[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.

[Multiorgan tuberculosis]. / Multiorganska tuberkuloza.

Tuberculosis is an unusual infectious disease because of the latent period between the infection and the appearance of the disease may be prolonged for many weeks, months, or years as it is in case of the secondary tuberculosis. Tuberculosis in organs other than the lung has been observed for many years but has not always been recognized as tuberculosis, and it has been given many names. Extrapulmonary tuberculosis gained new importance, because it represented a progressively greater proportion of new cases. Multiple extrapulmonary sites were reported rarely except for one anatomical site, which was reported frequently. Extrapulmonary rates increase with age, so there are marked differences in age in specific rate patterns among the sites. Extrapulmonary tuberculosis occurred in respiratory organs other than lung, such as lymphatic, urogenital, and central nervous system, abdominal, osteoarticular, as well as tuberculosis of other organs such as skin, pericardium and endocrine glands. This case was reported to analyse clinical, morphologic and laboratory characteristics, method of diagnosis and the outcome in patients with multiorgan tuberculosis in order to explore the factors which might contribute to the decision making, concerning these forms of tuberculosis. Recent knowledge of pathogenesis was summarized as well as clinical presentation and the effects of cytokines produced by T lymphocytes and cellular population on antimycobacterial immune defences, and also susceptibility to tuberculosis. Mortality remains high and the treatment should start as soon as tuberculosis is suspected.