[Laparoscopic pyeloplasty in adults--mid-term results in 32 laparoscopic pyeloplasties during 2003-2008]. / Laparoskopická pyeloplastika u dospelých--strednedobé výsledky 32 laparoskopických pyeloplastik 2003-2008.

Pyeloureteric iunction obstruction is the most common inborn error of the upper urinary pathways. In the time of routine prenatal ultrasound examination, this disease is discovered in the child's age, when it is treated most frequently. Publication summarizes the results of modern laparoscopic management in the adults, who had not been diagnosed previously and symptoms occurred many years after their birthdate. The surgical treatment has been changed in the approach, but not the goal of desobtruction. The results in the adults are influenced not only by the operation technique, but also by the length of time the obstruction lasted and by the number and severity of the inflammatory changes.

[Mid-term outcomes and survival rates in patients with radical retropubic prostatectomy (RRP) under current Czech healthcare system]. / Strednedobé výsledky a prezití nemocných po radikální retropubické prostatektomii (RRP) v soucasných podmínkách ceského zdravotnictví.

The mid-term results (5 yr) after radical retropubic prostatectomy (RRP) are outlined and compared with pre- and postoperative parameters of patients. While 5 years survival could be expected in as many as 92.4%, relatively higher age (majority over 65) brings a higher risk of complications with it, though fully comparable with international standards. No perioperative mortality was recorded (0%), obstructive symptoms post-operatively developed in 13.4% patients, who were subsequently managed successfully endoscopically. Continence with maximum one pad per 24 hours was recorded in 77.2%, the severe incontinence was only in 3.3%. Spontaneous erection was reported in 4.3%, but except for higher age, the other objective factors were involved.

Does the expression of fascin-1 and tumor subclassification help to assess the risk of recurrence and progression in t1 urothelial urinary bladder carcinoma?

INTRODUCTION: To evaluate the prognostic value of T1 subclassification and fascin-1 expression in T1 human urothelial cell carcinoma of the bladder. MATERIALS AND METHODS: In a prospective study with 105 consecutive patients, T1 tumors were subclassified into 2 groups according to the depth of tumor invasion. The tunica muscularis mucosae was used as a landmark. The expression of fascin-1 was examined by using an anti-fascin-1 mouse monoclonal antibody and was evaluated semiquantitatively for both intensity and distribution. The patients were followed up for 27.3 +/- 13.7 months. RESULTS: The T1 tumor subclassification was feasible in 99 patients (94%). T1a tumor was detected in 77 patients (73%), T1b tumor in 22 patients (21%). An invasive tumor was found in 5 patients (4.8%) during the restaging transurethral resection of the bladder. The risk of understaging in patients with T1b tumor was 18%. There was not a significant difference in time to the recurrence in the T1a and the T1b group. The progression-free survival rates were significantly different between both groups (p = 0.0034). No correlation was found between fascin-1 positivity and the depth of tumor invasion. Fascin-1 positivity did not correlate with recurrence or the progression-free intervals. In the multivariate analysis, only the extent of lamina propria invasion was an independent predictor of the tumor progression. The fascin positivity was not an independent prognostic factor relating to the risk of recurrence or progression. CONCLUSION: The finding of T1b tumor was connected with a significantly higher risk of progression and understaging. The fascin-1 expression did not correlate with the depth of tumor invasion or with the tumor recurrence or progression.

[Outcomes of transperitoneal laparoscopic nephrectomy for renal adenocarcinoma]. / Výsledky transperitoneání laparoskopické nefrektomie pro renální adenokarcinom.

Laparoscopic radical nephrectomy (LRN) is method of choice in malignant renal tumors (RCC) stage T1-3. Procedure has proved to be technically safe with low post-operative morbidity and standard oncological results, provided the patients are secondaries free in the time of surgery, and there was no positive margin in resected tissue. There was no recurrence even after 6 years of follow-up. The most influential variables regarding the survival of patients postoperatively were: presence of metastases in the time of surgery p <0.0001, pathological grade p < 0.001, stage p < 0.018 and p < 0.046, respectively, if the tumors were 4 cm and bigger. It could be concluded, that laparoscopic way of removing the tumor with the kidney has proved the same oncological results even in the mid-term follow-up, if compared with classical open surgery done lege artis.

