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Background/Aim. To date, most of the scientific attention has been aimed at the morphometric analysis of the nephrogenic zone (NZ) of the fetal renal cortex, while the quantification and analysis of the maturation zone (MZ) and other indicators of renal maturity were missing. The aim of the study was to examine the characteristics of fetal kidney cortex maturation, as well as to propose the development of a new cortical maturity index (CMI). Methods. The study included 42 paraffin molds of the fetal kidney, divided into three groups according to gestational age (GA). After hematoxylin and eosin staining, tissue sections were analyzed through the following parameters: the thickness of the NZ and MZ, the renal corpuscles area (RCa) and the glomerular capillary tuft area (GCTa), and the maturation stages of the glomeruli. In addition, a new parameter, CMI, was formed as a ratio of NZ and MZ thickness. The collected data were statistically processed. Results. Changes in NZ and MZ thickness were statistically significant, and they correlated with GA. A value of CMI higher than 0.2 was recorded in the kidney samples of fetuses younger than the 20th gestational week (GW), while a value lower than 0.1 was recorded in the samples older than the 30th GW. With an increase in GA in all zones of the renal cortex, RCa and GCTa decreased. A statistically significant reduction of GCTa was observed in the oldest group in the juxtamedullary and intermediate zones of the cortex (p < 0.01). Glomeruli located in the deeper parts of the cortex were more mature than the superficial ones. Conclusion. The measured parameters can serve as a starting point for future studies that would analyze the histomorphological characteristics of the fetal kidney cortex. In the absence of clinical data, a newly formed parameter CMI can represent assistance with the determination of GA, as it significantly correlates with GA (p < 0.01).

Introduction. Hemophagocytic syndrome (HS) after Bacillus Calmette-Guérin (BCG) immunotherapy is extremely rare in everyday practice. Only three cases of HS have been reported in the world until now. BCG is used for preventing the recurrence of superficial tumors of the urinary bladder. Severe complications after BCG immunotherapy are rarely seen. Case report. A 55-year-old patient was transferred to the Clinic for Urology after the second round of BCG immunotherapy, in bad condition, after transurethral resection of a bladder tumor. Computed tomography of the abdomen and lesser pelvis was performed, which did not indicate any clear signs of organ failure or disease. Antitubercular, antibiotic, corticosteroid, and symptomatic therapies were applied. The achieved effect of therapy was not satisfactory. HS after BCG immunotherapy was suspected. During further hospitalization, the patient’s already severe condition further deteriorated and became more complicated in the form of multiorgan dysfunction syndrome. Death occurred on the sixth day of hospitalization. A urine culture test was performed post-mortem and three months later, it was positive for Mycobacterium xenopi. Conclusion. Secondary HS after BCG immunotherapy is an extremely rare disease accompanied by a severe general condition of the patient, with many life-threatening complications that can lead to death. We have presented a case of severe HS after BCG immunotherapy that caused the death of the patient. This case was unique because, for the first time, the possible causative agent was isolated – Mycobacteria.

Introduction. Mucinous tubular and spindle cell carcinoma of the kidney (MTSCC) is a rare and recently described subtype of renal cell carcinoma (RCC). As its name indicates, the tumor is composed of three morphological structures: tubules consisted of cuboidal cells, spindle cells, and extracellular mucus. Case report. A 59-year-old female patient was admitted to the Emergency Center of the Clinical Center of Vojvodina due to injuries sustained in a traffic accident. After diagnostic procedures, computer tomography (CT) revealed a large asymptomatic cyst of the upper pole of the left kidney as an incidental finding. Four months later, after recovering from traumatic injuries, a control CT confirmed a well-circumscribed tumor, 90 mm in diameter, confined to a kidney, and a radical nephrectomy was performed. Histopathological evaluation showed that the necrotic tumor mass consisted of tubules made of cuboidal cells and cords made of spindle cells separated by pale mucinous material in some areas, while other tumor parts were of dense cellularity without mucin. No atypia was found. Conclusion. MTSCC is a variant of papillary RCC, thus, it is usually mistaken with papillary RCC with sarcomatoid differentiation. Because of the same immunoprofile as papillary RCC, histomorphology is imposed as the gold standard for making the diagnosis. MTSCC is a tumor with a generally favorable prognosis, and complete surgical excision appears to be adequate treatment, but single cases with metastatic disease have been reported. In this case, there were no signs of the dis-ease one year after surgery.

