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Introduction/Objective. Urothelial carcinoma is the most commonly diagnosed malignancy of urinary bladder in clinical and pathohistological practice where various prognostic factors play a significant role. One of the most important pathohistological prognostic factors is the intensity of immunohistochemical staining. Among various immunohistochemical markers that have been proven to influence disease progression and the patient’s survival, role of Ki-67 and GATA3 in prediction of disease prognosis has not been completely clarified yet. The aim of this study was to determine the predictive value of GATA3 and Ki-67 mutual expression in urothelial carcinoma. Methods. Eighty patients were included in this study, out of which four groups were formed based on the pathological stage of urothelial carcinoma. After using preferred antibodies, their staining intensity was analyzed semiquantitatively. Results. Results showed that there was statistically significant correlation between the type of urothelial carcinoma, the pathological stage, and invasiveness and different grades of GATA3 expression, as well as statistically significant correlation between the type of urothelial carcinoma and the pathological stage and different grades of Ki-67 expression. The regression model showed low value of GATA3 and Ki-67 mutual expression. There was also statistical significance regarding the pathological stage and invasiveness of the tumor in survival analysis. Conclusion. Predictive value of GATA3 and Ki-67 mutual expression resulted as low from this study, but to our knowledge this was the first study to examine their predictive capability on biopsy and transurethral resection specimens.

Background/Aim. Prostate carcinoma (PCa) and its parent organ are influenced by hormones, which is used for therapeutic purposes. Through androgen receptors (AR) androgens influence cell growth and function, proliferation, differentiation, apoptosis, lipid metabolism and secretory activity of the prostate, as well as development and progression of PCa. An antiandrogen therapy is carried out in patients with metastatic PCa, in order to block effects of androgens. By conducting immunohistochemical analysis of androgen receptors in the PCa tissue, we can assume how the tumour will react to an administered antiandrogen therapy, both in androgen-positive and androgen-negative, resistant tumours. Knowledge of the presence of AR in the tumour tissue may serve as a prognostic indicator in histopathological analysis. The aim of this study was to evaluate the expression of AR in patients with benign prostatic hyperplasia (BPH) and in those with PCa, before therapy. Methods. Immunohistochemical analysis was carried out by using anti-human AR monoclonal antibody AR441 (DAKO), and presence and intensity of AR were semi-quantitatively evaluated in 195 patients, 165 with BPH and 30 with PCa. Material for analysis was obtained by needle biopsy or transurethral resection of the prostate (TURP). Results. All secretory cells in patients with BPH were intensively androgen positive, while in patients with PCa they were mostly moderately to highly positive, but with foci of negativity. The observed negative correlation between AR and Gleason score and the International Society of Urologic Pathology (ISUP) grade group of PCa was not statistically significant. Conclusion. Study results indicate that PCa, before therapy, is androgen-dependent, with a high level of AR expression.

Background/Aim. Pelvic lymph node dissection (PLND) is the most accurate staging procedure in the diagnosis of lymph node involvement by prostate cancer. However, the therapeutic value of this procedure is still unclear. The objective of the study was to compare diagnostic and therapeutic values of extended and standard PLND as an adjunct of radical prostatectomy. Methods. The patients who underwent surgical treatment for clinically localized prostate cancer (n = 157) were enrolled in this open nonrandomized prospective study. In the standard PLND (sPLND) group 109 patients were enrolled while the extended PLND (ePLND) group involved 48 patients. Both groups were compared regarding age, prostate-specific antigen (PSA) level, a percentage of positive biopsies, preoperative and postoperative Gleason score, number of retrieved and positive lymph nodes, duration of surgery, blood loss, amount of lymphorrhea and biochemical recurrence-free survival. Results. The average number of retrieved lymph nodes was 17.27 and 24.46 in the sPLND and ePLND group, respectively (p = 0.001). The rate of positive lymph nodes was 9/109 (8.3%) and 8/48 (16.7%) in the sPLND and ePLND groups, respectively. Biochemical recurrence was noted in 38/109 (31.2%) and 7/48 (14.6%) patients in the sPLND and ePLND group, respectively (p = 0.003). Conclusion. Comparison of sPLND to ePLND led to the following conclusions: nodal yield was significantly higher in the ePLND group; the ePLND template was associated with a much higher rate of lymph node metastases; the biochemical recurrence-free survival rate was significantly more favorable in the ePLND group comparing to the sPLND group.

