Gentamicin concentrations in urine, cortex and medulla in an acutely obstructed kidney animal model.

Gentamicin was administered intraperitoneally, three times in 12 h to Hartley type guinea-pigs which had undergone complete unilateral ureteral obstruction with normal contralateral ureteral function for either 24 hours, 7 days or 21 days. Two hours after the last drug dose urine samples were collected from urinary bladder and obstructed ureter. Healthy and obstructed kidneys were then surgically removed from all sacrificed animals. Gentamicin concentration in urine of healthy kidney was 112-266 microg/ml, and in obstructed kidney 18-53 microg/ml, with a tendency of linear decrease over a 3-week obstruction period. The gentamicin concentration in obstructed renal cortex never exceeded one-third of the gentamicin concentration in unobstructed renal cortex. The maximum gentamicin concentration in obstructed renal medulla was 75% of the gentamicin concentration in unobstructed renal medulla.

[Antimicrobial therapy of urinary tract infections]. / Antimikrobno lijecenje infekcija mokracnog sustava.

Urinary tract infections (UTIs), according to localization of infection, can be subdivided into urethritis, cystitis, prostatitis and pyelonephritis, according to type of infection into symptomatic, asymptomatic, acute (first or single), recurrent, chronic, complicated and uncomplicated. Clinical symptoms of cystitis and leukocyturia are sufficient reason for early initiation of a three-day empirical antimicrobial therapy of acute uncomplicated cystitis in young women. Urine culture should be performed prior to the initiation of antimicrobial therapy in pregnant women, diabetics, recurrent UTIs, in case of unsuccessful prior treatment and in patients with pyelonephritis. All symptomatic UTIs should be treated, as well as asymptomatic bacteriuria in pregnant women, diabetics, preschool children and prior to urologic-gynecologic surgery. In complicated UTIs it is especially important to determine and try to eliminate or at least put under control the factors that complicate UTIs. Antimicrobial therapy of UTIs includes fluoroquinolones, co-trimoxazole, betalactam antibiotics, aminoglycosides and nitrofurantoin, tetracyclines, macrolides, and azalydes in case of sexually transmitted diseases caused by Chlamydia trachomatis and Ureaplasma urealyticum. Cystitis is treated for 1, 3 or 7 days, asymptomatic bacteriuria 3-7 days, uncomplicated pyelonephritis 10-14 days, bacterial prostatitis 4-8 weeks, and chronic nonbacterial prostatitis 2-4 weeks. Recommended therapy for chronic and complicated UTIs is 7-14 days only in relapses and reinfections, and in some patients it can last for several weeks, up to 6 months. Chemoprophylaxis in recurrent uncomplicated UTIs should be employed for at least 6 months.

Pheochromocytoma with negative urinalysis in pregnancy.

We present a rare case of adrenal pheochromocytoma in pregnancy, with serial 24-h urine specimen collections showing normal concentrations of catecholamine metabolites. The diagnosis was based on clinical presentation, abdominal ultrasound, and magnetic resonance imaging, and was confirmed on post-operative pathohistological examination. Clinical suspicion of pheochromocytoma in pregnancy should be sufficient to implement adequate therapeutic measures, regardless of urine catecholamine concentrations.

Clinical, histopathological and flow-cytometric properties of incidental renal cell carcinomas.

Medical records of 63 patients operated on for renal cell carcinoma (RCC) between 1986 and 1996 in the Karlovac General Hospital were studied retrospectively. In 23 (36.5%) patients, the tumor was incidentally detected. The median patient age was 62 in the incidental group and 64 years in the symptomatic group (P > 0.05). Ultrasonography was the leading technique for incidental detection of RCC. The median tumor diameter was 6 cm in the incidental group and 9 cm in the symptomatic group (P < 0.001). Incidental carcinomas had a lower stage (P = 0.022) and a lower nuclear grade (P < 0.001) than the symptomatic ones. The incidental cases were associated with a more favorable ploidy status (P = 0.027) and a lower proliferative activity (P = 0.005). The 5-year survival rate was significantly higher in incidental (81.4%) than in symptomatic cases (44.3%) (P = 0.020). Univariate analysis showed that tumor stage, ploidy status, and proliferative activity were good prognostic parameters, while patient age, tumor size, and nuclear grade were not. Tumor stage was the only independent prognostic parameter in multivariate analysis. In conclusion, the incidentally detected RCC show more favorable clinical, histopathological, and flow-cytometric characteristics and their prognosis is significantly better than in symptomatic cases.

