Mixed Methodology of Scientific Research in Healthcare.

Background: Scientific research is usually classified as quantitative or qualitative. However, methodologists are increasingly emphasizing the integration of qualitative and quantitative data as the center of mixed methods (mix methodologies). Mixed research method implies the use of different research methods, ie. quantitative and qualitative methods in one study. Objective: The aim of this review paper is to present the purpose of using a mixed methodology in health research. Methods: The relevant articles were searched from online data sources including PubMed and Google Scholar. Results: This approach to the use of mixed methods creates opportunities for a deeper study of various problems. The purpose of using mixed research methods is to obtain valid answers to research questions, however the researcher may still have different reasons or purposes for which he wants to strengthen the research study and its conclusions by applying mixed methods. The use of mixed scientific methodology is widely used in the field of health outcomes and should not be limited to a closed list of possible methodological options. Conclusion: Recently, there has been an increase in the number of scientific studies in healthcare that use mixed research methods. The advantage of applying this scientific method is that through the triangulation of data obtained by different (quantitative / qualitative) approaches, we get a deeper and more complete picture of the phenomenon in health care that we observe.

Complications After Ileal Urinary Derivations.

INTRODUCTION: The aim of the study was to determine the most frequent early and late complications in different types of ileal urinary diversions. PATIENTS AND METHODS: The study was conducted in a five-year period, on 106 patients who were diagnosed with invasive urinary bladder cancer and who had indication for radical cystectomy with one of the investigated types of urine derivation. They were divided into 2 groups, based on the type of ileal urinary diversions. RESULTS: The colonization of bacteria was more prominently present in the ileal conduit urinary diversion group (97%) compared to Ghoneim (25%) and Hautmann (10%) group, Ureteral stenosis was slightly less represented in the conduit group (9.1%). Wound infections were significantly more represented in the conduit (21.2%) than in the Ghoneim group (5%) Nighttime incontinence was present in 20% of patients in both groups or 4 patients in each group. Daytime incontinence in the Ghoneim group was present in 3 patients (15%) and in the Hautmann group 2 patients (10%). Late complications correlate significantly negative with the type of surgery and slightly negative with the grade, and significantly positively with the examined group and T stage, and slightly correlate positively to the N and R stages. Early complications correlate slightly negative with the type of surgery, slightly negative with the grade, and significantly positively with T stage, and slightly positively correlates with the N and R stage. CONCLUSION: The most commonly reported complications in ileal conduit are: prolonged ileus, stoma infection, wound dehiscence and bacterial colonization, followed by peristomal skin complications and complications related only to the stoma, such as stenosis and stoma retraction, and prolaps of ileostoma and ileointestinal stenosis. The ileus rate in orthotopic derivation was significantly lower than that of the ileal conduit group, which led to the conclusion that the neomybladder position does not disturb the anatomic abdominal structure.

Actual Contribution of Free to Total PSA Ratio in Prostate Diseases Differentiation.

OBJECTIVES: To determine significance and sensitivity of the Free to Total prostate specific antigen (PSA) ratio (%fPSA) in diagnosis of prostate cancer and to correlate its sensitivity and specificity with diagnosis. METHODS: Research included 220 patients, who had indication for biopsy (Clinic for Urology, University Clinical Center Sarajevo). RESULTS: Average age of patients was 64.6 ± 8.1 years. Kruskal Wallis test indicates that there is a significant difference in age in relation to the diagnosis (KW χ2=12.508; p=0.006). The correlation between the %fPSA level and diagnosis is positive and statistically significant (r=0.211; p=0.002) in the sense that cancer patients have the lowest %fPSA. Analysis of the sensitivity at 95% specificity of %fPSA compared to particular diagnosis shows the highest sensitivity for prostate cancer - 20.61% (8.35-31.02) with statistically significant AUC p<0.05. Analysis of %fPSA test in detecting prostate cancer, at cut-off values ≤ 0.16, shows a sensitivity of 72.3% and specificity of 50.4 (at cut-off values <0.07, sensitivity is 8.4%, and specificity is 97.8%). CONCLUSION: PSA is organ specific but not cancer specific marker, whose total value, as well as the %fPSA serve as a basis, with a digitorectal exam, in the detection of prostate cancer. By increasing the cut-off values sensitivity of %fPSA increases and specificity decreases. %fPSA has a relative importance in the detection of prostate cancer, and should not be used as a guideline, without prior clinical examination.