Background/Aim. The minimally invasive laparoscopic nephrectomy was first performed in 1991. The objective of this paper was to present the surgical technique of retroperitoneoscopic nephrectomy and to our experience with this procedure in removal of non-functioning kidneys. Methods. This retrospective study enrolled 55 patients who underwent retroperitoneoscopic nephrectomy at our institution during the period from January 2011 to November 2016. All patients had a unilateral non-functioning kidney confirmed by intravenous or computed tomography (CT)- urography and renal scintigram. Their medical records were analyzed for demographic data, duration of surgery, average blood loss, duration of hospital stay as well as time to return to normal life activities. Results. The mean age of patients was 43 years (range 23–78). Perioperative or early postoperative mortality was not recorded. Mean operative time was 82 minutes (range 45–210). The average blood loss was 90 mL (40–450). The average hospital stay was 4 days (3–7). Return to life activity was in average after 12 days (9–15). Conclusions. Retroperitoneoscopic nephrectomy for a non-functioning kidney is a feasible, safe, and effective minimally invasive method. The length of hospital stay and convalescence was shorter than after open nephrectomy.

Background/Aim. Ultrastructural analysis of tumours has shown many common characteristics of certain neoplasms, as well as their specificities. Primary renal epithelial tumours with granular oncocytic cytoplasm is a very heterogeneous group in their histological origin and biological behaviour, which results in a difference in treatment and prognosis of the disease, making accurate morphological diagnosis necessary. The aim of this study was to determine ultrastructural similarities and differences among primary renal epithelial tumours with granular oncocytic cytoplasm. Methods. The analysis of archival and routine material in the archives of the Department of Pathology, University Hospital in Plzen, Czech Republic, as well as archival and routine material in the Centre for Pathology and Histology, Clinical Centre of Vojvodina in Novi Sad, discovered 346 primary renal epithelial tumours with granular oncocytic cytoplasm and divided them into 5 groups: 1) renal oncocytoma (RO) (234 tumours), 2) oncocytic papillary renal cell carcinoma (OPRCC) (12 tumours), 3. sporadic renal hybrid oncocytic/ chromophobe tumour (HOCT) without evidence of Birt Hogg Dubé syndrome (BHD) (14 tumours), 4) chromophobe renal cell carcinoma (ChRCC) (21 tumours) and 5) granular renal cell carcinoma (RCC) [64 tumours + 1 clear cell RCC (CRCC) with hyaline globules]. Ultrastructural analysis of tumour cells at the subcellular level was done using electron microscope (Philips electron microscope TEM 208) at the Department of Pathology, University Hospital in Plzen, Czech Republic. Cellular organelles and pigments were evaluated in 5 tumours from each group according to the simple random sample principle with a total of 30 analysed tumours. Results. In all analysed primary renal epithelial tumours with granular oncocytic, cytoplasm dominant organelles were mitochondria. Specific ultrastructural characteristics of RO were round mitochondria with lamellar cristae, whereas ChRCC had numerous typical cytoplasmic microvesicles 100–700 nm large and mitochondria with tubulovesicular, lamellar and circular cristae. Ultrastructural specificity of hybrid tumours were rare microvesicles and numerous mitochondria of O-PRCC mitochondria with lamellar cristae and small intracytoplasmic vesicles, 100–200 nm large, and of granular RCC, in addition to mitochondria, also glassy hyaline globules (GHG). Conclusion. Ultrastructural analysis indicates mitochondria as the dominant organelle in the analysed tumours. Electron microscopy showed specificities, i.e., differences in appearance of cristae, presence and size of vesicles as well as deposition of pigment in and out of cytoplasm and glassy hyaline globules.

Introduction/Objective. Vesica ileale Padovana is the surgical technique for reconstruction of lower urinary tract following radical cystectomy using isolated ileal segment. This operative technique requires dissection of both ureters in full length, that can’t be possible in some cases. The paper is aimed to present our experience with modified surgical technique of vesica ileale Padovana using 40 cm of an isolated ileal segment and initial results. Methods. 10 male patients received modified ileal neobladder following radical cystectomy at our institution during the period 2008 to 2011. The mean age of patients was 59 years (45-70). Median follow-up was 76 months (62-93). Patients were monitored cautiously for functional outcome, local recurrence, and distant progression. Results. Perioperative, early and late postoperative mortality have not been noticed. There were only 2 major complications: prolonged postoperative ileus and prolonged urinary leakage requiring percutaneous nephrostomy and subsequent ureteral reimplantation due to stenosis of ureterovesical anastomosis in 1 patient (10 %), respectively. Average ileal neobladder capacity was 450 ml. Daytime and night continence were achieved in 9 (90%) and 7 (70%) of patients, respectively. Conclusion. This modification of orthotopic ileal neobladder has not been difficult to perform in our hands. Modified technique provides a clear advantage in easier ureteral implantation more proximally than in the original technique, requiring less length of ureters. Initial encouraging results should be confirmed in further clinical practice.

