Successful Laparoscopic Removal of a Self-Inflicted Thermometer that Spontaneously Migrated into the Peritoneal Cavity.

A sixty-three-year-old Caucasian male was referred to emergency service 10 hours after self-infliction of a mercury glass thermometer into the urethra. The patient presented without abdominal or voiding symptoms. Radiologicalimaging confirmed the presence of a thermometer in the peritoneal cavity, without signs of contrast leakage from the bladder. The patient underwent suture of the perforation site with a subsequent successful removal of the foreign body using laparoscopic approach. Recovery was uneventful.To the best of our knowledge, we are not aware of any previous report of laparoscopic removal of a mercury glass thermometer from the peritoneal cavity. Laparoscopic removal of fragile items, such as a thermometer, is obviously feasible but associated with substantial risks.

EFFICIENCY OF SILDANEFIL MONOTHERAPY IN BENIGN PROSTATIC HYPERPLASIA.

INTRODUCTION: High incidences of benign prostatic hyperplasia and lower urinary tract symptoms have a high socioeconomic importance. There are several published studies which have proved the efficiency of phosphodiesterase type 5 inhibitors in treatment of benign prostatic hyperplasia and lower urinary tract symptoms. However, more studies are needed to make this therapy the standard option for treating benign prostatic hyperplasia and lower urinary tract symptoms. This study was aimed at exploring changes in International Prostate Symptom Score, post voiding residuum and maximal urine flow in benign prostatic hyperplasia and lower urinary tract symptoms patients treated by sildenafil for benign prostatic hyperplasia and lower urinary tract symptoms. Matcrial and Methods. This study, which was conducted as a prospective:controlled, opened, randomized study, included 30 patients with benign prostatic hyperplasia and lower urinary tract symptoms. Research was conducted at the Department of Urology, Clinical Center of Vojvodina (November 2011 till November 2012). The inclusion criteria were as following: >45 years of age, International Prostate Symptom Score >3, prostatic specific antigen < l0, normal urinalysis. The patients were periodically tested for International Prostate Symptom Score, maximal urine flow, and post voiding residuum. RESULTS: Statistically significant changes were found in all pprameters: mean International Prostate Symptom Score value improved from 12.8 to 8.6 (32.8% change), mean post voiding residuum value decreased from 49.4 ml to 40.2 ml (186% change), mean maximal urine flow value increased from 11.8 mI/s to 12.8 mI/s (8.5% change). CONCLUSION: Treatment of benign prostatic hyperplasia and lower urinary tract symptoms with a continuous low dose of sildenatil seems to be a good treatment choice for the patients with mild to moderate benign prostatic hyperplasia and lower urinary tract symptoms, especially in the patients with concomitant erectile dysfunction. The authors are aware that their study is limited by a small number of patients. Since there are not too many studies on this topic, they believe that their study will contribute to the determination of place and role of this treatment approach.

Transplantation of infant kidneys--The surgical technique en bloc and transplant position variation: A case report.

INTRODUCTION: Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called "marginal donors" group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. CASE REPORT: We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. CONCLUSION: The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.

Preservation surgery in patients with localized renal cell cancer--nephron sparing surgery.

