Search

Introduction: Bladder tumors are the most common tumors of the urinary tract, accounting for about 5.5% of all cancers. In male it is on the 4th place, and in females it occupies the 7th place. TURBT is the gold standard for the initial treatment and diagnosis of bladder tumors. This intervention can be followed, in the case of non-muscle invasive tumors, by intravesical instillation, with a chemotherapeutic or with BCG. The aim of this work was to follow the evolution of patients with non-muscle invasive bladder tumors who have been treated with BCG (Bacillus Calmette-Guérin) immunotherapy. Matherial and methods: The study was a retrospective one, for a period of 5 years, between 2010 January 1 and 2014 December 31, including a number of 91 patients hospitalized in the Urology Clinic of Mureş County Clinical Hospital. Follow-up data at 24 months was present in 76 patients. Results: Of the 76 patients, 80.26% were male and 19.74% were female. The distribution of patients according to the environment of origin highlights the prevalence of the urban environment in the percentage of 72.36%, the rural area having a percentage of only 27.64%. The average age was 61.43 years. There was no statistically significant association between the gender of the patient and the rate of tumor recurrence. Of the 76 patients, 21 had tumor progression during the follow-up period. No patient was found to have progressed to invasive bladder tumor. Of the total number of 76 patients, at the end of the follow-up period, it was found that 8 discontinued treatment with BCG due to side effects such as: haematuria and tuberculous cystitis. In 3 patients, treatment with BCG failed and due to repeated recurrences required a total cystectomy. Conclusions: Instillational treatment with BCG immunotherapy remains the best option as an adjuvant in patients with non-muscle invasive bladder tumors to prevent recurrence and progression, in well-selected cases and with clear indication. [ABSTRACT FROM AUTHOR]

