The efficiency of urolithiasis treatment with extracorporeal lithotripsy in relation to the shock waves frequency.

OBJECTIVES: To compare the results of two frequencies of shock waves (1 SW/1 sec. and 1 SW/2 sec.) in the treatment of urolithiasis using the shock wave lithotripsy. BACKGROUND: SWL is the most frequent modality of the treatment of urolithiasis. The information on a better efficiency of applying shock waves of a lower frequency was proved both "in vitro" and "in vivo". After having corroborated the better efficiency of shock waves of lower frequency (1 SW per second) in extracorporeal lithotripsy, the authors compared it "in vitro" to still lower frequency (1 SW per 2 seconds). The still lower frequency did not result in any pronounced improvement of efficiency of extracorporeal lithotripsy. Now, the authors present the results of a study "in vivo". METHODS: The authors treated a set of 20 patients with urolithiasis of comparable size and location using the method of SWL and SW of identical intensity--20. The patients were divided into the two groups according to the frequency of the applied SW (A--1 SW/1 sec, B--1 SW/2 sec). RESULTS: In the group A, fragmentation was observed in 100% after on average 3550 SW. In the group B, fragmentation was observed in 90% after on average 3100 SW, leaving of concrements was observed in 70% after on average 3465 SW. CONCLUSION: The comparison of the results of two frequencies of shock waves (1 SW/1 sec and 1 SW/2 sec) in the treatment using SWL and the Piezolith 3000 device, did not prove any significant difference of effectiveness (Tab. 4, Ref. 16).

[Our experience in using fluorescence in situ hybridization FISH-Uro Vysion in diagnostics of urothelial carcinoma]. / Nase zkusenosti s metodou fluorescencní in situ hybridizace pri detekci uroteliálního karcinomu.

UNLABELLED: Urothelial carcinoma is a disease at high risk of recurrence after the initial therapy (70-80%) and with the tendency to progression accomplishing the recurrence (30%). Long lasting monitoring of patients with urothelial carcinoma is necessary. Cystoscopy and cytology are currently the primary modalities used to detect and monitor urothelial carcinoma. However, cytology has relatively poor sensitivity especially in well differentiated tumors. Cystoscopy is an invasive and relatively expensive method. Therefore, methods improving detection of urothelial carcinoma from urine specimens are employed. Uro Vysion (Vysis) fluorescence in situ hybridization (FISH) for improved detection of urothelial carcinoma was evaluated. MATERIALS AND METHODS: Bladder tumor progression is accompanied by increased chromosomal instability and aneuploidy of chromosomes 3, 7, 17 and loss of locus 9p21. A total of 124 patients were analyzed at Dpts. of Urology and Pathology, Faculty Hospital in Brno. Cytologically analyzed urine specimens were tested by FISH and simultaneously cystoscopy was employed including biopsy for histological examination. RESULTS: FISH analysis was positive in 35 cases, including 5 cases with negative biopsy and cytology. Negative FISH result was detected in 24 cases where the malignant status was determined. The sensitivity of FISH in our series was 58.9% and the specificity 88.1%. CONCLUSIONS: FISH is a relatively simple, speedy and non invasive diagnostic method. It detects the symptoms of malignity on the molecular level, which leads to earlier diagnosis and therapy and, hence, to potential extended survival. FISH makes it possible to take decision in cases of atypical or unclear cytological finding. The FISH method using the Uro Vysion kit appears as a prospective non invasive method capable of early UK detection, with a higher sensitivity than the standard cytology of urine.

[Controversial opinions in the prostate cancer treatment]. / Kontroverzní otázky karcinomu prostaty.

Attitude to prostate cancer topics has developed during last several decades explosively. Vast amount of information also brings flood of controversial opinions. Development in spiral upwards could only result from discussion based on evidence. We have not yet been able to achieve a primary prevention of the disease. Much information is promising and doubtlessly represents large potential. As the detection of cases in the early stage increases, the diagnosis of less aggressive or non aggressive forms, that need not to be radically treated, increases as well. We have a chance, though still limited, to differentiate forms of the disease more precisely than whenever before and the precise diagnostics should be included into the daily clinical practice. Surgical techniques have been developed and improved. It is necessary to adopt and use them because it can further improve already relatively good surgical results.

[Long-term experience with MESA, TESE techniques in the University Hospital (FN) in Brno]. / Dlhodobé skúsenosti s technikami MESA, TESE vo FN Brno.

Authors evaluated the experience of application MESA, TESE and ICSI techniques during 9 years long cooperation between Department of Urology University Hospital Brno and Institulions of reproductive Medicine University Hospital Brno. 104 surgical procedures were performed during this time period and as result 24 children were born.

