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Background: Vasculitides are specific inflammations of the blood vessel wall that can take place in any organ system of the human body. They may occur as a primary process (primary systemic vasculitides, PSV) or may be secondary to another underlying disease. In general, in association with the specific type of vasculitis, affected vessels vary in size, type, and location. In the following scoping review, we present clinical characteristics and manifestations of PSV with reference to the genitourinary system. Materials and methods: A non-systematic search of the relevant literature was conducted using three electronic databases (PubMed, Embase, and Web of Science) up to 29 October 2021. Results: Urogenital manifestations of PSV are infrequent, with the most commonly reported findings as prostatic or testicular involvements. However, almost all other organs of the genitourinary system can be affected. Conclusions: Because of the clinical heterogeneity and non-specific symptoms, the proper diagnosis of PSV is often delayed and constricted. Fast identification of urological manifestations of vasculitides is essential in implementing appropriate therapy and avoiding unnecessary, harmful, and invasive surgery.

Renal cell carcinoma (RCC) is the most common form of kidney malignancy. RCC is more common among men with a 2/1 male/female incidence ratio worldwide. Given the underlying epidemiological differences in the RCC incidence between males and females, we explored the gender specific 1H NMR serum metabolic profiles of RCC patients and their matched controls. A number of differential metabolites were shared by male and female RCC patients. These RCC specific changes included lower lactate, threonine, histidine, and choline levels together with increased levels of pyruvate, N-acetylated glycoproteins, beta-hydroxybutyrate, acetoacetate, and lysine. Additionally, serum lactate/pyruvate ratio was a strong predictor of RCC status regardless of gender. Although only moderate changes in metabolic profiles were observed between control males and females there were substantial gender related differences among RCC patients. Gender specific metabolic features associated with RCC status were identified suggesting that different metabolic panels could be leveraged for a more precise diagnostic.

This study aims to define the quality of life (QoL) of patients who had undergone laparoscopic pyeloplasty due to ureteropelvic junction obstruction. The QoL was investigated in 26 patients after pyeloplasty, on average, at a 7.5-year follow-up. The operation was performed in a single center between 2002 and 2009 and its effectiveness was confirmed by diuretic renography. The QoL was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Additionally, we used an own questionnaire, created for this study, specifically assessing the health-related quality of life after pyeloplasty. Overall, 96% of patients were satisfied with the surgical procedure and all would agree to have another pyeloplasty procedure if needed. In one case, dissatisfaction was caused by persisting postoperative pain. All patients but one, dissatisfied due to persisting pain, reported that the postoperative pain intensity was not a problem that would impact the QoL or professional activity. We conclude that laparoscopic pyeloplasty did not adversely affect the patients’ QoL, which might stem from beneficial functional outcomes making the patients satisfied with treatment results.

Introduction Anderson-Hynes (A-H) dismembered pyeloplasty has remained nearly unchanged since its introduction in 1949. The authors present a modification of the uretero-pelvic anastomosis as described by Anderson and Hynes. The new approach, called the W-type suture, is thought to be more watertight and associated with fewer complications than the original. Aim To assess the effectiveness of the modification of Anderson-Hynes dismembered pyeloplasty named the W-type suture. Material and methods The research is a retrospective study of 99 patients who underwent laparoscopic A-H pyeloplasty. In 49 patients unmodified laparoscopic A-H pyeloplasty was carried out. Fifty patients underwent laparoscopic A-H pyeloplasty with the anastomosis made using the aforementioned W-type suture. To assess the effectiveness of the W-type suture, we compared urine leakage duration - a direct indicator of anastomosis tightness - and frequency of postoperative complications. Results The mean duration of urinary leakage was 3 ±1.16 days for the W-type suture anastomosis group and 3.57 ±1.14 days for the unmodified A-H pyeloplasty group (p < 0.05). The frequency of post-operative complications did not statistically significantly differ between the groups except for fever (18.4% vs. 4%; p < 0.05). Conclusions The analysis of the collected data showed that the W-type suture might be a promising alternative to a traditional approach of performing the ureteropelvic anastomosis. Further research should be done to minimize biases present in this study, which might have influenced our results.

