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We report a case of transurethral resection of prostate (TURP) like syndrome of a 56-year-old female patient who underwent elective percutaneous nephrolithotomy (PCNL) under general anesthesia. Hypotonic sodium chloride (NaCl) solution was used in the procedure. 70 minutes intothe surgery end-tidal CO2 (EtCO2) significantly dropped and the patient was first hypertensive, then hypotensive, cyanotic, hypoxicand hyponatremic. Additionally, the patientdeveloped severe postoperative complications including acute renal insufficiency, acute pancreatitis, persistent pleural effusion. The patient alsounderwent necrosectomy procedure due to purulent and necrotic tissue in the lumbotomy incision and the removal of left perirenal abscess and hematoma. Hypotonic NaCl solution used in this PCNL procedure was inappropriate irrigation fluid.

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.

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.

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).

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.

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.

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.

Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia.

Urotelni rak najčešći je rak mokraćnog mjehura. Hematurija je najčešći simptom pri prezentaciji bolesti. Dijagnoza raka mokraćnog mjehura postavlja se uglavnom transuretralnom resekcijom nakon čega slijedi patohistološka dijagnoza. Nužno je utvrditi je li rak zahvatio mišićni sloj (mišićnoinvazivni rak) ili nije (mišićnoneinvazivni rak). Odluka o terapijskome modalitetu ovisi o kliničkom stadiju bolesti, prognostičkim čimbenicima i čimbenicima rizika. Za mišićnoneinvazivni rak mokraćnog mjehura uglavnom se preferira transuretralna resekcija tumora mokraćnog mjehura s intravezikalnom instilacijom Calmette-Guérinova bacila (BCG) ili bez nje. Za invazivni je rak metoda izbora radikalna cistektomija. Radioterapija se rabi u radikalne i palijativne svrhe. Metastatska bolest najčešće se liječi kemoterapijom metotreksat/vinblastin/doksorubicin/cisplatinom (MVAC) ili gemcitabin/cisplatinom (GC). Svrha je ovog članka predstavljanje kliničkih uputa s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnika s rakom mokraćnog mjehura u Republici Hrvatskoj., Urothelial cancer is the most common bladder cancer. Hematuria is the most common presenting symptom in patients with bladder cancer. The most common diagnostics of bladder cancer is performed by transurethral resection of bladder after which pathohistological diagnosis is set. It is necessary to determine whether the cancer penetrated in muscle layer (muscle-invasive cancer) or not (muscle-noninvasive cancer). Decision on therapeutic modality depends on the clinical stage of disease and on prognostic and risk factors. For muscle non-invasive bladder cancer transurethral resection is preferred with or without intravesical instillation of Bacillus Calmette-Guérin (BCG). For invasive cancer the method of choice is radical cystectomy. Radiotherapy is used in radical and palliative purposes. Metastatic disease is most frequently treated by chemotherapy metotrexate/vinblastine/doxorubicine/cisplatin (MVAC) or gemcitabine/cisplatin (GC). The purpose of this article is to present clinical recommendations to set standards of procedures and criteria in diagnostics, treatment and follow up of patients with bladder cancer in the Republic of Croatia.

