Tissue and urinary KIM-1 relate to tumor characteristics in patients with clear renal cell carcinoma.

The objective of this prospective follow-up trial was to ascertain whether the urinary kidney injury molecule-1 (uKIM-1) associates with tumor tissue (tKIM-1) expression and with the pathological characteristics of clear renal cell carcinoma (cRCC) in radically nephrectomized (RN) and/or in partially nephrectomized (PN) patients with cRCC, pre- and postoperatively. This clinical study included 40 patients subjected to RN/PN (cRCC group) and 30 healthy volunteers (control group). Urinary KIM-1 was determined by ELISA TIM-1/KIM-1 kit and normalized by urinary creatinine. Immunohistochemical staining (monoclonal anti-human anti-TIM-1/KIM-1/HAVCR antibody) was used for semiquantitative analysis of the tKIM-1 expression and expressed as a score (% KIM-1 positively stained tubules). Both markers were interpreted in terms of the tumor characteristics comprising tumor size, Fuhrman grade, pathological (pT) stage, tumor/nodes/metastasis (TNM) stage, lymphovascular invasion and type of surgery RN/PN. Preoperative uKIM-1 was significantly higher in the cRCC group compared to controls, such as uKIM-1 was statistically higher in RN than in PN patients. Postoperatively, uKIM-1 decreased to control values. Expression of tKIM-1 was documented in all nephrectomized patients. Significant associations were achieved between uKIM-1 and tKIM-1 and with considered tumor characteristics, especially with tumor size and grade. Based on the accomplished associations, we found uKIM-1 as a highly sensitive marker for cRCC diagnosis. The clinical trial registration number: 1110-2012.

Metastasis of Prostate Adenocarcinoma to the Testis.

INTRODUCTION: Prostate carcinoma is the most frequently diagnosed carcinoma in the male population. The most typical places of the metastases are pelvic lymphatic glands, bones and lungs, and very rarely it metastasizes into a testis. The prognostic importance of testicular metastasis of prostate cancer is not yet well-known, due to a very few published cases. According to the known facts, it is certain that a metastasis of the prostate carcinoma into a testis is a sign of an advanced disease. CASE REPORT: This work presents a 48-year-old patient, to whom an adenocarcinoma of the prostate has been proven by the pathohistological finding of transrectal biopsy, performed due to the elevated level of prostate-specific antigen (PSA). Nine years after the initial diagnosis, due to a gradual rise of PSA and tumorous enlargement of the left testis, left inguinal orchectomy and right orchectomy were performed. Metastatic dissemination of prostate adenocarcinoma into a testis was determined by a pathohistological analysis of the left testis. CONCLUSION: The metastasis of the prostate carcinoma into a testis, as a rare localization of the metastatic dissemination, after additionally performed orchectomy along with further oncological therapy, can provide a continuation of a good life quality as well as a control of the disease in a longer time period.

Pheochromocytoma of the urinary bladder--A case report.

INTRODUCTION: Pheochromocytoma of the urinary bladder is a rare tumor and presents less than 0.06% of all urinary bladder tumors. CASE REPORT: We presented a 49-year-old female patient with a history of daily paroxysmal hypertension accompanied with flushing of the face and upper chest, palpitations and excessive sweating prior to micturition. Ultrasonography reported a 3 cm bladder wall tumor. The 131I-metaiodobenzylguanidine (131I-MIBG) scan showed a pathological isotope accumulation in the projection of the bladder. The patient underwent a partial cystectomy. One year following the operation the patient was normotensive and without recurrence. CONCLUSION: The most efficient treatment option for bladder pheochromocytoma is surgical resection. The most important fact in the diagnostics is suspicion on this rare condition.

Urinary KIM-1 and AQP-1 in patients with clear renal cell carcinoma: Potential noninvasive biomarkers.

