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Aim: To present a case in which a malignant neoplasm of the kidney is the cause of Wunderlich syndrome and point out the importance of recognizing this syndrome in clinical practice. Case report: A male patient came to the emergency unit with pain in his left hemiabdomen, nausea, dizziness, and a darker stool. Physical examination did not reveal any pathological findings, but ultrasound examination revealed a more abundant perirenal collection. A detailed examination and CT finding revealed a mass on the upper pole of the left kidney as well as a more extensive perirenal hematoma. The urgent nephrectomy was performed and pathohistological findings confirmed that it was renal cell carcinoma (clear cell subtype). Two years later, the patient reappeared in the emergency department of the hospital due to severe paraparesis. After physical examination, the patient was sent for magnetic resonance imaging, which showed secondary pathological remodeling at several levels of the thoracic spine and the spread of the pathological process in the spinal canal. The patient then underwent laminectomy with reduction of the tumor in the spinal canal and the sample was sent for pathohistological analysis. Immunohistochemical staining confirmed renal cell carcinoma metastases. The patient was then sent for further oncological treatment. Conclusion: Wunderlich syndrome has an extremely rare occurrence in urological practice but should be included in the differential diagnosis in patients presenting with lumbar pain, palpable mass and signs of shock. This syndrome is most frequently associated with benign renal neoplasms, but, as in our patient, may be associated with malignant tumors. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to examine students’ awareness of testicular tumors, their knowledge of self-examination, and motivation to learn more about the disease. Subjects and Methods: The survey was conducted among 116 students of the University of Rijeka. The first group (42 students) consisted of first year students of the Department of Informatics, the second group consisted of 44 students of the second year of the Department of Informatics and the third group consisted of 30 young men of other student population. The survey used an anonymous survey questionnaire with 18 questions. Results: The median age of the participants in the first and third group was 19 years and 20 years in the second group. The largest number of students came from Primorje-Gorski Kotar County. The information about testicular tumor was known in 71.4% of students in the first group, 93.2% of students in the second group and 90% of students in the third group. The most important source of information for all three groups is the Internet and television. The testicular self-examination was done by 57.8% of the participants, and only 45.7% knew how to do it properly. Conclusions: Students are familiar with testicular tumors via the Internet and television and are eager to be better informed. Testicular self-examination, the method that can detect this disease, is conducted by only 50% of students, and less than 50% know how to do it, which is unsatisfactory. The data of our study show that it is necessary to educate students about this health problem. [ABSTRACT FROM AUTHOR]

Kidney transplantation is the most efficient method of renal replacement therapy. When this method is performed, native urinary bladder is the preferred urinary reservoir. However, in some patients with an anatomically and functionally abnormal lower urinary tract, the urinary bladder cannot be used for transplantation. In these patients, urinary diversion should be performed before kidney transplantation. We present a case of a 32-year-old male patient with orthotopic kidney transplantation performed using a colon pouch (Mainz-pouch III). He was born with severe anomalies including sacral agenesis, anorectal atresia, and hypospadias, which were corrected during childhood. Neurogenic bladder with severe vesicoureteral reflux led to end-stage renal disease. This dysfunctional bladder was unsuitable for kidney transplantation, and a staged approach for future transplantation was chosen. The first step was the creation of urinary diversion. Due to a short appendix, we created a continent, colon pouch (Mainz pouch III). Two years later, orthotopic kidney transplantation was performed using a right cadaveric kidney. The renal vessels were anastomosed to the aorta and inferior vena cava and the pyelon to the native ureter. Four years after transplantation, the patient has stable renal function without any complications. This is the first documented case of using Mainz-pouch III as a reliable option for kidney transplantation in selected patients. [ABSTRACT FROM AUTHOR]

