation using an intraoperative real-time conformal planning technique vs. post-implantation dosimetric outcome, in Institute "Prof. Dr. A. Trestioreanu" and Clinical Institute Fundeni, Bucharest. Also we evaluated the indications, the advantages and the limits of real-time and post-implantation dosimetry. [ABSTRACT FROM AUTHOR]

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

Introduction and aim Cryptorchidism or undescendent testis is a very common anomaly of the male genitalia, affecting 2% - 4% of male infants and about 30% in premature infants. The choice between orhiectomy and orhidopexy for uni/bilateral cryptorchidism in adolescents and young adults is still a debate in the urological practice. The aim of the study was to report a case of a young adult with bilateral cryptorchidism. Method and patients A case of 21 years old male with bilateral cryptorchidism is presented. The sperm analysis shown azoospermia and the level of plasma testosterone was at the lower border - 10.96 nmol/L (normal range 9.9 - 27.8 nmol/L). Contrast enhanced abdominopelvin computed tomography located left testicle in the upper third of inguinal canal and right testicle in the abdomen. The testicles were about the same size (3.8/2.2 cm on the left and 3.4/2 on the right). A standard orhidopexy on left side and, after 2 weeks, testicular autotransplantation on the right side was performed. Result 2 weeks postoperative check-up revealed the left and right testicle at the upper and, respectively, at the base of the scrotum. Doppler ultrasound detected peek systolic speed of 7.62 cm/sec and 31.64 cm/sec in the left, respectively, right testicle. Conclusion For a high level undescendet testis (into the abdomen or in the upper part of inguinal canal) the best aproach in order to achieve a good cosmetical aapearance of the genitalia and a good prezervation of testicular function is testicular autotransplantation. [ABSTRACT FROM AUTHOR]

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

Background and aims: The evaluation of the urinary and rectal toxicity after iodine -125 permanent implant, establishing any correlations between urinary and rectal toxicities and clinical and dosimetrical parameters. Methods: This prospective study analyses the data from 83 patients with localized prostate cancer who performed permanent implant with I-125 brachytherapy (BT), between October 5th 2006 and February 15th 2007, at The Oncology Institute, Bucharest and at The Fundeni Clinical Institute. The mean age was 65.96 years old. The uniform modified implant technique, was used for the implantation of seeds; 75 and 8 patients performed monotherapy and concomitant treatment, brachytherapy and external beam radiotherapy, respective. Because of the difficulty in establishing the biological equivalent doses, in a comparative way, for the patients treated with permanent implant as monotherapy, and for the patients treated with simultaneous therapy, we evaluated separately the patients who performed monotherapy and combined therapy. The following parameters have been analyzed, pre-implant prostate volume, number of implanted seeds, number of used needles, D90, V100, V150, V200, D1 at urethra, D1 at rectal mucous, in order to identify the predictive factors for urinary toxicity. Results: The average follow up was at 19 months (range 12-28 months). The prevalent symptomatology was urinary, the most important clinic features were: nocturia, dysuria, and urgency. None patient presented urinary incontinence. In the firsts three months, 50.66% of patients presented grade 1 urinary toxicity, 37.33% of patients presented grade 2 urinary toxicity and acute urinary retention occurred at 2 patients (2.67%). Grade 1 rectal toxicity, in the first 3 months, presented 4 monotherapy patients and 5 combined therapy patients. One patient presented rectal toxicity either in monotherapy group and combined therapy group. Univariate and multivariate analysis showed one single predictive factor for grade 2 urinary morbidity being preimplant prostate volume (p<0.05). Conclusions: In our study, acute urinary toxicities were mild/moderate with maximum intensity in the firsts 3 months and with a greater incidence of rectal morbidity in combined therapy group. [ABSTRACT FROM AUTHOR]

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