Background/Aim. Prostate carcinoma (PCa) and its parent organ are influenced by hormones, which is used for therapeutic purposes. Through androgen receptors (AR) androgens influence cell growth and function, proliferation, differentiation, apoptosis, lipid metabolism and secretory activity of the prostate, as well as development and progression of PCa. An antiandrogen therapy is carried out in patients with metastatic PCa, in order to block effects of androgens. By conducting immunohistochemical analysis of androgen receptors in the PCa tissue, we can assume how the tumour will react to an administered antiandrogen therapy, both in androgen-positive and androgen-negative, resistant tumours. Knowledge of the presence of AR in the tumour tissue may serve as a prognostic indicator in histopathological analysis. The aim of this study was to evaluate the expression of AR in patients with benign prostatic hyperplasia (BPH) and in those with PCa, before therapy. Methods. Immunohistochemical analysis was carried out by using anti-human AR monoclonal antibody AR441 (DAKO), and presence and intensity of AR were semi-quantitatively evaluated in 195 patients, 165 with BPH and 30 with PCa. Material for analysis was obtained by needle biopsy or transurethral resection of the prostate (TURP). Results. All secretory cells in patients with BPH were intensively androgen positive, while in patients with PCa they were mostly moderately to highly positive, but with foci of negativity. The observed negative correlation between AR and Gleason score and the International Society of Urologic Pathology (ISUP) grade group of PCa was not statistically significant. Conclusion. Study results indicate that PCa, before therapy, is androgen-dependent, with a high level of AR expression. [ABSTRACT FROM AUTHOR]

Background/Aim. Ultrastructural analysis of tumours has shown many common characteristics of certain neoplasms, as well as their specificities. Primary renal epithelial tumours with granular oncocytic cytoplasm is a very heterogeneous group in their histological origin and biological behaviour, which results in a difference in treatment and prognosis of the disease, making accurate morphological diagnosis necessary. The aim of this study was to determine ultrastructural similarities and differences among primary renal epithelial tumours with granular oncocytic cytoplasm. Methods. The analysis of archival and routine material in the archives of the Department of Pathology, University Hospital in Plzen, Czech Republic, as well as archival and routine material in the Centre for Pathology and Histology, Clinical Centre of Vojvodina in Novi Sad, discovered 346 primary renal epithelial tumours with granular oncocytic cytoplasm and divided them into 5 groups: 1) renal oncocytoma (RO) (234 tumours), 2) oncocytic papillary renal cell carcinoma (OPRCC) (12 tumours), 3. sporadic renal hybrid oncocytic/chromophobe tumour (HOCT) without evidence of Birt Hogg Dubé syndrome (BHD) (14 tumours), 4) chromophobe renal cell carcinoma (ChRCC) (21 tumours) and 5) granular renal cell carcinoma (RCC) [64 tumours + 1 clear cell RCC (CRCC) with hyaline globules]. Ultrastructural analysis of tumour cells at the subcellular level was done using electron microscope (Philips electron microscope TEM 208) at the Department of Pathology, University Hospital in Plzen, Czech Republic. Cellular organelles and pigments were evaluated in 5 tumours from each group according to the simple random sample principle with a total of 30 analysed tumours. Results. In all analysed primary renal epithelial tumours with granular oncocytic, cytoplasm dominant organelles were mitochondria. Specific ultrastructural characteristics of RO were round mitochondria with lamellar cristae, whereas ChRCC had numerous typical cytoplasmic microvesicles 100-700 nm large and mitochondria with tubulovesicular, lamellar and circular cristae. Ultrastructural specificity of hybrid tumours were rare microvesicles and numerous mitochondria of O-PRCC mitochondria with lamellar cristae and small intracytoplasmic vesicles, 100-200 nm large, and of granular RCC, in addition to mitochondria, also glassy hyaline globules (GHG). Conclusion. Ultrastructural analysis indicates mitochondria as the dominant organelle in the analysed tumours. Electron microscopy showed specificities, i.e., differences in appearance of cristae, presence and size of vesicles as well as deposition of pigment in and out of cytoplasm and glassy hyaline globules. [ABSTRACT FROM AUTHOR]