Introduction/Objective. The foramen of Vesalius is a variable foramen located at the base of the skull, anteromedial to the foramen ovale, and lateral to the foramen rotundum. Through this foramen, passes one of the emissary veins, which establishes communication between the cavernous sinus and the pterygoid plexus. The aim of the study was to determine the incidence of this foramen in adults depending on gender, along with the number of foramina, distributions relative to the side of the skull and diameter of the foramen. Methods. A material used in the study were digital computed tomography (CT) scans of adult paranasal cavities from the archives of the Radiology Center, archived in the PACS software system. We analyzed axial CT sections of 1 mm thickness. The research included 500 subjects (250 males and 250 females). Results. The foramen of Vesalius was present in 67.6% of respondents. In 50.9% cases, the foramen was bilateral and in 49.1% it was unilateral. The average oblique diameter of the foramen in men was 1.75 ± 0.59 mm and in women 1.56 ± 0.48 mm. In 22 subjects (6.51%) the foramina were doubled, and in two (0.60%) they were tripled. Conclusion. There was no statistically significant difference in the incidence of the foramen of Vesalius concerning gender. The mean diameter of the foramen was statistically higher in males. The presence of this foramen is important for neurosurgeons because, during the percutaneous trigeminal rhizotomy, the needle can pass through this foramen, injure the surrounding blood vessels, and lead to intracranial hemorrhage.

Introduction. Prostate cancer is one of the most common malignancies in men. The most common type is acinar adenocarcinoma. Small cell prostate cancer (SCPC) usually occurs together with coexisting prostate adenocarcinoma. Case report. A 72-years-old patient with voiding simptoms is presented. Initial level of prostate specific antigen (PSA) was 2.87 ng/mL. Twelve prostate biopsies were taken and in six of them neoplastic tissue was detected. The viewed tissue was most convenient to “small cell carcinoma“. Bone scintigraphy did not demonstrate dissemination of the cancer into the skeletal system. Multislice computed tomography (MSCT) of the pelvis did not reveal any special pathological changes. The patient underwent surgery – radical retropubical prostatectomy. Histopathological analysis revealed a poorly differentiated adenocarcinoma of the prostate with small cell carcinoma zones [Gleason score 5+5 (10), grade III, pT3bN1, stage IV]. Conclusion. Poorly differentiated adenocarcinoma of the prostate, especially in combination with SCPC, is an aggressive malignancy with most cases presenting with the extensive disease dissemination on diagnosis and poor prognosis. Small cell carcinomas of the prostate are extremely rare tumors of the neuroendocrine origin. Patients with mixed prostate cancer, compared to pure SCPC, have a better prognosis and greater survival rate. There is a lack of the evidence guiding treatment for SCPC.

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.

Introduction. Urinoma develops after disruption of collecting system of urinary tract and urine leak in surrounding tissue. Most common causes of urinoma are blunt or penetrating trauma. Less common causes are iatrogenic injuries or urinary tract obstruction. In this article we presented a rare case of the urinoma caused by infiltrative bladder cancer. Case report. Acutely ill, a septic patient with ileus and profound azothaemia was admitted to medical intensive care unit. Native computed tomography revealed moderate ileus, right kidney hydronephrosis, extensive retroperitoneal urinoma and vesical thickening with excluded infiltration of ureteral orifices. Computed tomography guided percutaneous drainage was done. Upon stabilization, patient underwent transurethral bladder tumor electroresection (histopathology report was: infiltrative transitional cell tumor of urinary bladder). Radical cystectomy was done. The patient’s recovery was uneventful. Conclusion. Urinoma formed due to spontaneous rupture of collecting system based on ureteral obstruction caused by urinary bladder tumor is very rare clinical case scenario. In case of urinoma of unclear etiology invasive bladder cancer should be excluded.

