HISTOPATHOLOGIC FEATURES OF KIDNEY TUMORS AND COMPARISON OF PATIENTS TREATED WITH RADICAL AND PARTIAL NEPHRECTOMY AT OSIJEK UNIVERSITY HOSPITAL CENTER FROM 2017 UNTIL THE END OF 2021.

The objective of this study was to present results of kidney tumor treatment at Osijek University Hospital Center over a 5-year period and to compare the outcomes between patients treated with radical nephrectomy (RN) and partial nephrectomy (PN). From November 2016 until the end of 2021, there were 280 consecutive PNs and RNs included in this cross-sectional study. Exclusion criteria were nephrectomies due to non-oncologic reasons and transitional cell carcinoma. There were 229 RNs and 51 PNs, median age of all patients was 62.5 (range 34-84) years. In the RN group, there were 197 renal cell carcinomas (RCC), predominantly clear-cell subtype, while among others there were 8 multilocular cystic renal neoplasms of low malignant potential (MCRNLMP) and 6 oncocytomas and angiomyolipomas each. There were 44 RCCs, 4 oncocytomas, 1 MCRNLMP and 2 cysts removed with PN; median R.E.N.A.L. score was 5. RN group had greater tumor diameters and higher tumor grade, higher postoperative creatinine levels and complications of higher grade. There was no difference in median hospital stay (6 days) and follow-up (20 months). With regard to oncologic safety, preservation of kidney function and lower overall morbidity, PN should be preferred to RN whenever oncologically safe and technically feasible.

MANAGEMENT OF LOCALLY ADVANCED, AGGRESSIVE PROSTATE CANCER - CASE REPORT.

Treatment of locally advanced prostate cancer (PC) represents a challenge before multidisciplinary team (MDT), typically includes not only local disease control but also systemic therapy and it should be tailored to each individual patient. We present a case of a 58-year-old man, whose PC presented itself as a locally advanced disease. Bearing in mind the patients' age, absence of comorbidities but also his preferences, MDT decided that the rational first step in almost imminent multimodal treatment should be radical prostatectomy (RP). Due to several local adverse factors (positive surgical margins, extracapsular extension, seminal vesicle involvement) on RP specimen pathohistology and postoperative prostate specific antigen (PSA) of 6.69 ng/ml our MDT determined luteinizing hormone-releasing hormone (LHRH) agonist therapy in the course of 3 years plus immediate salvage radiotherapy. The therapy was well tolerated, although there was one episode of transitory radiation cystitis roughly one year after its completion. After 45 months of follow-up the patient is without signs of biochemical recurrence of PC, with fully restored testosterone level and good quality of life. The main task in advanced PC management, through multidisciplinary approach, is providing good oncological outcome while trying to reduce treatment morbidity and to maintain a good quality of life.

Interleukin-6 polymorphism and prostate cancer risk in population of Eastern Croatia.

Recent studies suggest that chronic inflammation is crucial in the development and progression of prostate cancer (CaP). Interleukin-6 (IL-6) is a proinflammatory cytokine that plays an important role in intraprostatic inflammation and thus carcinogenesis. The -174G > C polymorphism of IL-6 gene has been associated with high IL-6 producer phenotype and an increased risk for CaP. The aim of this study was to evaluate the association between the mentioned IL-6 polymorphism and CaP risk, as well as to compare the genotype frequency between the different tumour grades of CaP, in population of Eastern Croatia. We analyzed the IL-6 polymorphism in 120 CaP patients and 120 controls with benign prostatic hyperplasia (BPH). CaP patients and BPH controls did not statistically differ in studied IL-6 polymorphism. Furthermore, high IL-6 producer genotypes (GG or GC) were more frequent in controls than in CaP group (86.7% vs 80.8%, respectively, p = 0.147). Also, no statistically significant difference in IL-6 high and low producer genotype frequency was noticed between well, moderately and poorly differentiated tumours. Our results, taken together with other studies on the subject, suggest that IL-6 - 174 single nucleotide polymorphism (SNP) distribution may differ between various ethnic groups and that a single cytokine gene polymorphism has probably just a minor effect on CaP susceptibility. Further studies should be performed to clarify the link between SNPs of different cytokines and the risk for CaP.

Lack of association between TNF-alpha promoter polymorphism and prostate carcinoma susceptibility in eastern Croatian population.