Usefulness of Total PSA Value in Prostate Diseases Diagnosis.

INTRODUCTION: Analysis of total value of prostate specific antigen (PSAT), with the unavoidable digital rectal examination (DRE) is the basis of prostate cancer detection. AIM: The aim of this study was to determine the specificity and sensitivity of the total value of PSAT in the diagnosis of prostate cancer. The aim was also to determine the significance of PSAT in diagnosis of benign prostate hyperplasia, precancerous conditions and inflammatory and atrophic changes of the prostate. MATERIAL AND METHODS: Data were collected from the "Register of PH biopsy" of Clinic of Urology, CCU Sarajevo. RESULTS: Analysis of correlation between the diagnosis and the PSAT value shows statistically significant negative correlation (r =-0,186; p = 0.006) in the sense that the value of the PSAT is highest in cancer patients, and the lowest in patients with benign prostatic hyperplasia. PSAT increases with age (r = 0.152; p = 0.025). For prostate cancer optimal sensitivity and specificity for PSAT value occurs at cut off value of> 8.6 ng /mL. Values lower than 2 ng/mL and higher than 10 ng/mL are most specific, and PPV increases with increasing value of PSAT. PSAT at values of <2 ng/mL and > 10 ng/mL are at high levels of specificity, and value > 10 ng / mL is also of high sensitivity in the detection of prostate cancer, and in this moment these values represent the optimal mode for the subsequent treatment. CONCLUSION: PSAT has a relative significance in the detection of prostate cancer, and should not be used as a guideline without DRE.

Sickness Impact Profile (SIP) Score, a Good Alternative Instrument for Measuring Quality of Life in Patients with Ileal Urinary Diversions.

OBJECTIVE: To determine the effectiveness of the use of the SIP score and the quality of life impairment in patients with ileal conduit and orthotropic ileal derivations by Hautmann and AbolEnein/Ghoneim. METHODS: Prospectively evaluated 146 patients in different age groups. In 66 patients ileal conduit derivation was performed, in 20 patients orthotropic derivation using Hautman technique was recorded and in 20 of them AbolEnein/Ghoneim was used. Prior to examining patients with urinary diversions, 40 patients with minor urological symptoms not requiring any active treatment, were surveyed in order to validate SIP score. Six months after the operation, all patients with urinary diversions filled the SIP score questionnaire. RESULTS: Using Crombach's Alpha equation the high reliability of SIP questionnaire was proven. Average scale value was 0,93. Using descriptive statistics mean values of all categories and dimensions of the SIP questionnaire of examined patients were determined, calculated according to the questionnaire manual being converted to percentage. Total value of SIP score for the ileal conduit group was 34,76% and in orthotropic derivation 18,52% respectively. For Hautmann procedure total SIP score was 18,35% and for AbolEnein/Ghoneim 18,7%. In the control group total SIP score was 9%. The most influential dimensions on the total score of ileal conduit were physical and psycho-social, while independent dimension did not significantly influent total SIP score. CONCLUSION: Taking into consideration the lack of questionnaires on quality of life for urinary derivations, SIP score as a general disease influence to the quality of life questionnaire represents a reliable alternative for objectification and quantification of the quality of life upon urinary derivation. According to this instrument, orthotropic derivations provide significantly better quality of life compared to ileal conduit.

Impact of complications and bladder cancer stage on quality of life in patients with different types of urinary diversions.

