Cilj: Prikazati učestalost i raspodjelu kalcificiranosti ilijačnih arterija u pacijenata u kojih je učinjena transplantacija bubrega u našem transplantacijskom centru. Ispitanici i metode: ...Retrospektivnim istraživanjem bili su obuhvaćeni pacijenti u Kliničkom bolničkom centru Rijeka u kojih je između 1. siječnja 2015. godine i 31. prosinca 2018. godine učinjena transplantacija bubrega. Procjena kalcificiranosti ilijačnih arterija učinjena je uz pomoć kompjutorizirane tomografije (CT). Rezultati: U promatranom razdoblju u našem transplantacijskom centru učinjeno je 115 transplantacija bubrega, a 92 (80 %) pacijenata imalo je prijeoperacijski CT. Prosječna dob pacijenata bila je 60,3 godina, a 26 % pacijenata je imalo šećernu bolest kao osnovnu bolest. Arterijske kalcifikacije pronađene su u 72 (78 %) pacijenata. Kalcifikacije su najčešće pronađene na desnoj zajedničkoj ilijačnoj arteriji (63 pacijenata – 68,5 %), a najrjeđe na lijevoj vanjskoj ilijačnoj arteriji (23 pacijenta – 25 %). Zaključak: Većina naših pacijenata ima prisutne kalcifikacije na ilijačnim arterijama. Prijeoperacijsko utvrđivanje njihove raspodjele i proširenosti ima važnu ulogu prilikom planiranja transplantacije bubrega.
Aim. To evaluate the incidence and distribution of calcifications of iliac arteries in patients with kidney transplantation in our transplant center. Patients and Methods. We retrospectively analyzed patients with kidney transplantation operated at University Hospital Rijeka from January 1st 2015 to December 31st 2018. The assessment of iliac arteries calcifications was made using computed tomography. Results. In observed period 115 kidney transplantations were performed in our transplant center and 92 (80%) of patients had preoperative CT scan. The average age was 60,3 years and 26% of patients had diabetes mellitus as principal disease. Arterial calcifications were found in 72 (78%) patients. The calcifications were most common in the right common iliac artery (63 pts – 68,5%) and rarest in left external iliac artery (23 pts - 25%) Conclusion. Most of our patients have calcifications of iliac arteris. Preoperative assessment of their distribution and extent had a very important role in the planning of kidney transplantation.
Summary
Background
Bladder outlet obstruction is an uncommon condition in women. Primary bladder neck obstruction is one of the functional causes of bladder outlet obstruction. We evaluated surgical ...treatment in our patients with primary bladder neck obstruction.
Patients and methods
We retrospectively evaluated the medical data of 47 female patients from the Department of Urology who underwent transurethral incision of the bladder neck from January 2000 to December 2012. All patients underwent transurethral bladder neck incision at the vesical neck and proximal urethra at the 5- and 7-o’clock positions. We compared symptoms and urodynamic parameters before and after the operation.
Results
Out of 47 female patients who underwent the operation, primary bladder neck obstruction was diagnosed in 42. The mean age was 44.3 ± 16.8 (range: 21–78) years. The postoperative maximal flow rates were significantly increased (20.6 ± 3.9 vs. 7.6 ± 3.2 mL/s,
P
< 0.0001), and the postvoid residual urine was decreased (31.3 ± 7.8 vs. 132.1 ± 22.24 mL,
P
= 0.0002) compared with preoperative findings. Improvement was evident in most patients (83.3 %). A repeat operation had to be performed in seven patients (16.7 %). Operative therapy failed in one patient (2.4 %).
Discussion and conclusions
The diagnosis of primary bladder neck obstruction in women is based on typical symptoms, uroflowmetry and multichannel urodynamics, including electromyography. Videourodynamics is obligatory in doubtful cases. Transurethral bladder neck incision is an effective therapy for female patients with primary bladder neck obstruction, and if necessary, a second procedure can be safely performed.
