Evaluation of the Treatment of Congenital Penile Curvature Including Psychosexual Assessment.

INTRODUCTION: Penile corporoplasty is a well-established treatment method of congenital penile deviation (CPD). Anatomical results are good with only slight differences between surgical procedures used. The disease however has huge influence on young male quality of life. This issue is not well analyzed in the literature. AIM: The aim of the study was to evaluate quality of life of the patients affected with CPD before and after the surgical treatment METHODS: Study population consisted of 107 patients with CPD referred for surgical management. Patients were evaluated with not only clinical assessment, but also by four questionnaires measuring various aspects of quality of life. They were: Short-Form Medical Outcomes, Sexual Quality of Life Questionnaire for Man, Beck Depression Inventory, and International Index of Erectile Function. RESULTS: Quality of life measurements showed deep decrease in the general quality of life, sexual performance, depression scale, as well as in physical and mental health in men with CPD. All these parameters were restored to normal after the successful surgical treatment with any method. CONCLUSION: CPD deeply decreases the quality of life of the affected men in many aspects. Surgical treatment is able to repair the anatomical deformity and as well as significantly restore the patients' psychosocial well-being.

Radiofrequency ablation of small symptomatic angiomyolipomas of the kidney: Report of two cases.

BACKGROUND: The development of more sensitive imaging techniques caused an increase in the number of diagnosed small renal tumors. The small size of the lesions allows for their treatment with minimally invasive nephron-sparing methods. Approximately 2-3% of these lesions are proved to be angiomyolipomas (AML). AML is a rare benign tumor of the kidney, sometimes causing pain and hematuria. The most commonly required approach is observation but in case of recurrent symptoms or larger tumors which may cause bleeding, a more active treatment is needed. This paper demonstrated the evolution of our attitude leading to utilization of radiofrequency ablation (RFA) as a minimally invasive option in the management of small symptomatic AMLs of the kidneys. MATERIAL/METHODS: We presented clinical data of two cases of symptomatic AML tumors in the kidney, treated with RFA. The tumors were diagnosed on the basis of a contrast-enhanced CT (computed tomography) scan. The probe was inserted into the lesion percutaneously under USG (ultrasonography) guidance. RESULTS: RFA proved to be an effective and safe method of treatment of renal AMLs. A follow-up carried out after 1.5 and 3 years, basing on contrast-enhanced CT tests, confirmed a complete ablation of the AML and decreased tumor size. CONCLUSIONS: Promising results of RFA in the management of AML may encourage urologists and radiologists to use this minimally invasive technology and to qualify patients for this treatment more often and thus to prevent potential complications in the future.

BRCA1 mutations and prostate cancer in Poland.

Evidence to date that BRCA1 mutation carriers are at an increased risk of prostate cancer is mixed - both positive and negative studies have been published. To establish whether or not inherited variation in BRCA1 influences prostate cancer risk we genotyped 1793 men with prostate cancer in Poland and 4570 controls for three founder mutations (C61G, 4153delA and 5382insC). A BRCA1 mutation was present in 0.45% of the cases and 0.48% of the controls (odds ratio=0.9; P=1.0). The odds ratios varied substantially by mutation. The 5382insC mutation is the most common of the three founder mutations. It was detected only in one case (0.06%), whereas it was seen in 0.37% of controls (P=0.06). In contrast, the 4153delA was more common in prostate cancer cases (0.22%) than in controls (0.04%) (odds ratio=5.1; 95% confidence interval: 0.9-27.9; P=0.1). The C61G mutation was also found in excess in cases (0.17%) compared with controls (0.07%) (odds ratio=2.6; 95% confidence interval: 0.5-12.7; P=0.5). Eight men with prostate cancer carried a mutation. Only one of these carried the 5382insC mutation, compared with 17 of 22 individuals with mutations in the control population (P=0.003). These data suggest that the 5382insC mutation is unlikely to be pathogenic for prostate cancer in the Polish population. The presence of one of the other alleles was associated with an increased risk for prostate cancer (odds ratio=3.6; 95% confidence interval: 1.1-11.3; P=0.045); in particular for familial prostate cancer (odds ratio=12; 95% confidence interval: 2.9-51; P=0.0004). We consider that the risk of prostate cancer in BRCA1 carriers varies with the position of the mutation.