Background: The incidence of intravesical recurrence (IVR) following radical nephroureterectomy (RNU) is reported in up to 50% of patients with upper tract urothelial carcinoma (UTUC). It was suggested that preoperative diagnostic ureteroscopy (URS) could increase the IVR rate after RNU. However, the available data are often conflicting. Thus, in this systematic review and meta-analysis we sought to synthesize available data for the impact of pre-RNU URS for UTUC on IVR and other oncological outcomes. Materials and methods: A systematic literature search of the PubMed, Embase, and Cochrane Library databases was performed in June 2021. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CI) were conducted. The primary endpoint was intravesical recurrence-free survival (IVRFS), with the secondary endpoints being cancer-specific survival (CSS), overall survival (OS), and metastasis-free survival (MFS). Results: Among a total of 5489 patients included in the sixteen selected papers, 2387 (43.4%) underwent diagnostic URS before RNU and 3102 (56.6%) did not. Pre-RNU diagnostic URS was significantly associated with worse IVRFS after RNU (HR = 1.44, 95% CI: 1.29–1.61, p < 0.001) than RNU alone. However, subgroup analysis including patients without biopsy during URS revealed no significant impact of diagnostic URS on IVRFS (HR = 1.28, 95% CI: 0.90–1.80, p = 0.16). The results of other analyses showed no significant differences in CSS (HR = 0.94, p = 0.63), OS (HR: 0.94, p = 0.56), and MFS (HR: 0.91, p = 0.37) between patients who underwent URS before RNU and those who did not. Conclusions: The results of this meta-analysis confirm that diagnostic URS prior to RNU is significantly associated with worse IVRFS, albeit with no concurrent impact on the other long-term survival outcomes. Our results indicate that URS has a negative impact on IVRFS only when combined with endoscopic biopsy. Future studies are warranted to assess the role of immediate postoperative intravesical chemotherapy in patients undergoing biopsy during URS for suspected UTUC.

Ureteropelvic junction obstruction (UPJO) causes a reduction in the urine flow from the renal pelvis into the ureter. Untreated UPJO may cause hydronephrosis, chronic infection or urolithiasis and will often result in progressive deterioration of renal function. Most cases of UPJO are congenital; however, the disease can be clinically silent until adulthood. Other causes, both intrinsic and extrinsic, are acquired and include urolithiasis, post-operative/inflammatory/ischemic stricture, fibroepithelial polyps, adhesions and malignancy. In the past, the most frequent symptom of UPJO in neonates and infants was a palpable flank mass. Nowadays, thanks to the widespread use of maternal and prenatal ultrasound examinations, asymptomatic hydronephrosis is diagnosed very early. In adults and older children symptoms may include intermittent abdominal or flank pain, nausea, vomiting and hematuria. In addition to high specificity and sensitivity in detecting UPJO, modern technologically advanced equipment such as ultrasound, magnetic resonance imaging and computed tomography provides a lot of information about the function of the affected kidney and the anatomy of the surrounding tissues. Treatment options for UPJO include a wide spectrum of approaches, from active surveillance or minimally invasive endourologic techniques to open, laparoscopic or robotic pyeloplasty. The main goal of therapy is to relieve symptoms and maintain or improve renal function, but it is difficult to define treatment success after UPJO therapy.

Preoperative Wilms tumor rupture is a challenge for tumor management as it may require upstaging. Tumor spillage of nephroblastoma may seriously affect the prognosis. The following study is a case report of preoperative Wilms tumor rupture in the left kidney of a child, resulting from blunt force trauma. The child was operated on with no prior chemotherapy. Wilms tumor rupture was confirmed intraoperatively. Nephroblastoma was classified as stage III and the child was assigned to oncological treatment, comprising chemotherapy and radiotherapy. Postoperative histopathology, however, did not confirm the rupture and was indicative of stage I.

Background Crossing vessels (CVs) are common in older children and adults with hydronephrosis but no gold standard exists on how to treat this condition. The final decision is made intraoperatively by the surgeon. Objectives To assess the outcome of the laparoscopic dismembered pyeloplasty with translocation of the CVs in children and adults. Material and methods Prospectively collected data from 3 departments was reviewed. Inclusion criteria were: 1) a transperitoneal laparoscopic approach; 2) dismembered pyeloplasty; and 3) the same operating pediatric urologist (RC) or urologist (TS). In the case of CVs, pyeloplasty with vessel transposition (children) or with cephalad translocation (adults) was performed. Forty-eight children and 41 adults met these criteria. Patients were divided into 4 groups: children with (group 1A) and without (group 1B) CVs, and adults with (group 2A) and without (group 2B) CVs. Any surgical reintervention at the uretero-pelvic junction (UPJ) was deemed a failure. Results The overall reintervention rate was 3/48 (6.25%) in children and 2/41 (4.9%) in adults (p > 0.05), and involved the following: 4 endopyelotomies and 1 redo pyeloplasty. Crossing vessels were identified in 28/48 (58%) children and 12/41 (29%) adults. The mean operation time was 152 min in group 1A and 161 min in group 2A (p > 0.5). Reintervention was needed in 2/28 patients in group 1A and in 1/12 patients in group 2A (p > 0.05). There was no difference in the failure rate between group 1A and group 1B, nor between group 2A and group 2B (p > 0.05). Conclusions Crossing vessels should be meticulously looked for during pyeloplasty in older children and adults. Dismembered laparoscopic pyeloplasty (LP) with dorsal transposition or cephalad translocation are comparable methods in terms of success rate for the treatment of UPJ obstruction in these patients.