BACKGROUND/AIM: Kidney injury molecule-1 (KIM-1) and aquaporin-1 (AQP-1) are potential early urinary biomarkers of clear renal cell carcinoma (cRCC). The aim of this study was to ascertain relationship between the urine concentrations KIM-1 and AQP-1 with tumor size, grade, pT stage and type of operation (radical or partial nephrectomy) in patients with cRCC. METHODS: Urinary concentrations of urinary KIM-1 (uKIM-1) and urinary AQP-1 (uAQP-1) were determined by commercially available ELISA kits. The analysis included 40 patients undergoing partial or radical nephrectomy for cRCC and 40 age- and sex-matched healthy adult volunteers. RESULTS: The median preoperative concentrations of KIM-1 in the cRCC group [0.724 ? 1.120 ng/mg urinary creatinine (Ucr)] were significantly greater compared with controls (healthy volunteers) (0.210 +/- 0.082 ng/mgUcr) (p = 0.0227). Postoperatively, uKIM-1 concentration decreased significantly to control values (0.177 +/- 0.099 ng/mgUcr vs 0.210 + 0.082 ng/mgUcr, respectively). The size, grade and stage of tumor were correlated positively with preoperative uKIM-1 concentrations. Contrary to these results, concentrations of uAQP-1 in the cRCC group were significantly lower (0.111 +/- 0.092 ng/mgUcr) compared with the control group (0.202 +/- 0.078 ng/mgUcr) (p = 0.0014). Postoperatively, the concentrations of uAQP-1 increased progressively up to control values, approximately. We find no significant correlation between preoperative uAQP-1 concentrations and tumor size, grade and stage. CONCLUSION: uKIM-1 was found to be a reliable diagnostic marker of cRCC, based on its significantly increased values before and decreased values after the nephrectomy.

An Aggressive Retroperitoneal Fibromatosis.

INTRODUCTION: Aggressive fibromatosis (AF) is a heterogeneous group of mesenchymal tumors that have locally infiltrative growth and a tendency to relapse. The clinical picture is often conditioned by the obstruction of the ureter or small intestine. Diagnosis is based on clinical, radiological and histological parameters. A CASE REPORT: We report a case of male patient, aged 35 years, with the retroperitoneal fibromatosis. He reported to the physician because of frequent urination with the feeling of pressure and pain. Computed tomography revealed the tumor mass on the front wall of the bladder with diameter of 70mm with signs of infiltration of the musculature of the anterior abdominal wall. Endoscopic transurethral biopsy showed proliferative lesion binders by type of fibromatosis. The tumor was surgically removed in a classical way. The patient feels well and has no recurrence thirty-six months after the operative procedure. CONCLUSION: The complete tumor resection is the therapeutic choice for the primary tumor as well as for a relapse.

Neobladder "Belgrade pouch": Metabolic consideration.

Background/Aim: The ileal neobladder should be a lowpressure reservoir with acceptable volume and relatively small resorptive surface. A larger inner surface of the ileal pouch is associated with the high resorption of urine metabolites through intestinal mucosa and systemic metabolic disturbances, while a too small pouch results in a higher frequency of voiding and incontinency. The aim of this study was to investigate it is possible to create a neobladder from a shorter ileal segment compared to standard surgical techniques, and reduce metabolic complications. Methods: This prospective study included 77 male patients, scheduled for radical cystectomy and orthotopic neobladder derivation. The patients were divided into two groups: the standard pouch (SP) group of 37 patients scheduled for standard orthotopic neobladder, using a 50−70 cm long terminal ileum segment; the "Belgrade pouch" (BP) group of 40 patients scheduled for original, orthotopic urinary reservoir, using a 25−35 cm long terminal ileum segment. We measured neobladder capacity, acidosis, base excess and bicarbonate concentration in the postoperative month 3rd, 6th, 12th and 15th. Results: At the end of the study, the patients from the SP group had much higher neobladder capacity than the natural bladder − 750 mL (range 514−2,050 mL); in contrast, the patients from the BP group had average capacity of 438 mL (range 205−653 mL) (p < 0.001). At the end of the study, there were more patients with acidosis (37.8% : 2.5%), base excess (35.1% : 7.5%) and low bicarbonate level (40.5% : 20.0%) in the SP group, than in the BP group, respectively (p < 0.001). Conclusion: "Belgrade pouch", make from 25−35 cm long terminal ileum segment may obtain adequate capacity and lower rate of metabolic disturbances than standard, high capacity orthotopic neobladders.