GOAL: Determine correlation between complications and stage of the disease and their impact on quality of life in patients with different types of ileal urinary derivation after radical cystectomy, and upon estimation of acquired results, to suggest the most acceptable type of urinary diversion. PATIENTS AND METHODS: In five year period a prospective clinical study was performed on 106 patients, to whom a radical cystectomy was performed due to bladder cancer. Patients were divided into two groups, 66 patients with ileal conduit derivation and 40 patients with orthotopic derivation, whereby in each group a comparison between reflux and anti-reflux technique of orthotopic bladder was made. All patients from both groups filled the Sickness Impact Profile score six months after the operation. All patients had CT urography or Intravenous urography performed, as well as standard laboratory, vitamin B12 blood values, in order to evaluate early (ileus or subileus, wound dehiscence, bladder fistula, rupture of orthotopic bladder, urine extravazation) and late complications (VUR, urethral stricture, ureter stenosis, metabolic acidosis, mineral dis-balance, hypovitaminosis of vitamin B12, increased resorption of bone calcium, urinary infection, kidney damage, relapse of primary disease), so as disease stage and it's impact on quality of life. RESULTS: From gained results we observe that each category of SIP score correlates with different rate of correlation with the type of operation, group, T, N, and R grade, except work category. Average value of SIP score rises depending on the type of operation and T stage. It is notable that there is no difference in T1 stage, no matter the type of operation. So the average value of SIP score in T1 stage for conduit was 20.3, for Abol-Enein and Ghoneim 17.25 and Hautmann 18.75 respectively. Average value of SIP score in T2 stage for conduit was 31, for Abol-Enein and Ghoneim 19.1 and Hautmann 17.8. Average value of SIP score in T3 stage for conduit was 38.03, for Abol-Enein and Ghoneim 18.75 and Hautmann 19.5. SIP score for T4 was present only in patients with conduit performed and average value od SIP score was 40.42. There is a high level of correlation of late complications and psychosocial and physical dimension with their parameters, while for an independent dimension of correlation is not significant. Early complications have insignificant correlation in all categories of SIP score. CONCLUSION: Upon analyzing quality of life and morbidity, significant advantage is given to orthotopic derivations, especially Hautmann derivation with Chimney modification, unless there are no absolute contraindications for performing this type of operation. Factors which mostly influence quality of life are cancer stage, type of derivation, late complications and patient age. SIP score, as a well validated questionnaire, are applicable in this kind of research.

Which is a better indicator of bladder outlet obstruction in patients with benign prostatic enlargement--intravesical protrusion of prostate or bladder wall thickness?

OBJECTIVE: To determine the correlation of intravesical prostatic protrusion (IPP) and bladder wall thickness (BWT) with clinical and urodynamic parameters, as well as their sensitivity and specificity with regard to bladder outlet obstruction in patients with a benign prostatic enlargement (BPE). MATERIALS AND METHODS: 111 patients with lower urinary tract symptoms and confirmed BPE completed the International Prostatic Symptom Score (I-PSS), as well as a transabdominal ultrasound to determine their prostate volume, a grade of IPP and BWT. All the patients were then subjected to the complete urodynamic studies (UDS). RESULTS: The IPP showed a good correlation with the prostate volume (r = 0.61) and serum PSA (r = 0.48); p = 0.0000, free uroflowmetry (r = -0.27; p = 0.004), as well as the determinants of urodynamic obstruction: bladder outlet obstruction index-BOOI (r = 0.36; p < 0.0001), and ICS and Schaefer obstruction class nomograms (rho = 0.33 and rho = 0.39, respectively; p < 0.001), while the BWT showed only a statistical correlation with age (r = 0.23; p = 0.02) and serum PSA (r = 0.4; p = 0.0000), regardless of an significant correlation with the IPP (r = 0.45; p = 0.0000). The ANOVA test showed a significant difference between the IPP grades for the observed clinical and urodynamic variables with an increase in significance for IPP>10 mm. The area under the ROC curve in the prediction of obstruction for the IPP is 0.71 (sensitivity 59.6, specificity 81.4), while the AUC for the BWT is 0.61 (sensitivity 64.5, specificity 59.2). The stepwise logistic regression model shows that most significant independent variables for the obstruction are the IPP, Q(max) free and age, with the area under the ROC curve of 0.78 (95% CI 0.695 to 0.856). CONCLUSION: The IPP higher than 10 mm as a non-invasive predictor of infravesical obstruction shows good correlations with clinical and urodynamic parameters, while the specificity and PPV against obstruction are significant. Despite a good correlation with IPP, the BWT is only a modest indicator of obstruction.

