The relationship between lower urinary tract dysfunctions and urinary leakage from ureterocystoneoanastomosis in male patients after kidney transplantation.

OBJECTIVES: The aim of this study was to investigate the association of lower urinary tract dysfunctions with urinary leakage from ureterocystoneoanastomosis (UCNA) after kidney transplantation. BACKGROUND: The UCNA leakage after kidney transplantation can be associated with various conditions while severe lower urinary tract dysfunctions could be one of them. METHODS: The analysis included all men who underwent kidney transplantation between January 2009 and December 2014. The parameters of storage and voiding functions were evaluated. All patients were monitored during their post-transplantation period for the incidence of urinary leakage from UCNA. Urodynamic parameters were compared between men with and without a documented leakage. RESULTS: The study cohort included 127 male patients, while UCNA leakage was observed in 11 (8.7 %) patients. Significant differences between both groups of patients were found for storage parameters (patients with leakage had smaller volume at first and a normal desire to void, smaller maximal cystometric capacity, and lower detrusor compliance) and voiding parameters (patients with leakage had a lower maximal flow rate, higher detrusor pressure at maximal flow rate and higher bladder outlet obstruction index). CONCLUSION: This study shows an association between lower urinary tract dysfunction and UCNA leakage in men without previous urological history (Tab. 2, Fig. 2, Ref. 24). Text in PDF www.elis.sk Keywords: urinary leakage, ureterocystoneoanastomosis, lower urinary tract dysfunctions, kidney transplantation.

Immune status in patients with subclinical forms of genitourinary tuberculosis.

The study aim was to determine whether there is a correlation between subclinical forms of genitourinary tuberculosis (GUTB) and immune status. All patients admitted to the Pneumology Clinic of the Thomayer Hospital, Prague with lung tuberculosis (LTB) were enrolled in the study. The study group consisted of 102 patients, 75 males and 27 females, median age of 46.8 years. In a previously published part of the study, 6.9 % of LTB patients were diagnosed with subclinical forms of GUTB. In the present part of the study, immune status was determined in patients with subclinical forms of GUTB by measuring circulating immunoglobulin G and CD4 T cell levels. The comparison of the immunological results did not show a statistically significant difference between the patients diagnosed with GUTB and other LTB patients..

How durable is the effect of mirabegron in successfully-treated overactive bladder patients? Analysis of a multicentre study.

OBJECTIVE: Many clinical studies indicate that pharmacologic treatment of overactive bladder (OAB) is considered effective and safe, but in real clinical practice a substantial proportion of patients discontinues the treatment. The reason for discontinuing the treatment most frequently reported is lack of efficacy and/or side effects. A further significant proportion of patients reports that they stopped the treatment because the symptoms disappeared or were resolved. This β3 agonist seems to be crucial in providing comparable efficacy in the OAB treatment and better tolerance in comparison with anticholinergics. Our aim was to investigate the durability of the mirabegron effect in successfully treated OAB patients and to understand more fully what prompts patients to return to the medication. Is this merely a subjective decision, or is it based on objective worsening of the symptoms? DESIGN: Analysis of multicentre prospective study. SETTINGS: Gynaecology and Obstetric Department First Faculty of Medicine, Charles University and General University Hospital, Prague. METHODS: This is an analysis of longitudinal multicentre study of OAB mirabegron treatment persistence. After continuing mirabegron treatment for more than 18 months patients were assessed by bladder diary and specific questionnaires. Patients with a UB-VAS score (Urgency Bother Visual Analogue Scale) of 50 or less were asked to stop the mirabegron treatment and restart the treatment any time later if they felt the need. Patients recorded the date of return to medication; they kept a daily bladder diary and filled in the same questionnaires as at the time of medication discontinuation. We provide a comparison of symptoms at the time of mirabegron discontinuation and at the time of mirabegron medication restart. RESULTS: 206 patients entered the study. 176 females (85%) and 30 males (15%) with mean age 62.9 ± 12.43, BMI ranging from 16.6 to 48.0 (mean 27.2 ± 4.96). After 18 months 126 patients were persisting with mirabegron treatment. 89 patients had UB-VAS score 50 (89 of 126 patients, i.e. 71%). Those patients were asked to stop the treatment. From the eligible group of 89 patients, 19 patients (21%) were unwilling to stop the treatment and were therefore excluded. There were no significant differences in bladder diary and QoL characteristics between patients who were unwilling to discontinue the treatment and patients who did stop taking the medication. The group who stopping treatment comprised 70 patients. At the time of last follow-up 22 patients (31%) had not restarted the medication, with mean follow-up of 122.6 days. Therapy was restarted by 48 patients (i.e. 69% of 70). The mean time without treatment was 48 days (± 32.0 days), median 53 days. There was significant worsening of OAB symptoms and subjective bother at the time of restarting the medication. CONCLUSION: Subjective bother based on increase number of frequency, urgency, and nycturia causes patients with positive experience to return to mirabegron treatment. Most patients with successfully-treated symptoms of OAB who discontinue treatment can only do so temporarily. A worsening of the symptoms occurs rather rapidly, because 69% of patients with OAB symptoms successfully treated with mirabegron (UB-VAS 50) are unable to discontinue taking the medication for more than two months.