[New aspects in prostate cancer therapy]. / Karcinom prostaty s novou tvárí.

Prostate cancer remains the most common noncutaneous human malignancy, and the second most lethal tumour among men. The clinical presentation of this tumour has recently completely changed, which is followed with the new diagnostic and therapeutic approach. However, the natural history of the disease is often prolonged, and the survival benefits of local therapy for men with low-risk tumours may not be realized for a decade or more, as is increasingly well demonstrated in long-term observational cohorts in both Europe and United States. A significant proportion of men with prostate cancer is over-diagnosed, in the sense that diagnosis may not improve their lifespan or quality of life. However, the extent to which over-diagnosis represents a true problem relates to the consistency with which diagnosis leads invariably to active treatment. Mainly due to PSA screening, prostate cancer is diagnosed at progressively earlier stages and with lower risk features; despite these trends, there are less patients now than a decade ago who undergo a trial of active surveillance only. Rates of brachytherapy and hormonal therapy have risen markedly. Important progress has been achieved in recent years in prostate cancer risk assessment. These advances, in combination with biomarkers in later stages of development, should be expected in the next years to yield further improvements in clinicians' ability to diagnose prostate cancer early, and guide appropriately selected patients toward the tailored treatment.

[Radical cystectomy in the treatment for bladder carcinoma: results of 125 operated patients]. / Radikální cystektomie u pacientu s nádory mocového mechýre--výsledky u 125 operovaných pacientu.

BACKGROUND: Radical cystectomy with pelvic lymphadenectomy and urinary diversion is standard treatment in patients with muscle-invasive and selected high-risk superficial bladder cancers. The aim of our study was to evaluate oncological results and correlate prognosis with the extent of the disease. METHODS AND RESULTS: Data of 125 patients (33 females and 92 males) with mean age of 59.8 years were analysed. Histological diagnosis was urothelial carcinoma in 114, squamous cell carcinoma in 8 and small-cell carcinoma in 3 patients respectively. During the mean follow-up of 22.4 months the disease-free survival (DFS) and disease-specific survival (DSS) were evaluated according to the extent of the disease. Tumours were classified as pTa, pT1, pTis in 31 (24.8%), as pT2 in 39 (31.2%), as pT3 in 24 (19.2%) and pT4 in 20 (16%) patients respectively. There was no tumour detected in the specimen in 11 (8.8%) of cases (pT0). Lymph node metastases were confirmed in 36 (28.8%) of patients. Three-year DFS and DSS were 100% and 100% in pT0, 76% and 87.1% in pTa, pT1, pTis, 69.2% and 82.9% in pT2, 32.9% and 62.4% in pT3 and 39.5% and 36.8% in pT4 tumours respectively (p = 0.0001, p = 0.0004). Three-year DFS and DSS reached 69.4% and 51.8% in patients with negative lymph nodes and 51.8% and 44.8% in patients with lymph node involvement (p = 0.0008, p < 0.0001). CONCLUSIONS: DFS and DSS after radical cystectomy depend from the local extent of the tumour and from lymph node status, which is a strong argument for its timely indication.

[Microsurgical subinguinal varicocelectomy in children and adolescents]. / Mikrochirurgická subingvinální varikokélektomie u detí a dospívajících.