Cilj: Prikazati naše rezultate u liječenju pacijenata s bubrežnim kamencima metodom miniperkutane nefrolitotripsije (miniPCNL). Pacijenti i metode: Retrospektivnim istraživanjem obuhvatili smo ...pacijente Klinike za urologiju, Kliničkog bolničkog centra u Rijeci
koji su između 1. kolovoza 2015. i 31. prosinca 2016. godine zbog bubrežnih kamenaca liječeni metodom miniPCNL-a. Rezultati: U promatranom razdoblju u našem centru operirano je 6 pacijenata ovom metodom, od kojih je jedan bio s transplantiranim bubregom. U svih pacijenata uspješno je učinjena litotripsija s holmium-laserom. Na kontrolnom RTG-u nije bilo ostatnih fragmenata. U četvoro pacijenata poslijeoperativno je došlo do razvoja febriliteta koji je uspješno liječen antibiotskom terapijom. Niti u jednog pacijenta nije bila potrebna reoperacija, dodatne procedure niti potreba za davanjem krvi. Zaključak: Miniperkutana
nefrolitotripsija je minimalno invazivna metoda koja se pokazala uspješnom i sigurnom u liječenju nefrolitijaze.
Urodinamika i njezina klinička primjena Trošelj, Marin; Rubinić, Nino; Vukelić, Ivan ...
Medicina fluminensis,
09/2017, Letnik:
53, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Urodinamika je metoda kojom se procjenjuje funkcija mokraćnoga sustava, najčešće njegovog donjeg dijela. Donji dio urinarnog sustava je funkcionalna cjelina koja se sastoji od mokraćnoga mjehura, ...sfinkterskoga mehanizma i mokraćne cijevi. Osnovna funkcija mu je punjenje i pražnjenje mjehura uz kontinenciju. Urodinamikom se mogu adekvatno evaluirati sve te funkcije. Urodinamika je indicirana kao nadopuna standardnim pretragama. Najčešće korištene metode su mikciometrija, cistometrija i profilometrija uretre. Mikciometrijom se određuje protok urina u jedinici vremena tijekom akta mikcije. Cistometrijom mjerimo
tlakove u mjehuru tijekom njegova punjenja i pražnjenja. Profilometrijom uretre određujemo tlakove u uretri, a dobiveni podaci govore nam o kontinenciji ispitanika. U preglednom radu prikazat ćemo osnove urodinamskog ispitivanja s kliničkim primjerima.
Our country Croatia is among the global leaders regarding deceased donation rates, yet we are facing organ shortage and concurrently a sharp decline in our acceptance rates for kidney offers. To ...reevaluate our organ acceptance policy, we retrospectively analyzed the factors that influenced the posttransplant outcomes of kidneys from elderly deceased donors at our center during a 20-year period and the changes to our organ acceptance criteria during Eurotransplant membership.
We studied all kidney transplants from donors ≥60 years old during the two 5-year episodes of Eurotransplant membership from 2007 to 2017 (period II and period III) and compared those data to data from the decade before Eurotransplant membership (period I, 1997-2007). Differences in acceptance rates and reasons for the decline of kidney offers between the two 5-year periods of Eurotransplant membership were analyzed.
In period I, 14.1% of all kidney allografts were obtained from donors ≥60 years old; in period II and period III the rates were nearly 2-fold higher (27.0% and 25.7%, respectively; P = .007 and P = .008). During the first 5-year period of Eurotransplant membership (period II), we accepted significantly more grafts from marginal donors with a higher number of human leukocyte antigen mismatches compared with period I. Consequently, the 3-month survival rate of kidneys from donors ≥60 years old dropped from 91.1% to as low as 74.2% (P = .034). After application of morestringent human leukocyte antigen matching, especially in human leukocyte antigen DR, and morestringent donor acceptance criteria in period III, graft survival improved to 91.1%.
Our experience indicates that careful selection of kidneys from elderly deceased donors and allocation to human leukocyte antigen-matched recipients is important to improve transplant outcomes.