Solifenacin is effective and well tolerated in patients with neurogenic detrusor overactivity: Results from the double-blind, randomized, active- and placebo-controlled SONIC urodynamic study.

AIMS: To investigate the effect on urodynamics of 4 weeks treatment with solifenacin succinate in patients with neurogenic detrusor overactivity (NDO) due to multiple sclerosis (MS) or spinal cord injury (SCI). METHODS: SONIC was a prospective, multicenter, double-blind, phase 3b/4 study investigating the efficacy and safety of solifenacin 10 mg in patients with NDO due to MS or SCI. Patients (n = 189) were randomized to placebo or active treatment (solifenacin 5 mg, 10 mg or oxybutynin hydrochloride 15 mg) for 4 weeks, after a 2-week, single-blind, placebo run-in period. The primary endpoint was change in maximum cystometric capacity (MCC) from baseline to end of treatment. The primary analysis compared solifenacin 10 mg versus placebo; all other comparisons were considered secondary. Secondary endpoints included changes in urodynamic parameters, patient-reported outcomes, and safety assessments. RESULTS: In the primary analysis, solifenacin 10 mg significantly improved mean change from baseline MCC versus placebo (P < 0.001) and was associated with improvements in bladder volume at first contraction and at first leak as well as detrusor pressure at first leak. Similar results were obtained for oxybutynin versus placebo. Patient perception of bladder condition significantly improved with solifenacin 10 mg versus placebo (P = 0.041). There was a clear improvement in quality of life (QoL) in the solifenacin arms versus placebo. The overall incidence of adverse events was low. CONCLUSIONS: In patients with NDO due to MS and SCI, 4 weeks of treatment with solifenacin 10 mg improved urodynamic variables and QoL versus placebo and was well tolerated. Neurourol. Urodynam. 36:414-421, 2017. © 2015 Wiley Periodicals, Inc.

[Cure effect and persistence of treatment with Mirabegron in patients with symptoms of overactive bladder: a multicentre clinical study]. / Lécebný efekt a perzistence na lécbe mirabegronem u pacientu s príznaky hyperaktivního mocového mechýre v multicentrické klinické studii.

OBJECTIVE: The objective of this study was to monitor and evaluate the persistence and cure effect of Mirabegron in patients with overactive bladder syndrome after 18 months of treatment. DESIGN: Prospective clinical study. SETTINGS: 10 gynecological and urological departments in CZE. MATERIALS AND METHODS: This is an analysis of a prospective, multicenter monitoring study from May to September 2014. The patients were 18 years old and had symptoms of OAB for a minimum of three months. Patient check-ups were performed 18 months after the first visit. The dosage of Mirabegron was 50 mg per day in 162 patients, though for 44 of the patients the treatment was changed. During the final check-ups it was ascertained how many patients had discontinued treatment with Mirabegron, at first as a proportion of the whole group of patients and then in relation to gender, age, previous treatment with anticholinergic drugs and changes in the treatment during the study. To evaluate treatment efficacy we employed the TS-VAS and PPBC. During the check-up it was ascertained how many patients had discontinued treatment with Mirabegron, and reasons for this were established. The statistics were calculated using the softwares STATISTICA 12 (Statsoft, USA) and SPSS 20.0 (IBM, v.20.0). RESULTS: Prospective monitoring was performed on 206 patients. Their mean age was 62.8 years; mean body mass index for the whole group of patients was 27.3. At the check-up 18 months post-initiation of treatment it emerged that 79 (38.3%) patients had discontinued the treatment. The reasons for discontinuation of treatment were insufficient treatment efficacy (35.4% of patients), while 49.4% cited other reasons (hospitalisation, surgery, gravidity) and 15.2% of patients discontinued therapy because of side effects. The evaluation of treatment persistence with Mirabegron in groups with relation to gender, age and previous treatment with anticholinergic drugs did not establish statistically significant differences. However, there was a statistically significant difference between groups in relation to changes of treatment during study. At the evaluation of the efficacy of the treatment during the check-up 18 months after initiation of treatment the mean TS-VAS was 73.4, a decrease of the scale of bothers evaluated by PPBC before treatment from a mean value of 4.6 to a value of 2.7. CONCLUSIONS: In our clinical study 18 months treatment persistence with Mirabegron was 61.7%. The reasons were reduced side effects and good cure effect of the drug.