[Long-term results of microsurgical varicocelectomy]. / Dlouhodobé výsledky mikrochirurgické varikokelektomie.

OBJECTIVE: Presentation of microsurgical varicocelectomy (MVE) treatment outcome in infertile males, in males with symptomatic varicocela and in males with hypotrophic testes. MATERIAL AND METHODOLOGY: From IV/98 to XII/05, a total of 350 patients with varcicocelas were operated in our clinic, using the MVE method. The authors assess the surgical method results in 131 patients. In 90.84% of the patients, the procedure was performed in order to manage infertility, in 7.63% for dyscomfort and in 1.53% due to findings of hypotrophic testes. 82.44% of the patients sufferred from a left-sided varicocela, 6.03% from a bilateral one and 1.53 % from a right-sided varicocela. RESULTS: Postoperative follow up of spermiograms (Spg), performed at three-month intervals, confirmed significant Spg improvements in 75.57% of the patients, in 13.74% of the cases no change was reported, and in 7.63% the Spg could not be assessed because the patients failed to turn up for a check up, and in 3.05% mild deterioration of the Spg was reported. CONCLUSION: Microsurgical varicocelectomy is a standard and highly effective treatment method of varicelas, which are indicated for management.

[Treatment alternatives of the locally advanced prostate cancer]. / Soucasné moznosti terapeutického ovlivnení lokálne pokrocilého karcinomu prostaty.

Author makes overview on locally advanced prostate cancer. In spite of the effort to make diagnosis in the earliest stage, disease is still pretty often diagnosed in locally advanced stage with significantly higher risk of progression and recurrence. He summarizes current view on available treatment alternatives (radical surgery, radiotherapy, hormonal treatment, chemotherapy) and their possible and proven combinations. Monotherapy is not considered as the optimal alternative, treatment of choices is the multimodal treatment strategy, though some combinations have been already confirmed as inappropriate.

[Recurrent prostatic carcinoma after curative radiotherapy and radical prostatectomy]. / Recidiva karcinomu prostaty po kurativní radioterapii a radikální prostatektomii.

INTRODUCTION: The authors evaluate indication criteria for individual therapeutic modalities of localized and locally advanced prostate cancer (CaP), but especially investigate progression of the disease in relation to CaP classification and other prognostic criteria. MATERIAL AND METHODS: The paper evaluates 120 patients altogether, treated by curative radiotherapy (RT) and 115 patients who underwent radical retropubic prostatectomy (RAPE). The patients were followed according to age, PSA value, Gleason score and life prognosis. The Partin nomograms were used to evaluate probability of localized disease, locally advanced disease, the involvement of seminal vesicles (gonecysts) and lymphatic nodes. The patients were also stratified according to T-classification, patients after RAPE also according to pT classification. RESULTS: RAPE: the mean period of observation was 37.9 month (6-114), 90 patients being without relapse (78.3%). A biochemical relapse occurred in 25 patients (21.7%). A local progression was confirmed by histology in 11 patients (44% of patients with progression, 9.6% of all patients after RAPE). RT: the mean period of observation was 26.75 months. A histological verification of the relapse was demonstrated in 14 patients (35.9% of patients with progression, 11.7% of all patients treated with RT). CONCLUSION: No progression was detected (under comparable period of observation) in patients with lower mean PSA values, a lower Gleason score and a higher probability of localized disease. In contrast, detection of a progression of the disease is significantly higher in patients with higher PSA values, a higher mean value of the Gleason score, higher probability of the locally advance disease or involvement of seminal vesicles. In order to reach good results in the therapy of prostate cancer for long periods of time, the disease must be detected in time and the stage of the disease should be determined exactly with a maximum precision possible. The prognosis in patients with worse "input" parameters is worse from the long-term point of view and these indices should be carefully controlled.

Severe complications following intravesical BCG instillation.

In patients with urinary bladder carcinoma, the intravesical BCG instillation is widely used. We present two cases of severe pulmonary afflictions developed during this treatment. The possible mechanisms of etiology are discussed and the classification of the intravesical BCG treatment side effects is suggested.

[Use of erythropoietin in radical prostatectomy]. / Pouzití erytropoetinu u radikální prostatektomie (RAPE).