Metronomic chemotherapy has been tested only a few times in the treatment of metastatic kidney cancer. We have combined metronomically dosed cyclophosphamide (mCTX) with full dosed interferon alpha (IFN) in patients with disseminated clear cell cancer. Toxicity was mainly attributable to IFN treatment. We have noticed mainly hematological and general symptoms with only few grade 3 or 4 adverse events. No patient required mCTX withdrawal. In 30 patients evaluated for the response, clinical benefit (CB) (objective responses and stabilization of the disease ≥24 weeks) was observed in 40%. Median overall survival (OS) for the whole group was 13.2 months. Survival responders and nonresponders were 9.5 versus 28.9 months (P=0.001). Patients with a higher hemoglobin concentration and fibrinogen level6 g/L had a higher probability of response. Responders also had different kinetics of fibrinogen than nonresponders. When assessed for clinical response, the combination of mCTX and IFN proved to be disappointing. In contrast, OS in patients with CBs proved to be long. It is crucial to properly select patients for whom some predictive markers can be used. The combination of metronomic chemotherapy with targeted therapies might be an interesting direction for further research.

Background Over the last few years the role of microorganisms in the pathogenesis of atherosclerosis has been widely discussed. Chlamydia pneumoniae activates immune cells to produce cytokines that are responsible for the formation of atheromatous carotid lesions. Material and methods The study was carried out at the Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, in 2002-2003, on 100 consecutive symptomatic patients with internal carotid stenosis, who underwent an endarterectomy procedure. Each patient had their carotid artery sampled in order to find C. pneumoniae DNA using the nested PCR method and some cytokines (TGF-β, VEGF, FGF, TNF-α) using immunohistochemical examination. The control group consisted of 20 young organ donors who had been diagnosed with brain death and who had their healthy carotid artery harvested. Analogous genetic and immunohistochemical tests were performed. Results We did not confirm the presence of either cytokines or C. pneumoniae in the healthy carotid arteries. The presence of FGF was probably due to intima fibroblast activity, which is responsible for elastin and collagen synthesis for the extracellular matrix. C. pneumoniae was discovered in 68% of patients with carotid plaques. Three cytokines (TGF-β, FGF, TNF-α) were detected in atherosclerotic internal carotid arteries as well. Conclusion Chronic infection by C. pneumoniae may exacerbate carotid plaque development and may lead to its destabilization.

Pregnancies in patients after cystectomy with urinary diversion, especially after the construction of a continent urinary reservoir, are rare. Experience in this field is limited and mainly concerns patients with congenital disorders, neurogenic diseases or trauma. In this paper, we report the outcome of pregnancy, delivery and the postpartum period in a 27-year old woman with a Studer ileal orthotopic neobladder after radical cystectomy, performed after the diagnosis of a malignant tumor at the age of 14.

This case report presents the diagnostic and treatment procedures of stone removal from the kidney of a 67-year-old donor, the transplantation of the kidney to a 65-year-old recipient, and the postoperative course until the end of hospitalization. Computed tomography performed before collecting the organ showed a staghorn stone in the renal pelvis and lower calyces in the right donor kidney. The stones were removed ex-vivo using a rigid ureteroscope and a holmium laser prior to transplantation. Then the organ was transplanted to the left iliac fossa of a 65-year-old man with end-stage renal failure. The authors think there is a possibility of increasing the kidney pool, by using organs containing large calculi. In such cases stones should be removed before the operation and the patient should be monitored regularly, especially in the first months after the transplant.

Introduction: It is believed that lower pole crossing vessels may play an important role in the etiology of uretero- pelvic junction obstruction (UPJO). A conventional operative technique, which seems to be widely used in patients with UPJO, is Anderson-Hynes (A-H) plasty with dorsal transposition of the vessel. An attractive alternative to dorsal transposition of the vessel might be its cephalad translocation. Aim: To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparo- scopic A-H or Y-V pyeloplasty. Material and methods: Eighty-five patients were included in the study. To assess the effectiveness of cephalad trans- location of the crossing vessel in patients who underwent laparoscopic pyeloplasty, the results of the procedure were compared to the results of laparoscopic pyeloplasties performed in patients without crossing vessels (control group). Success was defined as the following factors taken collectively: 80% or greater pain relief according to VAS, no sign of obstruction on intravenous urography (patent UPJ), decreasing excretion curve with T1/2 < 12 min, and improved or stable differential renal function on diuretic renography. Results: The mean follow-up was 53.7 months. There was no statistically significant difference in the success rate between the compared groups (group 1 - cases with cephalad translocation of the crossing artery, and group 2 - cases without crossing vessels) in patients who underwent A-H plasty or Y-V plasty. Conclusions: The analysis of our data seems to indicate that cephalad translocation of the anterior crossing vessel gives good therapeutic results in patients who undergo laparoscopic pyeloplasty.