[Degree of satisfaction of patients continuing overactive bladder treatment with mirabegron]. / Stupen spokojenosti pacientu pokracujících v lécbe hyperaktivního mocového mechýre mirabegronem.

OBJECTIVE: Overactive bladder syndrome is chronic disease with high prevalence rate (9-42%). This syndrome requires long term therapy, but the treatment persistence is after 3 months over all 26% with further decline in one-year period as low as 18.5%. Main reasons for stopping the treatment are low efficacy, the medication didnt work as expected and side effects. How much satisfied are patients with mirabegron persisting on its treatment? To answer this question, we provided secondary analysis of multicentre follow-up study of patients on mirabegron. We compared subjective and objective parameters between patients continuing mirabegron treatment and those who discontinued the medication. DESIGN: Secondary analysis multicentre prospective follow-up. SETTINGS: Ob/Gyn department First Faculty of Medicine, Charles University and General University Hospital, Prague. METHODS: It is secondary analysis of multicentre prospective study following patients with mirabegron 50 mg treatment. We have analysed objective data from micturition diary and subjective data using visual analogue scales (UB-VAS - urgency bother visual analogue scale, and TS-VAS - treatment satisfaction visual analogue scale) and compared data between the group of patients continuing mirabegron treatment and patients who stopped the medication during the study. RESULTS: We included 206 patients (176 women, 30 men) with diagnosis of overactive bladder. Patients continuing the treatment (group n1) had baseline UB-VAS 70.1 vs. 75.0 (p = n.s.) in patients who stopped the medication during the follow-up period (group n2). Baseline episodes of severe urgency and urge incontinence where n1 - 5.1 vs. n2 - 6.2 (p = n.s.). Six months urgency bother score UB-VAS was n1 - 32.4 vs. n2 - 58.9 (p < 0,001). Treatment satisfaction TS-VAS was n1 - 80.3 vs. n2 - 57.7 (p < 0,001). Number of severe urgencies with or without urge incontinence was after 6 months n1 - 2.1 vs. n2 - 3.3 (p = n.s.), lower in group continuing the treatment. When comparing the data between patients stopping the medication for reason of low efficacy (group s1) with patients stopping for other reasons (group s2) UB-VAS bas: s1 - 68.5 vs. s2 - 43.9 (p = 0.001); TS VAS s1 - 45.1 vs. s2 - 58.4 (p = n.s.) and number of severe urgency with or without incontinence s1 - 5.9 vs. s2 - 3.2 (p = 0.009). CONCLUSION: Our data shows that patients expectation on treatment with mirabegron is not low. Patients accept treatment either without side effects or with decrease of severe urgency with or without urge incontinence around 50%. Regardless the reason the patients continuing the treatment scale treatment satisfaction - TS-VAS over 70 points.

[Total pelvic exenteration - strategy and extent of surgery]. / Totální pánevní exenterace - strategie a rozsah operacního výkonu.

INTRODUCTION: Pelvic exenteration is an essential part of complex treatment of advanced tumours of the small pelvis. The strategy of surgery is well known and consensual. However, the optimal extent of lymphadenectomy is still under discussion. The aim of this paper is to summarize the strategy of surgery and the extent of lymphadenectomy. METHODS: Review of the literature and retrospective analysis of 63 patients of our cohort, operated on at the Department of Surgery of the First Faculty of Medicine, Charles University and Thomayer Hospital between 1999-2015. CONCLUSION: The paper describes indications for pelvic exenteration, the strategy of surgery and the necessary extent of lymphadenectomy.

[Expert recommendations: Hepatitis C and transplantation]. / Empfehlungen zur antiviralen Therapie der chronischen Hepatitis C bei Patienten auf der Warteliste und nach Transplantation.