Cilj istraživanja JJ stent je postao nezaobilazno pomagalo u liječenju brojnih uroloških bolesti. Kao i svako drugo medicinsko pomagalo, JJ stent ima svojih prednosti, ali i mana. Komplikacije JJ stenta su dobro opisane i velika većina nije životno ugrožavajuća. Ipak, u rijetkom broju slučajeva se JJ stent “zaboravi” čime njegovo odstranjivanje, po prestanku potrebe za istim postaje ozbiljan urološki problem. Najčešća tehnička komplikacija JJ stenta je stvaranje enkrustata JJ stenta, čime JJ stent postaje nefunkcionalan. Enkrustati JJ stenta se najlakše sprječavaju promjenom JJ stenta, a osim uloge biofilma i upale, drugi etiološki faktori nisu dovoljno poznati. Cilj istraživanja je bio analizirati predložene etiološke faktore stvaranja enkrustata JJ stenta. Također, cilj istraživanja je bio i provjeriti hipotezu da je kemijski sastav enkrustata JJ stenta istog sastava kao i primarni kamenac, a da u lužnatom urin prevladavaju fosfatni kamenci. Ispitanici i metode U prospektivno istraživanje je uključeno osamdeset ispitanika kojima je tijekom liječenja postavljen JJ stent. Grupa 1. je bila sastavljena od ispitanika u kojih su potvrđeni enkrustati JJ stenta (40 ispitanika), a Grupa 2. su bili ispitanici bez enkrustata na JJ stentu (40 ispitanika). Svi ispitanici su obrađeni standardnim protokolom predviđenim za urolitijazu, s uzimanjem odgovarajućih varijabli. Primarni kamenci i enkrustati su kemijski analizirani termogravimetrijskom metodom i infracrvenom spektroskopijom. Rezultati Ispitanici s enkrustiranim JJ stentom su značajno češće navodili subjektivne probleme, a bakteriološka analiza je značajno češće pokazala pozitivnu urinokulturu u istih. JJ stent je značajno duže bio postavljen u ispitanika s enkrustatima JJ stenta. Nema razlike u grupama po dobi, analizi sedimenta urina, vrijednosti ureje i kreatinina, te po vrijednosti pH. Najčešći tip primarnog kamenca je bio apatit, potom kalcijev oksalat (mono- i dihidrat), te struvit. Analiza sastava enkrustata je pokazala kako sastav enkrustata u većini slučajeva ne odgovara sastavu primarnog kamenca, a apatit je najčešći u grupi enkrustata. Zaključak Trajanje insercije JJ stenta i pozitivna bakteriologija urina su značajno povezane s nastankom enkrustata JJ stenta. Sastav enkrustata JJ stenta u većini slučajeva ne odgovara sastavu primarnog kamenca.

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

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.

Urotelni rak najčešći je rak mokraćnog mjehura. Hematurija je najčešći simptom pri prezentaciji bolesti. Dijagnoza raka mokraćnog mjehura postavlja se uglavnom transuretralnom resekcijom nakon čega slijedi patohistološka dijagnoza. Nužno je utvrditi je li rak zahvatio mišićni sloj (mišićnoinvazivni rak) ili nije (mišićnoneinvazivni rak). Odluka o terapijskome modalitetu ovisi o kliničkom stadiju bolesti, prognostičkim čimbenicima i čimbenicima rizika. Za mišićnoneinvazivni rak mokraćnog mjehura uglavnom se preferira transuretralna resekcija tumora mokraćnog mjehura s intravezikalnom instilacijom Calmette-Guérinova bacila (BCG) ili bez nje. Za invazivni je rak metoda izbora radikalna cistektomija. Radioterapija se rabi u radikalne i palijativne svrhe. Metastatska bolest najčešće se liječi kemoterapijom metotreksat/vinblastin/doksorubicin/cisplatinom (MVAC) ili gemcitabin/cisplatinom (GC). Svrha je ovog članka predstavljanje kliničkih uputa s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnika s rakom mokraćnog mjehura u Republici Hrvatskoj.

Background. Ureteral stent occlusion by encrustation is a major problem in long-term artificial urinary drainage. In this paper are demonstrated results of the investigation the physical chemical analysis of extracted encrustates to the stents for some patients with recurrent urolithiasis. Methods. We analyzed the composition of encrustates to 20 removed double J stents in patients with recurrent urolithiasis. Analysis of the encrustates composition were made by thermogravimetric analysis (Mettler TG 50) and FT-IR spectroscopy (Shimadzu 8400). Results. The results obtained were compared with encrustates compositionof the primary composition of kidney stones by patients previously excreted. Encrustates samples were taken from three different places on the stent to determine sample homogeneity, considering the diversity of environment through which the stent is situated. The results indicate composition diversity of the sample encrustated with the same stent. Analysis composition encrustates revealed struvite and carbonate hydroxyapatite as most frequent minerals. Conclusions. Based on results of analysis of the composition encrustates deposited at the stent in patients with recurrent urolithiasis we can concluded that it is not homogeneus and is not identical with the composition of primary kidney stones who is patients previously extracted.