All patients in the first group tolerated sampling of four transfusion units of autologous blood in the course of two weeks with subsequent erythropoietin administration very well. Erythropoietin was well tolerated, no local nor systemic undesirable side-effects or complications were observed. The mean transferrin and serum iron values remained during sampling of autotransfusions and erythropoietin administration within the range of normal values reported by our laboratory. The ferritin levels were above the norm. On the other hand in patients of the control group it was not possible--due to the decline of haemogram values--to sample in 45% the required amount of autologous blood before operation. For the same reason it was not possible to implement haemodilution as required. In similar blood losses administration of allogenic blood was necessary in 35% patients of the control group whereby in the group of patients with erythropoietin allogenic blood was administered in two cases (10%). Erythropoietin administration can effectively facilitate preoperative sampling of autotransfusion within a relatively short period. By its administration we can prevent a marked decline of red blood cells as a result of sampling of several preserves of autologous blood at a rapid rate. A satisfactory value of the haematocrit before the operation proper moreover makes it possible to collect a larger amount of blood in case of acute isovolaemic haemodilution. This enhances the patient's safety in relation to risks ensuing from administration of allogenic blood.

EAU guidelines on prostate cancer.

OBJECTIVES: To develop clinical guidelines for the management of patients with prostate cancer. METHODS: Guidelines were compiled by a working panel based on current literature following a literature review using MEDLINE. Already published structured analysis from national and international guidelines was used, and panel consensus was employed when literature evidence was absent or of poor quality. RESULTS: The full text of the guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article summarizes the main conclusions from the guidelines concerning the diagnosis and staging, treatment and follow-up of patients with prostate cancer. The diagnosis of prostate cancer should be based on histopathological or cytological examinations. N- and M-staging may be omitted in selected patients with a low serum prostate-specific antigen due to low risk of metastasis. Active treatment is warranted in most stages of prostate cancer but active monitoring is recommended for elderly patients with early stage tumours and is still optional in some other situations. Follow-up is based on a disease-specific history, serum-prostate-specific antigen supplemented by a digital rectal examination. Routine imaging is not necessary in asymptomatic patients. CONCLUSIONS: Prostate cancer is one of the most common malignancies in men. These guidelines have been drawn up to provide support in the management of this large group of patients.

[A case of high-flow priapism successfully treated with percutaneous selective embolization of the internal pudendal artery]. / Prípad vysokoprutokového priapismu úspesne vyreseného perkutánní selektivní embolizací a. pudendalis interna.

Relatively rare high-flow priapism is most frequently caused by contusion or direct injury of the cavernous artery with a subsequent uncontrolled inflow of arterial blood into the cavernous bodies. Knowledge of this pathophysiology and the development of intervention radiology made a more selective therapeutic approach possible. The authors present a report on a case of arterial or high-flow priapism which was successfully resolved by a minimally invasive approach--percutaneous superselective transcatheter embolization of the internal pudendal artery.

[Quality of life in incontinent men after implantation of an artificial urinary sphincter]. / Kvalita zivota u inkontinentních muzu po implantaci umelého sverace mocové trubice.

The authors implanted to a group of 10 patients incontinent after prostate surgery (on account of BPH and adenocarcinoma) an artificial AMS 800 sphincter. After a mean follow-up period of 29 months they evaluate based on a questionnaire the therapeutic effect and its influence on the patients quality of life as well as the adequacy of the approval procedure of indication on the part of the insurance company as it influences the quality of life. The effect of treatment and influence on quality of life is evaluated without exception very highly while the approval process is evaluated negatively. The authors draw attention to the risk of suicide in mentally otherwise sound subjects due to unsatisfactory solution of urinary incontinence. Correctly indicated treatment by an artificial sphincter can achieve very satisfactory results. The approval procedure must combine medical and rational aspects, it must be however revised, incl. the economic aspects of the system of health services.

Effectiveness of SWL for lower-pole caliceal nephrolithiasis: evaluation of 452 cases.

The authors report on the treatment of lower-pole caliceal nephrolithiasis with extracorporeal shockwave lithotripsy (SWL) using the Czech-made Medilit M-5 lithotripter. In 310 patients, they have performed 452 treatments and evaluated the results 3 months after the last session using plain radiographs and ultrasound examination. The effectiveness of treatment and the success rate of SWL decreased with increasing size of stones: with stones >20 mm, it declined to 30%. This poor success rate was attributable not only to the size of the concrement, but also to its location in a lower calix, which is unfavorable for the passage of fragments. For big lower-pole caliceal stones (>20 mm in the longest diameter), the authors recommend percutaneous nephrolithotomy as the primary management method, the effectiveness of which does not depend on the size of the stone. The success rate achieved in treating the lower-pole caliceal lithiasis using the Medilit M-5 machine was 61.3%, similar to that achieved with other lithotripters.

[Pitfalls in intravesical immunotherapy of superficial carcinoma of the gallbladder with BCG vaccine]. / Uskalí intravezikální imunoterapie povrchového karcinomu mocového mechýre BCG vakcínou.

