Acute and Late Genitourinary Toxicity after 72 Gy of Conventionally Fractionated Conformal Radiotherapy for Localised Prostate Cancer: Impact of Individual and Clinical Parameters.

AIM: Our aim was to estimate the incidence of acute and late genitourinary toxicity in patients treated with three-dimensional conformal radiotherapy (3DCRT) for localised prostate cancer and to estimate the possible influence of individual and clinical characteristics. MATERIALS AND METHODS: Between September 2009 and September 2013, 225 patients with localised prostate cancer were treated with 3DCRT. Ninety-four patients with an estimated risk of lymph node involvement ≤15%, according to the Roach formula, were evaluated in this study. All patients received a total dose of 72 Gy in 36 fractions. Acute and late genitourinary toxicity were graded according to the European Organization for Research and Treatment of Cancer radiation morbidity scoring scale. Characteristics such as age, smoking status, previous abdominal or pelvic surgery (PAPS), diabetes mellitus and the use of diuretics were analysed as possible predictive factors of toxicity. The median follow-up was 27 months. RESULTS: Grade ≥2 acute toxicity during 3DCRT developed in 25 of 94 patients (26.5%). Predictive factors of acute genitourinary toxicity grade ≥2 in the multivariate logistic regression analysis (MVA) were current smoking status (P = 0.003), PAPS (P = 0.012) and the use of diuretics (P = 0.017). The 2 and 3 year cumulative risk of late genitourinary toxicity grade ≥1 was 25.3% and 30.2%, respectively. In the MVA, acute genitourinary toxicity was significantly associated with late genitourinary toxicity (P = 0.024). CONCLUSION: Current smoking status, PAPS and the use of diuretics have a significant effect on the occurrence of acute genitourinary toxicity grade ≥2. The occurrence of any grade of acute genitourinary toxicity has a significant influence on the development of any grade of late genitourinary toxicity.

Bilateral renal cell carcinoma with bilateral synchronous adrenal gland metastases - a case report.

The authors reported a case of a 52-year-old patient with bilateral synchronous renal cell carcinoma synchronously disseminated in adrenal glands is presented. The patient underwent surgical treatment: radical nephrectomy on the right side, bilateral adrenectomie on the right and partial nephrectomy on the left side. Five years after surgery, patient is in complete remission.

Usage of GreenLight HPS 180-W laser vaporisation for treatment of benign prostatic hyperplasia.

INTRODUCTION: Laser therapy has gained increasing acceptance as a relatively less invasive treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). From the early procedure of interstitial laser coagulation through to the use of holmium laser enucleation of the prostate, there has been an expanding body of evidence on the efficacy of such procedures. One of the newer lasers is the Green Light HPS 180 W laser. Studies with this GreenLight laser (GLL) (American Medical Systems, Inc, Minnetonka, MN, USA) showing results as good as those of transurethral resection of the prostate (TURP). In this paper, the efficacy of the new GLL 180-W versus the gold standard TURP in patients with LUTS due to BPH was tested in a prospective clinical trial. OBJECTIVE: To compare results of Green light laser (GLL) evaporisation of the prostatae and transurethral resection of the prostate (TURP) for treatment of BPH. MATERIJALS AND METHODS: A total of 62 patients with BPH were randomly assigned to two equal groups: TURP or GLL. RESULTS: Both groups were compared regarding all relevant preoperative, operative, and postoperative parameters. Functional results in terms of improvement of International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR) urine were assessed at 1, 3, 6 and 12 mo. A total of 62 patients completed 12 mo of follow-up in the TURP and GLL groups, respectively. Baseline characteristics were comparable. Mean operative time was significantly shorter for TURP. Compared to preoperative values, there was significant reduction in hemoglobin levels at the end of TURP only. A significant difference in favor of GLL was achieved regarding the duration of catheterization and hospital stay. In the GLL, no major intraoperative complications were recorded and none of the patients required blood transfusion. Among TURP patients, 6 required transfusion, 1 developed TUR syndrome, and capsule perforation was observed in 5 patients. There was dramatic improvement in Qmax, IPSS, and GLL compared with preoperative values and the degree of improvement was comparable in both groups at all time points of follow-up. Four TURP patients and one GLL patients developed bladder neck contracture treated by bladder neck incision; none in either group experienced urethral stricture or urinary incontinence. CONCLUSIONS: Compared to transurethral resection of the prostate, GreenLight HPS 180-W laser photoselective vaporization of the prostate is safe and effective in the treatment of patients suffering from lower urinary tract symptoms due to benign prostatic hyperplasia.

Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

OBJECTIVE: The aim of the study was to analyzed the efficacy and safety of a minimally invasive surgical procedure using the Trans- Obturator-Tape with "outside-in" approach for treatment female stress urinary incontinence. PATIENTS AND METHODS: 171 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2014). 27 patients were previously operated for incontinence. Mean age was 59 years (37-80). 6 patients were having mixed incontinence, and 51 had SUI with urgencies. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. RESULTS: Mean follow-up was 22 months (4-45). At 12 months follow-up 91,2% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. 5 patients (2.9%) had post-operative urinary retention. CONCLUSION: The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

A case report of the first laparoscopic radical nephrectomy done at the Clinic of Urology, Clinical Centre of Serbia.

Laparoscopic interventions are at the very beginning of its evolution in the Clinic of Urology. The first steps have been made primarily to cope with problem of varicocele. We continued to gain laparoscopic experience by switching to solving some demanding intervention, primarily kidney cyst. The only logical next step lead to laparoscopic renal surgery. So, after a few successful primary simple nephrectomy, the next step was to perform a laparoscopic radical nephrectomy. Today, at the Clinic of Urology, Clinical Center of Serbia we successfully perform much more demanding interventions, such as extraperitoneal laparoscopic radical prostatectomy. In this paper we present our experience with the first laparoscopic radical nephrectomy, which was done at the Clinic of Urology, Clinical Center of Serbia.

Diagnostic and therapeutic protocol in the treatment of hypo functional kidney.

Laparoscopic nephrectomy is indicated in the treatment of many benign conditions of the kidneys. Hydronephrosis caused by obstruction of the ureter, either internal, or external, is one of the main indications for laparoscopic reconstruction. If an obstruction is prolonged, consequently, it leads to chronic inflammatory process accompanied by persistent and recurrent pain with fever, which eventually become resistant to therapy. If not operated sufficiently fast to resolve the causes, as a consequence it leads to hypofunction and ultimately afunction of affected kidney. In such a situation, the only therapeutic option is surgical treatment. By analyzing the case, we will try to illustrate the diagnostic algorithm and therapeutic treatment modality.

Preoperative Gleason score, percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy.

PURPOSE: To determine the factors that can improve the prediction of biochemical recurrence after radical prostatectomy for the patients with prostate adenocarcinoma. METHODS: Our study included 182 patients with prostate adenocarcinoma who were biopsied and underwent radical surgical treatment at the Clinic of Urology, Clinical Center of Serbia, Medical Faculty in Belgrade from 1994 to 2004. Patients were prospectively followed-up and monitored for a minimum of 8 years and data were statistically processed by multivariate regression analysis. We arranged the predictors into 3 regressive models. In the first model the predictors were clinical stage of the disease, preoperative Gleason score, F/T PSA ratio and PSA. In the second model these predictors were accompanied with the number of positive biopsies and percent of positive prostate biopsies. In the third model, patient follow-up was added to the predictors. In all 3 models biochemical recurrence was considered as a dependent variable. RESULTS: On multivariate analysis, patient follow-up (p<0.0001), percent of positive prostate biopsies (p<0.0001), bioptic Gleason score (p<0.0001) and preoperative PSA (p<0.003) were significant independent predictors of biochemical recurrence. The most successful prediction of recurrence that provided accurate prognosis for 80% of the patients was obtained by the third model using the percent of positive prostate biopsies, PSA and patient follow-up. CONCLUSION: As stated in multivariate analysis, the independent predictors according to the significance are the follows: patient follow-up, percent of positive prostate biopsies, bioptic Gleason score and preoperative PSA, whereas preoperative F/T PSA ratio is dependent predictor. The number of positive biopsies and clinical stage of the disease are of no significance.