Geografski prostor ovog istraživanja obuhvaća srednjodalmatinske otoke - Brač, Hvar, Vis, Šoltu i Čiovo s pripadajućim otočićima uključujući Drvenik Veli i Drvenik Mali, Biševo te pučinske otoke Jabuku, Brusnik, Svetog Andriju i Palagružu. U ovom radu se analizira prirodno-geografska osnova prostora i kulturno-povijesno naslijeđe s obzirom na mogućnosti turističkog vrednovanja. Demografski pokazatelji i trendovi razmatraju se u odnosu na razvoj turizma. Na taj način se analizira i socio-ekonomska preobrazba otočkih društava. Sam turizam predstavljen je kratkim povijesnim pregledom te analizom turističkih pokazatelja za svaki otok posebno i otočje u cjelini. Prostorne promjene ponajviše se analiziraju praćenjem promjena u broju stanova i kuća za odmor, te još nekim prostornim pokazateljima. Završna sintetska poglavlja obuhaćaju razradu tipologije naselja prema intenzitetu turisitčkog razvoja, SWOT analizu, pogled u budućnost i zaljučak.

Cilj: Metode neinvazivnoga odstranjivanja mokraćnih kamenaca uvedene su na Klinici za urologiju Kliničke bolnice Osijek u razdoblju 1986.-88. godine. Od 1.07.1988. do 31.12.2009. godine ekstrakorporalnom udarno-valnom litotripsijom (ESWL), perkutanom nefrolitotripsijom (PCNL), ureterolitolapaksijom (URC) liječeno je 10570 bolesnika s urolitijazom. Cilj je ove studije analiza iskustava stečenih njihovom primjenom u Klinici za urologiju KBC Osijek od 1988. godine do danas. Ispitanici i metode: U promatranom razdoblju liječeno je 5831 muškaraca, 4976 žena i 98 djece starih 2 do 79 godina (prosječna dob 42, 23 godine). Urađeno je ukupno 11305 ESWL-a, 262 PCNL-a i 623 URS-a. Rezultat tretmana je procijenjen na osnovi nativnih snimaka urotrakta, UZV pregleda bubrega i laboratorijskih nalaza najmanje tri mjeseca nakon posljednje hospitalizacije. Rezultati: Retrogradnim uvidom u medicinsku dokumentaciju 5542 redovito kontrolirana bolesnika , 73, 83% ESWL-om tretiranih bolesnika ocijenjeno je kao "stone free". Odljevni kamenci uspješno su tretirani monoterapijom ESWL-om 59, 02% bolesnika. Ukupno 132 odljevna kamenca tretirana su isključivo PCNL-om s uspjehom od 75, 28%, a u 130 bolesnika kombiniran je ESWL i PCNL s uspjehom od 82, 61%. URS je primijenjen u 381 (61, 16%) bolesnika s ureteralnim kamencima nakon neuspjeha ESWL-a, dok je u 242 (38, 84%) bolesnika URS bio metoda prvog izbora. Zaključci:Još od samog osnutka civilne Zakladne bolnice u Osijeku 1874. godine možemo pratiti pisane izvještaje osječkih liječnika, kirurga i konačno urologa o odstranjivanju kamenaca mokraćnog sustava. Konačna potvrda o suvremenosti osječke urologije bila je uspješno usvajanje poštednih metoda ESWL-a, PCNL-a i URS-a samo nekoliko godina nakon uvođenja u kliničku praksu tih metoda u vodećim zemljama svjetske urologije.

Urolitijaza, unatoč dugogodišnjim, kako fizikalno-kemijskim i metaboličkim, tako i kliničkim istraživanjima, ostaje i dalje do kraja nerazjašnjen proces u organizmu čovjeka. Mokraćni sustav je nestabilno kemijsko okruženje, prezasićenost s obzirom na uromukoide i kristaloide na površini između biomaterijala i mokraće može dovesti do značajnih problema i komplikacija kao što su npr. migracija, inkrustacija i stvaranje kamenca. Inkrustacija je višesložna, uočeno je da se proces inkrustacije odvija u znatno kraćem vremenu (nekoliko tjedana) za razliku od stvaranja kamenaca koji je dugotrajan proces. Mnoge indikacije povezane s urolitijazom mogu se ukloniti ureteralnim premošćivanjem. Urološki stentovi su inertni sintetski polimerni biomaterijali koji bi trebali omogućiti protok urina, međutim kod osoba koje stvaraju kamence se na njima ipak istaloži inkrustat pri čemu infekcija i inkrustacija su često povezani i jedan od glavnih limitirajućih faktora za dugotrajniju upotrebu ovih biomaterijala u organizmu. Cilj ovoga rada bio je načiniti fizikalno-kemijsku analizu izlučenih inkrustata na stentovima koji se koriste kod različitih uroloških tegoba. Nastali inkrustati sa stenta su uzorkovani i analizirani termogravimetrijskom (TG) analizom i FT-IR spektroskopijom. Inkrustati nisu bili jednoznačni te su uspoređeni sa sastavom primarnog kamenca koji je detektiran kod pacijenata.