BACKGROUND: Microsurgical varicocele repair has become the gold standard in adults and only a few reports are available in children and adolescents. We present our experience with this method and concentrate on the technical performance, complications and development of testicular size. METHODS AND RESULTS: 47 patients aged 11 to 18 years (x15.4) underwent microsurgical subinguinal repair for varicocele grade II.-III. Operation was indicated because of hypoplastic testicle (expressed by the atrophy index > 25%), pain, large varicocele or parents preference. The patients were examined clinically, by ultrasound including the Doppler study; hormonal examination was added using the gonadoreline stimulation test. Microscope has been used to identify the internal spermatic artery, to dissect the artery from the complex of small surrounding veins and to identify the lymphatic vessels. We found 3 recurrences in 46 patients (6%) operated for primary varicocele. The atrophy index decreased from x19.7 to 12.7%, without any association with pubertal stage. Atrophy of the testis was not found in any patient. Hydrocele was detected in one patient (2.1%), and left testicular hypertrophy also in one patient (2.1%). CONCLUSIONS: Microsurgical subinguinal varicocelectomy is a safe and efficacious method in children and adolescents; using the microscopic dissection, the internal spermatic artery and accompanying lymphatic vessels are safely spared.

[Endoscopic and conservative treatment of vesicoureteric reflux]. / Endoskopická a konzervativní lécba vezikoureterálního refluxu.

BACKGROUND: The aim of study is to evaluate the results of endoscopic treatment of vesicoureteric reflux (VUR) comparing with conservative mode. METHODS AND RESULTS: In the years 2003-2006 there were forty for children in prospective randomised study enrolled and divided into two groups. Twenty two children 1-40 months old (22.9 months) were operated. Dx/Ha (Deflux) was instilled for VUR grade 3-5. The results of treatment were compared with outcome of twenty two conservatively treated randomly assigned children aged 1-32 months (mean age 13.5 months) Postoperative videourodynamic study was used to evaluate for the presence of VUR and function of the bladder and ultrasound investigation was performed too (exclusion of obstructive megaureter in operated group). There were 22 children controled after instillation. The children were followed 11-24 months. VUR was cured in 12 cases (54.5%) and improved (grade 1-2) in 5 children (66.7%). All children absolved treatment without any complications, excluding one case with obstructive megaureter after pyelonephritis diagnosed. There were 22 children evaluated in conservative group. Five children were cured (22.7%) and VUR was improved (grade 1-2) in four (18.2%) CONCLUSIONS: Endoscopic miniinvasive instillation of dextranomer is safe and effective treatment of VUR in all age groups with good therapeutical outcome and minimum of adverse effects.

[Cystectomy in the treatment of bladder cancer]. / Cystektomie v léce nádoru mocového mechýre.

Radical cystectomy with pelvic lymphadenectomy and urinary diversion is an important component in the treatment of bladder cancer. It is considered the most important method in the therapy for muscle invasive and selected high-risk non-muscle invasive tumours with excellent local control and high complete remission rate. It consists of complete removal of tumour tissue in the bladder, small pelvis and regional lymph nodes. In males, urinary bladder and prostate are routinely removed; in females, bladder, uterus and anterior vaginal wall are removed. Urethrectomy is indicated only in selected situations. An integral part of the operation is the bilateral pelvic lymphadenectomy. Extravesical disease extension and lymph node positivity are unfavourable prognostic factors. Better prognosis is expected in patients with less than 5 positive nodes. Important prognostic factor is also the number of removed lymph nodes, which is a strong argument for meticulous bilateral pelvic lymphadenectomy. Lymph node density (number of positive nodes/ number of removed nodes) is considered as very important prognostic factor. Better prognosis can be expected in patients with less positive and more removed nodes.

[Progress of laparoscopic surgery in adults at the Department of Urology of the First Faculty of Medicine and General Teaching Hospital]. / Rozvoj laparoskopické operativy dospelých na Urologické klinice 1. LF UK a VFN v Praze.

Laparoscopy is the most modern operative technique, the main advantage of which is the least invasivity. In urology, the laparoscopy has won its yield only in nineties of 20th century, but it was in urology, where the robots were launched as first, and nowadays using them it is possible to perform ablative/reconstructive surgery in a tiny intracorporeal space. The price of laparoscopic operations is high and has been the only limit up to now, but technical approaches and indications have already been fixed.