[Giant hydronephrosis of the upper left kidney in the case of complete, one-sided double pelvis]. / Olbrzymie wodonercze górnego bieguna nerki w przypadku calkowitego, jednostronnego zdwojenia górnych dróg moczowych.

We present the case of giant hydronephrosis in double pelvis of the left kidney. Patient was admitted to the urology department with hypertension and palpable giant mass in the abdomen. During imaging examination (CT, MRI ) the diagnosis of double pelvis and ureter on left side was established. The upper collecting system was extremely hydronephrotic and afunctional. Patient underwent partial nephrectomy - upper part of left kidney. We evacuated 9 liters of stagnated urine. After surgery blood pressure normalised, renal efficiency remained normal.

Cytogenetic and molecular findings in 75 clear cell renal cell carcinomas.

Cytogenetic analysis of 75 clear cell renal cell carcinomas (RCC) from adult patients revealed abnormal karyotypes in 59 (79%) tumors. Among structural abnormalities, the most frequent were deletions and unbalanced translocations leading to loss of 3p (found in 68% of karyotypically abnormal tumors), followed by rearrangements of chromosomes 5 (in 37%) and 1 (in 20%). Fifteen unbalanced interchromosomal rearrangements and one reciprocal translocation have not been hitherto reported in clear cell RCC. The most common numerical aberrations were trisomy 7, seen in 44% of tumors, and loss of chromosome Y, detected in 48% of RCCs diagnosed in male patients. In 25 tumors, loss of heterozygosity (LOH) analysis was performed using five polymorphic markers spanning region 3p13-p25. LOH was identified in 10 RCCs with 3p loss detected cytogenetically and 4 karyotypically aberrant tumors without cytogenetic rearrangements of 3p; no LOH was found in 3 tumors with 3p loss seen at the cytogenetic level. Overall, 3p loss was detected by cytogenetic and/or LOH analyses in 75% of RCCs with abnormal karyotype studied. The presence or absence of 3p loss did not correlate with tumor size, nodal involvement, tumor grade or its ability to metastasize. However, karyotypes of metastasizing tumors contained more aberrations than those of non-metastasizing RCCs (5.5 versus 2.9 aberrations per tumor, respectively), and -14/14q-, -17 and -10 were significantly more frequent in metastasizing tumors, suggesting that these aberrations might contribute to the progression of RCC. One patient had t(X;1)(p11.2;p34) as a sole abnormality in the stemline. This is the sixth case with this translocation reported to date. Together with our case, all but 1 RCC with t(X;1)(p11.2;p34) had morphology with a clear cell component, which contrasts these RCCs from tumors harboring t(X;1)(p11.2;q21) that largely had papillary morphology.

[A case of non-seminomatous testis tumor]. / Przypadek guza jadra typu non-seminoma.

The authors present a case of germ cell tumor with combined histology, because of the unheard size of primary mass. Testis tumors in virtue of their localisation and simplicity of self-observation in most cases are early diagnosed. Unfortunately there are the cases of the patients who because of the shame, hide the disease even from the family for a long time.

Treatment of urethrorectal fistulas caused by radical prostatectomy - two surgical techniques.

INTRODUCTION: The repair of complex urethrorectal fistulas, which can be the result of treating prostate cancer with radical prostatectomy, is a big problem in urology and its final result is not always satisfactory. There are no universally accepted methods for repairing such fistulas. In our work we present a retrospective analysis of patients treated for urethrorectal fistulas after previous radical prostatectomy. The methods used were the initial excision and suture of the fistula, or a gracilis muscle flap interposition. MATERIAL AND METHODS: In the years 2000-2012, four patients were treated because of urethrorectal fistulas after radical prostatectomy. In two patients, open radical prostatectomy had been performed. Two other patients had been operated laparoscopically. Two patients had a primary fistula repair. They were operated using anterior perineal access. Two others were treated with the use of a gracilis muscle flap. RESULTS: During the follow up, there was no recurrence of fistulas. Medium follow up for the first two patients was 120 and 156 months, and follow up of two other patients was 16 and 23 months. Until now, there were no final postoperative complications. CONCLUSIONS: Repair of the fistulas requires an individual approach to each case. Excision and suturing of the fistula gives a very good final result, especially when the primary reconstruction is performed. Repair of urethrorectal fistula using a gracilis muscle flap appears to be an excellent option in cases of complex recurrent fistulas. It is also associated with low morbidity in patients and a high success rate.