Introduction Although most urologists agree that failures after laparoscopic pyeloplasty occur usually within a year after the operation, late failures are also reported. Aim To assess late results of laparoscopic pyeloplasty. Material and methods Seventy-eight of ninety-five patients who had been operated on between November 2001 and September 2009 were notified about the possibility of diuretic renography (DR). Excluded from the study were 3 patients who failed within 1 year after surgery, 2 others with late recurrences at 1.5 and 2.5 years postoperatively, 8 patients who were lost to follow-up immediately after the operation, 2 patients with equivocal DR after pyeloplasty and 2 cases with open conversion. Twenty-six (33.3%) patients responded to the notification. Mean follow-up was 89 months. In all patients DR, ultrasound, serum creatinine concentration, estimatated glomerular filtration rate and the assessment of symptoms were carried out. Success was defined as T1/2 ≤ 12 min and improved or stable differential renal function on DR. Results Diuretic renography revealed no obstruction in 25/26 (96%) patients. One woman was not appropriately hydrated, which rendered the result of the investigation unreliable. Mean half time to tracer clearance was 6.74 min. Mean split renal function on the operated side was 44.62%. Mean pain strength according to the VAS scale was 1.54. Conclusions Our study seems to indicate that recurrence after laparoscopic pyeloplasty in the follow-up period longer than 5 years is very unlikely. However, until more data are available, patients should undergo long-term follow-up to receive the benefit of the operation.

A primary aortocaval fistula (ACF) is present in less than 1% of all abdominal aortic aneurysms (AAA). The case of a 62-year-old patient with a ruptured AAA and ACF was reported. A stent-graft was implanted into the abdominal aorta. An inferior vena cava filter was inserted to prevent pulmonary embolism. The patient made a smooth recovery. The follow-up computed tomographic scan three months later did not reveal any evidence of endoleaks or that the fistula was still present. Hemodynamic changes with regard to transient acute liver impairment were discovered (renal and liver parameters were presented). Endovascular exclusion appears to be an effective option in the treatment of an aortocaval fistula in comparison to conventional open repair.

Purpose The authors analysed the distribution of c-kit-positive interstitial cells of Cajal (ICCs) in obstructed ureteropelvic junction (UPJ) and its age-related changes. Methods Twenty specimens were obtained from children with intrinsic ureteropelvic junction obstruction (UPJO), at the average age of 8.1 years (8 months–16.8 years), fixed in formalin and embedded in paraffin. Five control samples were taken from children at the average age of 2.3 years (2.4 months–7.4 years). All specimens were analysed by the immunohistochemistry test with light microscopy with respect to c-kit expression. The distribution of c-kit-positive ICCs in the two groups was compared and the correlation between the distribution of c-kit-positive ICCs and the patients’ age in UPJO cases was analysed. The results were examined by Yates’ χ2 test, Mann–Whitney U test, and t test for Pearson’s correlation coefficient. A P value

The aim of the study was to describe simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery, to discuss the details of a convenient laparoscopic approach and the way of port placement, as well as to present a review of the literature concerning combined laparoscopic procedures. A 72-year-old woman was admitted to our department because of a tumor of the right adrenal gland and a small tumor of the right kidney. The patient underwent simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery. The postoperative period was uncomplicated. The patient was discharged from the hospital on the 4th postoperative day. We believe that the proposed way of trocar placement would help to avoid a ‘rollover’ problem between the laparoscope and a Satinsky clamp or a ‘crossing swords’ problem between a Satinsky clamp and manipulators.

Background The formation of lymphatic vessels (lymphangiogenesis) occurs in tumor tissues and is crucial for tumor development and progression in some cancers. Lymphangiogenesis and its clinical effect on renal cell carcinoma have been less thoroughly investigated in comparison with angiogenesis. The aim of this study was to evaluate the role of lymphangiogenesis as a prognostic factor in renal cell carcinoma (RCC). Material/Methods The expression of peritumoral/intratumoral lymphatics was studied by immunohistochemical methods in paraffin-embedded nephrectomy specimens from 133 patients with clear cell carcinoma. Patients were divided into 3 groups depending on postoperative follow-up: I) patients without metastases, II) patients with metastases during follow-up, and III) patients with metastases during the operation. Peritumoral lymphatics (PTL) and intratumoral lymphatics (ITL) were immunostained with a D2-40 antibody. Results The mean number of PTL present in each group was I=14.1, II=10.6, III=12.1. The mean number of ITL present in each group was I=0.7, II=2.3, III=2.3. The 3 groups showed statistically significant differences only in the case of ITL. A mean count of ITL ≥1 is significantly associated with an increased risk of regional lymph node involvement and distant metastasis. Patients with expression ITL >0.2 and PTL ≤15.2 had a significantly shorter cancer-specific survival. Conclusions The number of ITL showed an association with more aggressive cases of RCC and progression of disease. Therefore, the level of expression ITL, together with stage and histological grading, may provide valuable predictive information about the outcome of treatment.

objectives. The objective of the study is to summarize the authors’ 10-year experience with laparoscopic adrenalectomy and to analyze the intra- and postoperative complications of the procedure. Material and methods. The records of 80 patients who had undergone laparoscopic adrenalectomy from January 2002 to January 2012 were reviewed retrospectively. There were 51 female and 29 male patients. The average age was 52. In 33 cases the right adrenal gland was affected, in 47 it was the left adrenal gland. Nineteen operations were performed with the retroperitoneal approach, in 61 a transperitoneal access was used. The average size of the tumor was 5 cm. The diagnosis was based on ultrasonography (USG) and computed tomography (CT). The biochemical tests were performed in all cases to assess hormonal activity of the tumor. Pheochromocytoma was diagnosed in 16 cases, Cushing syndrome in 3 cases, and Conn syndrome in 4 cases. All other tumors were hormonally inactive. Six patients were operated on because of adrenal metastases – from renal carcinoma in five cases and from lung carcinoma in one case. results. There were three open conversions. The mean operative time was 158 minutes. The mean hospital stay was 5.5 days Blood transfusion was necessary in three patients. Postoperative complications were observed in 11 patients (13.7%). Conclusions. Laparoscopic adrenalectomy is a safe and effective procedure and should be considered the first – line treatment of benign adrenal masses. Our experience indicates that patients with adrenal metastases are suitable candidates for laparoscopic adrenalectomy, providing a skilled laparoscopic surgeon is involved in operation.