[Degree of renal insufficiency in patients undergoing ileal conduit as a form of urinary diversion in relation to the type of ureteral insertion].

UNLABELLED: Ileal conduit as a form supravesical derivaton, is still one of most popular method of urinary diversion, in daily urological practice. Bearing in mind this fact, this type of diversion, rightfully so, is also called the "gold standard" in the derivation of urine. Considering the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that, in time, this type of diversion lead to some degree of renal insufficiency. Some authors, this effect on renal function, attribute to specific type of ureterointestinal anastomosis during formation of ileal conduit. A very important part of the surgical technique of creating ileal conduit is precisely a step of implantation ureters into the intestinal segment. The ultimate goal is to enable a more natural way of evacuation of urine from the upper urinary tract in terms of maintaining the quality of renal function. Numerous authors describes a quite number of techniques of ureteral implantation into the intestinal segment (Wallace A, Wallace B, Nesbit-Bricker, Le Duc ...). Each of these techniques has its own strengths and weaknesses, and the decision witch technique will be applied is still in the hand of urologist--operator, individually.Bearing in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that the renal function over the time will start to show signs of incipient or advanced failure. OBJECTIVE: To determine the most appropriate type ureterointestinal anastomosis in forming ileal conduit, as a form of supravesical urinary diversion, to ensure adequate renal function postoperatively as an important parameter of quality of life. METHODS AND PATIENTS: This is a retrospective study, which covered a population of 193 patients treated at the Department of Urology, Clinical Center of Serbia, who underwent creation of ileal conduit as a form of urinary diversion. The study was conducted 2007-2011. Postoperative follow-up lasts up to 48 months. The assess of the level of renal insufficiency were analyzed by monitoring parameters which determine the degree of anemia, and biochemical parameters of renal function. We have investigated three techniques of insertion of the ureters into the ileal conduit, which are used in the daily practice (Wallace A, Wallace B, Nesbit-Bricker). CONCLUSION: Kidney failure occurs equally often in all patients who underwent urinary diversion by ileal conduit, ignoring the type of insertion of the ureters to the intestinal segment.

The case of the diverticular bladder tumor treated with diverticulectomy.

INTRODUCTION: The majority of diverticular bladder tumors (DBT) are urothelial. Due to the lack of the muscular layer in the diverticulum, the progression of these tumors is easier than in the bladder wall. CASE REPORT: The case of invasive DBT with painless hematuria is presented. The patient was treated with diverticulectomy. CONCLUSION: Unifocal Stage-T3 DBTs can be successfully treated with diverticulectomy.

[Degree of postoperative renal deterioration in patients who have undergone ileal conduit as a form of urinary diversion in relation to the type of insertion of the ureter].