Laparoscopic nephroureterectomy with transvesical single-port distal ureter and bladder cuff dissection: points of technique and initial surgical outcomes with five patients.

Although a variety of techniques have been used to manage the distal ureter during laparoscopic radical nephroureterectomy (LNU), a consensus has not yet been established. Recently, some authors have used a single-port transvesical approach to excise the distal ureter and bladder cuff following LNU. The aim of the study was to present our initial experience in "en bloc" dissection of the distal ureter and bladder cuff during LNU, using a transvesical single-port approach (T-LESS) and standard laparoscopic instruments. From April to October 2012, 5 patients aged 45 to 73 years with upper urinary tract urothelial tumors were subjected to LNU/T-LESS. After a standard LNU was performed, a TriPort+(®) device was introduced into the bladder and the pneumovesicum was established. A bladder cuff with a distal ureter was dissected and put in the paravesical tissue. The bladder wall defect was closed with the V-loc(®) 3/0 suture. The LNU was then completed in the flank position. All procedures were completed successfully. No significant blood loss or complications were observed. The mean operative time was 250 min (range: 200-370) for a total procedure and 59 min (range: 42-80) for the T-LESS stage. The postoperative hospital stay was 5.2 days (range: 4-9). Pathologic examination revealed no positive margin in any of the cases. The LNU/T-LESS approach is an efficient and safe procedure. A well-visualized dissection of the distal ureter, closing the defect of the bladder, the use of standard laparoscopic instruments and a good cosmesis are advantages of the method.

Effects of tadalafil treatment on erectile function recovery following bilateral nerve-sparing radical prostatectomy: a randomised placebo-controlled study (REACTT).

BACKGROUND: The potential rehabilitative and protective effect of phosphodiesterase type 5 inhibitors (PDE5-Is) on penile function after nerve-sparing radical prostatectomy (NSRP) remains unclear. OBJECTIVE: The primary objective was to compare the efficacy of tadalafil 5mg once daily and tadalafil 20mg on demand versus placebo taken over 9 mo in improving unassisted erectile function (EF) following NSRP, as measured by the proportion of patients achieving an International Index of Erectile Function-Erectile Function domain (IIEF-EF) score ≥ 22 after 6-wk drug-free washout (DFW). Secondary measures included IIEF-EF, Sexual Encounter Profile question 3 (SEP-3), and penile length. DESIGN, SETTING, AND PARTICIPANTS: Randomised, double-blind, double-dummy, placebo-controlled trial in men ≤ 68 yr of age with adenocarcinoma of the prostate (Gleason ≤ 7) and normal preoperative EF who underwent NSRP at 50 centres from nine European countries and Canada. INTERVENTIONS: 1:1:1 randomisation to 9 mo of treatment with tadalafil 5mg once daily, tadalafil 20mg on demand, or placebo followed by a 6-wk DFW and 3-mo open-label tadalafil once daily (all patients). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Logistic regression, mixed-effects model for repeated measures, and analysis of covariance, adjusting for treatment, age, and country, were applied to IIEF-EF scores ≥ 22, SEP-3, and penile length. RESULTS AND LIMITATIONS: Four hundred twenty-three patients were randomised to tadalafil once daily (n=139), on demand (n=143), and placebo (n=141). The mean age was 57.9 yr of age (standard deviation: 5.58 yr); 20.9%, 16.9%, and 19.1% of patients in the tadalafil once daily, on demand, and placebo groups, respectively, achieved IIEF EF scores ≥ 22 after DFW; odds ratios for tadalafil once daily and on demand versus placebo were 1.1 (95% confidence interval [CI], 0.6-2.1; p=0.675) and 0.9 (95% CI, 0.5-1.7; p=0.704). At the end of double-blind treatment (EDT), least squares (LS) mean IIEF-EF score improvement significantly exceeded the minimally clinically important difference (MCID: ΔIIEF-EF ≥ 4) in both tadalafil groups; for SEP-3 (MCID ≥ 23%), this was the case for tadalafil once daily only. Treatment effects versus placebo were significant for tadalafil once daily only (IIEF-EF: p=0.016; SEP-3: p=0.019). In all groups, IIEF-EF and SEP-3 decreased during DFW but continued to improve during open-label treatment. At month 9 (EDT), penile length loss was significantly reduced versus placebo in the tadalafil once daily group only (LS mean difference 4.1mm; 95% CI, 0.4-7.8; p=0.032). CONCLUSIONS: Tadalafil once daily was most effective on drug-assisted EF in men with erectile dysfunction following NSRP, and data suggest a potential role for tadalafil once daily provided early after surgery in contributing to the recovery of EF after prostatectomy and possibly protecting from penile structural changes. Unassisted EF was not improved after cessation of active therapy for 9 mo. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01026818.

