Complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance.

OBJECTIVE: The aim of this study was to analyze the complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance. METHODS: This study included 106 totally laryngectomized patients who underwent secondary Provox 2 voice prosthesis insertion. Among them, 79 (74.5%) were irradiated. Surgery, prosthesis, fistula, and voice-related complications were analyzed and presented. RESULTS: Complications occurred in 23 (22%) patients. Fifteen of them were previously irradiated. There were no surgery-related complications. In the group of prosthesis-related complications, one patient had increased negative pressure during swallowing with extremely short prosthesis life time. There were 17 complications in the group of fistula related ones; 3 patients had excessive granulation tissue around the fistula and 14 patients experienced prosthesis displacement (7 had closed esophageal end of the fistula, 5 had the prosthesis turned sideways in an open fistula, one patient inhaled and one ingested the prosthesis). Tracheoesophageal voice was not established in 5 patients. Previous irradiation had no statistically significant influence on the complication rate (P = 0,251). CONCLUSIONS: The majority of complications following secondary voice prosthesis insertion are fistula-related ones, among which, displacement of the voice prosthesis is the most common. Previous irradiation does not significantly increase the risk of developing complications.

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.

Renal cell carcinoma in a horseshoe kidney.

A case of an adenocarcinoma within a horseshoe kidney (HK) is presented. Male patient presented with a history of a painless hematuria. A contrast enhanced magnetic resonance (MR) scan showed a horseshoe kidney. A large soft tissue mass was also noted on the right side. Kidney was receiving supply from two arteries on the left side and one at the right side. Angiography of the right renal artery demonstrated hypervascular tumor staining. The kidney was approached through midline abdominal incision, and a right heminephrectomy was performed. The histopathology examination showed pT2, grade 2 renal cell carcinoma. To conclude, angiography is indispensable for guiding surgical interventions.

Ketoprofen is superior to metamizole in relieving postoperative pain after head and neck tumor operation.

PURPOSE: Recently, nonsteroidal analgoantipyretics are recommended in the management of postoperative pain, with great attention to their safety. We conducted a randomized, single blind study to compare the analgesic efficacy and safety of ketoprofen and dipyrone (metamizole) after major head and neck surgery. PATIENTS AND METHODS: 60 patients received postoperatively 100 mg ketoprofen or 2.5 g metamizole i.v. every 8h over 72h with additional administration of tramadol in case of inadequate analgesia. Pain was assessed by visual numeric scale every 2h during the 72h. RESULTS: Patients in both groups had similar pain score during the first 2 postoperative days, while on the 3rd postoperative day patients in the ketoprofen group had significantly lower pain score (p <0.05). CONCLUSION: The efficacy of ketoprofen to achieve postoperative analgesia was comparable to metamizole during the first 48h, while ketoprofen was superior to metamizole during the 3rd postoperative day.

[Comparison of granisetron and metoclopramide for prevention of nausea and vomiting following total cystectomy and ileal conduit].

The objective of this study was to examine the use of granisetron in actual clinical practice and to compare effect of dose of 1 mg granisetron after total cystectomy plus ileal conduit with group of patients which received metoclopramide. Granisetron established total contol of PONV in 93,33% patients. Granisetron is 40% more effective in PONV control than metoclopramide. Only minimal nausea epizodes were observed in early postoperative period in patients who had received low dose of granisetron (1 mg i.v.).

Combined general and epidural anaesthesia versus general anaesthesia for radical cystectomy.

The basic objective of the study is to present the effects of two types of anesthesia, general and combined general and epidural, on intraoperative bleeding and to present the effect of epidural analgesia during the postoperative period in radical cystecomy. Subjects who received general and epidural anesthesia had on the average 28.5% less bleeding than those who only had general anesthesia. Patients who received postoperative epidural analgesia had statistically significantly better analgesia during the postoperative period than those who were administered Tramadol intramuscularly.

Glutathione S-transferase T1-1 activity upregulated in transitional cell carcinoma of urinary bladder.

