The GSTO2 (rs156697) Polymorphism Modifies Diabetic Nephropathy Risk.

Background and Objectives: In the development of type 2 diabetes mellitus (T2DM) and its complications, genetic and environmental factors play important roles. Diabetic nephropathy (DN), one of the major microangiopathic chronic diabetic complications, is associated with an increased risk of major cardiovascular events and all-cause mortality. The present study was designed to investigate the possible modifying effect of glutathione transferase polymorphisms (GSTM1, GSTT1, GSTP1 rs1138272/rs1695, GSTO1 rs4925 and GSTO2 rs156697) in the susceptibility to T2DM and diabetic nephropathy. Materials and Methods: GSTM1 and GSTT1 deletion polymorphisms were determined by multiplex PCR, whereas GSTO1, GSTO2, and GSTP1 polymorphisms were determined by the real-time PCR in 160 T2DM patients and 248 age- and gender-matched controls. Advanced glycation end products (AGEs) were measured by ELISA. Results: Among six investigated GST polymorphisms, a significant association between the GST genotypes and susceptibility for development of diabetes mellitus was found for the GSTM1, GSTT1, GSTP1 (rs1138272) and GSTO1 polymorphisms. When the GST genotypes' distribution in diabetes patients was assessed in the subgroups with and without diabetic nephropathy, a significant association was found only for the GSTO2 rs156697 polymorphism. Diabetic patients, carriers of the GSTM1 null, GSTT1 null and variant GSTO1*AA genotypes, had significantly increased levels of AGEs in comparison with carriers of the GSTM1 active, GSTT1 active and referent GSTO1*CC genotypes (p < 0.001, p < 0.001, p = 0.004, respectively). Conclusions: The present study supports the hypothesis that GST polymorphisms modulate the risk of diabetes and diabetic nephropathy and influence the AGEs concentration, suggesting the potential regulatory role of these enzymes in redox homeostasis disturbances.

Template-Independent Poly(A)-Tail Decay and RNASEL as Potential Cellular Biomarkers for Prostate Cancer Development.

The post-transcriptional messenger RNA (mRNA) decay and turnover rate of the template-independent poly(A) tail, localized at the 3'-untranslated region (3'UTR) of mRNA, have been documented among subtle mechanisms of uncontrolled cancer tissue growth. The activity of Poly(A) deadenylase and the expression pattern of RNASEL have been examined. A total of 138 prostate tissue specimens from 46 PC patients (cancer specimens, corresponding adjacent surgically healthy tissues, and in their normal counterparts, at least 2 cm from carcinoma) were used. For the stratification prediction of healthy tissue transition into malignant phenotype, the enzyme activity of tumor-adjacent tissue was considered in relation to the presence of microfocal carcinoma. More than a four-times increase in specific enzyme activity (U/L g.prot) was registered in PC on account of both the dissociation of its inhibitor and genome reprogramming. The obtained ROC curve and Youden index showed that Poly(A) deadenylase identified PC with a sensitivity of 93.5% and a specificity of 94.6%. The RNASEL expression profile was raised significantly in PC, but the sensitivity was 40.5% and specificity was 86.9%. A significantly negative correlation between PC and control tissue counterparts with a higher expression pattern in lymphocyte-infiltrated samples were reported. In conclusion, significantly upregulated Poly(A) deadenylase activity may be a checkpoint for the transition of precancerous lesion to malignancy, while RNASEL may predict chronic inflammation.

The Role of Nucleases Cleaving TLR3, TLR7/8 and TLR9 Ligands, Dicer RNase and miRNA/piRNA Proteins in Functional Adaptation to the Immune Escape and Xenophagy of Prostate Cancer Tissue.

