Introduction The optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes. Materials and methods The retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session. Results The mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r2 =0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively). Conclusions Extracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome.

Aim A standardized assessment for the optimal repair of hypospadias remains elusive. The aim of this study was to assess a postoperative cosmetic outcome of hypospadias repair using a validated questionnaire, Hypospadias Objective Scoring Evaluation (HOSE). Methods During the period between January 2016 and May 2019, 40 patients who underwent hypospadias repair were identified and they agreed to a follow-up using the HOSE. Distal hypospadias repairs underwent a cross-sectional assessment of the cosmetic outcome. Cosmetic assessment was performed by an independent physician using the HOSE scoring system. Results The native meatus was coronal in 10 (25%), subcoronal in eight (20%), and distal penile in 22 (55%) patients. Mean followup was 35.90 months (SD ±29.58) postoperatively (range 12-162 months). Complications occurred in one (2.5%) patient. Out of 40 uncomplicated repairs, 39 (97.5%) were satisfactory. A vertical slit-like meatus located at the distal glans was created in 33 (82.5%) boys, and at the proximal glans in seven (17.5%). The urinary stream was single and straight in 39 and spray in one patient. A straight erection was observed in 39 (97.5%) boys. The median HOSE score was 16 (range 12-16). One patient had a small, single coronal fistula. The technique used included tubularised incised plate urethroplasty. Conclusion The HOSE score is simple, easy, non-invasive and non-expensive tool for objective assessment of long-term outcomes of hypospadias repair.

Summary Patients are selected for radical prostatectomy with a disease limited to the organ, satisfying general condition and enough long life expectancy. Postsurgical findings often point out more advanced disease or less differentiated cancer compared to findings upon which an indication for prostatectomy was made, what affects prognosis and points out need for adjuvant treatment. The study is aimed at establishing in what manner the clinical stage and grade of the disease correlate to the definitive histological finding. The investigation was done in 80 patients with histologically proven, clinically organ confirmed prostate cancer, and initial PSA values 2-10 ng/ml, which underwent retro-pubic prostatectomy. Pathohistological analysis of complete resection sample was performed in order to establish spread and differentiation of the tumor. Clinical and pathological stage of the disease, Gleason score and Gleason grade were compared. In 11 patients (14%) extra-prostatic invasion of the disease was found following examination of the obtained slides. After surgery, in a significant number of patients inclusion of both prostate lobes was established, so the number of clinical stage T2b was significantly higher than pT2b (40 compared to 18), and T2c was significantly lower than pT2c (3 compared to 22). The Gleason score was underestimated in 25 (31, 25%) while it was overrated in 2 (2.5%). In more than one-third of patients the bioptical Gleason score was lower than the definitive pathohistologic score of the prostate slide. There is a significant difference between the biopsy and definitive pathohistologic T stage of prostate cancer also in a sense of underestimation. The frequency of established extra-capsular invasion and lymphatic metastasis corresponds to the rates of predictive models (Partin tables). The study did not show extra-capsular invasion in cases of well-differentiated prostate cancer (Gleason score ≤ 6).

Splenogonadal fusion (SGF) is a rare developmental anomaly in which an abnormal connection between the splenic tissue and gonads or mesonephric derivatives is present. This entity often presents with scrotal mass, inguinal hernia, or cryptorchidism. Less than 200 cases have been reported since it was first described in 1883. It can be of continuous and discontinuous type based on the presence of a band of connecting splenic tissue. Report a rare case of discontinuous type of SGF in an adolescent male presenting as nonpalpable testis. On evaluation, ultrasonography (USG) and magnetic resonance imaging of abdomen and pelvis, his left scrotal testis was atrophied and right intra-abdominal undescended testis. This is the first reported case of SGF from Bosnia and Herzegovina. Laparoscopy was demonstrated to be the only accurate exploratory procedure for the diagnosis and surgical treatment of SGF with non‐palpable testis.

© The Author(s) 2020. Published by ARDA. Abstract Background: The subject of this research is the creation of an optimal school bench design with the aim of determining the most favorable posture of students while sitting, taking into account the relevant ergonometric and biomechanical characteristics of the human body. For the proposed model of the school bench which allows adjusting the different slopes of its surface, the corresponding computer model of the student and the table was first created, and then biomechanical and RULA analysis was performed in order to determine the maximum load in the lumbar part. Next, for each test subject of given weight, it was necessary to determine the amount of maximum load in lumbar zone L3/L4 for different slope angles and to determine the critical angles at which the maximum permissible load of 3400 N is reached.

Abstract Although prostate cancer accounts for the highest number of newly diagnosed cases of cancer in men, it represents a specific diagnostic challenge in modern oncology. The standard diagnosis of prostatic carcinoma begins with the screening of serum concentrations of PSA (Prostate Specific Antigen). If the concentration of serum PSA levels is above 4 ng/mL, the patient is further referred to a digital rectal examination in order to determine an increase in prostate volume. In cases where enlargement of the prostate is observed, the next step is biopsy of prostate tissue. This physically painful and invasive approach to confirm the diagnosis is often unnecessary because, in many cases, the patohistologic analysis determines diagnosis of benign prostatic hyperplasia, and not a tumor. In this study, we investigated the possibilities of detection and measurement of the relative level of gene expression of the KLK3 (Kallikrein-related peptidase 3), PCA3 (Prostate Cancer Gene 3) and TEMPRSS: ERG (Transmembrane protease serine2 and in-ETS erythroblostosis virus E26 oncogene homolog) genes from the urine samples of patients with prostatic diseases and healthy controls. Urine was the sample of choice because it is taken in a non-invasive manner, and could potentially serve to make better selection to biopsy. One of the selected genes (KLK3) differed significantly in the samples of various pathological conditions of the prostate, and therefore we consider that its further investigation is reasonable.

