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Darbo tikslas. Įvertinti KT radinių, esant inksto sužalojimui, ryšį su klinikine inksto plyšimo išraiška. Tyrimo medžiaga ir metodai. Į tyrimą įtraukti pacientai, kurie 2011–2013 metais buvo gydyti Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (LSMUL KK) Urologijos klinikoje dėl inkstų sužalojimo (n = 21). Atlikta retrospektyvinė pacientų ligos istorijų analizė bei peržiūrėti ir išanalizuoti šių pacientų pilvo KT vaizdai. Pagal rastus pokyčius KT vaizduose nustatyti inkstų plyšimo laipsniai ir išmatuoti apytiksliai retroperitoninio tarpo hematomų tūriai. Inksto plyšimo laipsnis buvo vertintas remiantis Amerikos traumos chirurgijos asociacijos („American Association for the Surgery of Trauma“) gairėse 1987 metais pateiktais kriterijais. Vertintas KT vaizduose nustatytų patologinių pakitimų ir inkstų pažeidimo laipsnio ryšys su klinikiniais sužalojimo požymiais (anemija ir nestabilia hemodinamika). Rezultatai. Pirmojo laipsnio (I°) inksto plyšimų nustatyta nebuvo, 19 proc. (n = 4) nustatytas II°, 28,6 proc. (n = 6) – III°, 33,4 proc. (n = 7) – IV°, 19 proc. (n = 4) – V° inkstų plyšimas. Gautas statistiškai patikimas (p < 0,05) stiprus teigiamas (r = 0,772) ryšys tarp KT vaizduose nustatyto inksto plyšimo laipsnio ir retroperitoninio tarpo hematomos tūrio. Vertinant ryšį tarp paciento amžiaus ir inksto plyšimo laipsnio gautas statistiškai patikimas (p < 0,05) silpnas neigiamas (r = -0,44) ryšys. Pacientų (n = 16), kurių hemodinamika buvo nesutrikusi, vidutinis retroperitoninio tarpo hematomos tūris buvo reikšmingai mažesnis nei pacientų (n = 5), kurių hemodinamika buvo sutrikusi (atitinkamai 783,81 ml, nuo 103,6 iki 2031,8 ml, 1464,88 ml, nuo 586,1 iki 2141,1 ml). Išvados. Tiriamojoje grupėje dažniausi sužalojimai buvo IV° inksto plyšimai. Rečiau pasitaikė II°, III° ir V° inksto plyšimai. I° inksto plyšimo nebuvo. Sunkesnis inksto sužalojimo laipsnis lemia gausesnį kraujavimą į retroperitoninį tarpą ir sunkesnės anemijos išsivystymą. Jaunesniems pacientams yra nustatomi sunkesni inkstų sužalojimai.

Introduction The aim of study was to establish pretreatment and postoperative factors which could predict the early biochemical recurrence after radical prostatectomy. Materials and method 754 patients had undergone radical prostatectomy since January 2002 to December 2008 in our department and were included in this prospective study. Exclusion criteria were: neoadjuvant or adjuvant treatment (radiation or hormonal treatment) and N+. Following parameters were evaluated: age, PSA at time of biopsy, time period from biopsy to operation, biopsy and postoperative Gleason score, stage, high grade intraepithelial neoplasias, perineural invasion. Biochemical recurrence was detected if PSA value after radical prostatectomy was ≥0.2 ng/ml. All factors likely to be predictive were evaluated by univariate analysis (Log-rank test). Multivariate analysis using Cox model was completed for all factors with p value 10 ng/ml (HR 2.45, p = 0.008), pathological stage ≥pT3 (HR 2.371, p = 0.02), postoperative Gleason score ≥7 (HR 2.149, p = 0.049), positive surgical margins (HR 2.482, p = 0.014) and absence of high grade intraepithelial neoplasia in removed prostate (HR 0.358, p = 0.006) are independent factors influencing biochemical recurrence after radical prostatectomy. Conclusion Patients with higher PSA, locally advanced disease, positive surgical margins, and Gleason score ≥7 are at the highest risk for biochemical recurrence.

Our purpose was to evaluate the relevance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients. Material and methods. Our study included 195 men at high risk for prostate cancer (elevated prostatespecific antigen level and/or abnormal prostate detected by digital rectal examination). We consulted the patients in outpatient department of Kaunas University of Medicine Hospital during 2003–2007. We performed transrectal ultrasound-guided laterally directed sextant prostate biopsy in every patient. For the patients with benign histological findings and increased risk of prostate cancer, laterally directed sextant biopsies were repeated. Results. Prostate cancer was detected in 30.3% of patients (59/195) on the first prostate biopsy, in 13.1% (11/84) on the second prostate biopsy, in 10.3% (4/39) on the third, and in 7.7% (1/13) on the forth biopsy. After all biopsies, prostate cancer was detected in 38.5% (75/195) of patients, and it differed significantly from the percentage of prostate cancer cases detected on the first biopsy (30.3%, P=0.04). We detected 78.7% (59/75) of all prostate cancer cases by the first laterally directed sextant prostate biopsy. The rest 21.3% (16/75) of cases we detected by repeat biopsies. The second laterally directed sextant prostate biopsy revealed additional 14.6% (n=11) of prostate cancer cases and increased the detection of prostate cancer to 93.3% (70/75). At the time of the first prostate biopsy, prostate cancer was diagnosed most frequently when patients had both risk factors: elevated prostate-specific antigen level and abnormal digital prostate examination, prostate cancer was diagnosed in 45.3% of these patients. The odds ratio to detect prostate cancer by the first biopsy in patients with elevated prostate-specific antigen level and abnormal digital prostate examination was 3.7, and odds ratio to detect prostate cancer by repeat biopsies was 4.7. Conclusions. Repeat ultrasound-guided laterally directed sextant prostate biopsies reveal more cases of prostate cancer as compared to the first prostate biopsy. The majority of prostate cancer cases (93.3%) are detected by the first and second laterally directed sextant prostate biopsies. After the first negative prostate biopsy, we recommend to repeat prostate biopsy in high-risk patients.