Introduction and objectives. Penile fractures is rare medical condition and is a major urological emergency. Surgery is considered the standard therapy. In some cases it can be applied a conservative therapy. This study aims to assess the results of the two therapies in penile fractures. Material and Methods. Between January 2007 and October 2019 in Tirgu Mures Urology Clinic a total of 6 patients were admitted with penile fracture. At 4 of these patients we performed surgery intervention for treatment of penile fracture and at 2 of them conservative therapy because they refused surgery. We followed hospitalization period, the occurrence of penile angulation during erection and erectile function at more than 3 months post therapy using International Index of Erectile Function (IIEF). Results. Mean age was 37,35 years for patients with surgical therapy vs 22 years for patients with conservative treatment. Average days of hospitalization was 8,75 days vs 9 days. Average IIEF 1-5,15 at 3 months after surgery was 23,25 for the patients who undergone surgery and 27 for the patients with conservative treatment. Average IIEF 1-5,15 at 12 months after surgery was 22 for the patients who undergone surgery and 28 for the patients with conservative treatment. 2 patients with penile fracture were not subsequently presented to the control and we do not have data about erectile function at 12 months. In 1 patient with conservative treatment there was a slight angulation of about 10 degrees. The patient who had concomitant urethral involvement with the penile fracture had erectile dysfunction prior to trauma. For all patients with penile fracture we recommended a period of sexual abstinence for 8 weeks. Conclusions. Penile fracture although it is a rare pathological entity, it must be quickly diagnosed. The indicated treatment is the surgical one, the only one that ensures a reduced rate of complications. The conservative treatment being indicated only to the patients who refuse the surgery. Even though in our study erectile function was superior for patients treated conservatively, this is due to the presence in the group of patients treated surgicaly of a patient with middle/severe erectile dysfunction. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. In the EAU guidelines the percutaneous nephrolithotomy (PCNL) is the main indication for kidney stones with dimensions over 2 cm. Early recognition of the colonic perforation an important step in limiting an infection that can lead to subsequent sequelae The objectives of this study is to evaluate the cases in which colonic perforation has occurred, both in terms of possible favoring factors and from the perspective of the treatment applied and of the subsequent evolution of the patient. Material and Methods. Between January 2009 and January 2019 we performed 1394 PCNL interventions. All patients were operated in prone position. We analyzed the cases in which the colonic perforation appeared. Positive diagnosis was made after computerized tomography. We took into account the patients' age, sex, previous surgical history, body mass index, time to diagnosis of colonic perforation, type of treatment applied in this complication, length of hospitalization as well as case evaluation at 6 weeks and 6 months, respectively. Results. Of the 1394 patients in whom we performed PCNL, colonic perforation appeared in 4 of them, all female patients. A conservative treatment was applied to all patients. In patients with colonic fistula on the left side, healing was done without complications. In the patient with colonic fistula on the right side at 4 days postoperatively, surgery was required which resulted in the right colectomy. The ureteral stent was suppressed in all patients 6 weeks after discharge. The control at 6 weeks and at 6 months revealed a kidney without lithiasis, sterile urine culture or sequelae of the colonic fistula. Conclusion. Colon perforation is a severe complication after PCNL. Factors favoring these complications should be recognized preoperatively and thus the risk of colonic perforation can be reduced. Conservative treatment can be applied especially in cases where colonic perforation occurs following a PCNL performed on the left side. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. To evaluate long-term overall survival and predictive factors after TURBT and adjuvant intravesical Bacillus Calmette-Guérin (BCG) treatment, in patients with T1 bladder cancer. Materials and Methods. We retrospectively analyzed, 53 patients who underwent transurethral resection of bladder tumor (TURBT) for intermediate and high-grade T1 non-muscle invasive bladder cancer (NMIBC) followed by BCG instillations at our clinic between 2006 and 2008. Primary end-point was overall survival (OS). Data about survival were obtained from the National insurance registry. Survival analysis was performed using the Kaplan Meyer method, and the log-rank test was used for univariate comparisons. Univariable and multivariable Cox regression models addressed the association of prognostic factors with OS. Results. Median follow-up was 79 months (IQR 58-110 months), 33 (62.3%) patients died. In our study, males were 43 (81.13%) and females 10 (18.86%), 41 (77.35%) patients had tumors over 3 cm in diameter, 37 (69.81%) with multiple tumors at diagnosis and 43 (81.13%) patients with high risk tumors (G3). In univariable analysis, clinico-pathologic factors such as age (p=0.003) and recurrence of tumors (p=0.005) were associated with worse OS. In multivariable analysis, independent predictors of OS were gender (HR1.06, 95% CI 1.02-1.11, p=0.002), multifocality (HR 3.03, 95% CI 1.15-7.92, p=0.024) and tumor grade (HR3.59, 95% CI 1.23-10.14, p=0.019). Progression rate was 11.3%%. Recurrence rate was 30.2%. Five year overall survival was 72.2% (95%CI: 58.2-82.2) and at 10-yr 37% (95%CI: 24.4-49.6). Limitations include retrospective design, mono-center study and small sample size. Conclusions. Our study supports current evidence that BCG therapy with maintenance is an effective and safe therapy for T1 bladder cancer patients and it is a viable option for long-term use in such patients. We found that age and recurrence of tumors were associated with poor overall survival. Elderly patients should be strictly monitored and in recurrence patients alternative options may be offered. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Horseshoe kidney (HSK) is the most common renal fusion anomaly, affecting about 0.25% of the newborn. Sometimes this condition is associated with the obstruction of the ureteropelvic junction, lithiasis, is not uncommon for renal infections, abdominal masses and haematuria. For these patients, treatment of urolithiasis represents a particular challenge. ESWL is considered the first-line treatment for the majority of cases. Materials and Methods. We performed a retrospective review of all patients with horseshoe kidney treated and followed at the Urology Clinic of Targu Mures, from 23 July 1991 to 31 December 2017. All patients with stones within a horseshoe kidney that met the following inclusion criteria: a clear urinary path distal of the location of the stone, a functional kidney without stasis and the stone size ≤ 20 mm who underwent ESWL were included in the analysis. We performed a total of 158 ESWL treatments, with a mean of 1.95 ESWL procedures / stone. 3-months follow-up data were available for 60 patients. Results. From our patients 43 (53.08%) were men and 38 (46.92) were women. The average age was 46.32 years. The average size of the stone was 10.316 mm. Major complications after ESWL treatment were subcapsular renal hematoma in one case (1.23%) which only needed supportive care and observation, acute pyelonephritis in one case (1.23%), treated with appropriate antibiotics, hematuria with vesical globe in two cases (2.46%) which needed bladder washouts and catheterization with a three way catheter, with irrigation. Additional pathologies were present in 38 patients (46.91%), 16 had urinary tract infections (treated with the appropiate antibiotics before the ESWL), 12 patients had hypertension, 3 patients had type II diabetes and 16 suffered from obesity. Stone-free at 3 months was 70.31%. Conclusions. We can safely say that ESWL is a good and safe option of treatment in patients with horseshoe kidney if it is performed by a physician with extensive experience in this field. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The ureteropelvic junction (UPJ) dysfunction, having as consequence hydronephrosis, was traditionally treated surgically by pyeloplasty, the rate of success being 71-98%. Failure was followed by one of the following interventions: repeating pyeloplasty, replacement with ileum, ureterocalicostomy, renal autotransplantation and, lastly, nephrectomy. We evaluate the role of endopyelotomy in the management of ureteropelvic junction obstruction. Materials and Methods. In a period of 27 years (1987-2014), we performed a total of 833 endopyelotomies. In our study (1987-2002), we retrospectively identified 303 patients who underwent endopyelotomy for ureteropelvic junction obstruction, who came for regular check-ups. Patient demographics, operative information, complications and success rates were reviewed for 187 patients, who could be properly assessed, with a mean age of 51 years and mean follow-up of 44 months. Treatment success was defined as the absence of symptom recurrence and improved radiographic features on ultrasound, intravenous pyelography at most recent follow-up. Results. endopyelotomy data were analyzed in 187 patients. The success rate was 83.9%. Treatment failure occurred in 30 (16%) patients. There were 20 (10.69%) cases of ureteral hypoplasia with less favorable results. Four patients (2.13%) with renal-ureteral duplication had surgical failure at 6 to 12 months reevaluation. Four patients (2.13%) were found with renal ptosis and two patients (1.06%) with horseshoe kidney in which endopyelotomy failed. Conclusions. Antegrade endopyelotomy is a minimally aggressive surgical intervention in both children adults and the elderly. The endoscopic percutaneous approach of ureteropelvic junction allows solving of associated disorders, such as renal lithiasis. Laparoscopic and robotic assisted pyeloplasty are emerging as the gold standard of treatment for ureteropelvic junction obstruction, endopyelotomy it is the treatment of choice for failed open or laparoscopic pyeloplasty and concomitant renal calculi. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Congenital anomalies occur more often in the kidney than in any other organ. The association of abnormalities with stones has important clinical relevance. Our goal was to determine the clinical success and stone-free rates for patients with renal anomalies treated with ESWL. Materials and Methods. We performed a retrospective review of patients with renal anomalies treated at the Urology Clinic of Targu Mures, since January 2004 to December 2014. The inclusion criteria were: a clear urinary path distal of the location of the stone, a functional kidney without stasis and the stone size ≤ 25 mm ( 118 patients). We performed a total of 184 ESWL treatments (a mean of 1.559 ESWL procedures/stone). 3-month follow-up data were available for 88 patients. Results. Of the total ESWL procedures performed, 35 (29%) were horseshoe kidneys, 48 (41%) duplex kidneys, 15 (13%) malrotated kidneys, 13 (11%) ectopic kidneys and 7 (6%) hypoplastic kidneys. From the total of patients, 57 were women and 61 men. The mean age was 43.26 years. The average size of the stone was 10.228 mm. The average pacient stay was 4.77 days. Complications were subcapsular renal hematoma in two (1.69%) cases, acute pyelonephritis in two (1.69%) pacients, hematuria with vesical globe in another two (1.69%) cases and stone-street formation in 10 (8.47%). In 3 cases (2.54%) the procedure was unsuccessful and retrograde ureteroscopy was needed. Associated pathology was pressent in 61 pacients (51.69%): 21 (17.79%) presented urinary tract infection, 17 (14.41%) pacients were diagnosed with hipertension, 2 (1.69%) with diabetes and 21 (17.79%) suffered by obesity. Stone-free rate was 71.77%. Conclusions. In our oppinion ESWL is the treatment of choice for reno-ureteral lithiasis in renal malformations because is a non invasive treatment, no need for anestesia, the pacient stay is short, complications occure rarely and stone free rate is high. [ABSTRACT FROM AUTHOR]