Purpose The authors examined the number of interstitial cells of Cajal-like cells (ICC-LCs) in obstructed ureteropelvic junction (UPJ) in comparison with normal UPJ specimens and age-related changes. Materials and methods A total of 20 human formalin fixed, paraffin-embedded specimens of intrinsic UPJO from children at the mean age of 8.1 years (age range: 8 months–16.8 years) and 5 control samples from children at the mean age of 2.3 years (range 2.4 months–7.4 years) were investigated immunohistochemically for the expression of c-kit proto-oncogene by light microscopy with computerized image analysis. The results were examined by Fisher’s exact test, Yates’ chi-square test, and t test for Pearson’s correlation coefficient. A P value less than 0.05 was considered statistically significant. Results The number of ICC-LCs-dense fields was significantly higher in UPJO specimens in comparison with the normal group (P = 0.0004). The number of ICC-LCs-sparse fields was significantly lowered in UPJO specimens in comparison with the normal group (P = 0.0122). There was no significant difference in the number of ICC-LCs-medium fields in obstructed and normal UPJ specimens. The number of ICC-LCs was decreasing significantly with increasing age of the patients with UPJO (P = 0.0038). Conclusions The higher density of c-kit-positive ICC-LCs in UPJ may manifest the compensation of altered peristalsis in UPJO. The number of ICC-LCs-dense fields decreasing with age may show the failure of compensation and regression of the compensatory changes.

Wilms tumour is the most common renal tumour in children, accounting for above 90% of cases and comprising 8% of paediatric solid tumours. In adults, it is extremely rare and represents only 0.5% of all renal tumours. We reviewed 9 patients older than 16 years: three were treated in the Department of Paediatric Surgery and three in the Department of Urology; additionally, 3 patients were referred to us for consultation with regard to further treatment after having been operated on previously in other centres. Clinical presentation, stage distribution, histology, treatment, and prognosis of all the patients are presented. The age of 9 patients ranged from 17 to 32 years: there were 8 men and 1 women. Tumour stages were defined according to SIOP classification: 4 were of local stage II, 3 of stage III, and 2 of stage IV with metastases to lungs and bones. Three of them were treated according to the paediatric protocol of the Society of Paediatric Oncology (SIOP 93-01 protocol)—all after a fine-needle biopsy which confirmed nephroblastoma, received preoperative chemotherapy of two drugs (VCR + ACT D) during 4 weeks. Histological studies revealed a low-risk cystic tumour in one case, intermediate-risk tumour in 2 patients, and high-risk tumour with blastemal predominance or with the presence of diffuse anaplasia in 5 patients. One tumour was defined as a mixed high-risk tumour: renal cell carcinoma with nephroblastoma of blastemal predominance. Complete remission was achieved in 3 patients. Three relapsed after complete remission of 6–30 months. A second-line therapy was undertaken in these patients as well as in those who had undergone the initial treatment elsewhere. But the second-line therapy proved ineffective. Adult patients with Wilms tumour have more aggressive histology and poorer prognosis than children.

A retrospective study was performed to compare the results of laparoscopic pyeloplasty and antegrade endopyelotomy and complications observed after the two procedures.Seventy-five endopyelotomies and 90 laparoscopic pyeloplasties in patients with primary ureteropelvic junction obstruction (UPJO) were performed. The diagnosis of UPJO was based on a complete medical history, ultrasonography, urography (IVU), and/or diuretic renography. In 52 cases, a Whitaker test was performed before endopyelotomy. The mean follow-up was 31 months in the endopyelotomy group and 28.5 months in the laparoscopy group. Complete success was defined as absence of any clinical symptoms combined with significant reduction of hydronephrosis on diuretic IVU and ultrasonography, and no sign of obstruction on diuretic IVU, diuretic renography, or Whitaker test.Complete success was observed in 55.4% of patients after endopyelotomy and in 95.3% of patients after laparoscopic pyeloplasty. In patients with primary UPJO, laparoscopic procedures yield better therapeutic results than endopyelotomy, irrespective of the degree of hydronephrosis. The number of complications after the two procedures was comparable with the exception of intraoperative bleeding, which was more frequent in the case of endopyelotomy.Laparoscopic pyeloplasty should be the procedure of choice in the treatment of primary UPJO.