Suprapubic transvesical laparoendoscopic single-port bladder diverticulectomy: points of technique with medium-term surgical outcomes.

BACKGROUND AND PURPOSE: Various minimally invasive techniques have been developed for bladder diverticulectomy. One of the newest is transvesical laparoendoscopic single-site (T-LESS) surgery. In this article, we present points of technique with initial clinical results after a minimum of 7 months of follow-up. The aim of the study was to assess our first series of patients who underwent T-LESS surgery for transvesical excision of symptomatic bladder diverticula. PATIENTS AND METHODS: From March 2011 to February 2012, we successfully operated on five men aged 61 to 76 years (mean 66 years) for symptomatic (infections, residual of urine, neoplasm) bladder diverticula, with the use of the T-LESS approach. The procedures were performed using single-port TriPort+, standard laparoscopic instruments, and V-loc suture. All patients underwent follow-up of 6 weeks after surgery and every 3 months thereafter. The follow-up included urine tests, ultrasonography, and cystoscopy when needed. RESULTS: The average operative time was 122 minutes (range 80-175 min), and the blood loss was minimal. Patients were discharged on the third (range 2-4 day) postoperative day with no intra- or postoperative complications. The average 14-month follow-up (range 7-19 mos) confirmed good operative results in all cases. An insignificant small recurrent diverticulum was observed in one patient. The patients did not need transurethral resection of the prostate or reoperation. CONCLUSIONS: We consider this technique to be a feasible and safe procedure, and a valuable treatment option for bladder diverticulectomy.

Familial appearance of congenital penile curvature - case history of two brothers.

The true prevalence of congenital penile curvature (CPC) is difficult to determine. Some study reports suggests that this problem may occur in as many as 10% of the male population [1]. However, a literature search of the Medline database revealed no reference concerning familial appearance of congenital penile curvature. For that reason we would like to present our case series. Two brothers aged 25 and 26 respectively were admitted to the department of urology due to congenital penile curvature. Each patient was assessed by a history, physical examination, auto-photography of the erect penis, and a thorough sexual history. Concomitant anomalies of penile layers were absent in both cases. The Yachia [2] and Essed-Schroeder [3] corporoplasty technique were applied respectively. In follow-up both brothers reported straight erections. A survey of the fetal penis at different stages of development shows some degree of curvature in a considerable number of embryos [4]. Penile curvature may thus be considered almost physiological in embryos between 35 and 45 mm in length. Thus, it has also been proposed that penile curvature is secondary to an arrest in normal penile development [5]. Therefore, some form of congenital local androgen deficiency may be responsible for inherited penile curvature.

There is no place for targeted therapy neoadjuvant treatment in Polish Health System - An analysis of radical nephrectomies in patients with large kidney tumors.

INTRODUCTION: Despite the introduction of better diagnostic tools, very large kidney tumors are still not so rare in our country. The paper presents our experience in the treatment of 12 patients with kidney tumors larger than 14 cm in size. MATERIAL AND METHODS: Between spring 2009 and autumn 2011, radical nephrectomies were performed in 12 patients due to a large kidney tumor (larger than 14 cm in size). Symptoms (hematuria, weight loss, anemia, etc.) were not present in all the patients, but the kidney tumor was confirmed by imaging studies (ultrasound, CT, MRI) in all of them. RESULTS: Full recovery was observed with no severe complications in all of the patients treated with radical nephrectomy. Pathological staging was correctly established by imaging studies in all of them. After a few months, five of patients (41.6%) required systemic therapy due to lymph node involvement. CONCLUSIONS: Patients with large kidney tumors should be treated in selected medical centers that have experience in the treatment of such cases. Radical nephrectomy has to be the method of choice in the treatment of patients with this kind of tumor and its diameter should not disqualify from surgical treatment, which is still the only chance for the patients to be cured, as no adjuvant chemotherapy treatment has proved to be significantly effective.