UNLABELLED: Substitution of the bladder with segment of the digestive tract, within the radical treatment of bladder cancer, as well as treatment of the other bladder abnormality, is extremely demanding surgical procedure, that aims adequate treatment of the underlying disease and provide patient's renal function within physiological level. Surgical implantation of the ureter into the intestinal segment are an important part of the surgical technique, the formation of ileal conduit, with the ultimate aim of providing a more natural way of evacuation of urine from the upper urinary tract in terms of maintaining the adequate quality of renal function. Which of the existing surgical method of implantation of ureter in the intestinal segment will be applied, it is for urologist to decided, according to his affinity and/or his operating school of origin. The literature describes many procedures of this technique (Wallace A, B Wallace, Nesbit-Bricker, Le Duc). Bearing in mind that the ileal conduit, as a form of supravesical derivation, is still one of most widely used method of urinary diversion, with a very large number of patients during the follow-up period were recorded certain complications of renal function disorders, which by some authors attributed to a type of ureterointestinal anastomoses, during the creation of ileal conduit. Having in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect some degree of renal deterioration. These complications require prompt resolution. Bearing in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that the renal function over the time will start to show signs of incipient or advanced failure. OBJECTIVE: The main objective is to show the degree of renal deterioration, postoperatively, according to the type of insertion of the ureters to the ileal conduit. METHODS AND PATIENTS: The study was conducted retrospectively on material of Urological Clinic, Clinical Center of Serbia and on material of Faculty of Medicine, University of Belgrade, on 193 patients, for a period of five years (2007 to 2011), with a time of postoperative follow-up of patients up to 48 months (four years). Assessment of the level of renal deteriorisation was performed by ultrasound examination during regular audits of patients during follow-up. CONCLUSION: It was found that all three examed techniques in an insertion of ureter into ileal conduit were equally satisfactorily, with the similar degree of postoperative complications. Based on these facts, we can conclude, that the quality of life of patients in all three analyzed groups of ureteral insertion in the ileal conduit, approximately the same.

Diagnostic value of the nuclear matrix protein 22 test and urine cytology in upper tract urothelial tumors.

OBJECTIVE: To investigate the diagnostic value of the nuclear matrix protein 22 (NMP22) test in comparison to urine cytology for the detection of upper tract urothelial carcinoma. PATIENTS AND METHODS: Patients with transitional cell carcinoma of the upper urinary tract (n = 34) and patients with renal calculosis (n = 25) were included in this study. Voided urine samples and separated catheter urine specimens were assayed for NMP22 and cytological examination. RESULTS: The sensitivity of the NMP22 test in separated and voided urine was 73.2 and 70.5%, respectively, compared to 64.7 and 58.8% of urine cytology. The specificity of the NMP22 test in separated and voided urine was 88 and 92%, respectively, compared to 96 and 96% of urine cytology. The combination of separated and voided urine is the best method because the sensitivity is 79.41% and specificity 88%. There is a high agreement of the NMP22 test in voided and separated urine (kappa = 0.795, p < 0.01), indicating that the voided urine is adequate for diagnosis. CONCLUSIONS: The NMP22 test has higher sensitivity but lower specificity than cytology. The combination of these two tests could be a very useful diagnostic method for detection of upper urothelial tumors.

Urinary PSA level and relative tumor volume after prostate biopsy.

OBJECTIVES: To estimate the ratio between urinary prostate specific antigen (uPSA) and tumor volume after prostate biopsy. METHODS: From 2000 to July 2008, uPSA concentration was determined in 60 patients with clinically organ-confined prostate cancer (PCa). All patients underwent six-area transrectal ultrasound (TRUS)--guided biopsy, with at least 12 biopsy cores. Single pathologist determined tumor grade (G), Gleason score (GS), the percentage of tumor infiltration (% TI) and the percentage of positive cores (% PC) in all biopsy cores. Additionally, relative tumor-biopsy volume (RTV) was calculated by multiplying % PC, % TI and prostate ultrasound-derived volume (Vol). Forty-one patients underwent retropubic radical prostatectomy (RRP), while 19 patients underwent radiation therapy. RESULTS: Average uPSA was 308.6 +/- 311.9 ng/ml (range 0.06-988 ng/ml), average PSA was 9.7 +/- 5.5 ng/ml (range 1.2-24.3 ng/ml), tumor grade 1.7 +/- 0.8, Gleason score 5.2 +/- 1.3, the percentage of tumor infiltration 27.6 +/- 21.8%, and the percentage of positive cores, 52.2 +/- 30.7%. Average RTV was 6.3 +/- 8.4 ml (0.29-56 ml). All patients were divided in two groups: I, with RTV 4 ml and II, with RTV = 4 ml. The patients with RTV 4 ml had lower G (1.4 +/- 0.6 vs. 2.1 +/- 0.8, p = 0.0002), lower GS (4.5 +/- 1 vs. 5.8 +/- 1.3, p = 0.003) and higher uPSA (389.4 +/- 340.8 vs. 193.1 +/- 229.7, p = 0.014). There were no differences in serum PSA levels between the groups. CONCLUSION: Relative tumor-biopsy volume (RTV) is useful parameter in the preoperative assessment of tumor volume. Patients with higher RTV had significantly higher G and GS. However, these patients had significantly lower uPSA. This phenomenon could be the consequence of compromised PSA drainage from the peripheral zone of the prostate, caused by the tumor.