With the approval of new direct acting antiviral agents (DAA), therapeutic options for patients with chronic hepatitis C virus (HCV) infection are now generally available before and after liver transplantation (LT). Interferon-free DAA regimens are highly effective therapies and provide a good safety profile. However, the body of clinical evidence in this patient population is limited and the best treatment strategies for patients on the waiting list with (de)compensated cirrhosis and after LT are not well defined. The following recommendations for antiviral therapy in the context of LT are based on the currently available literature and clinical experience of experts in the field, and have been discussed in an expert meeting. The aim of this article is to guide clinicians in the decision making when treating patients before and after LT with DAAs.

Point Shear Wave Elastography by Acoustic Radiation Force Impulse Quantification in Comparison to Transient Elastography for the Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C: A Prospective International Multicenter Study.

PURPOSE: The aim of the present prospective European multicenter study was to demonstrate the non-inferiority of point shear wave elastography (pSWE) compared to transient elastography (TE) for the assessment of liver fibrosis in patients with chronic hepatitis C. MATERIALS AND METHODS: 241 patients with chronic hepatitis C were prospectively enrolled at 7 European study sites and received pSWE, TE and blood tests. Liver biopsy was performed with histological staging by a central pathologist. In addition, for inclusion of cirrhotic patients, a maximum of 10 % of patients with overt liver cirrhosis confirmed by imaging methods were allowed by protocol (n = 24). RESULTS: Owing to slower than expected recruitment due to a reduction of liver biopsies, the study was closed after 4 years before the target enrollment of 433 patients with 235 patients in the 'intention to diagnose' analysis and 182 patients in the 'per protocol' analysis. Therefore, the non-inferiority margin was enhanced to 0.075 but non-inferiority of pSWE could not be proven. However, Paired comparison of the diagnostic accuracy of pSWE and TE revealed no significant difference between the two methods in the 'intention to diagnose' and 'per protocol' analysis (0.81 vs. 0.85 for F ≥ 2, p = 0.15; 0.88 vs. 0.92 for F ≥ 3, p = 0.11; 0.89 vs. 0.94 for F = 4, p = 0.19). Measurement failure was significantly higher for TE than for pSWE (p = 0.030). CONCLUSION: Non-inferiority of pSWE compared to TE could not be shown. However, the diagnostic accuracy of pSWE and TE was comparable for the noninvasive staging of liver fibrosis in patients with chronic hepatitis C.

[Urine derivation after radical cystectomy]. / Derivace moci po radikální cystektomii.

INTRODUCTION: Radical cystectomy, performed both for the treatment of cancer and other conditions, needs to be followed by ensuring the derivation of urine. The aim of this work is to summarize the possibilities of urine derivation after cystectomy, their advantages, disadvantages and long-term results. METHODS: A review article summarising relevant literature and the team of authors own experience. CONCLUSION: This work compares advantages and risks of different types of urine derivation following radical cystectomy.

Influence of hepatitis C virus infection and high virus serum load on biliary complications in liver transplantation.

BACKGROUND: Biliary complications (BCs) and recurrent hepatitis C virus (HCV) infection are among the major causes of morbidity and graft loss following liver transplantation. The influence of HCV on BCs has not been definitely clarified. PATIENTS AND METHODS: We performed a retrospective cohort study to analyze risk factors and outcome of post orthotopic liver transplantation (OLT) BCs in 352 liver transplant recipients over 12 years in Munich, Germany (n = 84 with HCV; living donor and re-OLT were excluded). BCs diagnosed with imaging techniques and abnormal liver enzyme pattern, requiring an intervention, were considered. RESULTS: In a multivariate analysis, HCV serostatus and a high pre-and post-surgery HCV RNA serum load were independent risk factors for anastomotic strictures. HCV positivity and BCs alone did not alter graft loss. HCV-positive patients with BCs, however, had a significantly worse graft outcome (P = 0.02). Non-anastomotic strictures, bile leaks, and the number of interventions needed to treat bile leaks led to worse graft outcome in all patients. CONCLUSION: HCV positivity and a high HCV RNA serum load were risk factors for anastomotic strictures. BCs and HCV had an additive effect on graft loss.

[Nocturnal polyuria, treatment with desmopressin]. / Lécba nocní polyurie desmopresinem.