INTRODUCTION: Renal Cell Cancer ( RCC) is third most frequent urological cancer behind Prostate cancer and Bladder cancer. It represents 2-3 % of all cancers with annual increase in incidence of 2% in Europe (except Denmark and Sweden) and worldwide. Surgery is the only curative procedure, performed as radical nephrectomy (RN) or partial nephrectomy (nephron sparing surgery-NSS). Radical nephrectomy consists of nephrectomy with ipsilateral adrenalectomy and lymphadenetomy, but partial nephrectomy means resection of the tumor only with 1-3 mm of healthy surrounding tissue and preservation of the rest of the kidney as well as ipsilateral adrenal gland and lymph nodes. NSS is a method of conservation of attacked kidney and preservation of kidney's function with previous radical resection of localized RCC, respecting of all oncological principles. The aim of this study is to describe NSS procedure in details and present results of its 13 year use at Clinic of Urology in Novi Sad. MATERIAL AND METHODS: In the last 13 years there were 868 patients (pts) with RCC. NSS has been performed in 242 pts (27.88%). Bilateral tumors: synchronous 8 pts, asynchronous 3 pts. Better kidney has been operated, first. Indications for NSS were: absolute--34 pts (15.0%), relative--58 pts (23.1%) and elective--150 pts (61.9%).Surgery was performed according to esta- blished protocol for this procedure based on recommendation of Prof. A. Novick, Cleveland, USA. RESULTS: All patients underwent surgery under general anesthesia through lumbothomy, mostly.Tumor size was between 2.5-4.5 cm: over 4.5 cm (4-7 cm): 4 pts. Average age of pts--63.5 years (37-84), male: 148 (61.1%), female: 94 (38.9%). From 2001-2005, 2006-2010 i 2011-2013, 39,111 i 92 NSS has been done, respectively. It represented 13.5%, 36.6% , 50.54% of all pts with RCC underwent surgery in that period, respectively. There was an increase of NSS in that period compared to RN for localized RCC. There were no death outcomes inpts underwent NSS, local recurrence was seen in 1 patient (0.6%), urine leakage > 2 weeks 5 pts (5/242 = 2.06%),severe hemorrhage: 3 pts (1.23%), nephrectomy has been done. We do not have patients with von Hippel Landau (VHL) disease. CONCLUSION: Nephron sparing surgery Is the first choice of surgery for patients with low grade kidney tumors (up to 4.5 cm, even 7 cm), has excellent onco- logical results-comparable with radical nephrectomy, but with preservation of renal function and should be done by an experienced urological team in specialized urological centers with good anesteziological support.

[The use of rigid ureteroscope in the treatment of ureteral steinstrasse after extra corporeal shockwave lithotripsy of renal calculi--case report]. / Upotreba ridignog ureterorenoskopa u resavanju stein strasse celom duzinom uretera, nastalog nakon destrukcije kalkula u bubregu vantelesnim udarnim talasima - prikaz slucaja.

INTRODUCTION: Exracorporeal shockwave lithotripsy (ESWL) is the first choice for patients with urolithiasis. Increased use of endoscopic techniques provided increased use of ureteroscopic lithotripsy in the treatment of stones located in distal ureter, as well as ESWL. Rigid ureteroscope is usually used in the management of distal ureter stones, while middle and upper ureter stones should be treated by flexible ureteroscope or ESWL. At Urology Clinic in Novi Sad, ureteroscopy has been used since 1986, and more than 1000 procedures have been performed with success rate of over 95% (100% when we were able to reach the stone). The aim of this report is to show the destruction of stone along the ureter, using a rigid ureteroscope, shortly after the ESWL treatment of kidney stones. CASE REPORT: A 46-year-old woman was admitted to the Clinic with "steinstrasse" along the ureter, two weeks following ESWL of kidney stones. Primarily, she underwent ESWL without J-J stenting, at another urologic department. On admission to our Clinic, she complained of pain, nausea, mild temperature. An urgent diagnosis was carried out and left sided "steinstrasse" with hydronephrosis was confirmed by ultrasound, plain X-ray, laboratory findings. Ureteroscopy was performed under spinal anesthesia by rigid ureteroscope and the stone was destroyed along the ureter, even the pyelon was explored at the end of the procedure. The patient was advised to take a lot of fluids with diuretics and 80% of stones were eliminated in the first week after the procedure. At the first control, a month later, the patient was stone free. CONCLUSION: Rigid ureteroscope is a therapeutic option for distal ureteral stones, just as ESWL with comparable and reproducible results. This case confirms the fact that in strictly selected cases, and careful work of skilled urologists, rigid ureteroscope can be used for successful stone destruction in the middle and upper ureter.