Human Dirofilaria repens infection in Serbia.

Human infection by Dirofilaria repens in Serbia has been increasing steadily. The first case was reported in 1971, presented in the form of a single subcutaneous nodule on the back of a young boy. As established by a literature search, eight additional cases were reported until mid-2001. The most frequent site of infection was subcutaneous tissue, with the exception of two cases, in which parasites were found in subconjunctiva and epididymis. Our study, conducted from 2001 to 2008, encompasses 19 new cases. Most of them (63.1%) presented as ocular or periocular infections, in which the parasite was typically found under the conjunctiva. In other cases a parasitic nodule was localized in the temporal region of the head, epididymis, testicle, abdomen, breast or arm. The diagnosis was made by morphological and histological analysis of the extracted intact worms and parasite sections from the tissue. Morphology of the filarial worms was well preserved in more than half of the cases (12/19) and there was never more than one parasite found inside the lesions. Adult worms and immature nematodes were observed in nine and seven cases, respectively. Furthermore, in two cases microfilariae were discovered inside the pseudocoelom, sections of the female reproductive tubes filled with clearly visible larval stages. Dirofilaria repens infection was diagnosed by its morphological features (17/19) or by performing polymerase chain reactions (PCR) using paraffin-embedded tissues (2/19) in the cases where the morphology was insufficient for identification and the parasites had been determined initially as Dirofilaria spp. The amplified 246 bp PCR product showed that the worms were D. repens.

[Retrocaval ureter based on a series of 16 cases]. / Uretère rétrocave: à propos de 16 cas.

INTRODUCTION AND OBJECTIVES: To analyse the postoperative results of surgical treatment for retrocaval ureter. MATERIAL AND METHODS: The authors report a retrospective clinical study of a series of 16 patients (six women and 10 men) with a mean age of 38 years (range: 15-45 years) with retrocaval ureter treated between 1975 and 2005. The mean follow-up was 18 months (range: 12 to 34 months). All patients were evaluated by the standard diagnostic protocol for the time and were treated by one of the following surgical techniques: resection of the ureter and renal pelvis to renal pelvis anastomosis; resection of the ureter and pyelo-ureteric anastomosis; resection of the ureter and oblique end-to-end uretero-ureteric anastomosis; nephrectomy. RESULTS: The mean operating time was 95 min. Late postoperative follow-up revealed two cases (13%) of ureteric stenosis at the site of the oblique end-to-end uretero-ureteric anastomosis. Surgical revision was performed in one patient with resection of the ureter and reanastomosis, while anterograde dilatation of the stenosis was performed in the other patient. The postoperative course was uneventful in both patients. All patients were reviewed at six months with a satisfactory result, corresponding to reduction of hydronephrosis and improvement of renal function. CONCLUSION: Over the last 30 years, the diagnosis of retrocaval ureter has become more reliable and less invasive. Satisfactory results can be obtained with conventional surgical management.

Treatment of emergency surgical complications of kidney transplantations.