Background/Aim. Hormone suppression therapy is used in men with advanced prostate cancer improving chances of longer survival. The aim of this study was to investigate the influence of androgen blockades on testosterone and luteinizing hormone (LH) values in patients with locally advanced and metastatic prostatic cancer. Methods. The study included a total of 60 patients out of which 45 with prostatic cancer divided into 3 subgroups based on the type of the applied treatment protocol: 15 patients on monotherapy with luteinizing-releasing hormone (LH-RH) agonists (group I), 15 patients on total androgen blockade (group II) and 15 patients on monotherapy with antiandrogen (group III)). The control group consisted of 15 patients with benign prostatic hyperplasia. In all the patients, values of testosteron, LH and prostatespecific antigen (PSA) were monitored initially, as well as 3 and 6 months after the treatment protocol introduction. Results. In the patients of the groups I, II and III, values of testosterone decreased after three months by 95.58%, 95.72%, and 67%, respectively. The difference was significant (p < 0.01). Between the values after three and six months there was no significant difference in these groups of participants. Testosterone values were significantly higher in the patients of the group III in both analyses. Comparing the values between the groups III and I, as well as those of the groups III and II, a significant difference was found after three and six months of the therapy (p < 0.01). There was a difference in testosterone values between the groups I and II after 3 and 6 months, but not significant. All types of the applied treatment protocols in the therapy of prostatic cancer significantly decreased the values of LH compared to the basal ones. Conclusion. Total androgen blockade and LH-RH agonists are more effective in lowering testosterone values (to castration values) compared to the antiandrogen monotherapy, where testosterone values stay above the castration level. This therapy approach has advantages, since it decreases testosterone values providing better therapy response. There is a difference in testosterone values, but not significant, when total androgen blockade and monotherapy with LH-RH agonists are administered. Registered lower basal values of LH in all patients with prostatic cancer open the possibility to introduce LH as a new additional, significant marker in diagnosis of this neoplasm.

Background/Aim. Radical cystectomy is a method of choice in the therapy of infiltrative bladder cancer. The aim of this research was to analyze postoperative course after radical cystectomy (length of hospitalization, most frequent complications and utilization of antibiotics and transfusions). Methods. We analyzed the records of 82 patients operated on in the Department of Urology, Clinical Center of Vojvodina, in a three-year period. In order to aquire data World Health Organization (WHO) has developed Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Defined daily dose (DDD) is the assumed average maintenance dose per day for a drug use for its main indication. Results. Continent urinary derivation was preformed in 23.15% cases. Postoperative complications occurred in 18.29% of patients. Average blood utilization was 2.19 units. Blood utilization for continent derivations (n = 48) was 4.6 units, and incontinent ones 3.36 units. Totally 159.33 DDD/100 bed days were used. Conclusion. When preforming continent derivation there is a significant increase in blood utilization. Frequency of postoperative complications correlates to those reported in the literature.

Introduction. In males the ectopic ureter usualy drains into the prostate (50%). During ureteric developement a thin membrane (Chawalla’s membrane) separates the lumen of the ureter and the urogenital sinus at the point where the ureter joins the urogenital sinus. This membrane ruptures allowing urin to drain from the ureter to the urogenital sinus. The authors reported a case of renal dysplasia associated with ipsilateral uretral ectopia mimicking prostatic abscess. Case report. A subfebrile (37.3°C), 23-year-old patient, otherwise healthy, presented with persistent ascending perineal pain non-responsive to antibiotics and analgetics. Digitorectal examination (DRE) showed asymmetric prostate with a soft, tender, buldging left lobe suggestive of prostatic abscess. The diagnosis was suspected using transrectal ultrasonography (TRUS), but the picture of the anechoic tubular structure in the left lobe of the prostate with a proximal undefined extraprostatic extension and a caudal intraprostatic blind end was incoclusive for the definitive diagnosis of prostatic abscess. Magnetic resonance imaging (MRI) was ordered and definitive diagnosis of renal dysplasia associated with the ipsilateral ectopic ureter filled with inflamed content mimicking prostatic abscess was made. Transurethral incision/minimal resection of the distal, blindly closed end of left ectopic ureter was done. Endoscopic surgical treatment was sufficient for relief of clinical symptoms. The patient’s recovery was uneventful. Conclusion. To the best of our knowledge, a case of renal dysplasia with the ipsilateral ectopic ureter mimicking prostate abscess has not been reported so far. Cystic pelvic malformations in males may result from too craniall sprouting of the ureteral bud, with delayed absorption and ectopic opening of the distal end of the ureter.