UNLABELLED: Nonpharmacologic and especially pharmacologic treatment options are available for nocturnal polyuria. Desmopressin represents the basis of pharmacologic treatment. Desmopressin acetate is a synthetic analogue of arginine vasopressin with high affinity to V2 receptors with antidiuretic effect. It is the only medicament currently registered for antidiuretic treatment. Desmopressin has not any relevant affinity to V1 receptors, and therefore there is no hypertensive effect in contrary to natural vasopressin. Desmopressin use before a bedtime leads to reduced production of urine during a sleep, therefore time between desires to void is prolonged and number of nocturia is reduced. Clinical effect, in a meaning of reduced urine production and increased osmolality of urine, lasts approximately 8-12 hours. In the treatment of nocturnal polyuria desmopressin is used orally one hour before a bedtime. It is essential to titrate an ideal dose, the initial dose is 60 µg of MELT formula (fast melting oral formulation) and it can be increased according to the clinical effect up to the maximal recommended daily dose 240 µg. Patients treated with desmopressin should cut down a fluid intake 1 hour before and 8 hours after the use of desmopressin. Total number of adverse events connected withdesmopressin treatment in clinical studies was higher compared to placebo but the side effects were mostly mild. The most common adverse events were headaches, nausea, diarrhoea, abdominal pain, dry mouth and hyponatremia both in the short-term and long-term clinical trials. Hyponatremia was observed mainly in patients over 65 year of age. Therefore treatment with desmopressin should not be commended in patients over 65 year of age without close monitoring of the natrium level in serum and all patients should be informed about the first symptoms of hyponatremia - headache, nausea and insomnia. According to Evidence Based Medicine, the level of evidence for treatment of nocturnal polyuria with desmopressin is 1b and the grade of recommendation for treatment is A. KEYWORDS: nocturnal polyuria - treatment - desmopressin.

[Nocturia, incidence, ethiology, diagnostics]. / Epidemiologie, etiologie a diagnostika nykturie.

Nocturia is the complaint that the individual has to wake at night one or more times to void, according to the International Continence Society definition from the ICS Standardisation of Terminology Report 2002. As the nocturia definition is complicated there are also other slightly modified definitions. It is currently not absolutely clear if prevalence or incidence is more important for epidemiology evaluation of nocturia. Nocturia is a variable symptom and its presence in individuals is reversible therefore it is very difficult to obtain reliable incidence data. Nocturia prevalence varies remarkably in different studies according to evaluation methodology, nocturia definition, methods of data collection and characteristics of evaluated population. There are not enough studies, especially demographic ones, evaluating lower urinary tract symptoms and/or nocturia in males and females. There is relatively large number of comparative studies confirming strong correlation between aging and prevalence of nocturia. Prevalence of two or more voids per night in individuals in their twenties varies between 5-15 %, it progresses with age, and in the seventh decade of life ranges between 35-50 %. Prevalence evaluated by gender is higher among younger women compared to older women and older men compared to younger men. Currently there are only limited sources of data regarding nocturia incidence. Incidence of nocturia (two or more voids per night) in a population older than 60 years is 213 new cases/1000 persons/1 year in two year observation. Incidence of two or more voids per night is 75 new cases/1000 male/1 year in five year observation and 126 new cases/1000 male/1 year in ten year observation in male population. Incidence of nocturia rises significantly with age. Incidence of two or more voids per night increases by 2,7 % in the population of women after child birth during 5 year follow up and by 5,9 % during 12 year follow up. Incidence of nocturia newly diagnosed in a pregnancy drops down by 98% in 3 month after the child birth. The incidence data indicate that incidence of nocturia rises with age and probability of nocturia relief decreases with age. Incidence of mild nocturia is higher compared to incidence of severe nocturia and significant relief of nocturia in women after child birth is very inconsistent compared to increase of other lower urinary tract symptoms. Ethiology of nocturia might be polyuria, nocturnal polyuria or reduced bladder capacity. Nocturia and its ethiology can be determined in most cases with simple and commonly used investigative methods on the out-patients bases. The diagnostic algorithm should lead to verification of nocturia and identifying its cause because treatment of nocturia differs remarkably according to the etiology.

Dynamics of fertility in patients on waiting list for kidney transplantation.

