Today, percutaneous nephrolithotomy (PCNL) is a standard procedure in the treatment of large kidney stones. Development of the procedure began in 1976 with publication of the first reports, while ...turning point came in 1985 when the first 250 cases were described. Subsequently, PCNL has become standard in the treatment of kidney stones instead of open surgery. Numerous modifications of the procedure have been developed with advancement of modern technology. Nevertheless, there is still the necessity for clearer understanding of differences and circumstances of choice among different techniques. There are significant differences in the instruments used for the procedure, so we distinguish standard PCNL (working channel of 24-30 Fr), mini PCNL (working channel of 11-18 Fr), ultra-mini PCNL (working channel <15 Fr), and micro PCNL (working channel <6 Fr). With the development of flexible ureteroscopy (FURS), a combined method is also being developed, i.e., Endoscopic Combined IntraRenal Surgery (ECIRS, PCNL + FURS). Furthermore, each procedure can be performed in prone or supine position. The aim of this paper is to point out the similarities and differences, the advantages and disadvantages of different techniques, with an additional aim to present our experience and current standard practice in kidney stone treatment.
Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance ...of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature.
The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period.
A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n = 68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n = 51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation.
During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p = 0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p = 0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p = 0.007).
During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required. Display omitted
The postoperative care unit at the Department of Urology has significantly improved treatment of patients undergoing surgical procedures and reduced admission of urologic patients to the Intensive ...Care Unit (ICU). We examined the characteristics of urologic patients, time on mechanical ventilation, most common complications, and mortality in the period from January 2017 to March 2022. A total of 84 admissions to ICU were recorded, accounting for 1.5% of all patients having undergone surgical, therapeutic or diagnostic interventions under general or regional anesthesia at the Department of Urology. The most common reasons for admission to ICU were respiratory failure (79 patients), hemodynamic instability, and bleeding. The median time on mechanical ventilation was 9.7 2.4-58.2 hours in urology patients vs. 6 3-14.7 hours in the rest of surgical ICU patients (p=0.058). Hypertension and renal failure were more common in urologic than in the rest of surgical ICU patients (p<0.05). The overall mortality of urologic patients was lower than in the rest of surgical ICU patients (10.7% vs. 18.99%, p=0.08) but the difference did not reach statistical significance. Independently of the lower mortality, improvements in the outcome of urologic patients admitted to the ICU are feasible. Early identification of patients at risk of infections, postoperative respiratory failure, cardiovascular incidents, and bleeding may further reduce mortality and improve outcomes.
Higher turnaround of urologic patients in the tertiary clinical center can lead to more accompanying complications, ranging from 1% to 55% for various procedures, with the incidence of vascular ...injuries varying from 0.43% up to 9.5%. In patients with impaired renal function, it is imperative to prevent the loss of normal kidney function and potential hemodialysis. Being minimally invasive, endovascular procedures such as renal artery embolization (RAE) can treat major and life-threatening complications, but good and prompt communication between urologists and interventional radiologist is necessary for fast and effective treatment. Absolute contraindications for RAE are the presence of acute infection and previously known anaphylactic reaction to the iodine contrast media, while previous mild or moderate allergic reactions to iodine contrast media are not contraindications for RAE. Currently used embolic agents can be divided into temporary and permanent embolization agents. While the temporary embolization agent available is a gelatin sponge that could be used as complementary material or stand-alone, for permanent embolization interventional radiologists use microparticles, microspheres, liquid embolic agents, coils, and microcoils. RAE procedures are considered to be safe with a low incidence of complications, with non-target embolization being the most serious one. Postembolization syndrome is considered to be the most common adverse effect and it involves around 90% of patients. The overall results show that RAE is a safe, minimally invasive procedure that can effectively treat significant complications caused by other urologic procedures, with the reported success rates of 87%-100%.
The aim of this review is to summarise recent scientific literature regarding the clinical use of DCE-MRI as a component of multiparametric resonance imaging of the prostate. This review presents the ...principles of DCE-MRI acquisition and analysis, the current role of DCE-MRI in clinical practice with special regard to its role in presently available categorisation systems, and an overview of the advantages and disadvantages of DCE-MRI described in the current literature. DCE-MRI is an important functional sequence that requires intravenous administration of a gadolinium-based contrast agent and gives information regarding the vascularity and capillary permeability of the lesion. Although numerous studies have confirmed that DCE-MRI has great potential in the diagnosis and monitoring of prostate cancer, its role is still inadequate in the PI-RADS categorisation. Moreover, there have been numerous scientific discussions about abandoning the intravenous application of gadolinium-based contrast as a routine part of MRI examination of the prostate. In this review, we summarised the recent literature on the advantages and disadvantages of DCE-MRI, focusing on an overview of currently available data on bpMRI and mpMRI, as well as on studies providing information on the potential better usability of DCE-MRI in improving the sensitivity and specificity of mpMRI examinations of the prostate.
We sought to investigate whether quantitative parameters from a dynamic contrast-enhanced study can be used to differentiate cancer from normal tissue and to determine a cut-off value of specific ...parameters that can predict malignancy more accurately, compared to the obturator internus muscle as a reference tissue. This retrospective study included 56 patients with biopsy proven prostate cancer (PCa) after multiparametric magnetic resonance imaging (mpMRI), with a total of 70 lesions; 39 were located in the peripheral zone, and 31 in the transition zone. The quantitative parameters for all patients were calculated in the detected lesion, morphologically normal prostate tissue and the obturator internus muscle. Increase in the Ktrans value was determined in lesion-to-muscle ratio by 3.974368, which is a cut-off value to differentiate between prostate cancer and normal prostate tissue, with specificity of 72.86% and sensitivity of 91.43%. We introduced a model to detect prostate cancer that combines Ktrans lesion-to-muscle ratio value and iAUC lesion-to-muscle ratio value, which is of higher accuracy compared to individual variables. Based on this model, we identified the optimal cut-off value with 100% sensitivity and 64.28% specificity. The use of quantitative DCE pharmacokinetic parameters compared to the obturator internus muscle as reference tissue leads to higher diagnostic accuracy for prostate cancer detection.