Surgical complications subsequent to the kidney transplantation are not infrequent and they are characterized by the high percentage of graft loss (596-18% in standard surgical procedures and up to 37% in atypically performed transplantations). The study included 311 transplanted patients (206 (66.2%) living donors and 105 (33.8%) cadaver donors). Surgical complications developing during the immediate posttransplantation period as well as during the late period (after a year and a half) were classified as: I urinary complications; II vascular complications; III other complications. In majority of the cases urinary complications (urinary fistulas, ureteral obstructions, vesico-ureteral reflux) as well as other complications (cholecystopancreatitis and lymphocele) did not necessitate urgent treatment, unlike most of the vascular complications. All the vascular complications (29/311) developed during the immediate postoperative period, except for occurrence of arterial stenoses which ensued later on, while the development of symptoms was rapid. Severity of both symptoms and clinical picture necessitated urgent surgical re-intervention in order to preserve the graft and patient's life. Vascular complications were classified as: true vascular complications, hemorrhages and kidney ruptures in order to distinguish technical and other factors contributing to development of the complications. Onset of the true vascular complications related to the graft and recipient blood vessel changes was evidenced in 20 patients (69%/29 patients) while the incidence of hemorrhages and ruptures was considerably lower (14%/29 patients and 17%/29 patients). As for the true vascular complications, vascular stem thrombosis subsequent to cadaveric transplantations was the most frequent, and transplantectomy was performed in all the cases in absence of any lethal outcomes. Two cases with iliac artery rupture resulted in graft loss subsequent to urgen exploration. In all cases with hemorrhages the applied therapy resulted in positive responses, except in one case in which massive gastrointestinal hemorrhage led to lethal outcome. The response to the urgent surgical treatment of spontaneous kidney graft ruptures was positive in 60% of the cases, while in the remaining 40% transplantectomy was necessitated due to the extensiveness of the lesion in order to preserve patient's life.

Evaluation and management of traumatic rupture of the corpus cavrnosum.

Fracture of the penis, or rupture of the corpus c avernosum is an uncommon injury, but probably under-reported entity. Only approximately 180 cases have been reported in the literature. Penile fracture with urethral injury is even more uncommon, accounting for approximately 10 to 20% of the cases reported. Early reports on this injury suggest conservative therapy as the choice of treatment. Recent reports emphasize immediate surgical repair to prevent late sequelae of injury, especially those associated with urethral rupture. We review 5 cases with evaluation, treatment and followup. Delays in treatment lead to long-term complications.

Evaluation of the Bard BTA-test in the diagnosis of upper urinary tract tumours.

The BTA-test is an agglutination assay that qualitatively detects the presence of complexes of basement membrane within the urine of patients with bladder cancer. However, the significance of BTA test in other urotelial tumours has not been extensively studied. Therefore, in the present research, we examined the validity of BTA-test in patients suffering from ureteral or renal pelvis cancer, and compare results with urincitology. 35 patients were included in this study (13 with ureteral and 22 with renal pelvis cancer). BTA-test and urincitology in each patient was performed on two urine specimens: morning voiding urine and separate urine. Separate urine was obtained by means of ureteral catheter. The results of BTA test were compared with urine cytology. All patients udervent routine clinical examination (biochemical analysis, ultrasonography, i.v. urography and retrograde urography). The presence of urothelial carcinoma was histopatologically proved in all cases. 35 patients with renal calculosis without malignancy were control group. Separate and voided urine was taken for examination with BTA test and urincitology from all these patients. BTA test in urine specimen obtained by ureteral catheter were positive in 22 (62.9 %) patients and in complete urine in 18 (51,4%) patients. Urine cytology was positive in 20 (57,1%) separate urine specimen and in complete urine in 17 (48.6%) patients. Characteristics of each patient, clinical findings and patohystology findings take places in statistic evaluation of the results. The sensitivity of BTA test depends directly on histopatology characteristics of tumours. Tumours with high grade and high stage more often have positive resuIts of test and urincitology. The test had the highest sensitivity among the group of high risk patients, with T2, T3, T4 stadium, 77,8% in separate urine and 61.11% in voided urine with specificity of 80% for separate urine and 85.71% for voided urine. Sensitivity for cytology in the same group was 72,22% for separate and 55,56% for voided urine, with specificity of 97,14% in both specimens. Based on the obtained results, we can conclude that simple and rapid BTA test can have significant position in the diagnostics of upper urinary tract tumours, but we still have to search for an ideal tumour marker for transitional cell carcinoma of upper urinary tract.