Bladder outlet obstruction number: a good indicator of infravesical obstruction in patients with benign prostatic enlargement?

The objective of our study was to evaluate bladder outlet obstruction number (BOON) in order to predict infravesical obstruction in patients with benign prostatic enlargement (BPE). Two hundred patients with proven BPE from daily urological practice at the Urology Department of the Sarajevo University Clinical Centre were covered by a prospective study in period 2009-2011. All patients completed International Prostatic Symptom Score, their mean voided volume urine was determined from frequency-volume chart and their prostate volume was determined by transabdominal ultrasound. Subsequently, the patients had free uroflowmetry and they underwent complete urodynamic studies. BOON was calculated using the formula: prostate volume (cc)-3 x Qmax (ml/s)-0.2 x mean voided volume (ml). A satisfactory area under the curve (AUC) was obtained for the prediction of obstruction according to bladder outlet obstruction index, Schaefer obstruction class nomogram and group specific urethral resistance factor , with AUC of 0.83 (p<0.001). Following the comparison of different cut-off values of BOON according to the obstruction, the BOON >-20 has been found to be the most accurate obstruction indicator (sensitivity 76.5% and specificity 68.2%), with posttest probability of 77%. The BOON may be used in daily urological practice as a valid, non-invasive indicator of infravesical obstruction in patients with BPE, with a possibility of correct classification of obstruction in approximately 75% of the cases. Transabdominal ultrasound has shown to be applicable to the BOON formula in determining prostate volume.

The significance of the influence of aging and infravesical obstruction caused by benign prostatic enlargement on detrusor impairment.

OBJECTIVE: to analyze the influence of aging and infravesical obstruction on cystometric characteristics of patients with lower urinary tract symptoms (LUTS) and proven benign prostatic enlargement (BPE). METHODOLOGY: A retrospective analysis was performed of basic characteristics of randomly chosen 213 patients with LUTS caused by BPE and urodynamic findings made in period 2005-2009 at the Urology Department of the Sarajevo University Clinical Center. The patients were divided into groups based on their age (<60 years/46 patients, 60-69 years/95 pat., and >70 years/72 pat.), and the degree of bladder compliance loss (<20 ml/cmH2O-76 patients, 20-40 ml/cmH2O-57 pat., and >40 ml/cmH2O-80 pat.). All patients had International Prostate Symptom Score (IPS-S) completed, prostate volume measured transabdominally, free uroflowmetry, as well as complete urodynamic study (UDS) findings--cystometry and pressure/flow studies (PFS). The PFS data were plotted on L-PURR, URA and ICS nomogram, bladder contractility index (BCI) and obstruction coefficient (OCO) were calculated for each patient. RESULTS: There was no statistically significant difference of IPS-S, prostate volume and postvoid residual urine among the age groups. Qmax (ml/sec.) declines significantly with age (mean 11.9 vs. 10.3 vs. 7.9, ANOVA p < 0.001), along with statistically significant decrease of cystometric capacity (mean 331 ml vs. 293 mi vs. 264 ml, p = 0.001), bladder compliance (BC-ml/cmH2O) (mean 35.3 vs. 31 vs. 26.5, p = 0.013), with increased incidence of detrusor overactivity (DO) (21.7% vs. 32.6% vs. 45.8%, chi2 test for trend p = 0.006), followed by a higher incidence of obstruction (URA > or = 29 cmH2O) (37% patients vs. 61% patients vs. 72.2% patients Chi2 for trend=13.8; p = 0.0002), along with noticeable reduction of BCI (117 vs. 121 vs. 106; p = 0.02). Patients with severe BC damage (<20 ml/cmH2O) showed a difference with respect to the degree of obstruction and age, along with decreased cystometric capacity and higher incidence of DO, while the difference in IPP-S was insignificant. OCO with cut-off point of 1 showed significant difference with regard to age (66.3 vs. 66.6 years, T test, p = 0.015), prostate volume (45 cc vs. 51.8 cc, p = 0.007) and incidence of DO (26% vs. 43.4%, p = 0.02). CONCLUSION: the degree of bladder compliance loss and incidence of obstruction increase with age, as reflected in decreased bladder capacity, decreased urine voided volume and increased incidence of DO, along with noticeably impaired detrusor contractility.