[The p53 positivity in non-tumor mucosa in patients with superficial urinary bladder cancer]. / P53 pozitivita v nenádorove sliznici u pacientu s povrchovým uroteliiálním karcinomem mocoveho mechyre.

BACKGROUND: The aim of the study is to assess the prognostic value of p53 positivity in the non-tumor mucosa of urinary bladder in patients with superficial urinary bladder carcinoma. METHODS AND RESULTS: In 45 patients cold cup non-tumor mucosa samples were taken at the same time with the TUR of superficial urinary bladder carcinoma prospectively. Monoclonal antibody BP53-12-1 was used for the detection of p53 protein. When identifying positive colouring only the nuclear immunoreactivity was being evaluated. 200 nuclei at minimum were examined in several representative fields. The McCarthy method in Bacus modification was used to analyse the findings. It is a semiquantitative method which detects not only the percentage of p53 positive cells but also the intensity of positivity classified into four degrees (0 - negative, 1 - slightly positive, 2 - distinctly positive, 3 - strongly positive). The intensity of p53 positivity was quantified as HSCORE, where HSCORE = 7Pi (i + 1), in which i is one of the four see above degrees and Pi fluctuates from 0 % to 100 %. The result is a numerical figure from 100-400. A negative finding is of HSCORE 100, HSCORE of 400 is the highest possible. The samples were analysed in the analytical system LUCIA. The borderline value was quantified to HSCORE 200. All patients were carefully followed up and treated using usual schemes. The results were evaluated by the use of SAS system (Cary, USA). Thirty patients recurred during the follow-up and 7 of them progressed. The average HSCORE in those who did not recur was 130.2, in patients with the recurrence of tumor it was 162.5 and in patients with progression it was 169.2. We have found a correlation between the HSCORE and the risk of recurrence, which was statistically significant. CONCLUSIONS: The p53 positivity in non-tumor mucosa of urinary bladder in patients with superficial bladder cancer may bring additional information when predicting the risk of recurrence. More extensive studies need to be carried out.

[Detection of prostate cancer by ultrasonographically-guided transrectal prostate biopsies at the Department of Urology of the First Faculty of Medicine, Charles University and General Teaching Hospital in Prague, analysis of 1464 cases]. / Detekce karcinomu prostaty transrektální ultrasonograficky cílenou biopsií na urologické klinice 1. LF UK a VFN v Praze: analýza 1464 pozorování.

BACKGROUND: Early diagnostics of prostate cancer is still the most important factor in tumor-specific survival of patients harbouring this malignant disease. Without better understanding of the etiology and without relevant markers of the disease progression, only the early diagnostics of organ-confined disease can save the patient's life. METHODS AND RESULTS: Throughout 7 consecutive years, 1464 transrectal prostate biopsies in 1302 patients were performed. In all cases, the age, DRE (positive or negative), prostatic volume (ccm), total PSA in peripheral blood (ng/ml) were assigned, as well as free/total PSA ratio (%) in most of them. Apart from previously used linear regression, we applied logistic regression, since only age grows linear and DRE is determined only as positive or negative. The surrogate endpoint was ROC, which determines the area applying to the relations of sensitivity and specificity of any marker. Multifactorial logistic regression then reached best results at values over 0.8 in all tested age categories with maximal deviation of 8%, which had not been achieved before. CONCLUSIONS: Despite hundreds of papers published on this topic, the question of when and how the patient is indicated to the biopsy of the prostate has not been solved. A computer driven model based on 1464 documented examinations on the relatively homogeneous population is presented. On the basis of the combination of biological and statistical methods, the model can give correct predictions in 9 out of 10 cases.

[Analysis of results of percutaneous nephrolithotomies]. / Analýza výsledku perkutánních extrakcí konkrementu.