OBJECTIVES: To evaluate the presence of hormonal abnormalities and fertility disorders in patients with chronic kidney disease (CKD) awaiting renal transplantation. METHODS: From September 2009 to April 2011 all male patients with CKD awaiting kidney transplantation were investigated. The following tests were performed: semen analysis, serum concentration of testosterone, SHBG, LH, FSH and prolactin. Differences in hormone levels and sperm count parameters were statistically evaluated between the control group and the patient group. RESULTS: The group of patients consisted of 74 and the control group of 41 men. Average testosterone levels were lower in patients compared to control group. In patients significantly higher levels of SHBG, LH, FSH and PRL were found, and statistically significantly lower ejaculate volume, total sperm count, sperm concentration, total and progressive sperm motility and sperm morphology than in the control group. Within the group of patients a negative correlation between testosterone and PRL was found and a positive correlation between testosterone and total sperm motility and morphology. A negative correlation was detected between the duration of haemodialysis and testosterone, sperm concentration, total and progressive motility and sperm morphology. CONCLUSION: Significant changes in hormone levels and impaired fertility are found in haemodialyzed patients on a waiting list for kidney transplantation. The dynamics of these changes are dependent on the duration of haemodialysis (Tab. 4, Fig. 2, Ref. 15). Text in PDF www.elis.sk.

[Current state of diagnostics and treatment of overactive bladder in the Czech Republic - five years ago and today]. / Diagnostika a lécba hyperaktivního mocového mechýre v Ceské republice pred peti lety a dnes.

INTRODUCTION: Overactive bladder (OAB) presents one of the most frequent medical problems among the current adult population, with a significant impact on the quality of life of the affected patients. A questionnaire survey was carried out in 2006, with the aim to assess the level of knowledge regarding the problem of OAB among gynaecologists and urologists in the Czech republic, as well as to evaluate the currently applied methods of OAB diagnostics and treatment. The aim of this work was to perform a repeated survey after five years, and to evaluate, whether there have been any changes achieved in the monitored parameters. MATERIALS AND METHODS: A total of 290 respondents (181 gynaecologists, 109 urologists) were included in the survey in 2006; the study group in 2011 included a total of 285 respondents (180 gynaecologists, 105 urologists). The questionnaire used for the survey in 2011 was identical to the document utilized in the initial survey performed five years ago, with minimal changes. The anonymous questionnaire was designed as "multiple-choice", i.e. with a possible selection from proposed answers; the questions were targeted at the topics of definition, diagnostics and therapy of OAB. The obtained results were processed with the methods of descriptive statistics; the concordance of proportions was evaluated with the Fishers exact test. RESULTS: A total of 114 gynaecologists (63.3%), and 65 urologists (61.9%) were able to determine the correct definition of OAB, which presents a significant increase when compared to 2006 (p<0.0001). The most frequently applied methods of OAB diagnostics were patient history (gynaecologists: 97.8% in 2011 vs. 96.5% in 2006, urologists: 99.0% in 2011 vs. 99.0% in 2006), local examination (gynaecologists: 57.8% vs. 76.4%, urologists: 86.7% vs. 87.2%), bladder diaries (gynaecologists: 62.8% vs. 40.3%, urologists: 79.0% vs. 60.5%), and urine examination (gynaecologists: 71.1% vs. 82.3%, urologists: 96.2% vs. 97.1%). Anticholinergic medication is the first-choice in the OAB treatment in our conditions, which has been confirmed by 146 (81.1%) gynaecologists, and 89 (84.4%) urologists. In cases when the physicians use anticholinergic medication for the treatment of OAB, the first-choice medication is trospium, among both gynaecologists and urologists. In case of failure of the first-choice treatment, twenty-six (14.4%) gynaecologists from the addressed respondents try to continue with a treatment according to their own decision, 154 (85.6%) gynaecologists refer the patient to a specialist. Similarly, a total of 90 (85.7%) urologists try to manage the further course of treatment by their own means, 15 urologists (14.3%) refer the patient to a specialist. CONCLUSION: The level of understanding and awareness about the problem of OAB among the Czech gynaecologists and urologists has significantly improved during the past five years. The applied diagnostic and treatment methods for OAB are being harmonized with the International Continence Society (ICS) recommendations. Taking into consideration the prevalence of OAB among the population, it is desirable to increase the number of clinical departments who deal with the problem of OAB in a complex manner. The remaining significant task lies in the improvement of foreknowledge about the current possibilities and effectiveness of the OAB treatment among the patient population.

[Prevalence of women with overactive bladders in the Czech Republic]. / Prevalence zen s hyperaktivním mocovým mechýrem v Ceské republice.