Urinary incontinence (UI) is an everyday problem among a large proportion of adult women. The prevalence of UI ranges between 15% and 25% and the rate of incidence for each type of UI ranges between ...10% and 58%. Because women are concerned about UI during sexual intercourse, it has a negative effect on female sexual health. The incidence of UI during sexual intercourse in incontinent women has been reported to range between 10% and 27%. The prevalence of female sexual dysfunction is estimated to be 43%. There are conservative and surgical methods of treating UI but the number of published scientific articles dealing with the assessment of the effects of these types of therapy on improving sexual health in women treated for UI is deficient.
Wingless binding integration site proteins (Wnt) have an important role in normal kidney development and in various kidney diseases. They are required for complete epithelial differentiation and ...normal nephron formation. Changes in these proteins could also have important role in carcinogenesis. This study included 185 patients with clear cell renal carcinoma (ccRCC) in whom immunohistochemical expression of Wnt-4 protein in healthy and tumorous tissue after surgery was investigated. There was higher expression of Wnt-4 in healthy than in tumor tissue. No difference between Fuhrman's grade and Wnt-4 expression was found. A poor negative correlation between tumor size and Wnt-4 expression was found. Patients with suspected metastatic diseases had higher Wnt-4 expression. There was no difference in survival rates between Wnt-4 negative and positive groups. In our study we have shown that high Wnt-4 expression in healthy tissue decreases in low-grade tumors but then increases in high-grade tumors, suggesting that tumor progression requires Wnt-4 activation or reactivation.
Road traffic injuries cause considerable losses to individuals, their families, and to nations as a whole. Factors related to road traffic injuries and to the severity of such injuries have not been ...fully elucidated or evaluated. The aim of this study was to explore factors related to road traffic injuries and their severity in cohort of 200 road traffic accident (RTA) survivors from Eastern Croatia. Sustaining injury was associated with rural residence (p=0.032), lower education level (p=0.001), unemployment (p=0.001), being single (p=0.014), under average self-assessed economic status (p=0.001), alcohol abstinence (p=0.018), use of medications (p=0.031), self-assessed life-threat (p<0.001), pain after the RTA (p<0.001), hospitalization after the RTA (p<0.001), hospitalization duration (p<0.001), surgery (p=0.048), rehabilitation following the RTA (p=0.001) and PTSD symptoms (p=0.001). Injury severity was associated with lower education level (p=0.013), unemployment (p=0.004), being single (p=0.017), under average self-assessed economic status (p<0.001), alcohol abstinence (p=0.042), use of medications (p=0.014), self-assessed life-threat (p<0.001), pain after the RTA (p<0.001), being a pedestrian or a cyclist (p=0.011), hospitalization after the RTA (p<0.001), hospitalization duration (p<0.001), surgery (p<0.001), rehabilitation following the RTA (p=0.001), depression (p<0.001) and PTSD symptoms (p<0.001). In order to more adequately prevent road traffic injuries knowledge about factors associated with such injuries and their severity should be base for the creation of specific prevention programs at regional and national level.
Ozljede u cestovnom prometu uzrokuju znatne gubitke pojedincima, njihovim obiteljima i cijeloj naciji. Čimbenici povezani s ozljedama u cestovnom prometu i težinom takvih ozljeda nisu u potpunosti razjašnjeni ili procijenjeni. Cilj ovog istraživanja bio je istražiti čimbenike povezane s ozljedama u cestovnom prometu i njihovom težinom u skupini od 200 sudionika cestovnih prometnih nesreća (CPN) iz Istočne Hrvatske. Postojanje ozljede kod sudionika CPN bilo je povezano s ruralnim prebivalištem (p=0,032), nižom razinom obrazovanja (p=0,001), nezaposlenošću (p=0,001), samačkim životom (p=0,014), ispod prosječnim samoprocijenjenim ekonomskim statusom (p=0,001), apstinencijom od alkohola (p=0,018), upotrebom lijekova (p=0,031), osjećajem životne ugroženosti u CPN (p<0,001), boli nakon CPN (p<0,001), hospitalizacijom nakon CPN (p<0,001), trajanjem hospitalizacije (p<0,001), operacijom nakon CPN (p=0,048), rehabilitacijom nakon CPN (p=0,001) i postojanjem simptoma PTSP-a (p=0,001). Težina ozljede bila je povezana s nižom razinom obrazovanja (p=0,013), nezaposlenošću (p=0,004), samačkim životom (p=0,017), ispod prosječnim samoprocijenjenim ekonomskim statusom (p<0,001), apstinencijom od alkohola (p=0,042), upotrebom lijekova (p=0,014), osjećajem životne ugroženosti u CPN (p<0,001), boli nakon CPN (p<0,001), sudjelovanjem u CPN u svojstvu pješaka ili biciklista (p=0,011), hospitalizacijom nakon CPN (p<0,001), trajanjem hospitalizacije (p<0,001), operacijom nakon CPN (p<0,001), rehabilitacijom nakon CPN (p=0,001), postojanjem simptoma depresije (p<0,001) i simptoma PTSP-a (p<0,001). Kako bi se adekvatnije spriječile ozljede u cestovnom prometu, znanje o čimbenicima povezanim s takvim ozljedama i njihovom težinom trebalo bi biti temelj za stvaranje posebnih programa prevencije na regionalnoj i nacionalnoj razini.
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