The clinical course of non-muscle invasive bladder cancer after transurethral resection of the tumor with or without subsequent intravesical application of bacillus Calmette-Guérin: The influence of patients gender and age.

UNLABELLED: BACGROUND/AIM: The therapy with intravesical instillation of bacillus Calmette-Guérin (BCG) after transurethral resection (TUR) of tumor is the gold standard of treatment of non-muscle invasive bladder cancer (NMIBC). The role and importance of BCG intravesical therapy in various shape of tumors, were confirmed by our previous investigation. The aim of this study was to examine whether incidence of recurrence and tumor regression differs depending on sex and age of patients. METHODS: This study included a total of 899 patients suffering from NIMBC, treated at our institution from January 1, 2007 to March 1, 2013. Two groups of patients were formed: patients underwent TUR + BCG therapy (the group I) and the group II with patients in whom TUR was performed as only therapy. These two groups of patients were divided into subgroups of respondents male and female, age 60 years or younger and older than 60 years. Statistical analysis was performed using χ2 test and the Kolmogorov-Smirnov test. RESULTS: This research suggests that if the frequency of recurrence is seen as the only parameter, considering all the subjects, the lowest recurrence rate was determined in the male subjects, aged 60 years and younger who had received BCG after TUR. A high statistical significance was found in the incidence of recurrence in patients younger than 60 years, depending on the response to the therapy, while in those older than 60 years, the difference was at the level of statistical significance. This can be attributed to a certain degree of infravesical obstruction in older men. CONCLUSIONS: Sex and age of patients may have a significant influence on the course and outcome of NMIBC. The disease has the most malignant and most aggressive behavior when present in males older than 60 years.

Difference in recurrence frequencies of non-muscle-invasive-bladder tumors depending on optimal usage of intravesical immunotherapy of bacillus Calmette-Guérin.

BACKGROUND/AIM: The therapy with intravesical instillation of bacillus Calmette-Guérin (BCG) after transurethral resection (ITJR) of the tumor is the gold standard of treatment of non-muscle invasive bladder cancer (NMIBC). The aim of this study was to compare the frequencies of reccurence between a group of patients submitted to TUR + BCG therapy (group I) and a group of patients submitted only to TUR (group II). METHODS: The patients with NMIBC, a total of 899, treated in our Institution from January 1, 2007 to March, 2013, were included in this study and divided into two groups: group I and group II. These two groups were divided into three subgroups: solitary first diagnosed tumor ≤ 3 cm (SFDGT), solitary first diagnosed tumor > 3 cm and multiple first diagnosed tumors (MFDGT), and recedive tumors (RCT). Statistical analysis was performed by using χ2-test and Kolmogorov-Smirnov test. RESULTS: In the group I a total of 133 cases had reccurence contrary to 75 in the group II, making a statistically highly significant difference. Analysis of recurrences through the subgroups revealed: in the group I SFDGT recurrence occured in 27 of the cases vs 9 cases in the group II; in the group I MFDGT recurrence occured in 49 of the cases vs 31 in the group II (p < 0.001), and finally, in the group I RCT recurrence occured in 57 cases vs 35 cases in the group II (p < 0.001). CONCLUSION: The obtained results indicate no difference in the frequency of reccurence between the group I and group II regarding SFDGT, but a very high significant difference regarding those with MFDGT and RCT. These results should be taken into consideration in everyday clinical practise.

Radical cystectomy in eldery.