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In addition to the metabolic role of vitamin D, which is well known and clearly defined, there have been many hypotheses regarding its anti-proliferative and pro-apoptotic role. Epidemiology and Significance of Prostate Cancer. Prostate cancer is the second most common malignancy in men. Long period of cancerogenesis, available tumor markers and high incidence make this cancer ideal for preventive measures. Physiological Role of Vitamin D and its Effect on Prostate Cancer Cells. In vitro and in vivo studies have shown the anti-proliferative and pro-apoptopic role of vitamin D. Disorders of vitamin D metabolism are noted in vitamin D gene level, vitamin D receptor, vitamin D responsive elements and androgen receptors. We present the most important effect of those changes on vitamin D metabolism. Conclusion. Available studies on vitamin D level in serum, prostate tissue, observed activity of vitamin D enzymes and genetic changes give us only a slight insight into the basic mechanisms of vitamin D action in the development of prostate cancer; therefore, further investigations are needed. [ABSTRACT FROM AUTHOR]

Background/Aim. Radical cystectomy is a method of choice in the therapy of infiltrative bladder cancer. The aim of this research was to analyze postoperative course after radical cystectomy (length of hospitalization, most frequent complications and utilization of antibiotics and transfusions). Methods. We analyzed the records of 82 patients operated on in the Department of Urology, Clinical Center of Vojvodina, in a three-year period. In order to acquire data World Health Organization (WHO) has developed Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Defined daily dose (DDD) is the assumed average maintenance dose per day for a drug use for its main indication. Results. Continent urinary derivation was preformed in 23.15% cases. Postoperative complications occurred in 18.29% of patients. Average blood utilization was 2.19 units. Blood utilization for continent derivations (n = 48) was 4.6 units, and incontinent ones 3.36 units. Totally 159.33 DDD/100 bed days were used. Conclusion. When preforming continent derivation there is a significant increase in blood utilization. Frequency of postoperative complications correlates to those reported in the literature. [ABSTRACT FROM AUTHOR]

Background/Aim. To date, most of the scientific attention has been aimed at the morphometric analysis of the nephrogenic zone (NZ) of the fetal renal cortex, while the quantification and analysis of the maturation zone (MZ) and other indicators of renal maturity were missing. The aim of the study was to examine the characteristics of fetal kidney cortex maturation, as well as to propose the development of a new cortical maturity index (CMI). Methods. The study included 42 paraffin molds of the fetal kidney, divided into three groups according to gestational age (GA). After hematoxylin and eosin staining, tissue sections were analyzed through the following parameters: the thickness of the NZ and MZ, the renal corpuscles area (RCa) and the glomerular capillary tuft area (GCTa), and the maturation stages of the glomeruli. In addition, a new parameter, CMI, was formed as a ratio of NZ and MZ thickness. The collected data were statistically processed. Results. Changes in NZ and MZ thickness were statistically significant, and they correlated with GA. A value of CMI higher than 0.2 was recorded in the kidney samples of fetuses younger than the 20th gestational week (GW), while a value lower than 0.1 was recorded in the samples older than the 30th GW. With an increase in GA in all zones of the renal cortex, RCa and GCTa decreased. A statistically significant reduction of GCTa was observed in the oldest group in the juxtamedullary and intermediate zones of the cortex (p < 0.01). Glomeruli located in the deeper parts of the cortex were more mature than the superficial ones. Conclusion. The measured parameters can serve as a starting point for future studies that would analyze the histomorphological characteristics of the fetal kidney cortex. In the absence of clinical data, a newly formed parameter CMI can represent assistance with the determination of GA, as it significantly correlates with GA (p < 0.01). [ABSTRACT FROM AUTHOR]

