Objectives: To determine the optimal medication for the treatment of renal colic using evidence based medicine (EBM) parameters (RR, ARR, NNT, NNH, ARI, RRI). Sample and Methodology: During 2010, an ITT study was conducted on 400 outpatients of the Sarajevo University Clinical Center Urology Clinic in order to investigate renal colic pain relief drugs. Each group consisting of 100 patients was administered either Metamizol amp. i.v., or Diclofenac amp. i.m., or Butylscopolamine amp. i.v., while 100 patients belonged to the placebo group that was given distilled water (aqua redestilata). All patients completed visual analogue pain scale (VAPS) from 0 to 10 prior to and after the treatment. Results: Using EBM parameters Diclofenac Na and Metamizol were shown to be the most efficient in the treatment of renal colic. In these two groups, relative risk (RR) was 21 and 8,5% respectively; Absolute Risk Reduction (ARR) was 74 and 86% respectively, and Number Needed to Treat (NNT) was 1 for both groups, while chi-squared (X2) test has shown that there is no statistically significant difference between these two drugs when it comes to their effect. In the Butylscopolamine group, RR was 81; ARR 18%, while NNT was 5. With respect to side effects, only in his group it was shown that Relative Risk Increase (RRI) was 84, ARI 83%, while Number Needed to Harm (NNH) was 2. Conclusion: The most optimal medication for the treatment of renal colic according to EBM parameters is Diclofenac Na, followed by Metamizol. Butylscopolamine is not recommended for the treatment of renal colic.

OBJECTIVE To determine the correlation of intravesical prostatic protrusion (IPP) and bladder wall thickness (BWT) with clinical and urodynamic parameters, as well as their sensitivity and specificity with regard to bladder outlet obstruction in patients with a benign prostatic enlargement (BPE). MATERIALS AND METHODS 111 patients with lower urinary tract symptoms and confirmed BPE completed the International Prostatic Symptom Score (I-PSS), as well as a transabdominal ultrasound to determine their prostate volume, a grade of IPP and BWT. All the patients were then subjected to the complete urodynamic studies (UDS). RESULTS The IPP showed a good correlation with the prostate volume (r = 0.61) and serum PSA (r = 0.48); p = 0.0000, free uroflowmetry (r = -0.27; p = 0.004), as well as the determinants of urodynamic obstruction: bladder outlet obstruction index-BOOI (r = 0.36; p < 0.0001), and ICS and Schaefer obstruction class nomograms (rho = 0.33 and rho = 0.39, respectively; p < 0.001), while the BWT showed only a statistical correlation with age (r = 0.23; p = 0.02) and serum PSA (r = 0.4; p = 0.0000), regardless of an significant correlation with the IPP (r = 0.45; p = 0.0000). The ANOVA test showed a significant difference between the IPP grades for the observed clinical and urodynamic variables with an increase in significance for IPP>10 mm. The area under the ROC curve in the prediction of obstruction for the IPP is 0.71 (sensitivity 59.6, specificity 81.4), while the AUC for the BWT is 0.61 (sensitivity 64.5, specificity 59.2). The stepwise logistic regression model shows that most significant independent variables for the obstruction are the IPP, Q(max) free and age, with the area under the ROC curve of 0.78 (95% CI 0.695 to 0.856). CONCLUSION The IPP higher than 10 mm as a non-invasive predictor of infravesical obstruction shows good correlations with clinical and urodynamic parameters, while the specificity and PPV against obstruction are significant. Despite a good correlation with IPP, the BWT is only a modest indicator of obstruction.