Točna i pouzdana analiza kemijskog sastava bubrežnih kamenaca s definiranjem kristalnih komponenti koje se nalaze u sastavu kamenaca preduvjet je za djelotvorno medicinsko praćenje osoba koje stvaraju bubrežne kamence. Ona može značajno olakšati procjenu i tretman u takvim slučajevima. Za utvrđivanje sastava kamenaca koriste se brojne fizikalno kemijske tehnike. FTIR spektroskopija fizikalna je metoda za analizu kamenaca koja koristi sofisticiranu instrumentaciju, a zahtijeva usporedbu uzorka s poznatim standardima. U radu je prikazano dvadesetogodišnje iskustvo kliničkoga laboratorija u IR analizi sastava bubrežnih kamenaca. Glavne kristalne supstance koje se mogu naći u kamencima podijeljene su u šest glavnih grupa: kalcij oksalat, kalcij fosfat, infektivni kamenci, uratni kamenci, cistin i ostali.

Dvostruka J proteza mokraćovoda ili kolokvijalno "JJ" stent tanki je gumeni, plastični ili silikonski kateter koji se postavlja između bubrežne nakapnice i mokraćnog mjehura s ciljem omogućavanja protoka mokraće mimi organskih ili anorganskih prepreka od pijeloureteralnog pripoja uzduž mokraćovoda do vezikoureteralnog ušća. Razjašnjenje uloge biofilma unutar urotrakta objašnjava rekurirajuću struvitnu i apatitnu urolitijazu. Produkcija ureaze i bakterijski polisaharidi dokazani su ključni faktori virulencije bakterija uključeni u stvaranje kamenaca. U ovom radu pokazani su rezultati započetih istraživanja fizičko-kemijske analize istaloženih enkrustata na urološkim stentovima za nekoliko ispitanika. Dobiveni rezultati analize sastava enkrustata nisu bili jednoznačni.

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.

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 & Objectives: Several clinical studies revealed increased bone turnover and lower bone mass in patients with urolithiasis. Bone mass loss is particularly evident in idiopathic calcium stone formers. However, pathogenetic mechanisms and factors implicated in bone loss in these patients are still unknown. Osteopontin (OPN) is a phosphorylated protein of wide tissue distribution, that is found in association with organic matrix of kidney stones. It is a strong inhibitor of crystal formation and growth in vitro, but there is still debate regarding its effects upon crystal adhesion to tubular epithelial cells. OPN influences bone turnover, both by promoting differentiation of osteoclasts and by enhancing osteoclasts activity. Recent studies discovered important role of osteoprotegerin (OPG) and RANKL (receptor activator of NF-kappaB ligand) in bone turnover process, in addition to known effect of some cytokines (such as IL-1, IL-6, TNF) on bone resorption. The objective of this study is to assess changes of cytokines involved in bone turnover and increased bone resorption, as that might play role in bone loss in recurrent calcium stone formers. Material & Methods: Recurrent calcium stone formers were involved in the study and anthropometrical measurements were performed. Ca2+, Mg2+, P, creatinine, Na+, K+, Cl-, proteins, uric acid, alkaline phosphatase, osteocalcin, calcitonin, PTH, 25-OH D vitamin and 1, 25-OH D vitamin were assesed by standard biochemical analysis. IL-1, IL-6, TNF-α , OPG, RANKL and osteopontin serum levels were determined by quantitive enzyme-linked immunosorbent assay (ELISA) according to manufacture’ s protocol (Quantikine, R&D Systems, Inc., Minneapolis, USA). Bone mineral density (BMD ; g/cm2) was measured using dual-energy x-ray absorptiometry (« Lunar Prodigy» ). BMD measurements were performed at the lumbar spine, femoral neck, forearm and total body. Results are presented as bone mineral content (BMC ; g) and bone area (BA ; cm2) Results: Osteopenia was discovered in 27, 8% of recurrent calcium stone formers and 5, 7% had osteoporosis assessed by BMD described above. Kalcitonin and osteokalcin levels were normal in all participants. Vitamin D25 levels were increased in 16, 7% patients with a peak of 213 pmol/ml. PTH ranged from 31, 4 to 131 pg/ml and was increased in 26, 3% of patients. Pyrilinks D was increased in 30, 77% of male participants, whereas in females was increased in 57, 10%. However, crosslaps was increased in 46, 2% of male participants with no significant change in pre- and postmenopausal women. Conclusions: Increased production of cytokines enhances bone resorption and therefore lowers bone mass in patients with idiopathic calcium urolithiasis. Here we have determined factors that could have influenced the changes in bone density in recurrent calcium stone formers, but pathogenetic mechanisms still remain to be evaluated.