BACKGROUND/AIM: Radical cystectomy is the method of choice for the treatment of muscle invasive bladder cancer. This major surgery is associated with many complications, especially in older patients. The aim of this study was to analyze preoperative comorbidity, and intraoperative and postoperative complicatons in patients older than 75 years. METHODS: This clinical, retrospective study included 46 patients over 75 years, who underwent radical cystectomy. Indications for surgery, and complications during and after the surgery were followed up. RESULTS: Preoperatively, anemia caused by hematuria was registered in 76% of the patients. In 52% of the patients urine derivation was performed by ileal conduit, in 35% by ureterocutaneostomy and in 13% orthotopic ileal neobladder was created. The average duration of surgery was 190 (120-300) min. A total of 76% of the patients were treated by blood supstitution intraoperatively, average 630 (310-1230) mL. Concerning pathological stage of transitional cell carcinoma of urinary bladder, 26% of the patients had T2, 4% T3a, 52% T3b, and 14% T4a stage. In one case, planocellular carcinoma was diagnosed by patohistological examination, and in 2 cases prostate carcinoma was incidentally found. The average duration of hospitalization was 16 (8-35) days. CONCLUSION: The main reason for cystectomy in patients over 70-and 80 years was gross hematuria caused by bladder cancer, with consecutive anemia which could not be solved using endoscopic treat- ment or blood supstitution. As expected, a prolonged stay in hospital after cystectomy, and a higher rate of complications were recorded in this population.

Conversion from calcineurin inhibitors to sirolimus of recipients with chronic kidney graft disease grade III for a period 2003-2011.

BACKGROUND/AIM: Tremendous breakthrough in solid organ transplantation was made with the introduction of calcineurin inhibitors (CNI). At the same time, they are potentially nephrotoxic drugs with influence on onset and progression of renal graft failure. The aim of this study was to evaluate the outcome of a conversion from CNI-based immunosuppressive protocol to sirolimus (SRL) in recipients with graft in chronic kidney disease (CKD) grade III and proteinuria below 500 mg/day. METHODS: In the period 2003-2011 24 patients (6 famale and 18 male), mean age 41 +/- 12.2 years, on triple immunosuppressive therapy: steroids, antiproliferative drug [mycophenolate mofetil (MMF) or azathiopirine (AZA)] and CNI were switched from CNI to SRL and followe-up for 76 +/- 13 months. Nine patients (the group I) had early postransplant conversion after 4 +/- 3 months and 15 patients (the group II) late conversion after 46 +/- 29 months. During the regular outpatient controls we followed graft function through the serum creatinine and glomerular filtration rate (GFR), proteinuria, lipidemia and side effects. RESULTS: Thirty days after conversion, in all the patients GFR, proteinuria and lipidemia were insignificantly increased. In the first two post-conversion months all the patients had at least one urinary or respiratory infection, and 10 patients reactivated cytomegalovirus (CMV) infection or disease, and they were successfully treated with standard therapy. After 21 +/- 11 months 15 patients from both groups discontinued SRL therapy due to reconversion to CNI (10 patients) and double immunosuppressive therapy (3 patients), return to hemodialysis (1 patient) and death (1 patient). Nine patients were still on SRL therapy. By the end of the follow-up they significantly improved GFR (from 53.2 +/- 12.7 to 69 +/- 15 mL/min), while the increase in proteinuria (from 265 +/- 239 to 530.6 +/- 416.7 mg/day) and lipidemia (cholesterol from 4.71 +/- 0.98 to 5.61 +/- 1.6 mmol/L and triglycerides from 2.04 +/- 1.18 to 2.1 +/- 0.72 mmol/L) were not significant. They were stable during the whole follow-up period. Ten patients were reconverted from SRL to CNI due to the abrupt increase of proteinuria (from 298 +/- 232 to 1639 +/- 1641/mg day in 7 patients), rapid growth of multiple ovarian cysts (2 patients) and operative treatment of persisted hematoma (1 patient). Thirty days after reconversion they were stable with an insignificant decrease in GFR (from 56.10 +/- 28.09 to 47 +/- 21 mL/min) and significantly improved proteinuria (from 1639 +/- 1641 to 529 +/- 688 mg/day). By the end of the follow-up these patients showed nonsignificant increase in the serum creatinine (from 172 +/- 88 to 202 +/- 91 mmol/L), decrease in GFR (from 56.10 +/- 28.09 to 47 +/- 21 mL/day) and increased proteinuria (from 528.9 +/- 688 to 850 +/- 1083 mg/min). CONCLUSION: In this small descriptive study, conversion from CNI to SRL was followed by an increased incidence of infections and consecutive 25-50% dose reduction in the second antiproliferative agent (AZA, MMF), with a possible influence on the development of glomerulopathy in some patients, which was the major reason for discontinuation of SRL therapy in the 7 (29%) patients. Nine (37.5%) of the patients experienced the greatest benefit of CIN to SRL conversion without serious post-conversion complications.