AIM Establish the main differences in the prostate volume, prostate specific antigen density (PSAD), number of biopsy samples in patients with primarily or rebiopsy detected prostate cancer. MATERIALS AND METHODS In the 2007-2009 period, at the KCUS Urology Clinic, there were 379 TRUS guided prostate biopsies in 323 patients with known prostate volume. The total of 56 patients (17.3%) underwent the first rebiopsy, primarily due to precancerous lesions. The mean prostate volume, ranges of prostate size, PSAT, PSAD and the number of biopsy samples were analysed retrospectively, and the main characteristics in patients with primarily and rebiopsy diagnosed Pca were evaluated as well. RESULTS The first biopsy cancer detection rate was 29.6% (112/379). The rebiopsy detection rate was 30.3%. There was no statistically significant difference in the prostate volume and the number of biopsy samples among the total number of patients with prostate cancer against the group with benign (suspected) findings. There was a higher Pca detection rate in patients with the prostate volume < 40 cm3 and 40-60 cm3, against the group with the prostate volume > 60 cm3. PSAD was significantly higher in patients with PCa (0.24 vs. 0.18; p = 0.013). The total of 27.2% of the patients with negative biopsy findings and 48% of the patients with diagnosed Pca had PSAD > 0.15. PSAD showed sensitivity and specificity in prostate cancer detection of 50% and 75%, with PPV of 48%. Furthermore, the patients with PSAD >0.15 had a higher Gleason score versus the patients with PSAD < 0.15 (6.7 +/- 2.4 vs. 5.9 +/- 1.7; p < 0.003). A comparison of the main characteristics in patients with primarily and rebiopsy detected prostate cancer gave a statistically significant difference only in the number of biopsy samples (10.9 vs. 14.1, p <.0000). CONCLUSION Patients with a smaller prostate volume, lower PSAD and a higher number of biopsy samples in rebiopsy have a higher chance of prostate cancer detection. PSAD carries a higher specificity in rebiopsy decision, and a higher PSAD is related to a higher Gleason score.

OBJECTIVE to analyze the influence of aging and infravesical obstruction on cystometric characteristics of patients with lower urinary tract symptoms (LUTS) and proven benign prostatic enlargement (BPE). METHODOLOGY A retrospective analysis was performed of basic characteristics of randomly chosen 213 patients with LUTS caused by BPE and urodynamic findings made in period 2005-2009 at the Urology Department of the Sarajevo University Clinical Center. The patients were divided into groups based on their age (<60 years/46 patients, 60-69 years/95 pat., and >70 years/72 pat.), and the degree of bladder compliance loss (<20 ml/cmH2O-76 patients, 20-40 ml/cmH2O-57 pat., and >40 ml/cmH2O-80 pat.). All patients had International Prostate Symptom Score (IPS-S) completed, prostate volume measured transabdominally, free uroflowmetry, as well as complete urodynamic study (UDS) findings--cystometry and pressure/flow studies (PFS). The PFS data were plotted on L-PURR, URA and ICS nomogram, bladder contractility index (BCI) and obstruction coefficient (OCO) were calculated for each patient. RESULTS There was no statistically significant difference of IPS-S, prostate volume and postvoid residual urine among the age groups. Qmax (ml/sec.) declines significantly with age (mean 11.9 vs. 10.3 vs. 7.9, ANOVA p < 0.001), along with statistically significant decrease of cystometric capacity (mean 331 ml vs. 293 mi vs. 264 ml, p = 0.001), bladder compliance (BC-ml/cmH2O) (mean 35.3 vs. 31 vs. 26.5, p = 0.013), with increased incidence of detrusor overactivity (DO) (21.7% vs. 32.6% vs. 45.8%, chi2 test for trend p = 0.006), followed by a higher incidence of obstruction (URA > or = 29 cmH2O) (37% patients vs. 61% patients vs. 72.2% patients Chi2 for trend=13.8; p = 0.0002), along with noticeable reduction of BCI (117 vs. 121 vs. 106; p = 0.02). Patients with severe BC damage (<20 ml/cmH2O) showed a difference with respect to the degree of obstruction and age, along with decreased cystometric capacity and higher incidence of DO, while the difference in IPP-S was insignificant. OCO with cut-off point of 1 showed significant difference with regard to age (66.3 vs. 66.6 years, T test, p = 0.015), prostate volume (45 cc vs. 51.8 cc, p = 0.007) and incidence of DO (26% vs. 43.4%, p = 0.02). CONCLUSION the degree of bladder compliance loss and incidence of obstruction increase with age, as reflected in decreased bladder capacity, decreased urine voided volume and increased incidence of DO, along with noticeably impaired detrusor contractility.