Biochemical parameters of bone turnover in kidney transplant recipients.

Impairment of bone remodelling due to chronic renal failure persists even after successful kidney transplantation. Bone turnover was assessed in 22 kidney transplant recipients by measurement of serum bone markers: total (tALP) and bone alkaline phosphatase (bALP), osteocalcin (OC), procollagen I C-terminal propeptide (PICP), collagen I C-terminal telopeptide (ICTP), and iPTH. The patients were on dialysis 56.6 +/- 43.1 months before transplantation (mean +/- SD) and 34.2 +/- 23.0 months had elapsed after transplantation. The bone markers were within the reference range in 23% of patients for iPTH, 73% for tALP and 82% for bALP, 41% for OC, 73% for PICP and 50% for ICTP. A positive correlation was found between dialysis duration and ICTP, and iPTH and bone formation markers (OC, bALP). The obtained results indicate that bone turnover was increased after kidney transplantation, with prevailing bone resorption, which seems to be influenced by dialysis duration.

Urogenital war injuries.

Out of 1,350 war casualties treated at the University Hospital Rebro during the defensive war in Croatia, 60 (4.4%) injuries of the urogenital tract were present. Among these 60 casualties, 51 (85.0%) had multiple injuries, most often abdominal and urogenital. These patients were accordingly treated by combined urological and surgical teams. Regarding injuries, there were 21 kidney injuries, 11 ureter (2 patients had bilateral injuries), 7 urinary bladder, 2 urethral, 15 testicular, and 6 penile injuries subjected to surgical treatment. Nephrectomy was performed in 6/21 patients with kidney injuries. Orchiectomy was performed in 40% of patients with testicular injuries. In the remaining patients with urological tract injuries, surgical reconstruction with organ conservation was performed.

Human papillomaviruses are not associated with renal carcinoma.

In an attempt to better understand the troubling issue of renal human papillomavirus (HPV) infection, fresh tumour specimens obtained by surgical extirpation from tumours were compared for the presence of HPV. All of the renal carcinoma samples were examined by PCR using two sets of consensus primers and the specific primer pairs for HPV 16, 18, and 33. None of the 28 carcinomas and 17 corresponding normal tissues were found positive for HPV DNA in any of the applied analyses. Our results suggest that HPV does not play any role in the development of renal carcinoma in the general population.

Urolithiasis in childhood: surgery and lithotripsy.

From 1982 through 1993, 174 interventions in 160 infants and children with urolithiasis were performed at our department. There were 101 boys and 59 girls, mean age 8.9 years. The main causes of the interventions were congenital malformations in 62, followed by recurrent urinary tract infections in 29, previous operations in 17, and hypercalciuria in 35 patients. In 17 children, the cause of urolithiasis remained unknown. As a therapeutic option, extracorporeal shock-wave lithotripsy (ESWL) has become available since 1988. The malformations and postoperative conditions are surgically corrected, and the calculi removed in the same act. For post-infectious, idiopathic or hypercalciuric calculi, ESWL has been used in the majority of patients since 1988. Thus, a total of 129 calculi were removed by operation and 47 by ESWL, whereas 18 calculi were endoscopically extracted. There were no complications after either ESWL or open surgery. Calculi in congenital malformations or as a result of operation are still removed by open surgery. In other cases, ESWL is the method of choice.

Antibodies to Tamm-Horsfall protein in patients treated with extracorporeal shock wave lithotripsy (ESWL).