Background: The problem of heavy school bags is a global problem recognized in many countries in Europe and the world, including in Bosnia and Herzegovina. In addition to poor posture habits, "sedentary lifestyles" and insufficient physical activity, school bags is one of the main causes of low back pain and deformity in pupils. The recommendation of the World Health Organization (WHO) is that the weight of the school bag should not exceed 10% of the student's weight. However, in practice these limitations are far from reality with the obvious problems caused by too heavy bags. The aim of the paper is to identify and analyze the backbone load caused by the overweight school backpacks in real school work conditions and eliminate them by creating new solutions that are in line with ergonomic and biomechanical principles, as well as the recommendation given by WHO. Methods: The research included first grade primary school students at the age of seven, including their parents. The research began by interviewing parents with relevant questions, as well as measuring the students’ height and weight and the weight of their school backpacks. The analysis was performed in CATIA v5 software package (Dassault Systemes, Velizy-Villacoublay, France) using its advanced biomechanical modules. By knowing the anthropometric and work environment data with ergonomic design and analysis, the biomechanical analysis, rapid upper limb assessment (RULA) and carry analysis were performed. Results: The conducted survey showed that 84% of students walk from home to school nineteen minutes on average and that 77% of them carry their school backpacks independently. Based on the measurements, it has been shown that, on average, the weight of the school backpacks is well above the WHO recommendation. A study conducted on a representative sample of students confirmed the relation between fatigue and spinal pain caused by carrying a heavy school bag. Computer analysis showed excessive loads on the spinal segment of L4/L5 that were outside the normal range of 3,400 N. Conclusions: A simulated computer analysis using RULA and biomechanical analysis with calculations of maximum loads in the lumbar segment of students found that school backpacks carried by students were too heavy for their age and well beyond the normal limits and WHO recommendations. The analysis showed that it is necessary to reduce the weight of the bag by about 30%.

Introduction: The most common congenital abnormality of the penis is hypospadias. Although the main treatment is surgical; hormone therapy with dihydrotestosterone is also used. Materials and Methods: This randomized clinical trial was carried out between January 2012 and December 2017 on 79 children with hypospadias (in the Clinic of Pediatric Surgery, Clinical Centre University of Sarajevo). Their mean age was 38.2±2.8 months. GroupI included 36 children whom were treated with 2.5% dihydrotestosterone gel which was applied twice a day to the penile shaft and glans for one month prior to surgery. GroupII included 43 children whom did not receive any treatment preoperatively. Results: Mean age of patients in group I was 37.3±6.3 months and in group II it was 39.1±5.9 months which were comparable. Complications occurring postoperatively were: urethrocutaneous fistula in 6 patients (13.9%) in group II, versus 1 patient (2.7%) in group I. There were 2 patients with meatalstenosis in group II (4.7%), and 3 (8.3%) in group I. Finally, there was a significant difference (p<0.05) between the overall reoperation rates between groups (p<0.05). Conclusion : Pretreatment with 2.5% dihydrotestosterone transdermal gel before hypospadias repair is beneficial in decreasing complication rates.

Introduction: Cancer of the prostate (PCa) is the second most common cancer-related cause of death among men and the most common non-cutaneous malignancy in Western countries. Numerous papers have been published on the topic of various aspects of this disease; however, rather little has been written on the diagnostic and prognostic value of the prostate cancer obtained from needle biopsy. Aim: To examine the utility of Pixel Prostate software in determining the volume and topographic distribution cancer of the prostate (PCa), and to analyze it with other variables that are characteristic for PCa. Methods: retrospectively, 75 patients data and postoperative prostate specimens were analyzed, after determining topographic distribution and cancer volume (PCa), using PixelProstate software. Results: Mean VPCa was 6.99 cm3 (0.14-29.7; median 4.51), and mean percentage cancer volume relative to prostate volume (%VPCa) was 16% (0.1-67.2%; median 13%). 71% of the patients had T2 stage, while the rest had T3 stage. Apex involvement was present in 65% of the patients, while central zone involvement and extraprostatic extension were present in 23.5% and 22.7% of the patients, respectively. Preoperative Gleason score undergrading was present in 27 (36%) patients, while bilateral PCa finding was increased from 51% to 87%, postoperatively. The most discriminant variable according to the prediction of %VPCa>10% had preoperative bilateral needle biopsy findings, with AUC of 0.75 (<.001), with sensitivity and specificity of 84% and 70%, respectively; (+LR 2,8; PPV of 74%; NPV of 82%). %VPCa showed good correlation with prostate specific antigen (PSA) and PSA-density. Conclusion: A possibility of precise spatial orientation and volume characterization of the PCa by PixelProstate software was shown. Simultaneously, with time, a clinician, experienced by PP software feedback, gets better insight for the planning of future prostate biopsy, as an important factor in clinical decision making.