Objective: Determine diagnostic power and intercorrelation between bladder outlet obstruction number (BOO n) and intravesical prostatic protrusion (ipp) as non-invasive predictors of infravesical obstruction in patients with lower urinary tract symptoms due to benign prostatic enlargement. Mate rial and methods: prospective study during 2009-2010 analyzed data of 110 patients with proven benign prostatic enlargement. prostate volume and ipp were determined by transabdominal ultrasound, and patients underwent complete urodynamic studies (UDS). BOOn was calculated using the formula: prostate volume (cc)-3 x Qmax (ml/s)-0.2 x mean voided volume (ml). r esults: There is a statistically significant correlation between the values of ipp and BOOn (Spearman’s rank correlation coefficient rho=0.48, p=0.0001). BOOn is a more sensitive (sensitivity 82.4%, specificity 66.1%), while ipp is a more specific factor (sensitivity 58.8%, specificity 81.4%) in the group-wise prediction of bladder outlet obstruction (BOO). p ositive predictive value in the diagnosis of obstruction increases at the individual level combining the cut-off values for BOOn>-30, with ipp>10 mm (ppV 86.8%). Owing to a good correlation of ipp with different definitions of urodynamic obstruction, ipp was included in the BOO n formula instead of prostate volume. This number was arbitrarily called BOO n2. The combination of ipp >10 mm and cut-off value for BOOn2 >-50 showed that 88.6% of the patients were accurately classified in the zone of obstruction (mean ipp 14.9 mm), while BOO n2<-50 carried a high npV. Conclusion: The combination of cut-off values for BOOn and ipp increases test accuracy according to BOO at the individual level, thus facilitating clinical decision making regarding diagnostics and optimal choice of therapy in patients with B pe. Owing to its good correlation with obstruction determinants, ipp can be included in the formula for BOO n instead of prostate volume.

OBJECTIVE Establish the prostate cancer (PCa) detection rate and the premalignant lesion incidence, as well as their importance in cancer detection at the first rebiopsy. MATERIALS AND METHODS In the period 2006-2008, at the CCUS Urology Clinic, there were 585 prostate biopsies performed in 515 patients. 12% of the patients underwent the first biopsy due to premalignant lesion findings. The main characteristics of the patients--age, prostate specific antigen (PSAt)-total and PSA ratio (PSAr), the number of needle biopsies, Gleason score and the role of premalignant lesions in diagnosis of PCa at the first rebiopsy were processed retrospectively. RESULTS Primarily detected PCa amounted to 32.4% (167/515), while the rebiopsy showed the detection rate of 35.7% (25/70). No statistically significant age or PSAt and PSAr difference was observed, while there was, however, a difference in the number of biopsy samples, 11 (6-18) vs. 12 (8-20) and in the Gleason score (6.5 vs. 5.9) among the observed groups (p < 0.05). Atypical small acinar proliferation (ASAP) and high grade intra epithelial neoplasia (HGPIN), were found in 4.95% and 7.2% of the cases, while the ASAP + HGPIN combination was found in 1.5% of the cases. The PCa detection rate at the first rebiopsy in patients with ASAP, HGPIN and ASAP + HGPIN lesions was 50%, 23.6% and 50%, respectively. The ANOVA test showed a statistically significant shorter time period for rebiopsy in ASAP+HGPIN patients than that of patients with ASAP and HGPIN lesions. CONCLUSION A repeated positive biopsy establishes PCa in patients with lower PSAt values and the Gleason score, which is followed by an increased number of biopsy samples. ASAP and ASAP + HGPIN lesions carry a higher specificity of75% and 91%, respectively, while the PPV in prostate cancer detection for HGPIN is low (24%).

UNLABELLED Purpose of the research is to establish which clinical and biopsy parameters could predict extra-capsular spread of prostate carcinoma for 2-10 ng/ml PSA values, in patients submitted to radical retropubic prostatectomy. METHODOLOGY In the period of 30 months, 80 patients were treated with radical retro-pubic prostatectomy with bilateral pelvic lymphadenectomy, for whom clinical, biopsy, radiological and biochemical analysis were positive to organ limited tumor. Serum PSA, fpsa/tpsa, PSAD,values are evaluated, and other parameters as number of positive biopsies, percentage of positive biopsies, localization of positive biopsies, and perineural invasion and biopsy Gleason score. RESULTS from total number of 80 patients with 2-10 ng/ml PSA, 7 (9%) patients had extra-capsular spread of prostate carcinoma. Upon using multivariate regression analysis, following parameters were proved as significant predictors of extra-capsular spread: biopsy Gleason score, number of positive biopsy samples and invasion, while serum PSA, FPSA/TPSA ratio, PSAD, prostate age and volume have not shown as significant predictors for extra-capsular extension. CONCLUSION Biopsy GS, perineural invasion and number of biopsy samples are statistically significant predictors of extra-capsular spread of prostate carcinoma for 2-10 ml PSA. Percentage of positive biopsies, tumor length in a sample and the localization of positive biopsies are on the borderline of statistical significance and as such should be taken into consideration.