Acne inversa of the scrotum and penis - aggressive urological treatment.

Acne inversa is a rare chronic and debilitating inflammatory skin disease. The authors report a case of a 45-year old male who presented with acne inversa in the inguinal, perineal, and scrotal areas. After unsatisfactory pharmacological treatment a wide surgical excision of the affected skin was performed in stages. On follow-up the patient presented with a very good cosmetic and functional result. A review of the most recent literature is also presented.

Suprapubic transvesical laparoendoscopic single-site surgery for vesicovaginal fistula repair: a case report.

Some minimally invasive techniques have been introduced to decrease morbidity related to standard laparoscopic procedures. One such approach is laparoendoscopic single-site surgery (LESS), which can also be applied for transvesical surgery. The aim of the study was to present our initial clinical experience of using this technique for transvesical vesicovaginal fistula (VVF) repair. In August 2011, we carried out the LESS repair of a 3-mm in diameter vesicovaginal fistula on a 72-year-old woman, who failed the conservative treatment with Foley placement. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (4-channel, TriPort+, Olympus Winter&IBE GMBH) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with running absorbable V-Loc (Covidien, Norwalk, CT, USA) suture. Ureteral catheters were left for 5 days and the Foley catheter for 14 days. The operative time was 170 min. The blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 6-month follow-up the patient reported no involuntary discharge of urine into the vagina. Diagnostic scans revealed no presence of VVF and laboratory examination results were all within the normal range. Although substantial development of the instruments and skills is needed, the transvesical LESS vesicovaginal fistula repair appeared to be feasible and safe. Nevertheless, further experience and observations are necessary.

Laparoendoscopic single-port transvesical diverticulectomy: preliminary clinical experience.

PURPOSE: We present our single-center experience with three patients who were undergoing laparoendoscopic single-site (LESS) diverticulectomy through a single-port device introduced directly into the bladder. PATIENTS AND METHODS: During March and April 2011, we operated on three men aged 62 to 76 years (mean 67 y) for symptomatic bladder diverticula using a standard lithotomy position and general anesthesia. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (four-channel) via a 1.5-cm incision made 2 cm above the pubic symphysis. Standard 10-mm optic and rigid laparoscopic instruments were used. The defect of the bladder wall was closed with an absorbable 3/0 running V-Loc suture. An 18F Foley catheter was left for 4 to 7 days. RESULTS: The average operative time was 128 minutes (range 80-175 min). The blood loss was minimal. Patients were discharged on the third postoperative day with no intra-, nor postoperative complications. The 3-month follow-up confirmed good operative results in all cases. CONCLUSION: We consider laparoendoscopic single-port transvesical excision of bladder diverticulum as a feasible and safe procedure and a valuable treatment option for bladder diverticulectomy.

Laparoendoscopic single-site transvesical ureteroneocystostomy for vesicoureteral reflux in an adult: a one-year follow-up.

INTRODUCTION: Various minimally invasive techniques have been developed to decrease morbidity related to laparoscopic port placement and to improve cosmetic results while maintaining the same standards and efficacy of surgical care. One such approach is laparoendoscopic single-site surgery. We describe our initial clinical experience of using this technique for transvesical ureteral reimplantation. TECHNICAL CONSIDERATIONS: The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (3-channel) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm laparoscope was used with either straight or articulating instruments. The ureter was dissected, shortened, passed through the submucosal tunnel, and fixed in place with a running absorbable V-Loc suture. The operative time was 250 minutes. No significant bleeding or other complications were observed. CONCLUSION: Although further development of the instruments and skills is needed laparoendoscopic single-site surgery transvesical reimplantation of the ureter appeared to be feasible and safe. Nevertheless, further experience and observations are necessary.

Supernumerary kidney presenting as urinary leakage after an ipsilateral laparoscopic radical nephrectomy.

We present a case of a patient with supranumerary kidney diagnosed after laparoscopic radical nephrectomy. Urinary leakage, an unusual complication that appeared postoperatively, led to complementary examination and making the right diagnosis. The reevaluation of the preoperative CT (computed tomography) in enhancement phase and the new CT scan confirmed the presence of a real accessory organ connected to the main unit with a small bridge of tissue. The latter right nephrectomy was performed. Despite the scarceness of this anomaly, a thorough interpretation of images obtained during investigative procedures can provide a clue about the presence of this rare entity.