BACKGROUND: Percutaneous nephrolithotomy is an effective less invasive method for the treatment of nephrolithiasis. Authors retrospectively analysed results of this procedure performed in a single centre (Department of Urology, General University Hospital, Prague) from January 2005 till June 2007. METHODS AND RESULTS: Patients were acquired by an analysis of operating reports performed over a period January 2005 till June 2007 and subsequently a retrospective analysis of electronic and paper patient's records was carried out. Percutaneous nephrolithotomy was performed in 150 patients. Of those, 117 (78%) patients underwent primary and 33 (21.3%) secondary procedure. Analysed group consisted of 85 (56.7%) men and 65 (43.3%) women. Right-sided procedure was performed in 46% (69 times) and left-sided in 54% (81 times) of cases. Mean patient's age was 52.9 years (SD +/- 16.3). Mean stone size was 18.3 (SD +/- 9.5) mm. Staghorn calculi were present in 19 (12.7%) patients and 77 (51.3%) patients had more than 1 stone. Intracorporeal lithotripsy was necessary in 82 (54.7%) cases. Seventy eight (52.9%) patients were stone free after the procedure. There were 24 (16%) patients with an anatomic abnormality of upper urinary tract. The most common (in 64.3%) component in analysed stones was a calcium oxalate. CONCLUSIONS: The amount of stone free patients is rather lower compared to the literature results. However, definitive results are always affected by auxiliary procedures (mainly extracorporeal shock wave lithotripsy), which are not included in the analysis.

[Inovative techniques in partial laparoscopic resection of the kidney for adenocarcinoma]. / Inovativní techniky pri laparoskopické parciáilní resekci ledviny pro adenokarcinom.

Authors present the first case of laparoscopic partial resection of the kidney for RCC using modern technique of tissue sealing with FloSeal, which was used in this indication for the first time in the Czech Republic. The other most useful innovative point was the usage of tail-clipped sutures from resorbable material "Lahodny", which are suitable for suturing in renal parenchyma. Despite the relatively long time of warm ischemia, the function of rest of the kidney is more than satislying.

[Female sexual dysfunction]. / Zenská sexuální dysfunkce.

Female sexual dysfunction (FSD) is a disorder with relatively high incidence in the community. Its incidence in age-dependent and it can significantly limit the quality of life of women concerned. Dysfunction, as a multicausal and multidimensional problem, it comprises biological, psychological and interpersonal factors. Disorders are listed according to a sexual desire, arousal, experiencing an orgasm and pain incidence. Authors summarized data on incidence, diagnosis and therapy of this disorder.

[Role of laparoscopy in uro-oncology]. / Moznosti laparoskopie v uroonkologii.

The article reviews problems of laparoscopic surgery in uro-oncology. Examples supporting and opposing the laparoscopic alternative are given. Original objections against the use of the method for the treatment of malignancies are discussed from the retrospective position. According to the predominant views it looks that laparoscopic treatment by a highly educated team with good technical background, respecting oncologic and functional aspects, does not have worse short-term and long-lasting results. The improving diagnostics and possibility to identify malignancies in early stage of development will enable wider use of the laparoscopic surgery.

[Comprehensive long-term analysis of hypospadias repair using vascularized flaps and tubularized incized plates--report on 588 cases]. / Dlouhodobé výsledky rekonstrukce hypospadie pomocí vaskularizovaných laloku a tubulizace incidované ploténky--588 prípadu.