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: Past scientific research has undeniably established that the most significant factor causing high mortality and high morbidity rate in patients with chronic renal disease is atherosclerosis. Although different risk factors have a role in atherosclerosis development the most important factors when considering haemodialysis obligated CRF patients were oxidative stress and dislipidemia. Methods: The aim of the study was to measure the effect of haemodialysis treatment on the general antioxidative status of serum with special consideration of the specific oxidizability of lipids and proteins. Indicators for oxidative/nonoxidative status of plasma were monitored at the beginnig and at the end of the haemodialysis. The study was conducted on a group of 59 patients (aged 20-75 ; 32 males and 27 females). These results were compared to control group of 59 people (aged 21-67, 20 males and 39 females). Results: A decrease in antioxidant status was accompanied by increased oxidizability of lipids as well as proteins during hemodialysis. Total antioxidant status was decreased from 1, 69_0, 23 to 1, 48_0, 27 mmol/L ; Homocistein from 28, 1_9, 6 to 20, 0 _ 11, 3 _mol/L ; C-reactive protein from 17, 4_ 26, 6 to 12, 2_ 14, 8 mg/L and Uric Acid from 370, 6_ 71, 2 to 108, 8_ 32, 6_mol/L while there was increase in Albumin concentration from 37, 7_3, 7 to 42, 9_ 5, 9 g/L ; Autoantibodies to oxidized LDL from 413, 1_ 332, 2 to 530, 8_ 371, 2 mU/ml ; HDL-C from 0, 86_0, 25 to 1, 02_0, 3 mmol/L ; LDL-C from 2, 57_0, 81 to 2, 9_0, 98 mmol/L. Conclusion: Our data demonstrate that the sensitiveness of serum lipids and proteins to oxidative modification is severely increased by haemodialysis treatment. Our investigation, also showed presence of the important atherosclerosis risk factors between CRD patients: dislipidemia, homocysteinemia, chronic inflammation and oxidative stress

Dirofilariasis is a helminth infection caused by parasites of the phylum Nematoda, family Onchocercidea, genus Dirofilaria. Aedes, Anopheles, Culex or Mansonia mosquitoes are vectors for this parasite. The parts of the genital tract which are most commonly affected are the testical layers, epididymis and spermatic cord. This is a case of a 21 year old patient presenting with a helminthiasis caused by Dirofilaria repens, who was admitted to our hospital with a swelling nodule below his right testicle. During surgery performed at the Insitute of Urology, Clinical Hospital Center Osijek, a solid formation 1 cm in diameter was found in cauda epididymis, so an ex tempore biopsy was conducted and the specimen was histopathologicaly analysed. Serological tests have also been performed and the preliminary test results confirmed the diagnosis of a Dirofilaria repens infection. Dirofilariasis is very rare in our geographical area. To the authors' knowledge, this is the first case of scrotal dirofilariasis in the northeastern part of Croatia. The clinical importance of this case lies in the fact that the clinical presentation of this helminthiasis may be very similar to testical tumors, so misdiagnosis could be possible. However, since the treatment for dirofilariasis is surgical excision, the disease can be diagnosed after histopathological analysis of the specimen, where the parasite can be found. Finally, serological tests have to be performed to identify the parasite species.

