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Respecting the informed consent and its implementation is one of the fundamental components of high-quality health care. This article discusses the informed consent with an overview of Croatian and international legal documents and scientific studies dealing with this issue. Based on the review of the literature it can be concluded that this is an important issue that contains several key components that should be observed and investigated. It is necessary to evaluate the purposefulness and quality of the implementation of the informed consent, to systematically examine respect of the patients' right to information regarding the medical procedure during treatment, to explore decision-making model in the physician-patient encounter in Croatian hospitals, to determine the content and amount of information shared between physicians and patients, to determine the content and readability of consent forms and written patient information on the medical procedure. In order to assure higher quality of the implementation of the informed consent it is necessary to define by law a list of medical procedures that require written consent and to uniform consent forms for the same medical procedures country-wide.

Long-acting synthetic luteinising hormone-releasing hormone agonists have become the mainstay for androgen-deprivation therapy, because they avoid the physical and psychological discomfort associated with orchidectomy and lack the potential cardiotoxicity associated with estrogens such as diethylstilbestrol. Currently available luteinising hormone-releasing hormone agonist analogues include leuprolide, goserelin, triptorelin, degarelix and buserelin were administered as either intramuscular or subcutaneous depot injections on a 1, 2, 3 or 6 months basis. Histrelin acetate is the first long-acting luteinising hormone-releasing hormone agonist available as a once-yearly subcutaneous implant.

Studies were identified on internet by searching on address: http://www.ncbi.nlm.nih.gov/pubmed/ with criteria that studies should be placebo-controlled and randomized in trials of alpha-blockers in chronic category III prostatitis evaluated by symptom-score NIH-CPSI. From 13 clinical studies three were excluded because of not using NIH-CPSI, three were in Chinese language and two were congress abstracts. Analysed were five studies with four or five Jadad scale including 563 patients. Alpha-blockers alfuzosin, terazosin, tamsulosin and doxazosin have been used through 6 weeks and 6 months. Better results were accomplished by less selective alpha-blockers alfuzosin, terazosin and doxazosin through 3-6 months in patients having higher NIH-CPSI score and higher voiding score.

Catheterization remains the standard management of acute urinary retention (AUR), followed by a trial without catheter (TWOC) or prostatectomy in men who do not void spontaneously. If AUR is caused by increased sympathetic activity at the level of the prostatic smooth muscles, alpha-blockers (alpha-1 adrenoreceptor antagonists) should increase the likelihood of a successful trial without catheter (TWOC) following AUR. Alpha-blockers effectively reduce the symptoms associated with benign prostatic hyperplasia (BPH) and improve the urodynamic parameters of obstruction. They may diminish the incidence of AUR and the need for prostatectomy in symptomatic men. The adventage of tamsulosin and slow-release alfuzosin over doxazosin and terazosin in the management of AUR is that a therapeutic dose can be administered at the onset of AUR, thereby reducing the time for attempting catheter removal.

The aim of treatment for benign prostatic hyperplasia is relieving lower urinary tract symptoms, desreasing bladder outlet obstruction, improving bladder emptying, ameliorating detrusor instability, reversing renal insufficiency, and preventing future episodes of gross hematuria, urinary tract infection and urinary retention. A potent role of medical therapy is to prevent the development and/or progression of benign prostatic hyperplasia. Medical therapies investigated for benign prostatic hyperplasia include plant extracts, alpha adrenergic blockers and 5-alpha-reductase inhibitors. Clinical observations suggest that the efficacy of combination therapy could be superior to that of individual monotherapies.

With the widespread use of non-invasive diagnostic tools, such as abodminal ultrasound and computerized tomography, renal cysts are diagnosed with increasing frequency. In patients 50 years or older, simple renal cysts of various size may be found in nearly one third. Increasing frequency with age is clearly demonstrated. Two thirds of simple renal cysts are 2 cm or less in diameter. The average renal cyst needs about 10 years to reach 2 cm in size. Simple renal cysts (category I according to Bosniak classification) usually are asymptomatic, produce no harm to the kidney and require no treatment once diagnosed. However, an occasional eypanding cyst causes progressive obstruction to caliceal and pelvic outflow. There is a possible association between renal cysts and arterial hypertension. Renal cysts may produce segmental renal ischemia, and in turn activate the renin angiotensin system. Percutaneous cyst aspiration or surgical cyst removal could cause a fall in blood pressure. Bosniak suggested a classification in an attempt to sort out the different cases into nonsurgical (category I and II), and surgical ones (category III and IV). Borderline between cystic lesions type II and III is not clear-cut, but Bosniak type IV lesions are clearly cystic renal cell carcinoma.

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.