Introduction. High incidences of benign prostatic hyperplasia and lower urinary tract symptoms have a high socioeconomic importance. There are several published studies which have proved the efficiency of phosphodiesterase type 5 inhibitors in treatment of benign prostatic hyperplasia and lower urinary tract symptoms. However, more studies are needed to make this therapy the standard option for treating benign prostatic hyperplasia and lower urinary tract symptoms. This study was aimed at exploring changes in International Prostate Symptom Score, post voiding residuum and maximal urine flow in benign prostatic hyperplasia and lower urinary tract symptoms patients treated by sildenafil for benign prostatic hyperplasia and lower urinary tract symptoms. Material and Methods. This study, which was conducted as a prospective, controlled, opened, randomized study, included 30 patients with benign prostatic hyperplasia and lower urinary tract symptoms. Research was conducted at the Department of Urology, Clinical Center of Vojvodina (November 2011 till November 2012). The inclusion criteria were as following: >45 years of age, International Prostate Symptom Score >3, prostatic specific antigen <10, normal urinalysis. The patients were periodically tested for International Prostate Symptom Score, maximal urine flow, and post voiding residuum. Results. Statistically significant changes were found in all parameters: mean International Prostate Symptom Score value improved from 12.8 to 8.6 (32.8% change), mean post voiding residuum value decreased from 49.4 ml to 40.2 ml (18.6% change), mean maximal urine flow value increased from 11.8 ml/s to 12.8 ml/s (8.5% change). Conclusion. Treatment of benign prostatic hyperplasia and lower urinary tract symptoms with a continuous low dose of sildenafil seems to be a good treatment choice for the patients with mild to moderate benign prostatic hyperplasia and lower urinary tract symptoms, especially in the patients with concomitant erectile dysfunction. The authors are aware that their study is limited by a small number of patients. Since there are not too many studies on this topic, they believe that their study will contribute to the determination of place and role of this treatment approach. [ABSTRACT FROM AUTHOR]

Introduction. In recent years, there has been a growing global trend in the number of people with pathogens of sexually transmitted infections. There is a worldwide lack of data on the prevalence and incidence of sexually transmitted infections in the general population, especially among the high school students. Material and Methods. We conducted a cross sectional study on attitudes and knowledge of young people about sexually transmitted infections. The survey population included young people aged 14 to 20 years attending a high school in the city of Novi Sad. The data were collected through a questionnaire. Results. The percentage of students with signs and symptoms of sexually transmitted infections was higher among the students who did not use a condom during the last sexual intercourse compared to the students who used a condom. Conclusion. Young people engaging in risky sexual behavior showed better knowledge about sexually transmitted infections in comparison to young people who did not engage in risky sexual behavior. [ABSTRACT FROM AUTHOR]

Introduction. Actinomycosis of the urogenital tract mainly manifests with formation of renal and perirenal abscesses. When it comes to treating renal lodge abscesses caused by Actinomyces bacteria, the method of choice is mainly surgical evacuation of purulent collections, followed by administration of parenteral penicillin or cephalosporin antibiotics during a six week period. The definitive diagnosis is made based on the antibiogram findings, isolation of Actinomyces israelii from abscess collection, as well as by characteristic histological findings. The exact incidence and prevalence of urogenital actinomycosis is still unknown. Case Report. A 54-year-old female patient was admitted to the Emergency Department of the Clinical Center of Vojvodina for triage. She complained of pain in the left lumbar and gluteal region, weakness, malaise, and fever. She was treated with corticosteroids under the diagnosis of vasculitis five months prior to admission. Based on clinical, laboratory blood and urine tests, ultrasound examination of the abdomen and contrast CT of the abdomen and pelvis, the diagnosis of left kidney abscess was made. It also spread to the retroperitoneum (iliopsoas muscle, gluteus maxuimus and ipsilateral inguinal region). Urgent operative exploration of retroperitoneum and kidney was performed. A lumbotomy was performed in the left half of the retroperitoneum with evacuation of abscesses, as well as partial nephrectomy of the lower half of the left kidney. Subsequently, the obtained antibiogram of operatively sampled aspirate, renal actinomycosis was histopathologically verified. The surgically removed tissue that was sent for histopathology showed presence of connective tissue infiltrated with a pronounced inflammatory infiltrate composed of lymphocytes, plasma cells, histiocytes and granulocytes with numerous microabscesses and actinomycosis colonies. [ABSTRACT FROM AUTHOR]

Penile incarceration with a foreign body is a rare urological emergency necessitating prompt intervention. We present a 59-year-old patient who entrapped penis and right testicle with metal thread reducer for sexual arousal four days prior to admission to Emergency room. Ultrasound revealed significantly reduced Color Doppler signal in right testicle and completely absent signal in penile artery. After admission metal reducer was removed using a hacksaw in analgosedation. Magnetic resonance imaging showed penile ishemic changes. Patient had reduction of penile swelling and parts of the skin highly suspected of necrosis recovered fully with preserved sensations. Despite penile ischemia on magnetic resonance imaging patient had full recovery obtaining normal erections. Patient was discharged six days after admission, presenting with  normal International Index Erectile Function on follow up exam.