CILJ: Metode neinvazivnog odstranjivanja mokraćnih kamenaca primjenjuju se na Klinici za urologiju Kliničke bolnice Osijek u razdoblju 1986. do 1988. godine. Od 1.07.1988. do 1.07.2004. godine ekstrakorporalnom udarno-valnom litotripsijom (ESWL), perkutanom nefrolitotripsijom (PCNL) i ureterolitolapaksijom (URS) liječeno je 7279 bolesnika s urolitijazom. Cilj je ove studije analiza iskustava stečenih njihovom primjenom u Klinici za urologiju Kliničke bolnice Osijek od 1988. godine do danas. ISPITANICI I METODE: U promatranom šesnaestogodišnjem razdoblju liječeno je 3987 muškaraca, 3216 žena i 74 djece starih 4 do 77 godina (prosječna dob 42, 23 godine). Urađeno je ukupno 9008 ESWL-a, 212 PCNL-a i 399 URS-a. Rezultat je liječenja procijenjen na osnovi nativnih snimaka urotrakta, ultrazvučnog pregleda bubrega i laboratorijskih nalaza najmanje tri mjeseca nakon posljednje hospitalizacije. REZULTATI: Retrogradnim uvidom u medicinsku dokumentaciju 5542 redovito kontrolirana bolesnika, 80, 95% ESWL-om liječenih bolesnika ocijenjeno je kao “ stone free” . Odljevni kamenci uspješno su tretirani monoterapijim ESWL-om u 59, 02% bolesnika. Ukupno 82 odljevna kamenca tretirana su isključivo PCNL-om s uspjehom od 75, 28%, a u 130 bolesnika kombiniran je ESWL i PCNL s uspjehom od 82, 61%. URS je primijenjen u 156 (39, 09%) bolesnika s ureteralnim kamencima nakon neuspjeha ESWL-a, dok je u 243 (82, 61%) bolesnika URS bio metoda prvog izbora. ZAKLJUČCI: Još od samog osnutka civilne Zakladne bolnice u Osijeku 1874. godine možemo pratiti pisane izvještaje osječkih liječnika, kirurga i konačno urologa o odstranjivanu kamenaca mokraćnog sustava. Konačna je potvrda o suvremenosti osječke urologije uspješno usvajanje poštednih metoda ESWL-a, PCNL-a i URS-a tek nekoliko godina nakon uvođenja u kliničku praksu u vodećim zemljama svjetske urologije.

Analiza 14-godišnjeg iskustva u primjeni izvantjelesno-valne litotripsije u liječenju kamenaca mokraćnog sustava uz komparaciju s drugim metodama (perkutana nefrolitotomija, transuretralna litolapaksija, otvoreni operacijski zahvati).

A total of 142 war injuries to the urogenital organs in 115 of 4425 wounded patients were treated at our clinical hospital during 18 months of warfare in Osijek, Croatia. Kidney injury was the most common (64 cases) and urethral injury (4) the least common, with a relatively large number of urethral injuries (11). Twothirds of the injuries were associated with other trauma, most frequently abdominal injuries. The mortality rate was high (15,6%), explained by the proximity of the battlefield and resulting rapid patient transport (average 52,2 minutes), which excluded the possibility of separating out the moribund cases, as well as the exceptional destructive power of modern explosives and firearms, and associated wounds of the vital organs. Of the wounded, 60 % were members of the Croatian armed forces, 1 was a member of the United Nations Professional Force and 39,1% were civilians. Surgical intervention was characterized a tendency towards conservation and the avoidance of organ sacrifice. Thus, nephrectomy was performed in only one quarter of the cases of renal injury. Nevertheless, orchiectomy was performed in two-thirds of the cases of testicular injury. In 5 of 8 cases of corpus spongiosum, injury to the tunica albuginea was primarily reconstructed with free transplantation of the fascia lata. For urethral injury,resection with primary suture yielded good results in contrast to stents without resection in cases of urethral wall contusion, which resulted in urethral stenosis in our patients.