The aim of this study was to determine antibodies to Tamm-Horsfall protein in patients with nephrolithiasis treated with extracorporeal shock wave lithotripsy (ESWL). The values of antibodies to Tamm-Horsfall protein were determined by direct enzyme immunoassay. No statistically significant differences (P > 0.05) were observed for the IgG and IgM classes of antibodies between the groups of healthy subjects and patients with nephrolithiasis before, and 30 and 60 days after ESWL. The values of IgA class determined 30 days after treatment were significantly higher (P < 0.05) in patients, which could be due to the stimulation of the immune system. The highest values of antibodies to Tamm-Horsfall protein were obtained in both groups in the test with secondary antibodies directed toward IgM class, implicated at the presence of cross-reactive antibodies. Determination of antibodies to THP subunits isolated form urine of patients with nephrolithiasis should be performed.

Testicular trauma sustained during football.

Three patients having testicle injury received while playing football are reported. Two of them received a blow with a ball. Surgical findings revealed spermatic cord injury with scrotal haemorrhage in one patient, and intratesticular hematoma in another one. After hematoma evacuation and arrest of haemorrhage achieved by ligature, the testicle appeared normal. In the third case with testicle rupture after scrotal kick, early exploration finished with adequate debridement and approximation of the tunica albuginea laceration. Postoperative ultrasonography showed a homogeneous echo pattern of the remaining two-thirds of the parenchyma.

[Long-term follow-up of related kidney donors after nephrectomy]. / Visegodisnje pracenje srodnih davatelja nakon donorske nefrektomije.

From 1973 to July 1990, 183 kidney transplantations were performed at the Transplantation Unit of the Department of Urology--Faculty of Medicine--University of Zagreb. Out of these, 57 were from the living related donors. The research included 50 (88%) living related donors (28 mothers, 12 fathers, 5 brothers and 5 sisters) followed up from 1 to 15 years after donor nephrectomy. The donors' health conditions were evaluated by clinical-laboratory examinations (biochemical tests, renal function tests, urinoculture, ultrasound, isotopic renal studies, arterial blood pressure). In 48 (96%) neither morphological nor functional changes of the urinary system were found. A certain number of donors requested a transfer to less physically strenuous jobs. Except for the grafts functioning well in the recipients, the results also showed that the quality of donors' lives remained unchanged.

[Conservative surgical procedures in transitional cell carcinoma of the kidney and ureter]. / Konzervirajuci kirurski zahvati kod karcinoma prijelaznog epitela bubrega i uretera.

Conservative surgical procedure in selected patients with transitional cell carcinoma of upper urinary tract is alternative to radical surgery. Generally, a conservative surgical procedure is indicated in solitary low-stage lesions, particularly impaired renal function and bilaterality. At our Institute, conservative surgical procedure was performed in patients with solitary kidney and significant renal function damage. Survival after conservative and radical surgery was similar, extending the scope of indications for conservative surgical procedure in cases of low-grade low stage tumors.

[Injuries of the urogenital system]. / Ozljede urogenitalnog sustava.

War injuries of the urogenital system present serious injuries accompanied with significant morbidity and mortality as well as causing high degree of later disablement. The paper presents our experiences and basic directions in treating urogenital injuries especially those penetrating and inflicted by high velocity missiles. Thirteen patients with urogenital injuries have been operated on and that makes 4% of all war injuries treated at KBC-Rebro hospital. Among the total number of abdominal injuries those urological make a considerable share--as high as 21% and that could be the consequence of the triage. In all the patients except one, in whom either kidney, ureter or bladder has been injured there has also been an associated injury of another abdominal organ (mostly colon and small intestine, than liver and spleen). All the operating procedures have been performed together with the general surgery team. X-ray preoperative examinations have been carried out only in two patients while the general state of the rest of the patients has not allowed for such procedures which could delay surgery. Nephrectomy has been performed in only one out of these thirteen patients. Orchidectomy has been carried out in only one patient in whom extensive laceration of the testis has occurred, while in others preserving surgical treatment has been applied.

[Congenital ventral curvature of the penis]. / Kongenitalna ventralna kurvatura penisa.

We report two patients with congenital ventral penile curvature. Both patients were admitted to our Department at 18 years of age, because of deformation which was an obstacle to their normal sexual intercourse. Deformity was corrected with the Nesbit procedure using intraoperative artificial erection. During the surgical procedure no chordee or anomalies of the urethra or spongy tissue could be detected, thus changes were classified in a relatively rare group of deformities due to the inelasticity of tunica albuginea. We have also made some observations on the technique applied which could be helpful in practice.