Rare locations of metastastatic renal cell carcinoma: a presentation of three cases.

INTRODUCTION: Metastatic renal cell carcinoma (RCC) frequently spreads not only to neighboring lymph nodes, but also to distant organs, including the lungs, liver, bones and brain. CASE REPORT: We presented three cases of RCC with colon metastasis. In the first, 63-year-old patient, after left nephrectomy followed with lyphadenectomy in paraaortic lymph node, left hemicolectomy was done due to RCC metastasis in rectosigmoid colon. In the second, 35-year-old patient, left radical nephrectomy was followed two years later with partial right nephrectomy, lung metastasectomy, small bowel and coecum resection and right orchiectomy all as separate procedures in different time intervals. The patient died from brain and bone metastases two years after the first surgery. The third, 35-year-old patient, had right nephrectomy followed by repeted lymphadenectomies after 6, 12 and 24 months. Four years later RCC spreaded to coecum and right hemicolectomy was performed. CONCLUSION: RCC treated with nephrectomy should be carefully followed up with imaging methods as a proper treatment of RCC metastases to distant organs could be important for a patient survival.

Urodynamic characteristics of the modified orthotopic ileal neobladder.

BACKGROUND/AIM: Radical cystectomy is the method of choice in management of muscle invasive, organ-confined tumors of the bladder (T2-T4, N0-Nx). The most frequent continent orthotopic urinary diversion after radical cystectomy is the ileal neobladder. A modified technique consists of using a shorter segment of the terminal ileum than the standard technique, around 30 cm. The aim of this study was to determine the urodynamic characteristics of the orthotopic ileal neobladder created by a modified technique. METHODS: In this prospective clinical study we analyzed the urodynamic parameters of 24 patients who had underwent radical cystectomy with orthotopic urinary diversion by ileal neobladder created using a modified technique. In all the patients we performed invasive and noninvasive urodynamic investigations 12 months after the operation. The urethral pressure profile parameters analyzed were maximal urethral pressure, maximal urethral closure pressure and the functional urethral profile length. RESULTS: The average age of the patients was 63 (49-73) years, 90% were males and 10% were females. The median length of the shorter segment of the terminal ileum was 28 (range 22-35) cm. Prior to enterocystometry and uroflowmetry postvoid residual (PVR) urine was measured by a urethral catheter. The median PVR was 16.7 (0-140) mL. The median enterocystometric capacity was 396 (range 372-532) mL. The median end filling pouch pressure was 27.6 (range 20-70) cmH2O. The median maximal flow of urine was 22.1 (range 9.7-39.5) mL/s and the average flow of urine was 9.61 (range 3.6-17.6) mL/s. Flow time in the analyzed group was 47.5 (range 22-119) s. The median maximal urethral pressure was 54 (range 12-101) cmH2O, maximal urethral closure pressure 36.6 (range 6-91) cmH2O. Functional urethral profile length was 14.9 (range 4-37) mm. CONCLUSION: An ileal orthotopic pouch created by a modified technique using a shorter segment of the terminal ileum after 12 months presents with urodynamic characteristics similar to the native bladder.