BACKGROUND: The article presents a comprehensive long-term analysis of the modem hypospadias repair based on preservation and use of the urethral plate. METHODS AND RESULTS: In years 1987 to 2004, 476 patients (aged 8 months to 45 years) were operated using a praeputial (mostly) flap. 81% were indicated for reconstruction of a proximal form of hypospadias, mostly penile. In years 1986 to 1991, a tubularized flap was performed in 31 patients. Since 1992, an onlay island flap in 394 patients, inlay-onlay flap in 43 patients and onlay-tube-onlay flap in 8 patients have been used. In years 2000 to 2004, 112 patients (aged 13 months do 17 years) were operated using tubularized incised plate (TIP) repair, mostly because of distal form of hypospadias. To cover the neourethra, a dartos flap was used in 72 and spongioplasty in 37 patients. We achieved the primary healing in 89% and 91%, resp., of patients after onlay and onlay-inlay island flap repairs with an average follow-up of 6,7 and 5,7 years, respectively. The most frequent complications were fistula or dehiscence of the glans. After the TIP repair combined with a dartos flap, 89% of the first operated patients healed without complications with an average follow-up of 2.3 years. A higher complication rate (40%) was found after a spongioplasty with foreskin preservation. Secondary repairs were also associated with more complications. CONCLUSIONS: Using onlay and inlay-onlay one-stage repairs, or using TIP one-stage repair combined with a dartos flap, a successful primary hypospadias repair was achieved in 90% of patients. The definite repair should be completed during early childhood.

[Effect of biofeedback in the treatment of voiding dysfunction]. / Efekt biofeedbacku v lécbe nonneurogenních dysfunkcí dolních mocových cest u detí.

BACKGROUND: Biofeedback represents a treatment option for children with voiding dysfunction characterised with poor pelvic floor relaxation. METHODS AND RESULTS: Thirty nine children with symptoms of voiding dysfunction were treated in BFB program. Average number of sessions to achieve good response was three. Follow up was 12 to 24 months. Very good clinical response was obtained in 55, 7% of patients, who were characterised by cessation or resolution of incontinence in 66, 7%, dyscoordination in 57, 6% and urinary tract infection in 41, 1% of children. CONCLUSIONS: Biofeedback therapy is an effective method for treating poor pelvic floor relaxation. It helps to improve coordination of the detrusor and external sphincter function and it accelerates voiding reflex maturation.

[Fluorescence cystoscopy in the diagnostics and treatment of superficial urinary bladder tumors]. / Fluorescencní cystoskopie a její místo v diagnostice a lécbe povrchových nádoru mocového mechýre.

BACKGROUND: 5-aminolevulinic acid induced fluorescence cystoscopy can detect more tumour lesions comparing to standard cystoscopy. The goal of our study was to assess the influence of fluorescence cystoscopy used during transurethral resection on the recurrence rate and the length of tumor-free interval in stage Ta, Tl transitional cell carcinoma of the urinary bladder. METHODS AND RESULTS: In prospective randomized study 109 patients with primary or recurrent stage Ta Tl bladder transitional cell carcinoma treated with transurethral resection were enrolled. 17 patients with high grade tumors were evaluated separately. In group A the transurethral resection was performed with standard white light endoscopy, in group B with fluorescence cystoscopy. The patients were followed using standard cystoscopy and urinary cytology. Recurrence free interval was evaluated in whole groups and also for single and multiple and for primary and recurrent tumors separately. The median time to recurrence was 8.05 months in group A and was significantly shorter than 13.54 months in group B (p = 0.04, log-rank test). In separate analyses the median time to recurrence was significantly shorter using fluorescence cystoscopy in multiple (p = 0.004) and in recurrent (p = 0.02) tumors, but not in solitary and primary tumors. CONCLUSIONS: 5-aminolevulinic acid induced fluorescence cystoscopy used during transurethral resection reduces the early recurrence rate in stage Ta Tl bladder transitional cell carcinoma.

[Reconstruction surgical procedures for iatrogenic injuries to the ureter. Examples of uncommon, however successful approaches to their management]. / Rekonstrukcní operace po iatrogenním poskození mocovodu--príklady méne obvyklých avsak uspesných resení.

The authors present several less usual reconstructions of ureters after the primary iatrogenic lesions. The appropriate ureteric capacity to drain the urine after previous injury is quite demanding and hence before the definitive decision is made the wholesome health status of the patient is to be considered and all possible solutions should be weighted. The efficient primary urinary diversion above the lesion is unavoidable. The genuine reconstruction could be deferred by several weeks or months in the view that in some cases the least invasive (endourologic) methods can completely avoid the need of open surgery in difficult adhesions after previous major surgery.