Benigna hiperplazija prostate (BPH) karakterizirana je umnažanjem žljezdanih i/ili stromalnih elemenata prostate. Ona može dovest do uvećanja prostate i uzrokovati smetnje mokrenja donjeg dijela ...mokraćnog sustava (LUTS). Rast prostate ovisan je o dobi i utjecaju spolnih hormona, prvenstveno dihidrotestosterona. Simptomi se dijele na iritatvne, opstruktvne i postmikcijske. U osnovnu obradu pacijenata spada anamneza, korištenje upitnika o smetnjama mokrenja, dnevnik mokrenja, fizikalni pregled, analiza urina, serumska koncentracija kreatinina i prostata specifčnog antigena, mikciometrija i mjerenje rezidualnog urina. Terapiju se odabire na osnovi smetnji koje pacijent ima i rezultata dijagnostčke obrade. Prvi korak u liječenju predstavljaju određene promjene u ponašanju i prehrani. U pacijenata s blagim smetnjama preporučuje se aktivno praćenje. U ostalih pacijenata započinje se s medikamentoznom terapijom. Mogućnost medikamentozne terapije su mnogobrojne: blokatori alfa adrenergičkih receptora, inhibitori 5-alfa-reduktaze, antagonisti muskarinskih receptora, analog vazopresina – dezmopresin, agonisti beta-3 adrenergičkih receptora, inhibitori 5-fosfodiesteraze, fitoterapija i kombinirana terapija. U slučaju neuspjeha medikamentozne terapije ili prisutnost komplikacija BPH-a preporučuje se kirurško liječenje.
Limfocele su jedna od češćih kirurških komplikacija transplantacije bubrega. Retrospektivno smo analizirali bolesnike s transplantiranim bubregom u našem centru u kojih su dijagnosticirane limfocele. ...Tijekom 39 godina učinili smo 922 transplantacije bubrega, a limfocele su dijagnosticirane u 45 (4,9%) bolesnika. Limfocele smo liječili na sljedeći način: perkutana drenaža s instilacijom povidon-jodida u 36 (80%) bolesnika, perkutana drenaža s instilacijom tetraciklina u jednog (2,2%), perkutana aspiracija u četiri (8,9%) i kirurško liječenje u četiri (8,9%) bolesnika. U četiri (8,9%) bolesnika s recidivom sekundarni postupak bio je uspješan. Ukupno smo otvorenim kirurškim zahvatom liječili pet (11,1%) bolesnika, a laparoskopski četiri (8,9%) bolesnika. Perkutana drenaža limfocele, s instilacijom sklerozirajućeg sredstva ili bez instilacije, je metoda izbora u liječenju limfocele. Laparoskopska fenestracija limfocela je alternativa perkutanoj drenaži, posebno kod recidiva.
Wünderlich syndrome (WS) is a urological emergency characterized by retroperitoneal hemorrhage. In most cases, bleeding occurs from a renal angiomyolipoma (AML) and may be the first manifestation of ...the disease. We report a female patient with bilateral WS due to the metachronous rupture of renal AMLs. Because the patient was stable and the tumor was not malignant, treatment was conservative. Follow-up revealed the full recovery of kidney function and the resolution of the hematoma.
Spontaneous, nontraumatic retroperitoneal hemorrhage or Wunderlich syndrome (WS) is a rare but potential life-threatening condition. In most patients a bleeding renal neoplasm is the cause of the ...retroperitoneal hematoma. The management of this condition includes a conservative approach in the hemodynamically stable patients and active treatment in the unstable patients. Active treatment includes angioembolization or surgery. If angioembolization is not available open surgery is in most cases the preferred approach. We present a patient with a spontaneously ruptured kidney due to a central renal angiomyolipoma, which was treated by laparoscopic nephrectomy.
We report a case of a kidney-transplanted patient with urolithiasis treated with mini-percutaneous laser lithotripsy. The patient presented with renal dysfunction and graft hydronephrosis. Diagnostic ...procedures revealed ureterolithiasis as a cause of obstruction, and percutaneous nephrostomy was inserted as a temporary solution. Before surgery, the stone migrated to the renal pelvis. Mini-percutaneous laser lithotripsy was successfully performed, and during surgery, all stone fragments were removed. Six months after successful treatment, the patient has good functioning and stone-free graft.
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