[Morphology of the renal pelvis and elimination of fragments after ESWL treatment of lower calix calculi]. / Morfologija karlice bubrega i eliminacija fragmenata nakon ESWL tretmana kamena donjeg kaliksa.

INTRODUCTION AND OBJECTIVE: A prerequisite for successful outcome of exatracorporeal shock wave lithotripsy (ESWL) is effective stone fragmentation. Despite successful stone fragmentation, complete clearance of stone fragments cannot be achieved in every patient, due to various factors. The aim of this prospective study was to determine morphological factors that affect clearance following successful stone fragmentation by ESWL. MATERIAL AND METHODS: In the period October 1999 and January 2001, 60 patients (45 male and 15 female) with single lower pole kidney stones have been treated using lithotripter Lithostar 2000TM. Parameters of radiographic anatomy, measured on intravenous pyelography, included infundibular width and length, infundibuloureteral infundibulopelvic angles. After the follow-up period of 3 months, patients were divided into two groups regarding clearance status: Group I consisted of stone free patients, and group II of those with residual fragments. RESULTS: Average values of measured parameters in group I vs group II were as follows: infundibular length 27.70 +/- 5.48 mm vs 30.25 +/- 3.95 mm (p = 0.045, Mann-Whitney test); infundibular width 5.98 +/- 3.28 mm vs 4.70 +/- 1.30 mm (p = 0.018, Mann-Whitney test); infundibulopelvic angle 52.92 +/- 20.76 degrees vs 34.10 +/- 8.19 degrees (p = 0.00001, Mann-Whitney test); infundibuloureteral angle 48.00 +/- 21.13 degrees vs 30.70 +/- 7.49 degrees (p = 0.00001, Mann-Whitney test). CONCLUSION: This study revealed that parameters of infundibulopelvic anatomy were significantly different in the examined groups. The success of clearance of fragments following ESWL procedure can be predicted using these morphologic parameters.

The management of T1G3 bladder cancer.

INTRODUCTION: The treatment of T1G3 bladder cancer is still a controversial issue. Nowadays, intravesical bacillus Calmette-Guérin (BCG) instillation is considered to be the treatment of choice for patients with high-grade superficial bladder tumour after transurethral resection of all visible tumour. The aim of this retrospective study was to determine the effects and results of this approach, recurrence and progression rates in patients with T1G3 superficial bladder tumours. MATERIALS AND METHODS: 43 patients (28 male, 15 female; mean age 65.5 years, range 21-82) with T1G3 TCC (transitional cell carcinoma) bladder tumour underwent transurethral resection and subsequent intravesical BCG according to Morales protocol, in the period 1993-1998 at our institution. The mean follow-up period was 52.5 (range 30-96) months. RESULTS: After one or more initial courses of therapy, 33 patients were disease-free. Twelve patients (27.90%) had recurrent tumour after a median of 7 (range 3-46) months. After a second course of BCG treatment, 6 patients had no evidence of disease, 3 patients had progression and 3 had recurrence. Progression occurred in 7 (16.27%) patients after a median of 19 (range 3-43) months. Five patients underwent radical cystectomy and the remaining 2 underwent bladder-preserving therapies. Two patients died of TCC and 3 due to disease-unrelated conditions. CONCLUSION: Intravesical BCG instillation can be recommended as treatment modality for responders with T1G3 TCC bladder tumour. The benefit of the second course of intravesical BCG therapy has to be confirmed in further investigations.

Successful surgical reconstruction of ruptured renal pelvis following blunt abdominal trauma.

A 25-year-old man with occult ureteropelvic obstruction presented with abdominal pain 3 h following blunt abdominal trauma. Isolated rupture of the right renal pelvis was promptly diagnosed and the patient underwent immediate pyeloplasty according to the Anderson-Hynes procedure. The patient made an uneventful recovery. One year after surgery, renal function was satisfactory.