The prototypic sensors for the induction of innate and adaptive immune responses are the Toll-like receptors (TLRs). Unusually high expression of TLRs in prostate carcinoma (PC), associated with less differentiated, more aggressive and more propagating forms of PC, changed the previous paradigm about the role of TLRs strictly in immune defense system. Our data reveal an entirely novel role of nucleic acids-sensing Toll-like receptors (NA-TLRs) in functional adaptation of malignant cells for supply and digestion of surrounding metabolic substrates from dead cells as specific mechanism of cancer cells survival, by corresponding ligands accelerated degradation and purine/pyrimidine salvage pathway. The spectrophotometric measurement protocols used for the determination of the activity of RNases and DNase II have been optimized in our laboratory as well as the enzyme-linked immunosorbent method for the determination of NF-κB p65 in prostate tissue samples. The protocols used to determine Dicer RNase, AGO2, TARBP2 and PIWIL4 were based on enzyme-linked immunosorbent assay. The amount of pre-existing acid-soluble oligonucleotides was measured and expressed as coefficient of absorbance. The activities of acid DNase II and RNase T2, and the activities of nucleases cleaving TLR3, TLR7/8 and TLR9 ligands (Poly I:C, poly U and unmethylated CpG), increased several times in PC, compared to the corresponding tumor adjacent and control tissue, exerting very high sensitivity and specificity of above 90%. Consequently higher levels of hypoxanthine and NF-κB p65 were reported in PC, whereas the opposite results were observed for miRNA biogenesis enzyme (Dicer RNase), miRNA processing protein (TARB2), miRNA-induced silencing complex protein (Argonaute-AGO) and PIWI-interacting RNAs silence transposon. Considering the crucial role of purine and pyrimidine nucleotides as energy carriers, subunits of nucleic acids and nucleotide cofactors, future explorations will be aimed to design novel anti-cancer immune strategies based on a specific acid endolysosomal nuclease inhibition.

Association between Biomarkers of Oxidative Stress and Inflammation with Cardiac Necrosis and Heart Failure in Non-ST Segment Elevation Myocardial Infarction Patients and Various Degrees of Kidney Function.

The aim of this study was to explore the possible association between markers of inflammation and oxidative stress (OS) and markers of cardiac function and necrosis in 100 NSTEMI (non-ST-elevation myocardial infarction) patients with various degrees of kidney dysfunction. At admission, ejection fraction (EF), brain natriuretic peptide (BNP), troponin (TnI), creatinine phosphokinase (CPK), alanine transaminase (ALT), aspartate transaminase (AST), high-sensitive C-reactive protein (hs-CRP), interleukins 6 and 10 (IL-6, IL10), myeloperoxidase (MPO), transforming growth factor beta (TGF-ß1), glomerular filtration rate (GFR), and albuminuria were assessed. Study participants were divided into 2 subgroups based on the median level of EF. Compared to the high, patients in the low EF group had higher GFR, BNP, CPK, hs-CRP, IL-10, IL-6, and MPO values and lower albuminuria levels. The levels of EF decreased in parallel with the progression of CKD, whereas the levels of BNP, IL-6, and TGF-ß were significantly higher in late stages of CKD. Spearman's rho correlation analysis showed that EF was inversely correlated with MPO (r = -0.20, p = 0.05) BNP (r = -0.30, p = 0.002), hs-CRP (r = -0.38, p < 0.0001), IL-10 (r = -0.30, p = 0.003), and IL-6 (r = -0.24, p = 0.02) and positively with GFR (r = 0.27, p = 0.008). TnI was correlated with CPK (r = 0.44, p < 0.0001), CPK-MB (r = 0.31, p = 0.002), ALT (r = 0.50, p < 0.0001), AST (r = 0.29, p = 0.004), IL-10 (r = 0.22, p = 0.03), and MPO (r = -0.28, p = 0.006). In multivariate regression analysis, only BNP (ß = -0.011, p = 0.004), hs-CRP (ß = -0.11, p = 0.001), and GFR (ß = 0.12, p = 0.0029) were independent determinants of EF. Similarly, MPO (ß = -1.69, p = 0.02), IL-10 (ß = 0.15, p = 0.006), and AST (ß = 0.04, p = 0.001) were the 3 major determinants of TnI. Based on these associations, we built a predictive model including markers of inflammation and OS (MPO, IL-10, and hs-CRP) to identify patients with the most severe cardiac injury (combined EF below median and troponin above median values). Receiver-operator characteristic (ROC) analysis showed that the area under the ROC curve of this model to detect patients with low EF and high TnI was 0.67 (p = 0.015, 95%confidence interval = 0.53-0.81).