[Post-voiding residual urine and capacity increase in orthotopic urinary diversion--standard vs. modified technique].

BACKGROUND/AIM: Ever since the time when the first orthotopic urinary diversion (pouch) was performed there has been a constant improvement and modification of surgical techniques. The aim has been to create a urinary reservoir similar to normal bladder, to decrease incidence of postoperative complications and provide an improved life quality. The aim of this study was to compare post-voiding residual urine (PVR) and capacity of the pouch constructed by standard or modified technique. METHODS: In this prospective and partially retrospective clinical study we included 79 patients. In the group of 41 patients (group ST) pouch was constructed using 50-70 cm of the ileum (standard technique). In the group of 38 patients (group MT) pouch was constructed using 25-35 cm of the ileum (modified technique). Postoperatively, PVR and pouch capacity were measured using ultrasound in a 3-, 6- and 12-month period. RESULTS: Postoperatively, an increase in PVR and pouch capacity was noticed in both groups. Twelve months postoperatively, PVR was significantly smaller in the group MT than in the group ST [23 (0-90) mL vs. 109 (0-570) mL, p < 0.001]. In the same period the pouch capacity was significantly smaller in the MT group than in the ST group [460 (290-710) mL vs. 892 (480-2 050) mL, p < 0.001]. CONCLUSION: Postoperatively, an increase in PVR and pouch capacity was noticed during a 12-month period. A year following the operation the pouch created from a shorter ileal segment reached capacity of the "normal" bladder with small PVR. The pouch created by standard technique developed an unnecessary large PVR and capacity.

Short ileal segment for orthotopic neobladder: a feasibility study.

OBJECTIVES: The objective of this study was to present the construction of a neobladder with a modified pouch technique using 25-35 cm of terminal ileum. METHODS: Thirty-eight patients whose pouch was constructed from 25-35 cm of terminal ileum (short pouch [SP] group) were prospectively evaluated vs 41 patients whose pouch was constructed from 50-70 cm of terminal ileum (long pouch group). Pouch volume, post-void residual (PVR) volume, need for catheterization, continence and voiding frequency were evaluated at 3 and 12 months after surgery. RESULTS: SP group patients had significantly smaller pouch capacity (440 vs 840 mL, P < 0.001) at month 12, and smaller PVR at postoperative months 3 (11 [0-43]vs 40 [0-147] mL, P < 0.001) and 12 (10 [0-90]vs 72 [0-570] mL, P < 0.001). SP group patients had significantly higher voiding frequency on postoperative month 3 (10 vs 9, P < 0.001) and 12 (7 vs 6, P < 0.005). Continence was significantly improved in the SP group compared with the long pouch group after 12 months (63.2% vs 34.1%, respectively, P = 0.034). Full continence improved significantly over time (P < 0.001) in the SP group, from 26.3% at month 3 to 63.2% at month 12. CONCLUSION: A pouch constructed from 25-35 cm of terminal ileum provides adequate capacity, smaller PVR, satisfactory continence and a better 24-h voiding frequency pattern during the first postoperative year.

Living unrelated donor kidney transplantation--a fourteen-year experience.

BACKGROUND: In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. METHOD: We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I). The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 +/- 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. RESULTS: The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. CONCLUSION: In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.

[On 10-year experience in the use of direct and antireflux techniques of anastomosis of ureter and orthotopic intestinal neobladder after radical cystectomy].