Aim: To present a case with spontaneous, non-traumatic, perirenal haemorrhage (Wünderlich syndrome) as a first manifestation of renal cell carcinoma. Case report: A 37-year-old female was admitted to the emergency unit with sudden and severe pain in the left lumbar area of abdomen. She had normal voiding, without macrohaematuria or trauma in her medical history. Because of her generally instable state she was referred to emergency multi-slice computed tomography (MSCT) exam of the abdomen and pelvis which reveals inhomogeneous mass in the upper pole of the left kidney. Radiology report indicated perirenal haemorrhage most likely caused by an angiomyolipoma. The patient was operated on by urologist who performed a partial nephrectomy of the left kidney and evacuation of haematoma. Samples were taken for histopathology and cromophobe renal cell carcinoma which caused the perirenal haemorrhage was diagnosed. Our patient is controlled on a regular basis, without signs of tumour recurrence. Conclusion: Wünderlich syndrome as the first manifestation of renal cell carcinoma is a very rare but life-threatening manifestation of renal cancer that warrants urgent surgery. MSCT of the abdomen and pelvis is a method of choice in haemodynamically unstable patients with acute abdominal/lumbar pain. [ABSTRACT FROM AUTHOR]

Aim: To evaluate incidence, clinical evaluation and surgical treatment of our patients with renal cell cancer (RCC). Patients and methods: We retrospectively analyzed all patients with RCC operated in University Hospital Rijeka from January 1st 1972 to December 31st 2012. Results: In observed period 1045 patients were operated because of RCC. Number of operated patients has increased during time from 5 in the begining of 70-ties to more than 50 in the few last years. The number of asymptomatic patients has increased from 6% to 75%. The mean age was 63 years (range 21-86). Nephrectomy wasperformed in 95.3% patients, nephron sparing surgery in 2.6% and explorative lumbotomy in 2,1% of patients. The 5-year survival was 64% and 10-year survival 47%. Conclusion: The incidence of RCC substantialy increased during time. The new diagnostic methods found RCC in earlier phase and the nephron sparing surgery can be performed without negative influence on oncological outcome. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is characterized with proliferation of glandular and stromal components of the prostate. BPH can produce prostate enlargement and caused lower urinary tract symptoms (LUTS). The growth of the prostate depends on patient's age and influence of sexual hormones, specially dihydrotestosterone. Symptoms can be divided as irritative, obstructive and postmicturation symptoms. The basic evaluation included medical history, symptom score questionnaire, bladder diary, physical examination, urinalysis, creatinine and prostate specific antigen serum concentration, uroflowmetry and postvoid residual urine. The modality of treatment depends about patients symptoms and results of diagnostic evaluation. The initial step in the treatment are behavioural and dietary modifications. In the patients with mild symptoms watchful waiting is first line treatment. In the other patients medicamentous treatment is recommended. Pharmacological management included: alpha adrenoreceptor antagonists, 5-alpha-reductase inhibitors, muscarin receptors antagonists, vasopressin analogue - desmopressin, beta-3 agonists, phosphodiesterase 5 inhibitors, phytotherapy and combination therapy. If the medicamentous therapy failed or the complications of BPH are present surgical treatment is recommended. [ABSTRACT FROM AUTHOR]

We report a case of a kidney-transplanted patient with urolithiasis treated with minipercutaneous laser lithotripsy. The patient presented with renal dysfunction and graft hydronephrosis. Diagnostic procedures revealed ureterolithiasis as a cause of obstruction, and percutaneous nephrostomy was inserted as a temporary solution. Before surgery, the stone migrated to the renal pelvis. Mini-percutaneous laser lithotripsy was successfully performed, and during surgery, all stone fragments were removed. Six months after successful treatment, the patient has good functioning and stone-free graft. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common malignancy in men. The 5-year relative survival for all stages combined is 98.8%. Patients diagnosed with metastatic prostate cancer have median survival from 2 to 3 years. We describe a case of 64-year old man who clinically presented with inguinal lymphadenopathy. Because of elevated PSA levels biopsy of prostate was done and adenocarcinoma was diagnosed. Biopsy of inguinal lymph nodes confirmed the diagnosis of prostate cancer. Hormonal treatment was started and at the most recent follow-up, 10 years later, the patient is asymptomatic with no clinical signs of disseminated disease. [ABSTRACT FROM AUTHOR]