Die Behandlung der Urolithiasis bei Kinder unterliegt den gleichen Prinziprn wie bei alteren Patientengruppen. Die ESWL stellt die Therapie der Wahl in der konservativen Behandlung von Harnsteinen bei Kindern dar. In diser Untersuchung berichten wir uber unsere Erfahrung mit der ESWL bei Kindern uber einen Zeitraum von 10 Jahren zwischen 1986 und 1996. Wahrend dieser Zeit wurden in unserer Klinik 5000 Patienten mit ESWL behandelt. Darunter waren 38 Kinder (0,76%). Unter den so behandelten Kindern waren 23 mannlich (61%) und 15 weiblich (39%). 27 Kinder oder 72% waren zwischen 10 und 15 Jahren alt. Mehrere Konkremente wurden bei 5 Kindern gefunden und in 4 Fallen lagen Ausgušsteine vor. Die Verteilung der Konkremente war folgendermasen: Kelchsteine n=17 (44,7%), pyeloureteraler Ubergang n=2 (5,3%), Nierenbecken n=11 (28,9%) und Ureter n=9 (23,7%). Kalziumsteine wurden bei 84,3% der Falle gefunden, 10,5% der Patienten litten an Zystinsteinen und bei 5,2% lagen Harnsaurekonkremente vor. Insgesamt fuhrten wir bei den Kindern 48 ESWL durch. Allgemeinanasthesie wurde bei 12 Kindern oder 31,6% benotigt, bei 6 Kindern waren Sedativa und Analgesie notwendig, 20 Kinder oder 52,6% benotigten lediglich Analgesie. Bei 9 Kindern (23,7%) wurden zusatzlich Eingriffe benotigt. Bei 6 Kindern war vor ESWL die Anlage eines Doppel-J-Stents notwendig, in einem Fall wurde das Konkrement aus dem Harnleiter ins Nierenbecken luxiert, bei 2 Kindern wurden eine retrograde Ureterographie durchgefuhrt. Komplikationen nach ESWL-Behandlung im Sinne einer Steinstrase fanden sich bei 5 Patienten (13,1%). 3 Patienten wurden konservativ behandelt, bei einem Kind wurden eine Doppel-J-Anlage notwendig, in einem Fall wurde eine chirurgische Intervention notwendig. Nach 6-monatiger Beobachtungszeit waren 89% Patienten, die mit ESWL behandelt wurden, konkrementfrei. Unsere Erfahrung zeigen, das die ESWL die Therapie der Wahl bei Urolithiasis von Kindern ist.

Introduction: ESWL treatment of urinary stones in children is based on same principles as in adults. The ESWL je treatment of choice when conservative approach failed. MATRERIALS& METHODS: Since 1986 until 1998 at our department 6000 patients were treated with the ESWL. Among them 48 patients (0, 8%) were children, most of them or 33 were between 10 and 15 years old. RESULTS:In our children group we treated 26 calceal, 16 pyelon, 5 pyeloertheral segment and 11 uretheral stones. In 48 patients we perfomed 68 ESWL sesions. Treatmens were performed in general anaesthesia in 15 cases (31, 25%), in 24 only analgesia and in 9 sedation and analgesia.Supporting procedures were used in 11 patients (22, 9%) in 7 (14, 5%) cases "JJ" stent, "push and bang" in 2 (4, 2%) and retrograde catheter plus contrast in 2 (4, 2%) cases. Complication like "steinstrasse" were found in 7 patients (14, 58%). In 4 patients this complication were treated by conservative approach and in 3 patients by placing "JJ" stent.Febrile reaction was present in 5 patients. CONCLUSION: The average unmber of ESWL sessions for stone treatment were 1, 42. After 6 months of follow-up 89, 7% of patients were stone free. In our group of patients ESWL was successful method of urinary stone removal with very low incidence of complications.

Die Behandlung der Urolithiasis bei Kindern unterliegt den gleichen Prinzipen wie bei alteren Patientengruppen. Die ESWL stellit die Therapie der Wahl dar in der konservativen Behandlung von Harndzrinrn bei Kindern. In dieser Untersuchung wir uber unsere Erfahrungen mit der ESWL bei Kindern uber einen Zeitraum vor 10 Jahren zwischen 1986 und 1996. Wahrend dieser Zeit wurden in unserer Klinik 5000 Patienten mit ESWL behandelt. Darutner waren 38 Kinder (0, 76%). Unter den so behandelten Kindern waren 23 mannlich (61%) und 15 weiblich (39%). 27 Kinder oder 72% waren zwischen 10 und 15 Jahren alt. Mehrere Konkremente wurden bei 5 Kindern gefunden und in 4 Fallen lagen Ausgusteine vor. Die Verteilung der Konkremente war folgendermašen: Kechistein n=17(44, 7%, Pyeloureteraler Ubergang n= 2 (5, 3%), Nierenbecken n=11 (28, 9%) und Ureter n=9 (23, 7%). Kalziumsteine wurden bei 84, 3% der Falle gefunden, 10, 5% der Patienten litten an Zystinsteinen und bei 5, 2% lagen Harnsaurekonkremente vor. Insgesamt fuhrten wir bei den Kindern 48 ESWL durch. Allgemeinanasthesie wurde bei 12 Kindern oder 31, 6% benotigt, bei 6 Kindern waren Sedativ und Analgesie notwendig, 20 Kinder oder 52, 6% benotigten lediglich Analgesie. Bei 9 Kindern (23, 7%) wurden zusaltzliche Eingriffe benotigt. Bei 6 Kindern war vor ESWL die Analge eines Doppel-J-Stent notwendig, in einem Fall wurde das Konkrement aus dem Harnleiter ins Nierenbecken luxiert, bei 2 Kindern wurde eine retrograde Ureterographie durchgefuhrt. Komplikationen nach ESWL-Behandlung im Sinne einer Steinstrase fanden sich bei 5 Patienten (13, 1%).3 Patienten wurden konservativ behandelt, bei einem Kind wurde eine Doppel-J-Anlage notwendig, in einem Fall wurde eine chirurgische Intervention notwendig. Nach 6-monatiger Beobachtungszeit waren 89% der Patienten, die mit ESWL behandelt wurden, konkrementfrei. Unsere Erfahrungen zeigen das die ESWL die Therapie der Wahl bei Urolithiasis von Kindern ist.