INTRODUCTION: The term OAB (overactive bladder) was introduced in praxis in the year 2002 by Abrams. This term includes symptoms of urgency, with or without urgent incontinence, and it is generally accompanied by urinary frequency and nocturia. OAB is widespread among our female population. Approximately 20% of women suffer from this problem, but the frequency of the syndrome has not been assessed more precisely by means of questionnaires. The aim of our study was to assess the prevalence of OAB among patients who visited gynecologists in the first line and completed the Bladder Control Self Assessment Questionnaire (BCSAQ). MATERIAL AND METHODS: Five gynecologists in the first line questioned 492 consecutive patients as to whether they suffered from urgency, frequency, nocturia and urgent incontinence, and their answers were later evaluated. The BCSA questionnaires completed by the patients in the waiting room before seeing the doctor were subsequently also evaluated. RESULTS: Due to inquiries made by the gynecologist, 320 patients took the BCSA questionnaires in the waiting room before seeing the doctor, and 314 completed them; 14 patients completed the questionnaires after seeing the doctor who questioned them about problems with urgency. The patients then handed the completed questionnaires to the nurse, i.e. the total of 328 questionnaires were assessed. 159 patients suffered from urgency, and 35% of these patients had problems with leakage of urine. In reply to the question: Is it difficult to hold urine when you have the urge to go? 22% of patients from the whole group of patients (n = 492) answered yes. 24% of patients had problems with frequency, 32% with nocturia and 14% with urgent incontinence. CONCLUSION: OAB syndrome is widespread in our population; it constitutes a major problem which must be treated. Awareness of this problem has now improved; patients feel less embarrassed to discuss about problem, and increasingly they seek treatment, while at the same time gynecologists have improved their knowledge about the diagnosis and treatment of OAB. This means that the quality of life for these patients can be improved.

[Evaluation of initial experience with safety and short efficacy of mini-sling antiincontinence procedures MiniArc and AJUST system]. / Vyhodnocení prvých zkuseností s bezpecností a krátkodobým efektem mini-páskových antiinkontinentních operací MiniArc a AJUST.

OBJECTIVE: The aim of our study is to present initial experiences, with regard to safety and short-term efficacy, of mini-sling MiniArc and AJUST operations for stress urinary incontinence (SUI). DESIGN: Cross-sectional clinical study. SETTINGS: Gynecological and Obstetric Clinic 1. LF UK and VFN Prague; Gynecological and Obstetric Clinic FN Bulovka and 1. LF UK Praha; Urological dpt. FTN Prague; GONA spol. s r.o.; Urological dpt. FN Ostrava Poruba. MATERIALS AND METHODS: We present briefly the technique employed in the operations, the urodynamic examination procedure before and after the operation, and the subjective and objective outcomes of these procedures from the 5 above-mentioned hospitals which participated on the study. Objectively the leakage of urine was assessed during urodynamic examination and by cough test. Subjectively leakage of urine was assessed by ICIQ-SF questionnaire (The International Consultation on Incontinence, short form). This study evaluated the cure effect and complications accompanying the MiniArc and AJUST procedures, and compared these results. The clinical study included 66 women with previously untreated stress urinary incontinence. These women were randomly divided by envelop method into two groups; the first group of patients underwent operations using the MiniArc (n=33) technique and the second group the AJUST (n=33) technique. Mean age was 57.9 years in the AJUST group and 57.7 years in the MiniArc group. Mean body mass index (BMI) was 29.2/28.7 in the AJUST/MiniArc groups respectively, and mean parity was 2.09/2.24. We did not find statistically significant differences between these two groups. RESULTS: The curative rate of the MiniArc and AJUST procedure was evaluated 3 months after the operation (+/- 1 week). We can conclude from the outcomes of the cough test that this test was negative in 61 (92%) of patients overall; in the AJUST group it was 31 (94%) of patients and in the MiniArc group 30 (91%) of patients. In the subjective evaluation of the leakage of urine before operation (ICIQ-SF) the mean score in the group of patients who subsequently underwent the AJUST operation was 15.4 (SD-3.39; median-16, range 8-21) and in women who underwent the MiniArc operation it was 15.5 (SD-3.3; median-16, range 8-21). The AJUST/MiniArc procedure caused a statistical significant decrease in the total score to -14.09(SD-5.18)/-14.45 (SD-3.73). The difference in the decrease of the score between the AJUST/MiniArc groups was not statistically significant. In the AJUST group of patients, according to the ICIQ-SF, 30 (91%) women were without problem or improved [27 (81.7%) of women were without problem], while in the MiniArc group 32 (96.9%) were without problem or improved [24 (72.7%) of women were without problem]. The urodynamic examination before and after operation indicated that there were no differences between the groups of patients either before and or after the operation. Changes in the parameters MUCP, Qmax and others caused by the operation were not significant, and there were no statistical significant differences in the values of these parameters between the groups of patients. Complications of the MiniArc and AJUST procedures were not recorded. CONCLUSIONS: Our first experiences with MiniArc and AJUST procedures, including possible complications and curative rate, are positive. From the preliminary results the cure effect of MiniArc and AJUST 3 months after the operation (+/- 1 week) is similar. It will be important to evaluate the efficacy of these procedures one year after the operation for a definitive evaluation of the cure effect.