Summary Objective The authors of this study have attempted to develop a noninvasive therapeutic method, which aims to restore proper trophicity within the small pelvis. They made an attempt to assess the efficacy of the physiotherapeutic procedures aimed at moderating the severity of symptoms in patients suffering from benign prostatic hyperplasia (BPH) and at improving patients' quality of life. Methods The studies were carried out on a group of 43 men with BPH, who were subjected to a medical massage of the abdominal integuments. The I-PSS symptoms scale and LQ assessing quality of life tools were employed to assess the efficacy of the method. Results There was an improvement in all studied cases: I-PSS improved 50% ( P ⩽ 0.0001 ) and LQ improved 41% ( P ⩽ 0.0001 )). It should also be mentioned that the method was approved by patients, many of whom would like it to continue receiving this attention. Conclusion Medical massage intervention resulted in a marked subjective improvement in micturition and in patients' subjective assessment of the quality of life.

Background. Bladder cancer occurs mainly in adults. In children, younger than 10 years in particular, it is very rare. Objectives. The aim of the study is to retrospectively evaluate the efficacy of transurethral resection of the bladder tumour (TUR-BT) of transitional cell carcinoma (TCC) of the bladder in children. Material and Methods. Transurethral resection of the bladder tumour was performed in 7 boys aged 4 to 17 years (median 12.1 years). In all cases laboratory tests, ultrasound, and cystoscopic tumour biopsy were carried out prior to the resection. Doxorubicin was additionally instilled intravesically as one dose in two patients. The Foley catheter was left in the bladder for 1 to 4 days (median 1.85 days). The follow-up period ranged from 10 months to 10 years (median 4 years). Results. Papillary urothelial neoplasm of low malignant potential (PUNLMP) was diagnosed in 5 patients and urothelial papilloma in 2. Local recurrence was observed in one case two years after the resection. In all other cases complete remission was achieved. Conclusions. Transitional cell carcinoma of the bladder in children is usually benign and endoscopic treatment (TUR-BT) seems to be the treatment of choice. To determine a follow-up schedule a more substantial group of children with bladder cancer should be analysed (Adv Clin Exp Med 2015, 24, 3, 505–509).

Fibroepithelial polyps (FEPs) are rare benign ureteral neoplasms of mesodermal origin. As an intrinsic cause of ureteropelvic junction obstruction (UPJO) they are very uncommon. Excretory urography and diuretic renography used by many urologists to diagnose a UPJO may not detect the ureteral polyp. We present a case of ureteropelvic junction obstruction caused by a fibroepithelial polyp, which was not diagnosed preoperatively. The patient underwent successful laparoscopic excision of the polyp with Anderson-Hynes pyeloplasty. We believe that laparoscopy is a useful, minimally invasive operative technique in the treatment of FEPs and may be considered a procedure of choice in large polyps, in which cases the endoscopic procedure is difficult or impossible to perform.

Laparoscopic radical nephrectomy has been widely accepted as the preferred management of low stage renal masses. Endoscopic management is advantageous for its reduction in perioperative and postoperative complications. In the mid-1990s, morbid obesity was considered a relative contraindication to laparoscopic technique. The authors present two cases of laparoscopic radical nephrectomy due to renal tumors in extremely obese patients. The aim of this study is not only to present the operative technique but also to show that the laparoscopic procedure is safe and effective in morbidly obese patients.

In comparison to an open procedure, the laparoscopic radical nephrectomy has demonstrated advantages in regard to perioperative morbidity, postoperative pain, time of hospitalization, and convalescence. However, most series of laparoscopic radical nephrectomy are confined to T1 tumors. The authors present a case of a large-volume- T2 renal tumor treated laparoscopically. The aim of the study is to present the operative technique and to discuss several unique problems that arise during the laparoscopic procedure in patients with large renal masses.

Background. Renal transplantation is performed in thousands of patients with end-stage renal disease. The most common complications are ureteral or ureterovesical junction pathologies. We describe two very rare cases of a complication of unknown mechanism following renal transplant. Case report 1: A 57-year-old woman was evaluated after renal transplantation. The graft did not regain its function postoperatively because of acute posttransplant renal insufficiency. Redon tube drainage rose to 575 ml on day 11 and to 1360 ml on day 12. Fluid analysis and cystography led to the conclusion that no ureteroneocystostomy existed. Reoperation followed. The kidney was rescued and the patient discharged in good condition. Case report 2: A 30-year-old woman with acute posttransplant renal insufficiency after renal transplantation was evaluated. Drain tubes were removed on day 8. Graft biopsy was performed on day 16 because of suspected acute graft rejection. No aberrancies on histology were seen. The patient’s general condition worsened and ascites developed. During cystoscopy, no distal end of the JJ-cathether was seen, which led to the conclusion that no ureteroneocystostomy existed. She was reoperated on day 23 posttransplant. The kidney was rescued and the patient was discharged in good condition. Conclusions. The most common cause of urine leakage in kidney transplant recipients is ureteroneocystostomy leak. The possibility of a lack of any junction between the ureter and bladder should be taken into account. Cystoscopy and cystography, which are fast to perform and not cumbersome to the patient, should be performed early as they allow for fast and reliable diagnosis before reoperation.