Au cours des 18 mois de guerre en Croatie, de mai 1991 a novembre 1992, 4425 blesses ont ete soignes a l hopital cliniqu d Osijek en Croatie. 115 (2,6%)avaient des blessures des organes uro-genitaux dont 32 (27,8%) des lesions genitales. Ces dernieres ont ete traitees immediatement apres avoir soigne les lesions viscerales associees. En matiere de chirurgie, une attitude conservatrice fut adoptee de principe. Ainsi, tes testicules blesses ont put etre preserves dans pres de la moitie des cas. Une greffe libre d aponevrose du muscle droit sur la perte de substance de l albuginee donne de bons resultats immediats, mais sa distension secondaire altere le resultat esthetique et rend l erection difficile.

During 18 months of the 1991-1992 war against Croatia, 4425 injured were treated at the Department of Surgery, Osijek University Hospital. Among them 46 had tendon injuries, 20 with tendon laceration and 26 with total rupture. In 12 wounded primary repair was performed, 4 of an extensor tendon, 7 of a flexor tendon and 1 of both flexor and extensor. Four patients with primary flexor tendon repair had a good functional result. In other 34 no primary repair was done. Good function was achieved in 18 cases.

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.

Incidencija umetnutih stranih tijela u donji urogenitalni trakt jest niska. Strana tijela su najčešće samostalno umetnuta, a kao motivi se navode autoerotska stimulacija, seksualna radoznalost, seksualna eksperimentiranja i često su povezani sa poremećajem mentalnog zdravlja. Liječenje je određeno veličinom, lokacijom, oblikom i pokretljivošću stranih tijela, a najčešće se uspiju ukloniti endoskopskim zahvatima. Mi prikazujemo slučaj 87-godišnjaka sa stranim tijelom u penilnoj uretri koji se nije uspio riješiti endoskopskim putem već je bio potreban operativni zahvat.

Traumatske ozljede vanjskih spolnih organa u muškaraca rijetko su smrtonosne, ali mogu imati trajne posljedice na kvalitetu života. S obzirom na usku povezanost spolnog i mokraćnog sustava, najčešće istovremeno nastaju i ozljede uretre. Zbog visokog rizika od razvoja infekcija ozljeđenog područja i velike važnosti očuvanja funkcije mokrenja, plodnosti i seksualne funkcije ove ozljede predstavljaju ozbiljan urološki problem koji zahtjeva hitan urološki tretman. Razumijevanje anatomije, mehanizma nastanka ozljeda, kliničkih znakova i simptoma te poznavanje mogućnosti liječenja od presudne je važnosti za uspješno liječenje. Konzervativno liječenje može biti prikladno u pojedinim situacijama. Međutim, brzi kirurški tretman često je obavezan kako bi se smanjile komplikacije, utvrdio točan opseg ozljeda te povećala uspješnost liječenja. Danas prevladavaju ozljede zadobivene u sportskim nesrećama i to na prvom mjestu one iz bicikliranja, a potom slijede košarka, nogomet, bejzbol i hokej. Prikazujemo slučaj 62-godišnjaka hospitaliziranog na Zavodu za urologiju KBC Osijek koji je nakon pada sa bicikla zadobio ozljedu korijena penisa i skrotuma.