Purine adducts as a presumable missing link for aristolochic acid nephropathy-related cellular energy crisis, potential anti-fibrotic prevention and treatment.

Aristolochic acid nephropathy is a progressive exposome-induced disease characterized by tubular atrophy and fibrosis culminating in end-stage renal disease and malignancies. The molecular mechanisms of the energy crisis as a putative cause of fibrosis have not yet been elucidated. In light of the fact that aristolochic acid forms DNA and RNA adducts by covalent binding of aristolochic acid metabolites to exocyclic amino groups of (deoxy)adenosine and (deoxy)guanosine, we hypothesize here that similar aristolochic acid adducts may exist with other purine-containing molecules. We also provide new insights into the aristolochic acid-induced energy crisis and presumably a link between already known mechanisms. In addition, an overview of potential targets in fibrosis treatment is provided, which is followed by recommendations on possible preventive measures that could be taken to at least postpone or partially alleviate aristolochic acid nephropathy.

Development and Validation of a Multivariable Predictive Model for Mortality of COVID-19 Patients Demanding High Oxygen Flow at Admission to ICU: AIDA Score.

INTRODUCTION: Risk stratification is an important aspect of COVID-19 management, especially in patients admitted to ICU as it can provide more useful consumption of health resources, as well as prioritize critical care services in situations of overwhelming number of patients. MATERIALS AND METHODS: A multivariable predictive model for mortality was developed using data solely from a derivation cohort of 160 COVID-19 patients with moderate to severe ARDS admitted to ICU. The regression coefficients from the final multivariate model of the derivation study were used to assign points for the risk model, consisted of all significant variables from the multivariate analysis and age as a known risk factor for COVID-19 patient mortality. The newly developed AIDA score was arrived at by assigning 5 points for serum albumin and 1 point for IL-6, D dimer, and age. The score was further validated on a cohort of 304 patients admitted to ICU due to the severe form of COVID-19. RESULTS: The study population included 160 COVID-19 patients admitted to ICU in the derivation and 304 in the validation cohort. The mean patient age was 66.7 years (range, 20-93 years), with 68.1% men and 31.9% women. Most patients (76.8%) had comorbidities with hypertension (67.7%), diabetes (31.7), and coronary artery disease (19.3) as the most frequent. A total of 316 patients (68.3%) were treated with mechanical ventilation. Ninety-six (60.0%) in the derivation cohort and 221 (72.7%) patients in the validation cohort had a lethal outcome. The population was divided into the following risk categories for mortality based on the risk model score: low risk (score 0-1) and at-risk (score > 1). In addition, patients were considered at high risk with a risk score > 2. By applying the risk model to the validation cohort (n = 304), the positive predictive value was 78.8% (95% CI 75.5% to 81.8%); the negative predictive value was 46.6% (95% CI 37.3% to 56.2%); the sensitivity was 82.4% (95% CI 76.7% to 87.1%), and the specificity was 41.0% (95% CI 30.3% to 52.3%). The C statistic was 0.863 (95% CI 0.805-0.921) and 0.665 (95% CI 0.598-0.732) in the derivation and validation cohorts, respectively, indicating a high discriminative value of the proposed score. CONCLUSION: In the present study, AIDA score showed a valuable significance in estimating the mortality risk in patients with the severe form of COVID-19 disease at admission to ICU. Further external validation on a larger group of patients is needed to provide more insights into the utility of this score in everyday practice.

The Association of Polymorphisms in Nrf2 and Genes Involved in Redox Homeostasis in the Development and Progression of Clear Cell Renal Cell Carcinoma.

Deleterious effects of SNPs found in genes encoding transcriptional factors, as well as antioxidant and detoxification enzymes, are disputable; however, their functional significance seems to modify the risk for clear cell renal cell carcinoma (ccRCC) development and progression. We investigated the effect of specific Nrf2, SOD2, GPX1 gene variants and GSTP1ABCD haplotype on ccRCC risk and prognosis and evaluated the association between GSTP1 and regulatory (JNK1/2) and executor (caspase-3) apoptotic molecule expression in ccRCC tissue samples and the presence of GSTP1 : JNK1/2 protein : protein interactions. Genotyping was performed in 223 ccRCC patients and 336 matched controls by PCR-CTTP and qPCR. Protein expression was analyzed using immunoblot, while the existence of GSTP1 : JNK1 protein : protein interactions was investigated by immunoprecipitation experiments. An increased risk of ccRCC development was found among carriers of variant genotypes of both SOD2 rs4880 and GSTP1 rs1695 polymorphisms. Nrf2 rs6721961 genetic polymorphism in combination with both rs4880 and rs1695 showed higher ccRCC risk as well. Haplotype analysis revealed significant risk of ccRCC development in carriers of the GSTP1C haplotype. Furthermore, GSTP1 variant forms seem to affect the overall survival in ccRCC patients, and the proposed molecular mechanism underlying the GSTP1 prognostic role might be the presence of GSTP1 : JNK1/2 protein : protein interactions.

Predictors of Mortality in Critically Ill COVID-19 Patients Demanding High Oxygen Flow: A Thin Line between Inflammation, Cytokine Storm, and Coagulopathy.

INTRODUCTION: Mortality among critically ill COVID-19 patients remains relatively high despite different potential therapeutic modalities being introduced recently. The treatment of critically ill patients is a challenging task, without identified credible predictors of mortality. METHODS: We performed an analysis of 160 consecutive patients with confirmed COVID-19 infection admitted to the Respiratory Intensive Care Unit between June 23, 2020, and October 2, 2020, in University Hospital Center Bezanijska kosa, Belgrade, Serbia. Patients on invasive, noninvasive ventilation and high flow oxygen therapy with moderate to severe ARDS, according to the Berlin definition of ARDS, were selected for the study. Demographic data, past medical history, laboratory values, and CT severity score were analyzed to identify predictors of mortality. Univariate and multivariate logistic regression models were used to assess potential predictors of mortality in critically ill COVID-19 patients. RESULTS: The mean patient age was 65.6 years (range, 29-92 years), predominantly men, 68.8%. 107 (66.9%) patients were on invasive mechanical ventilation, 31 (19.3%) on noninvasive, and 22 (13.8%) on high flow oxygen therapy machine. The median total number of ICU days was 10 (25th to 75th percentile: 6-18), while the median total number of hospital stay was 18 (25th to 75th percentile: 12-28). The mortality rate was 60% (96/160). Univariate logistic regression analysis confirmed the significance of age, CRP, and lymphocytes at admission to hospital, serum albumin, D-dimer, and IL-6 at admission to ICU, and CT score. Serum albumin, D-dimer, and IL-6 at admission to ICU were independently associated with mortality in the final multivariate analysis. CONCLUSION: In the present study of 160 consecutive critically ill COVID-19 patients with moderate to severe ARDS, IL-6, serum albumin, and D-dimer at admission to ICU, accompanied by chest CT severity score, were marked as independent predictors of mortality.

Predictive Markers for Malignant Urothelial Transformation in Balkan Endemic Nephropathy: A Case-Control Study.

Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease frequently accompanied by urothelial carcinoma (UC). In light of the increased UC incidence and the markers observed in BEN patients with developed UC, the aim of the current case-control study is to assess survivin, p53 protein, growth factors and receptors (VEGF, VEGFR1, IGF I, IGF-1R and IGFBP5), tumor marker (TF)/CD142, circulating soluble Fas receptor and neopterin, as potentially predictive markers for UC in patients with BEN (52 patients), compared to healthy, age-matched subjects (40). A threefold increase was registered in both circulating and urinary survivin level in BEN patients. Especially noticeable was the ratio of U survivin/U Cr level five times the ratio of BEN patients associated with standard renal markers in multivariate regression models. The concentrations of VEGF, VEGFR1, (TF)/CD142, (sFas) were not significantly different in BEN patients, while urinary/plasma level demonstrated a significant decrease for VEGF. The levels of IGF I, IGFBP5 and IGF-1R were significantly reduced in the urine of BEN patients. Plasma concentration of neopterin was significantly higher, while urinary neopterin value was significantly lower in BEN patients compared to healthy controls, which reflected a significantly lower urine/plasma ratio and low local predictive value. As BEN is a slow-progressing chronic kidney disease, early detection of survivin may be proposed as potential predictor for malignant alteration and screening tool in BEN patients without the diagnosis of UC.

The assessment of knowledge and attitudes of men in Serbia about prostate cancer and possibilities for its early detection and treatment in 2011: a cross-sectional study.

PURPOSE: To assess the knowledge and attitudes of men in Serbia about prostate cancer (PCa) and possibilities for its early detection and treatment in 2011. METHODS: This cross-sectional study included 407 men of various ages and education levels selected randomly and divided in 2 groups according to age (up to 40 and over 40 years). The assessment of knowledge and attitudes was based on a survey made up of 12 multiple choice questions conducted with direct contact with respondents from October 15th to December 15th 2011 with their voluntary consent. The results were evaluated in the total sample and between the groups. RESULTS: Patient groups significantly differed according to knowledge about PCa treatment success (p<0.001) and stage in which PCa is most frequently detected (p<0.001) as well as according to attitudes about community-based interventions for increasing the awareness of PCa (p<0.001). Sixty-one percent of respondents over 50 years hadn't done preventive prostate examination despite recommendations. Ninety percent of all respondents believed the community-based intervention should have been implemented in Serbia to increase the men's awareness of PCa. CONCLUSION: The study reported lack of men's knowledge about PCa in Serbia in 2011, while there was a common agreement among men on the necessity of spreading more information about this disease.

First reported case of fulminant TB with progression of infection from lungs to the genitourinary region.

Although tuberculosis (TB) is a curable disease, it continues to be one of the leading infections associated with death in the world. Extra-pulmonary TB (EPTB) occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura, bone and genitourinary tract as the most common locations. Genitourinary tuberculosis, the second most common EPTB, is very difficult to diagnose unless there is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical evidence of renal involvement is a rare entity among genitourinary tuberculosis. We presented the first reported case of TB prostatitis and orchitis associated with pulmonary TB and the presence of an acute massive caseous pneumonia in an immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid progression of disease and deterioration of general conditions taking to death, which occurred four days after TB treatment had started. Disseminated TB is a relatively uncommon cause of acute massive caseous pneumonia; however, there should always be suspicion of the disease, since it is a potentially treatable cause. This rare case supports the assertion that TB should be considered as an important differential diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in the body.

First reported case of fulminant TB with progression of infection from lungs to the genitourinary region

ABSTRACT Although tuberculosis (TB) is a curable disease, it continues to be one of the leading infections associated with death in the world. Extra-pulmonary TB (EPTB) occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura, bone and genitourinary tract as the most common locations. Genitourinary tuberculosis, the second most common EPTB, is very difficult to diagnose unless there is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical evidence of renal involvement is a rare entity among genitourinary tuberculosis. We presented the first reported case of TB prostatitis and orchitis associated with pulmonary TB and the presence of an acute massive caseous pneumonia in an immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid progression of disease and deterioration of general conditions taking to death, which occurred four days after TB treatment had started. Disseminated TB is a relatively uncommon cause of acute massive caseous pneumonia; however, there should always be suspicion of the disease, since it is a potentially treatable cause. This rare case supports the assertion that TB should be considered as an important differential diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in the body.

Buccal mucosal graft interposition in the treatment of recurrent vesicovaginal fistula: A report on two cases.

OBJECTIVE: To present the use of autologous buccal mucosa graft (BMG) in the treatment of recurrent vesicovaginal fistula (VVF). CASE REPORTS: In 2011, two women, aged 45 years and 56 years, were admitted due to recurrent VVF. Both women had previously undergone abdominal hysterectomies for benign conditions and, subsequently, vaginal VVF repair due to vaginal urine leakage. On admission, the younger woman had a round fistula, with a diameter of 1.5 cm, located on the left side, supratrigonally; the other woman had an ellipsoidal fistula measuring 2.5 cm × 1.5 cm, located medially and supratrigonally. Both women underwent suturing of the VVF with the interposition of BMG. After the last treatment, both women were cured. CONCLUSION: Treatment of recurrent VVF with the interposition of BMG is a good alternative to the use of other tissue grafts. Larger series are needed to confirm the advantages of this method.

Idionathic retroneritoneal fibrosis: A Report on 15 Patients.

BACKGROUND/AIM: Retroperitoneal fibrosis (RPF) repre sents a chronic pathological process characterized by fibro sis which entraps and compresses the ureters and the grea blood vessels in the retroperitoneal space. A specific form of RPF is idiopathic RPF, an uncommon collagen vasculaj disease of unclear etiology. The series of 15 patients whicl underwent open surgical repair due to idiopathic RPF is presented herein. METHODS: From 1989 to 2012, 11 male and 4 female patients underwent surgery due to primar RPF. The ureters were entrapped unilaterally (7 patients), or bilaterally (8 patients). Major symptoms included low bacl pain due to hydronephrosis (9 patients), uremia (4 patients) and urinary tract infection (2 patients). The diagnosis was based on intravenous urography (IVU), retrograde uretero pyelography and computed tomography (CT). RESULTS: Surgical procedures included intraperitoneal ureteral dis placement (8 patients) and ureteral wrapping with omental flap (6 patients). One patient underwent bilateral uretera stenotic segments resection and oblique ureterography, followed by wrapping with omental flap. Pathological examination confirmed primary RPF in all patients. The meat operative time was 3.5 h (range 2.5-4.5 h). The average in trahospital stay was 21 days (range 16-26 days). The meat follow up was 32 months (6-46 months). During the follow up, 12 patients had improvement on IVU. CONCLUSION: Early recognition of signs and symptoms of RPF is of the utmost importance for the outcome. Surgical procedures including ureteral wrapping with omental flap, or intraperi toneal ureteral displacement, usually represent definitive treatment.

Bilateral triple renal pelvis: a case report.

INTRODUCTION: Triple renal pelvis is an extremely rare variation of the renal collecting system. To the authors' knowledge, bilateral triple renal pelvis has not yet been described in the literature. CASE REPORT: A 55-year-old man was hospitalized due to papillary bladder cancer, detected on ultrasonography. As incidental finding, intravenous urography revealed bilateral triple renal pelvis. Six weeks after transurethral resection of the bladder tumor (TURB) the patient was admitted again, for the second TURB. Computed to mography-urography confirmed the presence of bilateral triple renal pelvis. CONCLUSION: The unique case of bilateral triple renal pelvis was presented as an extremely rare variation of the renal collecting system.

Evaluation of free-to-total prostate specific antigen (F/T PSA), prostate specific antigen density (PSAD) and (F/T)/PSAD sensitivity on reduction of unnecessary prostate biopsies for patients with PSA in gray zone.

AIM: We evaluated the influence of ratio between free-to-total prostate specific antigen (F/T PSA) and prostate specific antigen density (PSAD)-(F/T)/PSAD on reduction of unnecessary prostate biopsies in grey zone (prostate specific antigen (psa) value 4.0-10.0 ng/ml). METHODS: The study included 108 patients. For all patients serum total PSA (T PSA), free PSA (F PSA), F/T PSA and PSAD were analyzed. The group was divided due to the prostate volume into: entire group (regardless the prostate VOL-Group 1) and group with prostate VOL<40 (Group 2). RESULTS: Seventy five patients were diagnosed with benign prostatic hyperplasia (BPH) and 33 with prostate cancer (CaP). F/T PSA and (F/T)/PSAD showed significantly lower values in patients with CaP versus those with BPH, while PSAD had significantly higher values. For the cutoff values of 1.12 for (F/T)/PSAD, we found sensitivity to be 67% and specificity 60%, and the (AUC) 0.701. For patients with VOL<40, statistical significance remained with AUC of 0.732 (p=0.003), cutoff was 0.82, and with sensitivity 77% and specificity 68%. CONCLUSIONS: Most significant prostate carcinoma predictors were PSAD and (F/T)/PSAD, where we proposed that patients with (F/T)/PSAD values below 1.49 ± 0.94 and PSAD values above 0.17±0.06 should be included for biopsy.

Diode laser vaporization of prostate as treatment for benign prostatic enlargement: initial results of 73 patients with 1 year follow-up.

OBJECTIVE: Our objective is to evaluate the efficacy, safety and 12 month outcome of a 980 nm diode laser with Twister fiber in the treatment of benign prostatic enlargement. MATERIALS AND METHODS: Between February 2011 and January 2013, 73 patients with benign pros- tatic enlargement had undergone diode laser vaporization of prostate at our institution. The fol- lowing parameters were assessed at baseline, and after a follow-up period of 3 and 12 months: International Prostate Symptom Score, peak urinary flow rate, post-void residual urine volume, and quality of life score. RESULTS: The procedure was completed successfully in all patients with no intraoperative complications. At 12 months postoperatively the percentage improvements in IPSS was -69.09%, Qmax +197%, PVR -88.54%, and QoL -68.29%. CONCLUSION: Diode laser vaporization of prostate is safe and effective method for treatment of benign prostatic enlargement.

New and experimental techniques in the treatment of benign prostatic diseases.

BACKGROUND: Benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) are disorders with high prevalence and have a great impact on overall morbidity in men. The patients that do not respond to medical therapy for lower urinary tract symptoms (LUTS) related to BPH are candidates for surgery. However, the number of men with BPH/LUTS seeking for non-surgical, or for less invasive treatment is growing. AIM: To present the basic information about minimally invasive treatment modalities for BPH and CP: intraprostatic injections, urethral lift procedures, modifications of transurethral microwave thermotherapy (TUMT), prostatic artery embolization etc. CONCLUSION: The majority of these techniques is still in experimental phase and not widely accepted. However, it is very likely that new, safe and minimally invasive techniques will appear in the near future.

Genitourinary injuries associated with pelvic fractures.

INTRODUCTION: Pelvic fractures represent approximately 3% of all skeletal injuries. About 15% of patients with pelvic fractures have associated bladder or urethral injuries. The most common causes of pelvic fracture are motor vehicle accidents, motorcycle crashes, motor vehicles striking pedestrians, and falls. MATERIAL AND METHODS: Retrospective study included the patients treated in the Emergency Center, Clinical Center of Serbia, Belgrade, between 2000 and 2009. Of 7445 patients, there were 894 injuries of the urinary tract and 376 pelvic fractures; 55 patients with pelvic fractures (14.6%) had bladder or urethral injuries. There were 31 patients with bladder injuries, 22 patients with urethral injuries, and two patients with associated injuries of the posterior urethra and the bladder neck. RESULTS: The bladder injuries were treated by surgical exploration, cystostomy, suture of the bladder lesions and urethral catheterization. Urethral injuries were treated by primary cystostomy and urethral reconstruction and catheterization in 18 patients (82%), while cystofix-cystostomy was performed in four patients (18%). DISCUSSION: Genitourinary injuries increase overall mortality in patients with pelvic fracture, compared with traumas without associated GU injuries. These patients require multidisciplinary approach, preferably in tertiary institutions.