Influence of the prostate volume, prostate specific antigen density and number of biopsy samples on prostate cancer detection.

AIM: Establish the main differences in the prostate volume, prostate specific antigen density (PSAD), number of biopsy samples in patients with primarily or rebiopsy detected prostate cancer. MATERIALS AND METHODS: In the 2007-2009 period, at the KCUS Urology Clinic, there were 379 TRUS guided prostate biopsies in 323 patients with known prostate volume. The total of 56 patients (17.3%) underwent the first rebiopsy, primarily due to precancerous lesions. The mean prostate volume, ranges of prostate size, PSAT, PSAD and the number of biopsy samples were analysed retrospectively, and the main characteristics in patients with primarily and rebiopsy diagnosed Pca were evaluated as well. RESULTS: The first biopsy cancer detection rate was 29.6% (112/379). The rebiopsy detection rate was 30.3%. There was no statistically significant difference in the prostate volume and the number of biopsy samples among the total number of patients with prostate cancer against the group with benign (suspected) findings. There was a higher Pca detection rate in patients with the prostate volume < 40 cm3 and 40-60 cm3, against the group with the prostate volume > 60 cm3. PSAD was significantly higher in patients with PCa (0.24 vs. 0.18; p = 0.013). The total of 27.2% of the patients with negative biopsy findings and 48% of the patients with diagnosed Pca had PSAD > 0.15. PSAD showed sensitivity and specificity in prostate cancer detection of 50% and 75%, with PPV of 48%. Furthermore, the patients with PSAD >0.15 had a higher Gleason score versus the patients with PSAD < 0.15 (6.7 +/- 2.4 vs. 5.9 +/- 1.7; p < 0.003). A comparison of the main characteristics in patients with primarily and rebiopsy detected prostate cancer gave a statistically significant difference only in the number of biopsy samples (10.9 vs. 14.1, p <.0000). CONCLUSION: Patients with a smaller prostate volume, lower PSAD and a higher number of biopsy samples in rebiopsy have a higher chance of prostate cancer detection. PSAD carries a higher specificity in rebiopsy decision, and a higher PSAD is related to a higher Gleason score.

Does the combination of intravesical prostatic protrusion and bladder outlet obstruction number increase test accuracy according to benign prostatic obstruction at the individual level?