Introduction. Through androgen receptors, androgens regulate prostate cellular growth and function, proliferation, differentiation, apoptosis, lipid metabolism and secretory activity, as well as development and progression of prostate cancer. Prostate cancer, and its primary glandular tissue are influenced by hormones, and it is used for therapeutic purposes. Anti-androgen treatment is carried out in patients with metastatic prostatic cancer, in order to block effects of androgens. Immunohistochemical analysis of androgen receptors in the prostate cancer tissue may help us to assume how the tumors will react to the anti-androgen therapy, if they are androgen-positive, -negative, or hormone resistant tumors. Knowledge of the presence of androgen receptors in the tumor tissue may be a prognostic indicator in histopathological analysis. The aim of this study was stereological evaluation of androgen receptor expression in patients with benign prostatic hyperplasia and in patients with prostatic cancer, before therapy. Material and Methods. Immunohistochemical analysis was carried out using anti-human androgen receptor monoclonal antibody 441. The presence and intensity of the androgen receptors were evaluated in 195 patients: 165 with benign prostatic hyperplasia and 30 with prostatic cancer using Weibel's multi-purpose M 42 stereological test system. Material was obtained by needle biopsy or transurethral resection of the prostate. Results. All secretory cells in patients with benign prostatic hyperplasia were androgen positive, while in patients with prostatic cancer, all tumors were mostly androgen positive, some with foci of negativity. The resulting negative correlation with Gleason score and International Society of Urological Pathology grade was not statistically significant. Conclusion. Study results of stereological analysis of androgen receptors indicate that prior the therapy prostate cancer is androgendependent, with a high level of androgen receptor expression, although slightly lower compared to benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

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A case study of a sixty-three-year-old white male presented with self-infliction of a mercury glass thermometer in peritoneal cavity through the urethra. Topics discussed include urinalysis revealed red blood cells in the high power field; computed tomography confirmed the same; and successful removal of laparoscopic was performed.

A letter to the editor is presented in response to the article on the clinical application of prostate volume estimation computed tomography in patients having lower urinary tract symptoms.

Introduction. Kidney transplantation is a treatment modality for patients with end-stage renal disease. Nowadays, in the Western world, laparoscopic living donor nephrectomy represents the treatment of choice for graft retrieval. The aim of this paper was to present the laparoscopic living donor left nephrectomy technique. Results. Only one living donor nephrectomy has been performed at the Clinical Center of Vojvodina so far. The authors reviewed the literature data on the results and complications of laparoscopic living donor nephrectomies. Conclusion. Laparoscopic living donor nephrectomy is a feasible procedure, but according to most authors, it should be performed by surgeons with significant experience in laparoscopic nephrectomy. [ABSTRACT FROM AUTHOR]

Introduction. Zinner syndrome is a rare congenital malformation characterized by ipsilateral renal agenesis or hypoplasia, seminal vesicle cysts, and ejaculatory duct obstruction. Patients are usually asymptomatic or develop unspecific symptoms. Case Report. We present a case of a 22-year-old male patient who presented with painless terminal hematuria. The patient denied trauma or other urinary tract symptoms. Magnetic resonance imaging of the abdomen and pelvis revealed a right renal hypoplasia, a tortuous dilated right ureter draining into polycystic right seminal vesicle, and a dilated ejaculatory duct. Conclusion. The size of the seminal vesicle cyst and symptoms affect the treatment. Asymptomatic cysts may be treated conservatively, while cysts that cause symptoms are often an indication for surgical treatment, due to the possibility of infertility caused by the obstruction of the ejaculatory canal. Magnetic resonance imaging has high-resolution properties providing excellent presentation of anatomical relationships and pathology which is extremely important in case of the need for surgical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Bladder cancer is the second most common urological cancer (after prostate cancer, and before kidney and testicular tumors). After setting a diagnosis for bladder cancer, transitional cell carcinoma (TCC), 25% of pts have extravesical spread of the disease, and almost 50% dies in the follow-up period and after radical surgical procedures. About 30-40% pts develop a recurrence, even after radical cystectomy is preformed, and with negative lymph nodes. T2 stage is underestimated in 40-50% of cases, whereas lymph nodes are positive in 10% of cases in T1 stage of the disease. The aim of this study was to present modern diagnostic-therapeutic procedures, which are being used in multimodal treatment of invasive bladder tumors (surgery, chemotherapy, radiotherapy), indications for their use, and treatment outcome in regard to the stage of the disease., Pathological Diagnosis: Pathological diagnosis is a key factor for correct and on-time treatment. Pathological diagnosis is made by the biopsy of the tumor. Clinical diagnosis is made by using modern diagnostic procedures (ECHO, CT, MRI, PET scan), and tumor markers (DNA content, p-53, E-Catherine, pRb -retinoblastoma, BCL-2, PCNA, telomerase, NMP-22, BTA-test, etc.)., Treatment of Bladder Cancer: Treatment of bladder tumors is multimodal, multidisciplinary and includes surgery, chemotherapy and radiotherapy. In regard to indications and established protocols, surgery is partial, simple or radical cystectomy, followed by different types of urine derivation (wet stoma--Bricker's ileal conduit, dry stoma--Kock pouch, ureterosigmoidostomy--Mainz pouch II, or orthotopic ileal bladder substitution). The use of new operative procedures can be done only during the early stage of the disease. Orthotopic substitution of bladder with ileum, significantly improves the quality of life in these patients. Also, the use of new chemotherapeutics (Methotrexate, Vinblastine, Cisplatine, Gemcitabine, Taxol, alone or in combination) or radiotherapy together with surgery increases the survival rate, even in patients with invasive form of disease., Conclusion: Using new diagnostic equipment, up-to date therapeutic procedures, bladder cancer becomes a curable disease (depending on the stage of the disease) with high survival rate and better quality of life.