We present a case of 52 year old male with an acute renal failure that took place 4 days after open transabdominal surgery repair of infrarenal abdominal aneurysm along with aneurysm of left common iliac artery and dilatation of left external iliac artery. Patient was subjected to 13 hemodialysis treatments that resulted in satisfactory recovery of renal function. One month after aneurysm repair he developed the right ureteral leak, consequently urinoma and acute renal failure once again. We suppose that ureteral leak was related to segmental ischemic necrosis of right ureter but not to traction or other iatrogenic ureteral injury. Percutaneous nephrostomy and insertion of ureteral stent was resulted in complete recovery of renal function.

BACKGROUND Prostate specific antigen (PSA) has significance in diagnostics of the prostate cancer, establishing stage of the disease and follow up of results of the treatment with different methods. Increased PSA levels in serum is not characteristic only for persons who have prostate cancer but also of those with benign conditions, especially in range of 4.0 ng/mL to 10.0 ng/ml, where we see a lot of results superposition. Marker determination of free and total PSA-ratio FPSA/TPSA and total PSA and prostate volume--PSA density was introduced for improvement of the sensitivity of PSA. Purpose is to analyze demonstrators of the concentration of PSA and its fraction in patients with histologically confirmed and radically removed prostate cancer, and to establish its correlation with advancement and differentiation of the disease. WORK METHOD The investigation was done in 80 patients with histologically confirmed, prostate cancer clinical stage T1-2, NO, MO, initial PSA level of 2-10 ng/ml and performed radical prostatectomy. RESULTS Out of 80 patients, 6 of them (9%) had total serum PSA level within referral values (<4 ng/ml). There were 55 patients (68%) with values of ratio FPSA/TPSA from 0 to 0.15, 18 (23%) patients had values between 0.16-0.19 and 7 (9%) patients had values above 0.20 ratio FPSA/TPSA. Fifty patients (62%) had PSA density in values to 0, 15, and 30 patients (38%) had values above 0.15. According to completed multiple regression analysis values of PSA, ratio FPSA/TPSA and PSA density had no statistically significant correlation with extra-capsular invasion and lymphatic metastasis, which points out that as it is, they do not contribute to its prediction. CONCLUSION Significant number of patients with histologically proven and radically removed prostate cancer had serum PSA level within normal referral values. PSA density and ratio FPSA/TPSA can help in differentiating malignant from benign changes in prostate in PSA values to 10 ng/ml but not with absolute safety since significant number of patients with proven cancer had these parameters in level range characteristic for benign diseases.

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome is unsatisfactorily defined and insufficiently studied illness. Also, the treatment success is questionable and therefore, this illness is a therapeutical problem for urologists--which medications are the best choice in treating this uncomfortable condition? This paper presents results of prospective, open, analytical, comparative study that was performed on 90 patients with diagnosed chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Patients were divided into three groups and were treated with two medications ciprofloxacin (C), doxazosin (D) and combination of ciprofloxacin + doxazosin (C+D). The effects were measured using symptom questionnaire for prostate illnesses of the National Institute for Health - USA (NIH-CPSI). During the basic evaluation, sum ranging from 0 to 43 was calculated for each patient. This number is called total sum NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) of the questionnaire, which generates the questions from 1 to 9. The most significant change occurred in C+D group where the total sum changed from 18-38 in the beginning to 5-31 at the end of the treatment (55,1% (p<0,001)). Significant changes were also found in D group where the change was 46, 4% (p<0,001). At the end of the treatment no significant change was registered in C group (p<0,005): p<0,001--significance threshold. Combination of ciprofloxacin + doxazosin proved to be the best choice for treatment.