Voiding dysfunction is frequently seen in the early posttransplant period. Among other causes, this condition can arise due to bladder outlet obstruction. Primary bladder neck obstruction (PBNO) is a possible but very rare cause of bladder outlet obstruction. We present the case of a 52-year-old woman who, after kidney transplantation, presented with PBNO. The diagnosis was established based on symptoms, uroflowmetry, and multichannel urodynamics with electromyography. The transurethral incision of the bladder neck was made at the 5- and 7-o’clock position. After the operation, the maximal flow rate was significantly increased, and postvoid residual urine was decreased compared to the preoperative findings. The patient was followed for 5 years, and her voiding improvement is persistent. This is the first reported case of PBNO treated with a transurethral incision of the bladder neck in a posttransplantation female patient. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney. The major goal of imaging techniques is to correctly differentiate between benign and malignant renal lesions. We present the cases of six patients with renal masses that were interpreted completely differently based on ultrasound (US) and computerized tomography (CT) findings. From January 1st, 2008 to March 1st, 2014, 307 patients from our center underwent nephrectomy for RCC. In all patients US and CT were performed before the operation. In six patients, the US indicated a focal, solid renal lesion that was interpreted by CT as a cystic lesion (Bosniak II-III). Because discrepancies were evident, renal biopsies were performed. The biopsies revealed RCC in the six patients, all of whom underwent subsequent nephrectomy. All of the patients were confirmed to have macroscopically solid RCC without any cystic components. In most cases, CT is the most accurate diagnostic technique for the clinical diagnostic classification of renal masses. In cases where US characterizes a renal lesion as solid, despite CT findings of a cystic lesion, kidney biopsies are recommended. The 6 cases reported here support our belief that, in diagnostic processes of RCC, these techniques should be complementary used. [ABSTRACT FROM AUTHOR]

Introduction: Bone morphogenetic proteins (BMPs) have been studied in several cancers, but only limited information is available about renal cell carcinomas (RCCs). We determined the expression of mRNA of several BMP ligands and BMP receptors (BMPRs) in healthy kidney tissue and RCCs, and data were compared to clinicopathological parameters. Material and Methods: Sixty-four samples of RCCs and healthy renal tissues were prospectively examined. The expression of BMP2, BMP4, BMP6, BMP7, BMPRIA, BMPRIB and BMPRII mRNA was determined using semiquantitative reverse transcriptase-polymerase chain reaction. Results: The expression levels of different BMP ligands and BMPRs were considerably higher in RCCs than in normal kidney tissue. BMP ligands showed elevated expression in clear-cell RCCs, whereas all three BMPRs showed higher expression levels in non-clear-cell RCCs. In clear-cell RCCs, the expression levels of BMP2 progressively increased and expression levels of BMP6, BMP7 and BMPRIB were lost with higher tumor stage. Conclusions: All BMPs and their receptors have stronger expression levels in RCC. The expression level of BMP2 is strongly elevated in kidney cancer. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Spontaneous, nontraumatic retroperitoneal hemorrhage or Wunderlich syndrome (WS) is a rare but potential life-threatening condition. In most patients a bleeding renal neoplasm is the cause of the retroperitoneal hematoma. The management of this condition includes a conservative approach in the hemodynamically stable patients and active treatment in the unstable patients. Active treatment includes angioembolization or surgery. If angioembolization is not available open surgery is in most cases the preferred approach. We present a patient with a spontaneously ruptured kidney due to a central renal angiomyolipoma, which was treated by laparoscopic nephrectomy. [ABSTRACT FROM AUTHOR]

Wünderlich syndrome (WS) is a urological emergency characterized by retroperitoneal hemorrhage. In most cases, bleeding occurs from a renal angiomyolipoma (AML) and may be the first manifestation of the disease. We report a female patient with bilateral WS due to the metachronous rupture of renal AMLs. Because the patient was stable and the tumor was not malignant, treatment was conservative. Follow-up revealed the full recovery of kidney function and the resolution of the hematoma. [ABSTRACT FROM AUTHOR]