OBJECTIVES: To perform a systematic functional investigation of different glutathione S-transferase (GST) classes, including GST class Theta (GSTT) member GSTT1-1, in transitional cell carcinoma (TCC) and the surrounding normal uroepithelium of the same individuals. Recently, it was suggested that GSTT1-1 might be an important risk modulator for TCC. METHODS: Tumor samples and surrounding normal uroepithelium were obtained from 24 patients with TCC of urinary bladder. The following substrates with differential specificities were used: 1-chloro-2,4-dinitrobenzene for overall GST activity; 7-chloro-4-nitrobenzo-2-oxa-1,3-diazole for GST Alpha; 1,2-dichloro-4-nitro-benzene for GST Mu; 4-vinylpyridine for GST Pi 1-1(GSTP1-1); and 1,2-epoxy-3-(p-nitrophenoxy)propane for GSTT1-1. RESULTS: GSTP1-1 and GSTT1-1 activities were demonstrated in all uroepithelial and TCC samples, and GST Mu activity was detectable in 11 of 24 patients. In the tumor specimens, significant upregulation of all expressed GST subtypes was observed. The mean GSTP1-1 and GSTT1-1 level in TCC was increased 2-fold and 3.6-fold, respectively, compared with the mean level in the normal uroepithelium (P <0.001). Tumor GSTT1-1 activities correlated statistically significantly with the tumor stage (P <0.05). CONCLUSIONS: In tumors and adjacent normal uroepithelium of patients with TCC, three major cytosolic GST classes, Mu, Pi, and Theta, were expressed. Although the GST isoenzyme pattern in TCC was similar to that of the corresponding normal uroepithelium, during cancer progression a clear tendency toward an increase in all the GST subtypes expressed was noted. For the first time, distinct GSTT1-1 activity levels were demonstrated in human uroepithelium, as well as its pronounced upregulation in TCC.

[Tumors of the upper urinary tract: results of conservative surgery]. / Tumeurs de la voie excrétrice supérieure: résultats de la chirurgie conservatrice.

OBJECTIVE: To determine the results of conservative surgery for upper urinary tract urothelial tumours. PATIENTS AND METHODS: From 1986 to 1997, 352 patients were treated in the Belgrade urology clinic for upper urinary tract urothelial tumour. 54 patients (15.3%) were treated by conservative surgery. The sex ratio was 1.3 men for 1 woman. The mean age was 63 years. In most cases, the tumour was situated in the ureter. Conservative surgery was performed on principle in 60% of patients for a small isolated lesion (solitary low-stage, low-grade tumour). In contrast, in about 40% of cases, conservative surgery was performed by necessity due to the presence of bilateral tumours, a solitary kidney or renal failure related to Balkan nephropathy. The median follow-up was 67.3 months (range: 6 months-14 years). RESULTS: 15.8% of patients developed a local recurrence during the follow-up period. The risk of recurrence was higher when conservative surgery was performed for indications of necessity than when it was performed on principle (21.7% versus 11.8%), but the difference was not statistically significant (c2 test, t test). The stage and grade of differentiation were identified as the most significant predictive factors for the risk of local recurrence. The overall 5-year survival rate was 67% with more favourable results in the case of conservative surgery performed on principle compared conservative surgery by necessity (72% versus 60%). The difference between these results was not statistically significant, but a statistically significant difference was observed for tumour stage and grade (grade III versus grade I and II, pT3 versus pT1, pT2). The 5-year survival probability was 68.5%. Recurrence was most likely to occur during the early postoperative course, as 81.56% occurred during the first 18 months. CONCLUSION: Urothelial tumours can be managed conservatively. However, the risk of recurrence is directly correlated with the tumour stage and grade, with a high level of statistical significance, and with the type of indication for conservative surgery performed, but with no statistically significant difference.

[Comparison of upper urinary tract tumors in the region of Balkan nephropathy with those of other regions of Yugoslavia]. / Comparaison des tumeurs du haut appareil urinaire dans la région de la néphropathie balkanique avec celles d'autres régions de Yougoslavie.