BACKGROUND/AIM: Today, radical cystectomy is the method of choice in treatment of muscle invasive bladder carcinoma in stage T2-T4a, No-Nx, Mo, and orthotopic derivation is for patients the most comfortable derivation of urin. From 1888 when Tizzoni and Foggi performed the first orthotopic derivation on animals, and 1913 when Lemoin declared the first orthotopic derivation in humans there has been a constant improvement and modification of orthotopic urinary diversion after radical cystectomy which significantly decrease the number and severity of postoperative complications. The aim of this study was to compare complications regarding the direct and antireflux ureter-neobladder anastomosis. METHODS: This retrospective study included 79 selected patients operated over the last ten years having medical records available. Previously, we excluded the patients with prior radiation therapy, systemic illness, diabetes mellitus, previous history of calculosis and metabolic disorders etc. Hautmann orthotopic technique was used in almost 70% of the patients. We analyzed complications regarding direct and antireflux ureter-neobladder anastomosis with a median follow-up period of 4.72 years. We followed-up the appearance of unilateral and bilateral hydronephrosis, forming of renal stones in the patients without previous history of renal calculosis, and renal insuficiency caused by stenosis on the site of anastomosis. We used the Kolmogorov Smirnov test, Mann-Whitney U test, Student's ttest i chi2 test for statistic analysis. RESULTS: The median age of the patients was 68.2 years. Totally 88.61% of the patients were male and 11.39% were female. The direct anastomotic technique secundum Wallace was used in 43.03% of the operated patients and antireflux technique secundum Le Duc in 56.97%s. Renal deterioration caused by stenosis on the site of the ureter-neobladder anastomosis was statistically significantly higher in the antireflux anastomosis compared to direct anastomosis (chi2= 4.71, p = 0.0299). No one of the patients with direct anastomosis had poucho-ureteral reflux higher grade than gr III. CONCLUSION: In our study, complication as renal deterioration as a result of stenosis on the site of the ureter anastomosis was significantly more common in the group of patients exposed to antireflux technique.

[Use of gastric segment in urinary bladder replacement after total cystectomy].

Drainage of urine by abnormal way is urinary derivation. Various forms of urinary derivations are available for urinary bladder replacement after radical cystectomy for invasive bladder tumor. Construction of continent urinary reservoir, so called pouch, from different bowel segments is named continent urinary derivations. If such urinary reservoir is connected with urethra, then it is about orthotopic derivation and reservoir is defined as neobladder. Upon satisfactory results of introduction of continent urinary derivations with Mainz pouch I and Orthotopic Mainz pouch, we performed continent orthotopic urine derivation with isolated gastric segment in 74-year old male patient who had previously undergone radical cystoprostatectomy because of the invasive urothelial cancer of the urinary bladder. Even though there were no major surgical complications in the near postoperative course, the patient had to be operated ten months later for ileus; 20 months after the procedure, significant loss of neobladder capacity, bilateral vesicoureteral reflux, persistent urinary infection and incipient renal failure were manifested. In the further course, reoperation was needed and neobladder augmentation by ileal pouch along with both ureteral reimplantations into the pouch wall was carried out. After this reintervention, the patient was alive in the following three years with satisfactory quality of life and preserved renal function. Our conclusion is that gastric neobladder should not be the first method of choice for urinary bladder replacement after radical cystectomy in older patients.

[Advanced prostatic carcinoma with low levels of serum prostate-specific antigen]. / Uznapredovali karcinomi prostate sa niskim serumskim vrednostima prostata-specificnog antigena.

The serum levels of prostate-specific antigen (PSA) represent a significant diagnostic and monitoring parameter of prostatic carcinoma (PC). The aim of the study was to establish correlation of serum PSA level in addition to grade, histological type, and clinical stage of PC in patients with normal or intermediary PSA serum level. In 37 untreated PC patients with preoperative serum PSA levels ranging between 0.1 and 9.6 ng/ml, paraffin-embedded tissue and serum samples were immunohistologically studied and immunoassay for PSA was done. The most representative was poorly differentiated PC with D stage. In serum samples from PC patients 27 (73.7%) normal (< or = 4.0 ng/ml), and 10 (27.3%) intermediate (4.1-10 ng/ml) PSA levels were found. Immunohistochemistry, in 36 PC (97.3%) had demonstrated the expression of PSA. Our study results had shown low serum PSA levels in some patients with advanced poorly differentiated PC.