Premature ejaculation is one of the most common sexual problems of men. Annoyances are affected by both partners, and solving the problem should be approached as soon as possible. Urologists are part of a multidisciplinary team made up of psychiatrists, psychologists, psychotherapists, sexologists, endocrinologists, family doctors and trained nurses. Since the etiology and possible diagnostic and therapeutic methods, only approach with the active participation of the patient and his partner can lead to satisfactory results. This article describes the etiology and types, as well as diagnostic methods and treatment of premature ejaculation. [ABSTRACT FROM AUTHOR]

Aim. To explore personal biography of Vinko Frančišković (1919-1984), to improve the understanding of the beginnings of Croatian cardiothoracic and transplantation surgery. Methods. Comparative critical analysis of written published materials, archival materials and information collected through oral history interviews. Results. Vinko Serafin Frančišković was born in Praputnjak, a settlement of the eastern surroundings of Rijeka, Croatia. He was raised up in the Italian language and culture by his aunt, a mother's sister and her husband. He went to the Royal Classical Grammar School Giovanni Prati in Trento. On July 15, 1943, he defended his thesis, titled A contribution to the surgical therapy of fractures of the femoral neck at the Faculty of Medicine, University of Padua. Conclusion. The represented data about Vinko Frančišković's life, especially those concerning his secondary and higher education, explain some of his crucial personal traits and his later professional pathway. [ABSTRACT FROM AUTHOR]

Urodynamics is a method for evaluation of urinary tract function, specially lower urinary tract. Lower urinary tract is a unique functional entity consisted of urinary bladder, sphincteric mechanism and urethra. Their main function is storage of urine, voiding and continence. Urodynamics is used for evaluation of all this functions. Urodynamics is performed as adjunct to the basic clinical evaluation. The most frequently used methods are uroflow, cistometry, and urethral profilometry. Uroflow represent urinary flow during micturation. Cistometry is used for measurement of pressures during storage and expulsion of the urine. Urethral profilometry measured urethral pressure and show data about patient's continency. In this review article we present basic information about urodynamic tests with clinical examples. [ABSTRACT FROM AUTHOR]

Aim: Autosomal dominant polycystic kidney disease is the most common renal hereditary disease. During many years renal cysts become larger, the functional nephron mass decreases and enlarged kidneys compress the surrounding structures. We present the case of a patient with polycystic kidney disease and inferior vena cava thrombosis after kidney transplantation. Case report: Three months after kidney transplantation into the left iliac fossa, the 67 year-old woman was admitted to our hospital due to swelling oft the right leg. Clinical and ultrasound examination revealed deep vein thrombosis of right leg and therapy with heparine was introduced. Since there was no improvement, a computerized tomography examination was performed that confirmed deep vein thrombosis of the right leg, thrombosis of iliac veins on the right side and partial thrombosis of the distal part of the inferior vena cava. As radiologic imaging revealed compression of the right polycystic kidney onto the inferior vena cava, we performed nephrectomy of the polycystic kidney to prevent complete thrombosis. The postoperative course was uneventful, with a regression of the right leg edema and stable graft function. Discussion and conclusion: In patients with large polycystic kidneys, compression of the inferior vena cava may lead to its thrombosis. A nephrectomy should be performed in time. [ABSTRACT FROM AUTHOR]

Aim: To present our results in the treatment of nephrolithiasis using mini percutaneous nephrolithotripsy (miniPCNL). Patients and methods: We retrospectively analyzed all patients with nephrolithiasis treated with miniPCNL in Department of Urology, University Hospital Rijeka from August 1st 2015 to December 31st 2016. Results: In observed period 6 patients were operated with this novel method and one has transplanted kidney. In allpatients lithotripsy was successfully performed with holmium laser. On the control x-ray the residual fragments were not found in any patients. Postoperatively, in four patients febrility was noticed and successfully treated with antibiotics. Neither the one patient need reoperation, auxiliary procedures or blood transfusion. Conclusion: Mini percutaneous nephrolithotripsy is a minimally-invasive method which is successfull and safe method in the treatment of kidney stones. [ABSTRACT FROM AUTHOR]