OBJECTIVE: Determine diagnostic power and intercorrelation between bladder outlet obstruction number (BOON) and intravesical prostatic protrusion (IPP ) as non-invasive predictors of infravesical obstruction in patients with lower urinary tract symptoms due to benign prostatic enlargement. MATERIAL AND METHODS: Prospective study during 2009-2010 analyzed data of 110 patients with proven benign prostatic enlargement. Prostate volume and IPP were determined by transabdominal ultrasound, and patients underwent complete urodynamic studies (UDS). BOON was calculated using the formula: prostate volume (cc)-3 x Qmax (ml/s)-0.2 x mean voided volume (ml). RESULTS: There is a statistically significant correlation between the values of IPP and BOON (Spearman's rank correlation coefficient rho=0.48, p=0.0001). BOON is a more sensitive (sensitivity 82.4%, specificity 66.1%), while IPP is a more specific factor (sensitivity 58.8%, specificity 81.4%) in the group-wise prediction of bladder outlet obstruction (BOO). Positive predictive value in the diagnosis of obstruction increases at the individual level combining the cut-off values for BOON>-30, with IPP >10 mm (PP V 86.8%). Owing to a good correlation of IPP with different definitions of urodynamic obstruction, IPP was included in the BOON formula instead of prostate volume. This number was arbitrarily called BOON2. The combination of IPP >10 mm and cut-off value for BOON2 >-50 showed that 88.6% of the patients were accurately classified in the zone of obstruction (mean IPP 14.9 mm), while BOON2<-50 carried a high NPV. CONCLUSION: The combination of cut-off values for BOON and IPP increases test accuracy according to BOO at the individual level, thus facilitating clinical decision making regarding diagnostics and optimal choice of therapy in patients with BPE. Owing to its good correlation with obstruction determinants, IPP can be included in the formula for BOON instead of prostate volume.

Extracapular extension predictors of prostate carcinoma for 2-10 ngr/ml PSA values.

UNLABELLED: Purpose of the research is to establish which clinical and biopsy parameters could predict extra-capsular spread of prostate carcinoma for 2-10 ng/ml PSA values, in patients submitted to radical retropubic prostatectomy. METHODOLOGY: In the period of 30 months, 80 patients were treated with radical retro-pubic prostatectomy with bilateral pelvic lymphadenectomy, for whom clinical, biopsy, radiological and biochemical analysis were positive to organ limited tumor. Serum PSA, fpsa/tpsa, PSAD,values are evaluated, and other parameters as number of positive biopsies, percentage of positive biopsies, localization of positive biopsies, and perineural invasion and biopsy Gleason score. RESULTS: from total number of 80 patients with 2-10 ng/ml PSA, 7 (9%) patients had extra-capsular spread of prostate carcinoma. Upon using multivariate regression analysis, following parameters were proved as significant predictors of extra-capsular spread: biopsy Gleason score, number of positive biopsy samples and invasion, while serum PSA, FPSA/TPSA ratio, PSAD, prostate age and volume have not shown as significant predictors for extra-capsular extension. CONCLUSION: Biopsy GS, perineural invasion and number of biopsy samples are statistically significant predictors of extra-capsular spread of prostate carcinoma for 2-10 ml PSA. Percentage of positive biopsies, tumor length in a sample and the localization of positive biopsies are on the borderline of statistical significance and as such should be taken into consideration.

Prostate cancer detection rate and the importance of premalignant lesion in rebiopsy.

OBJECTIVE: Establish the prostate cancer (PCa) detection rate and the premalignant lesion incidence, as well as their importance in cancer detection at the first rebiopsy. MATERIALS AND METHODS: In the period 2006-2008, at the CCUS Urology Clinic, there were 585 prostate biopsies performed in 515 patients. 12% of the patients underwent the first biopsy due to premalignant lesion findings. The main characteristics of the patients--age, prostate specific antigen (PSAt)-total and PSA ratio (PSAr), the number of needle biopsies, Gleason score and the role of premalignant lesions in diagnosis of PCa at the first rebiopsy were processed retrospectively. RESULTS: Primarily detected PCa amounted to 32.4% (167/515), while the rebiopsy showed the detection rate of 35.7% (25/70). No statistically significant age or PSAt and PSAr difference was observed, while there was, however, a difference in the number of biopsy samples, 11 (6-18) vs. 12 (8-20) and in the Gleason score (6.5 vs. 5.9) among the observed groups (p < 0.05). Atypical small acinar proliferation (ASAP) and high grade intra epithelial neoplasia (HGPIN), were found in 4.95% and 7.2% of the cases, while the ASAP + HGPIN combination was found in 1.5% of the cases. The PCa detection rate at the first rebiopsy in patients with ASAP, HGPIN and ASAP + HGPIN lesions was 50%, 23.6% and 50%, respectively. The ANOVA test showed a statistically significant shorter time period for rebiopsy in ASAP+HGPIN patients than that of patients with ASAP and HGPIN lesions. CONCLUSION: A repeated positive biopsy establishes PCa in patients with lower PSAt values and the Gleason score, which is followed by an increased number of biopsy samples. ASAP and ASAP + HGPIN lesions carry a higher specificity of75% and 91%, respectively, while the PPV in prostate cancer detection for HGPIN is low (24%).