Results of application of orthotopic urine diversion according to Studer.

INTRODUCTION: Prolonged survival of patients undergoing radical cystectomy due to the infiltrative carcinoma of the urinary bladder has increased the need for development of the orthotopic bladder enabling preservation of the upper urinary ways for the extended period of time. Orthotopic bladder with tubular afferent segments in which ureters are implanted without antireflux mechanism has been introduced into the practice in 1984 by Studer and collaborates. MATERIAL AND METHODS: In the period 1998-2007 12 patients averagely aged 62 years were subjected to orthotopic derivation from ileum, when low-pressure reservoir was constructed and the ureters were implanted into the afferent non detubularized segment of ileum without antireflux mechanism. The follow-ups included determination of serum creatinine level, ultrasound monitoring of the upper urinary ways condition in three-month intervals and pyeloureterography with intravenously applied contrast medium one year after the surgery. Immediately before the follow-up examinations, the patients were asked to complete voiding and incontinence onset diary. RESULTS: Complete exclusion of the kidney that was in the stasis before surgery was evidenced only in one case, in a patient with tumor infiltration of the ureteral orifice. Significant obstruction of the uretero-ileal anastomosis was found in 4 renal units and it was resolved by antegrade balloon catheter dilatation. Diurnal continence was established in all patients within the initial 6 months after the surgery. Mild form of nocturnal incontinence persisted in 33% of the patients. Stenosis of the urethrovesical anastomosis was a cause of urine retention in 1.8% of patients and it was endoscopically resolved. CONCLUSION: The advantage of implantation into the afferent non detubularized segment of ileum over the antireflux mechanism has been verified in our study based on the low percent of stenoses.

Orthotopic neobladder: a 22-year experience.

OBJECTIVE: To analyze the outcome of orthotopic ileal neobladder related to complications and quality of life. PATIENTS AND METHODS: From 1985 to 2006, 75 patients with mean age of 57 years, (41-75) underwent radical cystectomy and orthotopic ileal neobladder substitution. The mean follow up was 72 months (6-144). Mean operative time was 240 minutes. RESULTS: Intraoperative blood loss ranged from 250 to 2810 ml. Ureteral stents were removed on 14th postoperative day, and patients were discharged at 2st day, average. Complications appeared in 23 patients. There were two recurrent TCC in the neobladder. Three patients died from pulmonary embolism. Vesicoureteral reflux appeared in three patients, and it was bilateral in two patients. Total of 98% patients have daytime continence. CONCLUSION: Continent urinary reservoirs represent the state of the art in urinary diversion. Surgeons who perform these operations are urgent to institute requirements for careful long-term follow-up of these patients.

Modified Mainz pouch II urinary diversion and quality of life.

The current referential literature describes over 40 surgical techniques of continent urinary derivations. A variation of ureterosigmoidostomy, published by Hadzi Djokic et al. (1996) is a combination of the original Mainz pouch II (sigma rectum pouch) technique (Fish & Hohenfellner, 1991) and modified ureterointestinal anastomosis as described by Camey & LeDuc (1979) with a few new details described by the author himself. In the period 1994-2006, the total of 236 patients were treated by this method. Radical cystectomy in cases of multifocal transitional cell carcinoma of the bladder was the most common indication for this method (91,5%). In the course of follow-up (mean duration 24 months) the quality of life (QL) of these patients was evaluated by physical characteristics, mental status, social aspects and comparative evaluation of quality of life with ileal conduit which is still considered the "gold standard" for urinary derivations. A very good quality of life in all studied dimensions (3/4) patients) suggests the fact that this form of continent urinary derivation provides the patients with the fair quality of life and confirms justifiability of this surgical procedure under certain indications.