Introduction: Exracorporeal shockwave lithotripsy (ESWL) is the first choice for patients with urolithiasis. Increased use of endoscopic techniques provided increased use of ureteroscopic lithotripsy in the treatment of stones located in distal ureter, as well as ESWL. Rigid ureteroscope is usually used in the management of distal ureter stones, while middle and upper ureter stones should be treated by flexible ureteroscope or ESWL. At Urology Clinic in Novi Sad, ureteroscopy has been used since 1986, and more than 1000 procedures have been performed with success rate of over 95% (100% when we were able to reach the stone). The aim of this report is to show the destruction of stone along the ureter, using a rigid ureteroscope, shortly after the ESWL treatment of kidney stones., Case Report: A 46-year-old woman was admitted to the Clinic with "steinstrasse" along the ureter, two weeks following ESWL of kidney stones. Primarily, she underwent ESWL without J-J stenting, at another urologic department. On admission to our Clinic, she complained of pain, nausea, mild temperature. An urgent diagnosis was carried out and left sided "steinstrasse" with hydronephrosis was confirmed by ultrasound, plain X-ray, laboratory findings. Ureteroscopy was performed under spinal anesthesia by rigid ureteroscope and the stone was destroyed along the ureter, even the pyelon was explored at the end of the procedure. The patient was advised to take a lot of fluids with diuretics and 80% of stones were eliminated in the first week after the procedure. At the first control, a month later, the patient was stone free., Conclusion: Rigid ureteroscope is a therapeutic option for distal ureteral stones, just as ESWL with comparable and reproducible results. This case confirms the fact that in strictly selected cases, and careful work of skilled urologists, rigid ureteroscope can be used for successful stone destruction in the middle and upper ureter.

Introduction and Objective: A prerequisite for successful outcome of exatracorporeal shock wave lithotripsy (ESWL) is effective stone fragmentation. Despite successful stone fragmentation, complete clearance of stone fragments cannot be achieved in every patient, due to various factors. The aim of this prospective study was to determine morphological factors that affect clearance following successful stone fragmentation by ESWL., Material and Methods: In the period October 1999 and January 2001, 60 patients (45 male and 15 female) with single lower pole kidney stones have been treated using lithotripter Lithostar 2000TM. Parameters of radiographic anatomy, measured on intravenous pyelography, included infundibular width and length, infundibuloureteral infundibulopelvic angles. After the follow-up period of 3 months, patients were divided into two groups regarding clearance status: Group I consisted of stone free patients, and group II of those with residual fragments., Results: Average values of measured parameters in group I vs group II were as follows: infundibular length 27.70 +/- 5.48 mm vs 30.25 +/- 3.95 mm (p = 0.045, Mann-Whitney test); infundibular width 5.98 +/- 3.28 mm vs 4.70 +/- 1.30 mm (p = 0.018, Mann-Whitney test); infundibulopelvic angle 52.92 +/- 20.76 degrees vs 34.10 +/- 8.19 degrees (p = 0.00001, Mann-Whitney test); infundibuloureteral angle 48.00 +/- 21.13 degrees vs 30.70 +/- 7.49 degrees (p = 0.00001, Mann-Whitney test)., Conclusion: This study revealed that parameters of infundibulopelvic anatomy were significantly different in the examined groups. The success of clearance of fragments following ESWL procedure can be predicted using these morphologic parameters.