Acute renal failure and ureteral leak after open surgery aortoiliac aneurysm repair.

We present a case of 52 year old male with an acute renal failure that took place 4 days after open transabdominal surgery repair of infrarenal abdominal aneurysm along with aneurysm of left common iliac artery and dilatation of left external iliac artery. Patient was subjected to 13 hemodialysis treatments that resulted in satisfactory recovery of renal function. One month after aneurysm repair he developed the right ureteral leak, consequently urinoma and acute renal failure once again. We suppose that ureteral leak was related to segmental ischemic necrosis of right ureter but not to traction or other iatrogenic ureteral injury. Percutaneous nephrostomy and insertion of ureteral stent was resulted in complete recovery of renal function.

Using verapamil as protective factor in renal ischemia reperfusion injury during anatrophic nephrolithotomy.

Anatrophic nephrolithotomy (ANL) in the selected cases represents the method of choice in the treatment of staghorn calculi. We evaluated postoperative outcome of patients subjected to standard ANL that received 10 mg of Verapamil immediately before declamping renal artery, due to prevention of reperfusion injury. From 2002 to 2005, 18 nephrolithotomies were performed on 15 patients, in the Urology Clinic, University of Sarajevo Clinics Centre. Preoperative evaluation included intravenous urography and radionuclide renal scans which had been repeated 6 months after the operations. 10 males and 5 females were operated with mean age of 45 years. Urography and renal scans showed severe calyceal distortion and infundibular stenosis in 83% cases, complicated with ureteropelvic junction obstruction in 55% cases. Chronic kidney failure was present in 60% patients. Mean operative time was 150 minutes, with mean cold ischemia time of 61 minutes and mean blood loss of 300ml. There were five minor postoperative complications. Residual small calculi were found in 3 patients. Kidney function was stabilized in the patients suffering from chronic kidney failure, which was proved by radio nuclide imaging. ANL improved by using calcium channel blockers as a protective factor for reperfusion injury proved to be a good treatment choice with a low level of complications and noticeable stabilization and improvement of kidneys function.

Management of chronic nonbacterial prostatitis/chronic pelvic pain syndrome.

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome is unsatisfactorily defined and insufficiently studied illness. Also, the treatment success is questionable and therefore, this illness is a therapeutical problem for urologists--which medications are the best choice in treating this uncomfortable condition? This paper presents results of prospective, open, analytical, comparative study that was performed on 90 patients with diagnosed chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Patients were divided into three groups and were treated with two medications ciprofloxacin (C), doxazosin (D) and combination of ciprofloxacin + doxazosin (C+D). The effects were measured using symptom questionnaire for prostate illnesses of the National Institute for Health - USA (NIH-CPSI). During the basic evaluation, sum ranging from 0 to 43 was calculated for each patient. This number is called total sum NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) of the questionnaire, which generates the questions from 1 to 9. The most significant change occurred in C+D group where the total sum changed from 18-38 in the beginning to 5-31 at the end of the treatment (55,1% (p<0,001)). Significant changes were also found in D group where the change was 46, 4% (p<0,001). At the end of the treatment no significant change was registered in C group (p<0,005): p<0,001--significance threshold. Combination of ciprofloxacin + doxazosin proved to be the best choice for treatment.