Two consecutive episodes of acute hepatitis C with different genotypes in a hemodialysis patient responsive to PEG-interferon monotherapy.

We report the case of a 63-year-old male patient on long-term hemodialysis who suffered two consecutive episodes of persistent hepatitis C virus infection with different genotypes and was successfully treated with pegylated IFN-alpha monotherapy each time.

Molecular profiling in IgA nephropathy and focal and segmental glomerulosclerosis.

The aim of the study was to characterize by molecular profiling two glomerular diseases: IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) and to identify potential molecular markers of IgAN and FSGS progression. The expressions of 90 immune-related genes were compared in biopsies of patients with IgAN (n=33), FSGS (n=17) and in controls (n=11) using RT-qPCR. To identify markers of disease progression, gene expression was compared between progressors and non-progressors in 1 year follow-up. The results were verified on validation cohort of patients with IgAN (n=8) and in controls (n=6) using laser-capture microdissection, that enables to analyze gene expression separately for glomeruli and interstitium. In comparison to controls, patients with both IgAN and FSGS, had lower expression of BAX (apoptotic molecule BCL2-associated protein) and HMOX-1 (heme oxygenase 1) and higher expression of SELP (selectin P). Furthermore, in IgAN higher expression of PTPRC (protein-tyrosine phosphatase, receptor-type C) and in FSGS higher expression of BCL2L1 (regulator of apoptosis BCL2-like 1) and IL18 compared to control was observed. Validation of differentially expressed genes between IgAN and controls on another cohort using laser-capture microdissection confirmed higher expression of PTPRC in glomeruli of patients with IgAN. The risk of progression in IgAN was associated with higher expression EDN1 (endothelin 1) (AUC=0.77) and FASLG (Fas ligand) (AUC=0.82) and lower expression of VEGF (vascular endothelial growth factor) (AUC=0.8) and in FSGS with lower expression of CCL19 (chemokine (C-C motif) ligand 19) (AUC=0.86). Higher expression of EDN1 and FASLG along with lower expression of VEGF in IgAN and lower expression of CCL19 in FSGS at the time of biopsy can help to identify patients at risk of future disease progression.

[Evaluation of the tumor extension before planned radical prostatectomy: a prospective study]. / Moznosti stanovení lokálního rozsahu karcinomu prostaty pred plánovanou radikální lécbou: prospektivní studie.

BACKGROUND: Study compares results of preoperative diagnostic methods with measurements of tumor extension in a specimen obtained by radical prostatectomy. METHODS AND RESULTS: One hundred forty-six patients with clinically identified cancer were enrolled in the study and subjected to radical prostatectomy. Each patient underwent transrectal sonography (TRUS), Power Doppler sonography with 3D reconstruction (3D-PDS), and the risk of the occurrence of locally advanced tumor was assessed using Partin tables. In subgroups of localized and locally advanced tumor, individual preoperative parameters were compared. ROC curves were generated for individual preoperative parameters and the area under the curve (AUC) was calculated. Multivariate logistic regression analysis was performed to determine independent predictors of extraprostatic tumor extension. A statistically significant difference between patients with localized and locally advanced tumor was observed in PSA levels (p < 0.014), PSA density (p < 0.004), DRE (p < 0.037), TRUS (p < 0.003), and 3D-PDS (p < 0.000). The highest AUC value was found for 3D-PDS 0.776, TRUS 0.670, and PSA density 0.639. According to multivariate analysis, independent preoperative predictors of extraprostatic tumor extension were PSA density, preoperative Gleason score 7, and 3D-PDS finding. CONCLUSIONS: Power Doppler sonography with 3D reconstruction represents the most reliable preoperative diagnostic tool in determining locally advanced tumor. Together with PSA density and the presence of aggressive tumor (Gleason score > or =7) in prostate biopsy, it is one of independent predictors of locally advanced prostate cancer.