Hyperbaric oxygen therapy (HBOT) in case of hemorrhagic cystitis after radiotherapy.

INTRODUCTION: We present the effect of hyperbaric oxygen therapy (HBOT) after radiotherapy for cancer in the pelvic cavity resulting in hematuria. Increasing the pressure of oxygen (PO2) in ischemic tissues favors the formation of new blood vessels and increases the secretion of collagen. MATERIAL AND METHODS: We evaluated 10 patients who were treated with HBOT from October 2006 to December 2010 due to persistent radiation damage to the lining of the bladder leading to recurrent hematuria. The study group was comprised of seven men and three women. In the case of cervical and endometrial cancers, 30 Gy of brachytherapy with 45-50 Gy of teleradiotherapy were used. In prostate cancer (PCa), we applied 50 Gy of teleradiotherapy with an additional dose of 20-24 Gy, and in the case of bladder cancer (BCa), 50 Gy of teleradiotherapy was applied with an additional dose of 16 Gy. HBOT consisted of 60 HBO2 treatments, in which patients were administered 100% oxygen at a pressure of 2.5 atm. RESULTS: The group effect of total or partial resolution was observed in six patients. In one case, treatment was discontinued due to an increase in hematuria and the consequent suspicion of bladder tumor recurrence. While in and additional three cases, the treatment did not produce the desired result. CONCLUSIONS: Treatment of hemorrhagic cystitis is a difficult therapeutic challenge. One possible method is the implementation of HBOT. In very difficult cases, HBO2 treatment appears to be effective in giving more than half of patients a chance of getting better.

Effect of total and partial nephrectomy on the elimination of ciprofloxacin in humans.

BACKGROUND: Renal cell carcinoma (RCC) is the most common form of kidney cancer. Surgery is a standard procedure to resect the tumor during total (TN) or partial (nephron-sparing) nephrectomy (PN). Ciprofloxacin is most often administered at the usual intravenous dose of 100-400 mg/12 h. The application of such low doses of ciprofloxacin as 200 mg/24 h carries the risk of achieving subtherapeutic concentrations even in patients with limited renal function. The aim of the study was a comparison of concentrations and pharmacokinetics for ciprofloxacin at steady-state in patients after total and partial nephrectomy and evaluation of the effectiveness of the iv dose 200 mg/24 h against the theoretical value of MIC, 0.5 µg/ml. METHODS: The research was carried out on two groups of patients after nephrectomy: total (group 1, n = 21; mean [SD], age, 62.9 [14.4] years; weight, 76.0 [14.6] kg; creatinine clearance, CL(CR), 90.7 [22.2] ml/min) and partial (group 2, n = 15; 61.7 [9.3] years; 87.8 [16.4] kg; CL(CR), 107.8 [36.4] ml/min). The patients were treated with ciprofloxacin in the dose of 200 mg/24 h (iv). Plasma concentrations of ciprofloxacin at steady state were measured with validated HPLC method with UV detection. RESULTS: The mean values of plasma concentrations of ciprofloxacin at steady state in group 1 and 2 were: C(ss)(max), 2.012 and 1.345; C(ss)(min), 0.437 and 0.244 µg/ml, respectively. The main pharmacokinetic parameters for ciprofloxacin in group 1 and 2 were as follows: AUC((0-last)), 30.9 [17.9] and 19.5 [8.7] µg h/ml; AUMC((0-last)), 177.91 [11.1] and 91.9 [66.5] µg h(2)/ml; t(1/2ß), 13.9 [7.7] and 9.8 [3.3] h; MRT, 16.5 [12.1] and 9.77 [5.4] h; V(d), 115.0 [67.2] and 142.2 [78.7] l; CL, 6.2 [3.3] and 10.8 [5.7] l/h, respectively. With the assumed MIC = 0.5 µg/ml, the values of C(ss)(max)/MIC < 10 and AUC/MIC < 125 were obtained in all the patients. CONCLUSION: In our patients we observed significant differences in some pharmacokinetic parameters of ciprofloxacin after two types of nephrectomy.

Operative shortening of the sling as a second-line treatment after TVT failure.

INTRODUCTION: Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure. MATERIALS AND METHODS: Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients. RESULTS: All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure. CONCLUSIONS: The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure.