[Stricture recanalisation of the distal urether with various endoprothesis].

INTRODUCTION: Application of the metallic stents in the interventional uroradioligy is the result of continous development of the new generation methods percutaneous nephrostomy (PCN), ballon catheter dilatation (BCD), methal and covered stent application. Application of metal stents in the renal canal system was attempted in order to eliminate BCD and PCN--related limitations as well as poor therapeutic results of these methods in a number of etiopathogenic groups of urinary stasis. Years--long application of interventional uroradiology methods, until the development of metallic stengts had shown the following therapeutics facts: PCN is incapable to resolve the caus of urinary obstruction. Permanent good therapeutic BCD results mostly depend on pathohistological aspect of the stricture, metallic stents are most frequently the last choice in therapeutics approch to urinary tract obstructions and their application is directly dependent on previous therapeutics results accomplished by PCN and BCD. In therapeutical sequences new generation of covered stents have important place as method of selection in patients of irreversibile uroopstruction of distal ureter. OBJECTIVE: The main goal of this study was to analize therapeutics results, advanteges and shortages of insercion plastics and opened metallic endoprothesis, and to analize results of covered methal applications on the contrary of using older interventional uroradiology methods. METHOD: Sixthytwo patients with distal urether strictures threated in the Deparment of interventional uroradiology Institute od Radiology Clinical centre of Serbia in Belgrade, participated in the study. Results were analized with Person's 2-test, Fisher test and Student T-test. RESULTS: In our study we had highly significant differences in comparison with number of patients and type of stents during the time after recanalization was reached. Also it was highly significant differences acorrding the type od used interventional uroradiology method that treated proliferation and the success of recanalization. CONCLUSION: Application of covered temporary uretheral stents have number advanteges against using generation older permanent methal endoprothesis.

[Imaging capabilities in upper urothelial malignancies differentiation].

UNLABELLED: Aim of our study is to analyze sensitivity and specificity of imaging procedures in characterization upper urothelial malignancies, according to algorithm suggested by American Urology Association. MATERIAL AND METHODS: We analyzed 242 patients with kidney tumor masses who had been operated during 2006/2007 at Urological clinic in Belgrade. Due to pathohistological exam 210 patients had kidney parenchyma and 32 patients upper urothelial kidney tumor. RESULTS: According to tumor stage, computed tomography was sufficient and definitive diagnostic tool concerning both renal epithelial and upper urothelial malignancy. Only in four cases 1.60% (4/242; CT in 3/4, MRI 1/4) preoperative site of origin was different from histopathology findings. This mislead to inappropriate surgery plan. CONCLUSION: Familiarity with limitations and capabilities of imaging modalities is crucial for appropriate diagnosis. It should respect algorithm but has to be individual adapted.

Local recurrence of bladder cancer after cystectomy with orthotopic bladder substitution and ileal conduit.

OBJECTIVE: To present the local recurrence rates after radical cystectomy for advanced bladder cancer and to compare them between patients with orthotopic neobladder and ileal conduit. PATIENTS AND METHODS: 97 patients with radical cystectomy were analyzed: 75 patients with orthotopic ileal neobladder, operated from 1985. to 2006, and 22 patients with ileal conduit, operated from 2000. to 2006. RESULTS: Overall recurrence rate was 41.3% in the neobladder group, and 50% in the ileal conduit group. The rate of pelvic, upper urinary tract and urethral recurrence was 13.3%, 8%, and 10.6% in the neobladder group, and 9.1%, 13.6% and 9.1% in the ileal conduit group. CONCLUSION: Comparable recurrence rates, operative time, the complexity of the surgical technique and the results between two groups, strongly support the construction of orthotopic neobladder, as superior in functional, esthetic, and psychological point of view.

Interventional radiology methods of treating ureteral strictures developed on anastomoses after the radical cystectomy in Mainz pouch II and ileal conduit derivation.

UNLABELLED: OBJECTIVE of this work is to evaluate interventional radiology modalities such as balloon catheter dilation (BCD) and stent insertion, as minimally invasive methods in treatment uretero-enteral anastomotic strictures. MATERIAL AND METHOD: Retrospective study enrolled 26 patients (pts) in whom percutaneous BCD (17 pts) and metal stent implantation (9 pts) were done. Study was conducted from June 2005 till August 2007 and included total amount of 470 pts operated during 4 year period from 2003 till 2007. In 26 pts 35 ureteral units were treated, all of them in ambulatory conditions under oral analgosedation, monitored by fluoroscopy. Percutaneous BCD or stent implantation was performed in 24 pts and in 2 pts combined antegrade-retrograde approach for stent delivery, was applied. In all cases percutaneous nephrostomy (PCN) was left for 7 days period after procedure but in 6 units (5 pts) it remained permanent solution. First check up was done 7 days after by contrast media injection through nephrostomy tube prior to its extraction. Second control was done 30 days after by ultrasound exam and the last control (3 months after) by intravenous urography (IVU). RESULTS: In our specimen 17pts had strictures unilaterally (65.4%) and in 9 pts (34.6%) it occurred bilaterally. First check up revealed 82.7% success of BCD, in 17.3% BCD was repeated with the final success rate of 73.5% (19/26). In four pts (26.5%) after BCD reobliteration happened and PCN was left. Patent ureteral lumen was observed in 6 pts (85.7%) with stent inserted while one pt underwent surgical reintervention. No significant difference between BCD and stent insertion success rate was noticed, based upon morphological parameters (ureteral lumen diameter, pelvicaliceal system dilatation) and serum creatinin level. CONCLUSION: BCD and stent insertion showed satisfactory results (following 3 months) in ureteroenteral anastomotic stricture recanalization. They include ambulatory conditions, ability to repeat procedure, without complications -excluding restenosis which finally can be surgically treated.

Stage T2 prostate cancer presented with high serum prostate specific antigen and nonspecific bone lesions.

OBJECTIVE: To present the case of T2 prostate cancer (PCa) mimicking disseminated PCa that was successfully treated with radical retropubic prostatectomy (RRP). PATIENT AND THE METHOD: The patient had prostate specific antigen (PSA) level higher than 30 ng/ml and multiple atypical lesions on bone scan. TRUS-guided biopsy proved small PCa, only in 1/18 biopsy cores, with Gleason grade 6 (3+3). Bone lesions appeared to be posttraumatic. RESULT: The patient underwent RRP; six months after surgery there is no evidence of the disease. CONCLUSION: Serum PSA level is the sum of cancer activity, normal and BHP tissue production, as well as the result of other pathological conditions, like prostatitis. In some cases, inflammation can be responsible for high PSA level and over-staging.

Border line cases and diagnostic doubts in definition kidney parenchymal and collecting tract neoplasia.

Aim of this work is to present cases of renal neoplasms where all available diagnostic modalities and control exams were applied, still explorative surgery was needed. Asymptomatic tissue mass with diagnostic findings of hypovascular renal cell carcinoma and renal pelvic carcinoma were inconclusive. While percutaneous CT guided biopsy is advisable in such cases, it was not performed due to central, hilar localization of the lesions and its small dimensions. In rare cases, such ours are diagnosis is achieved by surgery-histology examination.