Objectives: Computerized tomography (CT) is the most accurate method for evaluating pelvic calcifications, which are of utmost importance for planning kidney transplantation (KT). The aim of our study was to evaluate the incidence and distribution of iliac artery calcifications and correlate the novel pelvic calcification score (PCS) with cardiovascular risk factors and graft and overall survival in KT patients. Methods: We retrospectively included 118 KT patients operated at our institution with pretransplant pelvic CT. Calcification morphology, circumference and length of both common and external iliac arteries were independently scored by two uroradiologists. PCS was calculated as the total score sum of all three calcification features in all vessels. PCS correlation with graft and patient survival was performed. Results: Calcification in at least one vascular segment was found in 79% of patients. PCS was significantly higher in male patients (p = 0.006), patients over 55 years (p < 0.001), and patients on haemodialysis (p = 0.016). Patients with a PCS >3 had significantly shorter graft and overall survival rates (p = 0.041 and p = 0.039, respectively). Conclusions: The extent of iliac artery calcification in KT recipients quantified by PCS on pretransplant CT correlates with graft and overall patient survival. A PCS over three was associated with worse clinical outcomes and could become a possible prognostic factor. Advances in knowledge: Our novel PCS is a robust method for quantifying iliac artery calcification burden. Since higher a PCS correlates with worse patient and graft survival, PCS has the potential to become a prognostic factor in kidney transplant patients. [ABSTRACT FROM AUTHOR]

Objectives: Computerized tomography (CT) is the most accurate method for evaluating pelvic calcifications, which are of utmost importance for planning kidney transplantation (KT). The aim of our study was to evaluate the incidence and distribution of iliac artery calcifications and correlate the novel pelvic calcification score (PCS) with cardiovascular risk factors and graft and overall survival in KT patients. Methods: We retrospectively included 118 KT patients operated at our institution with pretransplant pelvic CT. Calcification morphology, circumference and length of both common and external iliac arteries were independently scored by two uroradiologists. PCS was calculated as the total score sum of all three calcification features in all vessels. PCS correlation with graft and patient survival was performed. Results: Calcification in at least one vascular segment was found in 79% of patients. PCS was significantly higher in male patients (p = 0.006), patients over 55 years (p < 0.001), and patients on haemodialysis (p = 0.016). Patients with a PCS >3 had significantly shorter graft and overall survival rates (p = 0.041 and p = 0.039, respectively). Conclusions: The extent of iliac artery calcification in KT recipients quantified by PCS on pretransplant CT correlates with graft and overall patient survival. A PCS over three was associated with worse clinical outcomes and could become a possible prognostic factor. Advances in knowledge: Our novel PCS is a robust method for quantifying iliac artery calcification burden. Since higher a PCS correlates with worse patient and graft survival, PCS has the potential to become a prognostic factor in kidney transplant patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate the prognostic value of the local NK cell count in patients with recurrent non-muscle-invasive bladder cancer. Methods: The archival paraffin-embedded primary tumor specimens were derived from retrospectively-selected patients, who were treated between 1996 and 2001 for bladder cancer. The study group consisted of 46 patients who developed recurrent disease during their first two post-operative years. The control group consisted of 27 patients who did not develop recurrent disease during their first two post-operative years. Specimens were assessed immunohistochemically with standard "ABC" technique. The frequency of NK cells was expressed as total number, estimated for each tumor by counting the positive NK cells in 10 high-power representative fields. Statistical analysis was done using Kruskal-Wallis test. Results: Patients with recurrent non-muscle invasive bladder cancer in general have significantly higher values of stromal NK cell count than the control group. Patients with single tumor and smaller tumors show a statistically significant difference in NK cell count between study and control group. There also exists a statistically significant difference in stromal NK cell count in patients with clinical stage Ta tumor. Conclusions: Our results confirm an association of the bladder wall NK cell count in bladder cancer patients with the natural history of disease. Further well-performed, reproducible, large, prospective investigation stratified by clinical parameters, such as tumor number and diameter, is needed to display the true value of this marker in the clinical work-up of bladder cancer patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Bladder cancer is a common cancer of the urinary tract, characterized by high metastatic potential and recurrence. The research applies a transfer learning approach on CT images (frontal, axial, and saggital axes) for the purpose of semantic segmentation of areas affected by bladder cancer. A system consisting of AlexNet network for plane recognition, using transfer learning-based U-net networks for the segmentation task. Achieved results show that the proposed system has a high performance, suggesting possible use in clinical practice. Urinary bladder cancer is one of the most common cancers of the urinary tract. This cancer is characterized by its high metastatic potential and recurrence rate. Due to the high metastatic potential and recurrence rate, correct and timely diagnosis is crucial for successful treatment and care. With the aim of increasing diagnosis accuracy, artificial intelligence algorithms are introduced to clinical decision making and diagnostics. One of the standard procedures for bladder cancer diagnosis is computer tomography (CT) scanning. In this research, a transfer learning approach to the semantic segmentation of urinary bladder cancer masses from CT images is presented. The initial data set is divided into three sub-sets according to image planes: frontal (4413 images), axial (4993 images), and sagittal (996 images). First, AlexNet is utilized for the design of a plane recognition system, and it achieved high classification and generalization performances with an A U C m i c r o ¯ of 0.9999 and σ (A U C m i c r o) of 0.0006. Furthermore, by applying the transfer learning approach, significant improvements in both semantic segmentation and generalization performances were achieved. For the case of the frontal plane, the highest performances were achieved if pre-trained ResNet101 architecture was used as a backbone for U-net with D S C ¯ up to 0.9587 and σ (D S C) of 0.0059. When U-net was used for the semantic segmentation of urinary bladder cancer masses from images in the axial plane, the best results were achieved if pre-trained ResNet50 was used as a backbone, with a D S C ¯ up to 0.9372 and σ (D S C) of 0.0147. Finally, in the case of images in the sagittal plane, the highest results were achieved with VGG-16 as a backbone. In this case, D S C ¯ values up to 0.9660 with a σ (D S C) of 0.0486 were achieved. From the listed results, the proposed semantic segmentation system worked with high performance both from the semantic segmentation and generalization standpoints. The presented results indicate that there is the possibility for the utilization of the semantic segmentation system in clinical practice. [ABSTRACT FROM AUTHOR]

