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Biti će prikazan program transplantacije bubrega na Klinici za urologiju KBC-a Osijeka, odnosno rezultati rada "najmlađeg" transplantacijskog centra u Hrvatskoj, od 2007. do 2013. godine.

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.

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.

Introduction: Both bladder cancer or cancer of kidney collecting system and urether have always been a specific issue at our department. An incidence of bladder cancer is on high rise in last few years in Croatia showing a 2-3 fold rise in number of new cases. Relatively known toxic agents that can cause bladder cancer, together with better understanding of gene aberrations have given us a needed perspective of this problem. Symptoms are relatively specific, and what is more important are very obvious. A wide spectrum of treatment options can assure us that every patient will get best and specific care for its disease, modeled by every patient life style and of course a disease itself. An endemic nephropathy is a disease specific for our region and it’ s shown that a greater risk for urothelial carcinoma is common with this condition. All above is a warning for better control and understanding of our patients treated for bladder or collecting system urothelial cancer. Materials and methods: Operating protocols, patient’ s charts, ambulance charts and other associated material of each operated patient at our clinic has been used. We included in our analysis selected tumors: 1.Urothelial cancers of the kidney in last 10 years. 2. Cancer of the bladder in last 10 years for those treated with TUR and in last 20 years for those treated with cystectomy. Results: A total of 84 patients have been operated for urothelial tumor of kidney collecting system and urether with average age of 70, 2 years for all patients, average age is same for male and female patients, and slight predominance of female patients (52 F: 31 M). In all patients a transitiocellulare carcinoma was found. Transurethral resection, electro coagulation or cystectomy due to bladder cancer was reason for operation in 1079 cases. In 41 patients a cystectomy was performed with high predominance of male population (34 vs. 7 female) with average age 58, 6 years. Formation of ileum conduit was done in 34 patients ; one neo bladder was made, while other types of urine derivation were done (Coffey, ureterocutaneostomy) in 6 patients. A transitocellulare carcinoma was found in 81, 5 % and in 18, 5% a planocellulare carcinoma. Total of 1038 operations was made by means of transurethral resection or electro-coagulation (EC). Of those TUR was made in 802 cases and EC in 236 cases, EC is in more then 85% done when a small recidive tumor is found. We had high predominance of male population in sample: 619 male patients and 183 female. Average age of those treated by TUR or EC was same: 66, 3 years. Grading and TNM staging for patients treated with different types of operations is shown on table 1. and table 2. In 10, 5% of patients treated with cystectomy a positive regional lymph nodes were found. We had two postoperative deaths in patients with cystectomy performed. Recurrence rate is over 60%. Discussion: Incidence of bladder cancer is not high, but it is on constant rise. We have a small but constant number of 2-3 cystectomies per year. More than one fact is account for that: long preclinical period of disease, following co morbidity, patients’ refusal to a radical procedure… In those in whom we perform a radical operation, often a local invasion is found thus making ileum conduit ideal choice for urine derivation. All data for bladder cancer are as expected, but recurrence rate of 60% is somewhat higher then cited (1, 2, 3). Explanation for a high recurrence rate can be found in different postoperative therapy protocols within hospitals, since a significant number of outside patients are treated within our clinic, but discharged for later care in primary hospital. A large number of urothelial carcinomas of kidney collecting system and urether could be explained by presence of endemic uropathy in our region (1, 2).

Učinjena je analiza transuretralnog liječenja raka mokraćnog mjehura na našem odjelu u periodu od 1004-2003. Analiza proširenosti, TNM klasifikacije, histološkog nalaza, operativnog zbrinjavanja i komplikacija je učinjena. Naši rezultati su u okviru svjetski prihvaćenih normi uz nešto veću učestalost uznapredovalih stadija bolesti.

Aims: To analyze performed nephrectomy in our clinic due to renal cancer diagnosed in our patients, retrospectively and to begin forming Cancer Registry to support future studies and patients follow up. Materials & methods: Data was obtained from patient's history, laboratory findings, imaging procedures, pathologist remarks and ambulance charts to asses survival rates. All patients underwent surgery in our clinic and all procedures were performed by different departments of our hospital. Results: Total of 269 patients were operated for parenchymal renal cancer in given period of time. Of those 114 patients were females and 155 male, with female to male ratio of 1:1, 36. Average age at the time of operation was 61 years, male population slightly older (61, 5 years) than females (60, 5 years).Also we measured size of tumor but classified by type of procedure (simplex or radical nephrectomy), measuring 6, 9 cm (in largest dimension) for radical nephrectomy and 7, 7 cm for simplex nephrectomy. Predominant stage in our patients wasT1, with T3 as second and of those 17% patients presented with distant metastases (M1) at the time of operation. In 91% of our patients clear cell renal cancer was pathological finding with only sporadic finding of other type of tumors such as oncocytoma, sarcoma and some benign forms. In 269 operated patients, clinically significant complications showed in only 10 patients, prolonging hospital treatment or needing intensive treatment, of those with lethal outcomes. Survival rates are also presented classified by type of procedure (simplex/radical). Conclusion: This retrospective study stands as baseline in our attempt to create a Cancer Registry by our department, helping us to choose best and needed treatment for each patient. Also, as said before this is a first review with more to come in future.

U radu je ispitan funkcijski kapacitet bubrega prije i nakon nefropeksije radionuklidnim testovima. Ispitano je 86 bolesnica. Rezultati su pokazali da nakon nefropeksije nestaje mobilnost bubrega, renalni plazmatski protok operiranog bubrega u ortostazi značajno raste, smanjuje se učestalost boli i uroinfekta i nestaje oscilatorna hipertenzija.

The aim of this study is to asses the diagnostic value of PSA in follow-up in the group of 59 patients who receive antiandrogene therapy. All of the patients have skeletal dissemination of the prostate cancer which is demonstrated by the skeletal scintigraphy.

A thousand urolithiasis patients were treated by the method of extracorporeal shock wave lithotripsy using a Siemens Lithostar second-generation lithotriptor. Data obtained three and six months after the treatment were analyzed. The study group comprised 518 males and 482 females, mean age 45.25 years. Medication with analgetics and occasionally sedatives was required in 9.6% of patients. Anesthesia was administered only in children, and when the method was combined with percutaneous nephrolithotripsy or ureterorenoscopy (22 patients). Out of 1194 stones, 27, 81% were situated in the renal pelvis and pelvicoureteral segment, 39, 29% in calices, and 22.01% in the ureter. More than three stones in the pelvis pelvicoureteral segment, 39, 29% in calices, and 22, 01% in the ureter. More than three stones in the pelvis and calices of the same kidney were regarded as multiple stones and registeree as a single case (4, 52%). There were 6, 37% of staghorn stones. The sccess rate of nearly 90% coincided with the results reported by other authors and once again presented extracorporeal shock wave lithotripsy as a method of choice in the treatment of urinary stones.

Ispitivanjem učestalosti urolitijaze u 186 radnika, koji rade na povišenoj temperaturi (35°C ili više), našli smo 10 bolesnika sa urolitijazom (5, 4%). U kontrolnoj grupi radnika koji rade na temperaturi nižoj od 25°C, učestalost urolitijaze je manja i iznosi 14 bolesnika na 584 ispitanika (2, 3%). Razlika u učestalosti urolitijaze je statistički značajna (p