A single nuclear polymorphisms (SNPs) in the promoter region of the tumor necrosis factor-alpha (TNF-alpha) gene are involved in regulation of expression levels of TNF-alpha and therefore are associated with oncogenesis of several cancers. Aim of our study was to investigate the effect of G--->A polymorphism at -308 position in the promoter region of the TNF-alpha gene on prostate cancer (CalphaP) susceptibility in a subset of patients from Eastern Croatia. Study population consisted of 240 patients (120 with CalphaP, 120 controls). They were genotyped for TNF-alpha G-308A polymorphism using real-time PCR (LightCycler Instrument, Roche Diagnostics) and melting curve analysis method. X(2) test was used to compare distribution of TNF-alpha polymorphism genotypes between patients and control group. Relative risk was estimated by the odds ratio (OR). There was no significant statistical difference (X(2)=0.000, DF=1, p=1, OR=1, 95%CI=0.5537-1.8059) between patients and control group. Besides, data of CalphaP patients were stratified according to pathohistological diagnosis (PHD) by Gleason score and groups were compared according to TNF-alpha genotypes. Also, all patients and CalphaP patients were grouped according to prostate volume (V) into three groups: V<50 mL, V50-100 mL, V>100 mL. These groups were also compared according to TNF-alpha genotypes. There were no significant statistical differences between any of groups. Our findings suggest that TNF-alpha -308 SNP is not associated with CalphaP in Eastern Croatia population.

Vitamin D Status in Renal Transplant recipients is not Associated with Erectile Dysfunction.

Erectile dysfunction (ED) is a highly prevalent disorder among renal transplant recipients. Vitamin D deficiency (VDD) has been associated with several ED risk factors but only recently directly linked to ED. We conducted a study to investigate whether vitamin D serum levels were associated with the presence and severity of ED in 40 male patients that underwent deceased donor kidney transplantation (TX) from 2001 to 2013. Blood samples were collected on two seasonally distinct occasions and 25(OH)D concentration was assessed by radioimmunoassay. A 5-item version of the International Index of Erectile Function (IIEF-5) was used for ED evaluation and group stratification. We found comparable rates of ED (75%) and VDD (42.5%-62.5%) as in previously published studies. Serum levels of 25(OH)D did not differ between patients with and those without ED on both measurements (p=0.656 and p=0.914, respectively), or when comparing different ED severity groups. Duration of renal replacement therapy before TX and graft duration until analysis were longer in patients with ED (p=0.022 and p=0.05, respectively), but with the results being nonsignificant on logistic regression. In conclusion, we found no association of 25(OH)D concentration with the presence and severity of ED in renal transplant recipients. So far, there are no similar published data.

Trends in testicular germ cell cancer incidence in Eastern Croatia.

AIM: To investigate a possible association between radioactive and toxic elements contamination, mainly depleted uranium (DU) from the 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 the 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 the 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 a possible causative correlation between the depleted uranium exposure and testicular germ cell cancer.

Extracorporeal shockwave lithotripsy in elderly: impact of age and comorbidity on stone-free rate and complications.

INTRODUCTION: The aim of this study was to investigate and compare the success and complication rates of extracorporeal shockwave lithotripsy (SWL) in three cohorts of patients older than 60 years. PATIENTS AND METHODS: Our study included 444 patients older than 60 years who were treated with SWL between May 2001 and May 2008 at the Croatian Referential Center for Urolythiasis in Osijek. Three groups were formed: group I (60-65 years old), group II (66-70), and group III (> 70). There were 175, 151, and 118 patients in groups I, II, and III, respectively, with a mean age of 67.7 ± 5.4 years for all patients. Demographic data, comorbidities, kidney function, stone characteristics, treatment details, complications, and stone-free rate (SFR) were analyzed. RESULTS: We performed 1.7 ± 1.12 sessions per patient, with 3166 ± 571.3 impulses per session and a mean energy of 18.78 ± 0.64 kV. Three groups did not differ in number of SWL sessions (p = 0.78), number of impulses (p = 0.34), energy level (p = 0.5), stone size (p = 0.3), and pretreatment creatinine level (p = 0.88). Comorbidities were found in 55% of patients, with almost every third patient having two or more ones present. Complications were noted in 6% of patients, with no significant difference when comparing complication rates between the groups. An overall SFR of 67.98% was found. There was no statistically significant difference when comparing SFRs between the studied groups, even after dividing patients into those with renal and ureteral stones. CONCLUSION: Our study shows that good SFR and low rate of complications can be achieved with proper patient selection for SWL, regardless of patients' age and comorbidities.