Anatrophic nephrolithotomy (ANL) in the selected cases represents the method of choice in the treatment of staghorn calculi. We evaluated postoperative outcome of patients subjected to standard ANL that received 10 mg of Verapamil immediately before declamping renal artery, due to prevention of reperfusion injury. From 2002 to 2005, 18 nephrolithotomies were performed on 15 patients, in the Urology Clinic, University of Sarajevo Clinics Centre. Preoperative evaluation included intravenous urography and radionuclide renal scans which had been repeated 6 months after the operations. 10 males and 5 females were operated with mean age of 45 years. Urography and renal scans showed severe calyceal distortion and infundibular stenosis in 83% cases, complicated with ureteropelvic junction obstruction in 55% cases. Chronic kidney failure was present in 60% patients. Mean operative time was 150 minutes, with mean cold ischemia time of 61 minutes and mean blood loss of 300ml. There were five minor postoperative complications. Residual small calculi were found in 3 patients. Kidney function was stabilized in the patients suffering from chronic kidney failure, which was proved by radio nuclide imaging. ANL improved by using calcium channel blockers as a protective factor for reperfusion injury proved to be a good treatment choice with a low level of complications and noticeable stabilization and improvement of kidneys function.

Paper goal is to determine complications after urgent surgical treatment of patient with penile fractures, by using circumferential-degloving technique (degloving penile skin to root of penis). In period between 1998-2006 year, 23 patients have been treated as urgent cases with clinically proven penis fracture, age between 18 and 35. Patients were treated in 3 medical centers in Bosnia and Herzegovina(Sarajevo, Tuzla and Zenica). All 23 (100%) patients were injured during sexual intercourse. In the case of 20 (86,9%) patients partial rupture of corpus cavernosum was verified. Two (8,6%) patients had a complete rupture of urethra and it was primary sutured. In 22 cases (95,6%) spontaneous erection appeared, and in the case of 2 (8,6%) patients penile curvature was verified. Urgent surgical treatment is the best therapy choice, which enables preservation of erection in great number of cases in patients with penile fracture.

Primary retroperitoneal mucinous cystadenocarcinoma is very rare disease. It is very similar to cystadenocarcinoma ovary. Histogenesis of this tumour still remains unknown. In our case report tumour was noticed in left retroperitoneum during routine ultrasound check of stomach in female patient 43 years old. CT studies of kidney, retroperitoneum and pelvis, irigography studies and gynecological examination was done additionally.

UNLABELLED Renal colic represents the the collection of the acute symptoms which are characterized by very intensive and antagonizing pain, so, that withstanding, it calls for fast diagnosis and precise and speedy treatment. Intervention in renal colic cases has to be based on the knowledge on the origin of pain, renal damage suffered, and also has to protect the kidney from any damaged caused by the prolonged obstruction. MATERIAL AND METHODS This paper presents the results from prospective, analitical, comparative, ITT (intention to treat) study that has been carried out 200 ambulatory treated seperate patients with renal colic, divided into four groups, in the time period from year 2003 to 2005. In all these cases the the efficiency and the active time time of standard medications used with renal colic symptoms. RESULTS 2 grams of Metamizol i.v. and 75 mg of Diclofenac i.m. have shown equal efficiency in pain relief, which is 6 hours after the administration of therapy, while 50 mg of Butylscopolamin i.v. requires additional analgesic treatment (p < 0.05). The effect of Metamizol is a bit stronger 15 minutes after the application than the rest of the medications, but 30 minutes after the application the effects of Metamizol and Diclofenac are almost identical. Using meta analasys and EBM (Evidence Based Medicine) parameters in regard to the side effects, the made conclusion was that Diclofenac is the medication of choice for renal colic. Reserve medication is Metamizol, while Butylscopolamin causes negative side effects in 84% of the cases, and in 24% of the cases it causes cupping of the renal colic.

Primary retroperitoneal mucinous cystadenocarcinoma is very rare disease. It is very similar to cystadenocarcinoma ovary. Histogenesis of this tumour still remains unknown. In our case report tumour was noticed in left retroperitoneum during routine ultrasound check of stomach in female patient 43 years old. CT studies of kidney, retroperitoneum and pelvis, irigography studies and gynecological examination was done additionally.