Introduction Many options exist for the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), including transurethral resection of the prostate (TURP), laser surgery, and open adenomectomy. Recently, endoscopic techniques have been used in the treatment of BPH. Material and methods We reviewed clinical studies in PubMed describing minimally invasive endoscopic procedures for the treatment of BPH. Results Laparoscopic adenomectomy (LA) and robotic-assisted simple prostatectomy (RASP) were introduced in the early 2000s. These operative techniques have been standardized and reproducible, with some individual modifications. Studies analyzing the outcomes of LA and RASP have reported significant improvements in urinary flow and decreases in patient International Prostate Symptom Score (IPSS). These minimally invasive approaches have resulted in a lower rate of complications, shorter hospital stays, smaller scars, faster recoveries, and an earlier return to work. Conclusions Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery. These procedures have a short learning curve and offer new options for the surgeon treating BPH.

The case of a patient with type II TAAA (thoracoabdominal aortic aneurysm), who underwent multistage hybrid procedure, is presented. This high-risk patient was excluded as ineligible for conventional open repair. At first, the bypass between both common carotid arteries was inserted. Then, the transperitoneal viscerorenal revascularization was performed to ensure blood perfusion. At the end, the stent graft from the aorta arch to its bifurcation was deployed with endovascular techniques. This stent graft covered left common carotid artery, left subclavian artery, visceral trunk, superior mesenteric artery and both renal arteries. The patient had been observed for eight years with relatively low complication rate. The hybrid open-endovascular repair (HOER) shows promising results in patients at prohibitive risk for classic reconstruction.

An attempt has been made to prospectively compare the results of two laparoscopic pyeloplasties: Dismembered Anderson-Hynes (A-H) plasty and nondismembered Y-V plasty. Complications following the procedures have been studied as well.Fifty patients with primary ureteropelvic junction obstruction (UPJO) were prospectively selected at random to undergo dismembered A-H (25 patients-even numbers) and nondismembered Y-V (25 patients-odd numbers) laparoscopic pyeloplasty. UPJO was diagnosed on the basis of ultrasonography, excretory urography, and diuretic renography (DR). The intensity of pain was assessed according to a visual analog pain scale (VAS). Success was defined by three factors taken collectively: 80% or greater pain relief in comparison with the preoperative VAS score, no obstruction on DR (decreasing renographic excretion curve, T(1/2)12 min), and improved or stable differential renal function. The mean follow-up was 26.2 months for the A-H group and 26.6 months for Y-V group (P=0.865).Both groups were comparable in terms of preoperative data, except for the presence of the crossing vessel, which was more often observed in the Y-V group. No statistically significant differences between the studied groups were found in operative times, morbidity, and hospitalization length. The success rate in the A-H group was 95% and 86% in the Y-V group, the difference being not statistically significant.Laparoscopic A-H pyeloplasty achieved a higher success rate then Y-V pyeloplasty; however, the difference was not statistically significant.

Objectives To compare the complications of laparoscopic pyeloplasty observed in 3 periods of our learning curve using the Clavien classification. Methods We reviewed and retrospectively analyzed the records of 150 cases of laparoscopic pyeloplasty performed for primary ureteropelvic junction obstruction at our center. All patients were divided into 3 groups according to the order of the case number (1-50, 51-100, 101-150) to compare the intergroup differences in the preoperative data and perioperative parameters. The postoperative complications were subdivided according to the 5-grade Clavien classification of surgical complications. The groups of patients with and without complications were compared with respect to age, degree of hydronephrosis, positive urine culture before surgery, concomitant nephrolithiasis, crossing vessel, and the type of operation performed (dismembered vs nondismembered). Results The success rate was 90.5%. The mean follow-up was 53.7 months (range 5-103). Intraoperative complications occurred in 9 (6%) of 150 patients and postoperative complications in 27 (18%) of 150 patients. No statistically significant differences were seen between the incidence of intra- and postoperative complications among the compared groups. The only statistically significant difference among the groups with and without complications was the presence of a positive urine culture (19% vs 6%, respectively). Conclusions The most common complications were connected with stent obstruction, and they did not seem dependent on surgeon experience. Patients with a preoperative positive urine culture might have a greater risk of postoperative complications.

The aim of the study was to describe the technique of modified laparoscopic Foley Y-V pyeloplasty-anterior Y-V plasty and the results of the operation in the authors' material. In the modified operation, a V-shaped flap is created from the anterior wall of the renal pelvis. Thus two lines of sutures are located on the anterior, easily accessible wall of the renal pelvis. Thirty-six patients were operated on using this technique from May 2005 to January 2009. One patient did not turn up for the follow-up. Complete success was observed in 34 of 35 patients (97.1%). The mean follow-up time was 24 (4–43) months. The mean operative time was 160 minutes. We did not observe any serious complications in the postoperative period. Our results seem to indicate that the anterior Y-V plasty may constitute a reasonable treatment option for patients with small or intrarenal pelvis and no dorsally crossing vessels.