Surgical treatment and complications of penile fractures.

Paper goal is to determine complications after urgent surgical treatment of patient with penile fractures, by using circumferential-degloving technique (degloving penile skin to root of penis). In period between 1998-2006 year, 23 patients have been treated as urgent cases with clinically proven penis fracture, age between 18 and 35. Patients were treated in 3 medical centers in Bosnia and Herzegovina(Sarajevo, Tuzla and Zenica). All 23 (100%) patients were injured during sexual intercourse. In the case of 20 (86,9%) patients partial rupture of corpus cavernosum was verified. Two (8,6%) patients had a complete rupture of urethra and it was primary sutured. In 22 cases (95,6%) spontaneous erection appeared, and in the case of 2 (8,6%) patients penile curvature was verified. Urgent surgical treatment is the best therapy choice, which enables preservation of erection in great number of cases in patients with penile fracture.

[Primary retroperitoneal mucinous cystadenocarcinoma]. / Primarni retroperitonealni mucinozni cistadenokarcinom.

Primary retroperitoneal mucinous cystadenocarcinoma is very rare disease. It is very similar to cystadenocarcinoma ovary. Histogenesis of this tumour still remains unknown. In our case report tumour was noticed in left retroperitoneum during routine ultrasound check of stomach in female patient 43 years old. CT studies of kidney, retroperitoneum and pelvis, irigography studies and gynecological examination was done additionally.

[Comparative efficiency study, safety and usage of tested drugs in patients with renal colic]. / Komparativna studija efikasnosti, sigurnosti i upotrebe ispitivanih lijekova, kod pacijenata sa renalnom kolikom.

UNLABELLED: Renal colic represents the the collection of the acute symptoms which are characterized by very intensive and antagonizing pain, so, that withstanding, it calls for fast diagnosis and precise and speedy treatment. Intervention in renal colic cases has to be based on the knowledge on the origin of pain, renal damage suffered, and also has to protect the kidney from any damaged caused by the prolonged obstruction. MATERIAL AND METHODS: This paper presents the results from prospective, analitical, comparative, ITT (intention to treat) study that has been carried out 200 ambulatory treated seperate patients with renal colic, divided into four groups, in the time period from year 2003 to 2005. In all these cases the the efficiency and the active time time of standard medications used with renal colic symptoms. RESULTS: 2 grams of Metamizol i.v. and 75 mg of Diclofenac i.m. have shown equal efficiency in pain relief, which is 6 hours after the administration of therapy, while 50 mg of Butylscopolamin i.v. requires additional analgesic treatment (p < 0.05). The effect of Metamizol is a bit stronger 15 minutes after the application than the rest of the medications, but 30 minutes after the application the effects of Metamizol and Diclofenac are almost identical. Using meta analasys and EBM (Evidence Based Medicine) parameters in regard to the side effects, the made conclusion was that Diclofenac is the medication of choice for renal colic. Reserve medication is Metamizol, while Butylscopolamin causes negative side effects in 84% of the cases, and in 24% of the cases it causes cupping of the renal colic.

[Hemangiopericytoma malignum pelvis]. / Hemangiopericitoma malignum pelvis.

Haemangiopericytoma is an uncommon tumour of vascular origin. We report a case of one of the rarer sites of this tumour in man: pelvic paravesical site. We report case of 47 years old man with pelvic hemangiopericytoma and discuss imaging studies and pathohystological findings. Although modern imaging techniques have provided useful information concerning the hypervascular and clearly demarcated appearance of this tumour which displaces but does not invade adjacent organs, its diagnosis can only be established by histology. Its degree of malignancy and its invasive potential are unclear. The risk of local recurrence and metastases in more than one half of cases justifies wide surgical excision, possibly combined with adjuvant radiotherapy, and long-term follow-up. That is to say, that hemangiopericytoma malignum pelvis is the very rare sites of this tumour and till now it is not reported in Bosnia and Herzegovina.