OBJECTIVES: To compare the epidemiological and histological characteristics of upper urinary tract tumours in the region of Balkan endemic nephropathy with those of urothelial tumours observed in other regions. MATERIAL AND METHODS: From 1970 to 1997, 766 patients were treated in the Belgrade Department of Urology for an upper urinary tract tumour. These patients were derived from 3 regions: the region of Balkan endemic nephropathy (BEN), the region of probable Balkan endemic nephropathy (PBEN) and the region without Balkan endemic nephropathy (WBEN). The incidence of tumours in BEN + PBEN patients was 68% versus 32% for WBEN patients. The histological and epidemiological characteristics of the tumours in these three groups were compared. RESULTS: Tumours were more frequent in women in the BEN and PBEN groups (1.2:1 and 1.1:1) than in the WBEN group (0.6:1). The tumour was diagnosed an average of 5 years later in the first 2 groups than in the WBEN group (p < 0.05). The BEN and PBEN groups presented a higher incidence of renal failure (45% and 35%), but especially a much higher incidence of bilateral tumours (13% and 6%) than in the WBEN region (2%). CONCLUSION: Our analysis shows that upper urinary tract tumours depend on geographical factors: the incidence of these tumours is significantly higher in regions of BEN and PBEN, women are more frequently affected, tumours are associated with a high incidence of renal failure, bilateral tumours are more frequent, and tumours are more frequent in older patients. Comparison of the histological and pathological characteristics of the tumours did not reveal any significant difference between these three regions.

[Surgical treatment and quality of life in patients with carcinoma of the penis]. / Hirurski tretman i kvalitet zivota bolesnika sa karcinomom penisa.

Penile carcinoma is a rare disease with the annual incidence of 1-2 cases per 100,000 men. About 95% of all penile malignancies are squamous cell carcinoma. At the Clinic of Urology in the period 1988-1998 we treated 58 patients with penile carcinoma. Nine of these (15.5%) were subjected to total penectomy due to the extent of the lesion, while partial amputation of the penis was performed in 84.5% (49 cases). The aim of the therapy was to completely remove the primary lesion with adequate margins. Postoperative follow-up comprised, among other things, evaluation of the quality of life as reflected in pain, sexuality and emotional distress. Quality of life of patients subjected to partial penectomy where no cases of relapse were recorded, was satisfactory, while in cases of total penectomy about 24% (14 patients) suffered marked emotional distress induced by the loss of the mark of male sexuality and sexual impotence. In the light of the prominent problems related to the quality of life induced by severe psychological influence of penis amputation, local excision, Mohs's operation and laser therapy are increasingly used in the treatment of penile carcinoma.

[Quality of life in patients with renal carcinoma]. / Kvalitet zivota kod bolesnika sa karcinomom bubrega.

First line treatment of renal cell carcinoma (RCC) is radical nephrectomy. In patients with metastasis or with local recurrence adjuvant immunohaemiotherapy is necessary. Interferon alpha is used with or without Interleukin 2 in combination with cytostatics. Immunotherapy induces some adverse effects which might compromise the treatment. The aim of this pilot study was to asses the effect of interferon on the quality of life in patients with RCC previously treated with radical nephrectomy. The originally made questionnaire was used to measure the impact of the treatment on quality of life of 15 patients. It was that Interferon did not alter significantly the quality of life in examined patients.

[Quality of life in patients with tumors of the upper urothelium and indications for conservative surgery]. / Kvalitet zivota bolesnika sa tumorom gornjeg urotelijuma kao indikacija za primenu konzervirajucih operacija.

The motives for performing conservation surgery in tumors of the upper urinary tract are progressive renal failure associated with those tumors, frequent bilateral tumors, and tumors on solitary kidney, which does not always comply with the patho-anatomic characteristics of the tumor and possibilities of this type of surgery. The aim of the study was to separate the real indications for the application of this therapy, independently of the expected quality of life after the operation. Out of 682 patients with upper urothelial tumor conservation surgery was performed in 161 patients. The indications were characterized as "real", oncologic in 121 patient, and in 40 patients (25%) the main reason was preservation of quality of life. During the five-year follow-up period recurrence developed in 17% of patients in the group with oncologic indications, "real" indications, and in as much as 40% of patients from the group in with the main reason was preservation of quality of life. Thus, the oncologic indications must be primary in reaching the decision for conservation surgery in tumors of the upper urinary tract, and the quality of life should be an additional motive for this therapy.

[Ileal conduit--quality of life]. / Ilealni konduit--kvalitet zivota.

Removal of the urinary bladder--cystectomy--imposes the problem of urine derivation. The most sophisticated forms of urinary derivation imply those where the continent urinary reservoir is anastomosed to the urethra. One of these is Came's enteroplasty. In our hospital this technique was applied on 52 patients. Postoperative complications and obtained results suggest that this form of urinary derivation is an important step forward not only to incontinent forms of derivation, but to non-orthotopic continent urinary derivations, as well. All patients in our series were very successful in reintegration into the normal life, i.e. they were able to achieve a high quality of life after otherwise mutilating surgical procedure.