The authors present their experience with the use of BCG immunotherapy in the treatment of superficial carcinoma of the urinary bladder in 30 patients as regards side-effects and tolerance of preparations. In the discussion they deal in particular with the classification and therapy of side-effects.

[Prenatal use of a vesico-amniotic shunt in obstructive uropathy]. / Prenatální aplikace vezikoamniálního shuntu pri obstrukcní uropatii.

Obstructive uropathy was diagnosed in a fetus in the 31st week of gestation. Good renal functioning and a low L/S index (lecithin/sphingomyelin) in amniotic fluid having been found, a vesocoamniotic shunt was inserted percutaneously. Draining through the shunt lasted for three weeks; then the gravidity was terminated due to stent dislocation while the lung maturity was good. After delivery, right kidney afunction, 4th-5th degree reflux and left-sided hydroureter were diagnosed. At the age of one year, nephrectomy on the right, left-sided hydroureter resection and plastic correction of the megaloureter on the right were performed. The child's condition is satisfactory.

[Intravesical immunotherapy with BCG vaccine in superficial carcinoma of the urinary bladder]. / Intravezikální imunoterapie povrchového karcinomu mocového mechýre BCG vakcínou.

The authors present their experience with the use of BCG immunotherapy in the treatment of superficial bladder cancer in 42 patients as regards antitumorous effectivity. They compare BCG immunotherapy with intravesical chemotherapy and evaluate exact diagnostics before indication BCG immunotherapy.

[Initial experience with the MESA and TESE techniques in the treatment of infertile men with azoospermia]. / První zkusenosti s technikami MESA a TESE pri lécbe infertilních muzu s azoospermií.

The authors evaluate their initial experience and results of the technique of microsurgical aspiration of epididymal sperm (MESA) and extraction of testicular sperm (TESE) combined with intracytoplasmic sperm injection into the oocyte (ICSI) in men with azoospermia. The above methods were used in 16 patients with repeatedly assessed azoospermia. Epididymal sperm was obtained in six instances, testicular sperm in 10 instances. With epididymal sperm after ICSI 50% fertilization was achieved after ICSI, with testicular sperm 51% fertilization of oocytes.

[Ureteroscopy--an alternative treatment in ureterolithiasis]. / Ureteroskopie--alternativa resení ureterolitiázy.

The authors evaluate the results of 315 ureteroscopies performed in 1991-1995 at the Urological Clinic in Brno Bohunice. 290 ureteroscopies were made on account of ureterolithiasis, diagnostic ureteroscopy was performed in 17 patients, in four instances extraction of a foreign body was involved and in four instances during ureteroscopy the stenosis of the ureter was severed. One-stage operations were successful in 226 patients (78%), in 42 patients (14%) after ureteroscopy ESWL had to be made. Ureteroscopy as a two-stage operation was performed in 12 patients (6%), five cases were resolved by open surgery because ureteroscopy failed. The authors evaluate early and late complications, none of which called for nephrectomy. The authors discuss the position of ureteroscopy in ureterolithiasis which is one of the most frequent indications.

[Effective treatment of nephrolithiasis of the lower calix using ESWL (evaluation of 452 procedures)]. / Efektivnost resení nefrolitiázy dolního kalichu metodou ESWL (zhodnocení 452 výkonu).

The authors present their results with the treatment of nephrolithiasis of the lower calix using the method of extracorporeal lithotripsy with the Czech apparatus Medilit M-5. In 310 patients they made 452 operations and checked the therapeutic results three months after the last session. For checking they used a native nephrogram and examination by ultrasound. With the increasing size of concrements the effectiveness declined and thus also the success of ESWL(in concrements above 20 mm in size it declined to 30%). This is not due only to the size of the concrement but also its site in the lower calix which is unfavourable for the elimination of fragments after ESWL. The authors recommend therefore in large concrements of the lower calix (more than 20 mm in the longitudinal axis) to select as the primary method percutaneous nephrolithotomy which is highly effective in this localization and is independent on the size of the concrement. The general success rate achieved in treatment of lithiasis of the lower renal calix with Medilit M-5 is 61.3% and is comparable with other lithotriptors.

[Implantation of inflatable penile prostheses as an effective alternative surgical treatment for erectile disorders]. / Implantace inflatabilní penilní protézy jako efektivní alternativa chirurgického resení poruch erekce.

The authors present an account of their own experience with results and complications of inflatable penile prostheses implanted in a group of 30 patients with organic erectile dysfunction. They discuss possible complications of this operation as well as the place of penile prostheses in the treatment of erectile dysfunction.