We present a case of necrotizing vasculitis with the testicle as the isolated affected organ. A 25-year-old man, pretreated for epididymo-orchitis, presented with a presumed testicular neoplasm. Radical orchiectomy was performed and diagnosis of necrotizing vasculitis was established. In the absence of any other sign of systemic disease, the diagnosis of isolated necrotizing vasculitis of the testis was confirmed. Two years after the operation, the patient showed no symptoms of systemic disease. [ABSTRACT FROM AUTHOR]

Studies show insufficient sensitivity of virtual non-contrast (VNC) reconstructions for stone detection in dual-energy CT urography (DE-CTU). The aim of this study was to investigate if side-by-side-evaluation of both VNC and post-contrast images could increase the sensitivity of single-phase split bolus DE-CTU. Consecutive patients with haematuria who underwent split bolus DE-CTU on the same dual-source DE-CT scanner were retrospectively enrolled in the study. Intravenous furosemide and oral hydration were employed. Two readers, independently and then jointly in two separate sessions, recorded the location and the longest axial stone diameter on three randomised sets of images: separate VNC and post-contrast images, and side-by-side-reconstructions. True non-contrast (TNC) images served as the standard of reference. A total of 83 urinary stones were detected on TNC images. Independent reader side-by-side-evaluation of VNC and post-contrast images yielded higher stone detection sensitivity (76 and 84%, respectively) compared to evaluation of only VNC (71 and 81%, respectively) or post-contrast images (64 and 80%, respectively). The sensitivity of joint reader evaluation of side-by-side-images reached almost 86% and was not significantly different from TNC images (p = 0.77). All stones larger than 3 mm were correctly detected by side-by-side-evaluation. Dose reduction of 55% could be achieved by omitting TNC scans. Side-by-side-VNC and post-contrast image evaluation enable detection of clinically significant urolithiasis on single-phase split bolus DE-CTU with significant dose reduction. This study shows that single-phase DE-CTU is feasible if VNC imaging is simultaneously utilised with post-contrast images. [ABSTRACT FROM AUTHOR]