The study was performed on 45 patients with heart transplantation out of which 30 presented serologic cytomegalovirus infection. For histological study we used: hematoxylin eosin, van Gieson, Masson's trichrome, green methyl pironin stains. Immunohistochemistry was performed using ABC technique (avidin - biotin complexes or avidin - biotin) with the following monoclonal antibodies: CD8, CD4, CD20, CD68, CD31, CD45 RO, HLA-DR, and E13. In many of our cases cytomegalovirus infection was commonly associated with acute rejection. The presence of endothelial cells expressing HLA-DR antigens and subendothelial accumulation of activated T lymphocytes and macrophages, often in contact with endothelial cells, highlights the role of cellular immunity in the production of accelerated atherosclerosis lesions. [ABSTRACT FROM AUTHOR]

The etiological role of HPV infection in the pathogenesis of bladder tumors remains uncertain. Case-control study, NMIBC patients answered a 37 items questionnaire regarding knowledge of HPV, were compare with a healthy control group. Group A started earlier the sexual life than the group B (18 vs. 19 years), but the first cohabitation took place later (37 vs. 24 years, p = 0. 03).Group A had more sexual partners than group B (>10, 32% respectively 17.6%). 56% of patients with NMIBC heard about HPV infection and only 47% of controls and 32% of group A respectively 41% of group B didn't know if HPV infection represents a risk for their health. From this study results a lack of knowledge about HPV infection in NMIBC patients. [ABSTRACT FROM AUTHOR]

We will present the case study of a 61 years old Caucasian female patient who required a dermatological consult for two well defined painful ulcerations on her right leg, with overhanging borders, a geographical erythematous-purplish outline and a surface covered with adherent necrotic deposits. Ten years prior she was diagnosed with Sjögren's syndrome. After skin biopsy, pyoderma gangrenosum diagnostic was established, a rare finding in a Sjögren's syndrome patient. Systemic corticotherapy and chemical debridement of the lesions proved a successful treatment method. [ABSTRACT FROM AUTHOR]

Background: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial., Objective: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management., Design: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference., Setting: Online Delphi survey and consensus conference., Participants: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management., Outcome Measurements and Statistical Analysis: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus)., Results and Limitations: Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease., Conclusions: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)