A retrospective study was performed to compare the results of dismembered and nondismembered Y-V laparoscopic pyeloplasties and the complications observed after the two types of surgery.Eighty-eight patients with ureteropelvic junction obstruction (UPJO) underwent a laparoscopic operation. In 2 cases, an open conversion was made. A laparoscopic Hynes-Anderson pyeloplasty (LH-AP) was performed on 50 patients, whereas a laparoscopic Y-V pyeloplasty (LY-VP) was performed in 36 cases. The diagnosis of UPJO was based on a complete medical history, ultrasonography, diuretic urography (IVU), and/or diuretic renography. The mean follow-up was 29 (range, 6-66) months. Complete success was defined as the absence of any clinical symptoms, combined with a significant reduction of hydronephrosis on IVU and ultrasonography, as well as no sign of obstruction on IVU and/or diuretic renography.The mean operative time for LH-AP was 219 minutes and for LY-VP 185 minutes. The mean hospital stay after LH-AP was 5.9 days and after LY-VP 5.3 days. The overall success rate was 91.5% (91.8% for LH-AP patients and 91.2% for LY-VP patients).LY-VP appears to be a safe, attractive alternative to LH-AP.

The aim of this study was to compare the results of two procedures: laparoscopic Foley Y-V pyeloplasty and our modification of the technique. Sixteen operations performed were Foley Y-V plasties (LY-VP), and 23 were the modifications (LY-V1P). In the modified version, a V-shaped flap was created from the anterior wall of the renal pelvis. Ultrasonography, diuretic urography, and/or diuretic renography were used to diagnose ureteropelvic junction obstruction. The mean follow-up was 30 months. Complete success was defined as the absence of any clinical symptoms combined with a significant reduction of hydronephrosis on diuretic urography and ultrasonography as well as no sign of obstruction on diuretic urography, diuretic renography, and/or the Whitaker test. We did not observe any serious postoperative complications. The success rate was 93.3% for LY-VP patients and 95.4% for LY-V1P patients. The modified plasty group had easier intracorporeal laparoscopic suturing while maintaining similar postoperative outcomes.

Bladder agenesis, especially in male, is a rare congenital anomaly. This is a case report of a male patient with several congenital anomalies including penoscrotal transposition, severe kidney's dysplasia, and agenesis of the bladder. The patient lived for 4 months and died because of severe pneumonia.

Xanthogranulomatous pyelonephritis (XGPN) is rare form of chronic, usually unilateral, renal infection that involves damage to the renal glomeruli and periglomerular tissue and destruction of the renal parenchyma. Nephrectomy is usually necessary and the prognosis is good if XGPN is unilateral and treated early. XGPN typically affects middle-aged females and is extremely rare in children. We report one case of XGPN in a seven-year-old girl who was operated on at our institution be-cause of lower urinary tract dysfunction and renal insufficiency – the left kidney was removed and the bladder was augmented by means of the remaining ureter. The histopathological evaluation of the removed kidney showed chronic XGPN.

A 29-year-old primigravida was admitted to the urology ward with acute urinary retention. The patient underwent cystoscopy, MRI (magnetic resonance imaging), and tissue biopsy, which consequently led to the diagnosis of bladder neck leiomyoma that obstructed urine outflow. Subsequent to a cesarean section, a successful transurethral resection was performed. Here the diagnostic complexity in the pregnant patient, clinical course, and outcome are described. One year after successful treatment both mother and daughter are in good condition.

Background. Urethral stenosis or abnormalities in the external urethral meatus in girls may lead to serious functional bladder outlet obstruction and recurrent urinary tract infections. Objectives. The aim of the study was to analyze the efficacy of meatotomy in girls with an anterior deflected urinary stream (AdUS) and symptoms of detrusor overactivity. Material and Methods. A group of 67 girls between the ages of 5 and 16 (mean age: 8.6 years) with symptoms of detrusor overactivity participated in the study. The girls were treated with oxybutinin in the years 2010−2011. The group included 37 girls with AdUS (the AdUS group) while the remaining 30 girls (the OXY group) were found to have a normal urinary stream. In the AdUS group an external urethral meatus incision was performed. The follow-up period was three months. The presence of urinary tract infections (UTI) as well as nocturnal bedwetting and daytime incontinence were analyzed before and after treatment. Results. After three months, in the AdUS group no UTI was found in 12 children (32%) (p < 0.05), including 11 patients with prior febrile UTI (p < 0.05). Recovery from daytime urinary incontinence was observed in 20 girls (54%) and recovery from nocturnal bedwetting in 8 girls (22%). In the OXY group no infections were found in three girls (10%); recovery from daytime urinary incontinence was noted in 21 girls (70%) and from nocturnal bedwetting in 10 girls (33%). Conclusions. Girls with symptoms of detrusor overactivity accompanied by an anterior deflected urinary stream experience UTIs and fever more often than girls with detrusor overactivity and a normal urinary stream. An incision in the external urethral meatus in girls with AdUS and detrusor overactivity seems to be effective treatment for recurrent urinary tract infections, especially febrile ones (Adv Clin Exp Med 2014, 23, 2, 283–287).