Haemangiopericytoma is an uncommon tumour of vascular origin. We report a case of one of the rarer sites of this tumour in man: pelvic paravesical site. We report case of 47 years old man with pelvic hemangiopericytoma and discuss imaging studies and pathohystological findings. Although modern imaging techniques have provided useful information concerning the hypervascular and clearly demarcated appearance of this tumour which displaces but does not invade adjacent organs, its diagnosis can only be established by histology. Its degree of malignancy and its invasive potential are unclear. The risk of local recurrence and metastases in more than one half of cases justifies wide surgical excision, possibly combined with adjuvant radiotherapy, and long-term follow-up. That is to say, that hemangiopericytoma malignum pelvis is the very rare sites of this tumour and till now it is not reported in Bosnia and Herzegovina.

Aim of kidney transplantation is to keep the functions of graft as long as possible, with an improvement of survival and quality of patients’ lives. Aim of this article was to show the outcome of kidney transplantation in patients who were treated and monitored on Institute of Nephrology, CCU of Sarajevo in period between 1996 and 2004. and to identify the factors which can interfere with graft surviving. Retrospective analysis of data from the register of kidney transplanted patients was done. In the mentioned period 29 kidney transplants were performed, and at the same time 15 previously transplanted patients (total of 44) were monitored. Patients were followed until death or graft insufficiency. Most often cause of chronic renal failure before the transplantation were glomerular diseases (3l,8% cases), and chronic pyelonephritis in 29,5% cases. Living-donor related kidney transplantation was performed in 56,8% of patients, living-donor unrelated in 27,3% of patients and cadaveric in 15,9% of patients. Post-transplant complications occurred in 29,5% of patients. Analysis of graft surviving on 12 months, 5 years and 10 years monitoring showed functional grafts in 87,5%, 80% and 75,0% of patients. Cumulative survival of patients on one year monitoring is 100%, on 5 year 100%, and on 10 year 93,8%. Primary causes of graft function loss were recurrent kidney diseases. Three patients (6,8%) died due to concomitant diseases, irrespective of the transplantation. Kidney transplantation is a successful treatment of a chronic renal failure with a high percentage of patients survival and long term graft survival, but also with serious post-transplant complications.

UNLABELLED The aim of this study is to determine mortality rate, intraoperative, early postoperative complications and length of postoperative hospitalization in patients treated with cystectomy carried out for radical or palliative purposes. TESTS AND METHODS This retrospective study included 57 patients that were treated in the Urological Clinic Clinical Centre University of Sarajevo in period from January 2000 until July 2004, for bladder cancer. RESULTS Early mortality rate was 3.5%, early postoperative complication rate was 33.2% and it normally included prolonged ileus, wound dehiscence and urinary infection. CONCLUSION Early mortality and the intraoperative one did not rise when compared to the results indicated in professional literature; early postoperative complications and length of postoperative hospitalization increased. Postoperative mortality and early postoperative complication rates are not statistically in patients over the age of 70 but they depended on concomitant diseases (comorbidity) and general health status of patients.

OBJECTIVE to compare predictive value of urodynamic parameters (level of obstruction and stop-flow test) to post prostatectomy outcome. SAMPLE AND METHODOLOGY 30 patients elected for prostatectomy based to the patient's symptoms, radiological signs of benign prostate enlargement and signs of the retention of urine. All patients underwent complete UDM-uroflowmetry, cystometry and pressure/flow studies, after fulfilling International Prostatic Symptom Score (I-PSS). Three months after operations patients were submit same tests. Schafer nomogram was used for determination of grade of obstruction as well as grade of detrusor contractility, and stop flow test is performed to calculate maximal estimated flow (Qmaxest). RESULTS 7 (23, 5%) patients were out of obstruction before the operation coupled with detrusor under activity. Postoperatively group symptoms reduction, reduction of post void residual (PVR) urine and increase of Qmax was noticed. Incidence of detrusor hyperactivity is reduced. As a measure of absolute postoperative success for the individual patient, I-PSS <7 with Qmax >15 ml/sec is taken. By this way, urodynamic measurement have shown sensitivity of 75%, specificity of 91%, PPV of 75% and post-test probability of 78% for prediction of excellent postoperative outcome for the patients with strong detrusor who were in the obstruction preoperatively, while stop-flow test with Qmaxest >35ml/sec showed lower predictive value of postoperative success (sensitivity of 89%, specificity of 62%, PPV of 50% and post-test probability of 50%). CONCLUSION Preoperatively obstructed patients with preserved detrusor contraction according to Schafer nomogram will experience much better outcome, while stop-flow test is not powerful indicator of postoperative favorable outcome.

OBJECTIVE examine detrusor contraction duration (DCD) in relation with obstruction grade and strength of detrusor contractility; analyze individual correlations of this parameter with urodynamic, physiological and symptoms variables in patients with benign prostatic enlargement (BPE). SAMPLE AND METHODOLOGY 102 patients with proved BPE, underwent complete urodynamic measurements (UDM), namely uroflowmetry, cystometry and pressure/flow studies. Postvoid residual urine (PVR) was measured and the International Prostate Symptom Score (I-PSS) was fulfilled by each patient. Methodology of measurement and definitions of UDM are based on definitions and terminology defined by the International Continence Society. RESULTS After grouping the patients (average age 64,7+/-8,5) related to obstruction grades according to the Schafer nomogram, ANOVA has shown a group extension of the detrusor contraction duration related to higher levels of obstruction (LinPURR 0-VI; p<0,01), which is also followed by stronger detrusor contractility (Pdetmax; p<0,001). Dichotomizing of the patients with DCD cut off point 90 sec. has shown that 67% patients with underactive detrusor have DCD>90 sec, while extension of DCD and increase of the obstruction level are directly related to preserved detrusor contractility only in 20,5% cases. There is neither statistically significant difference of DCD in the patients that are not in obstruction allocated in two groups depending on detrusor contraction strength, (t=1.2, p>0.05); nor in the patients who are in obstruction range, divided on the same way (t=0.568, p>0.05). There is also no difference of the same patients groups regarding PVR (t=1.38 and t=1.17, p>0.05). Individual correlation of DCD with I-PSS has not been shown (r=0.16, p>0.05), although there is a statistically significant correlation with its obstructive subset (r=0.20, p<0.05), as well as, with LinPUR and URA nomograms (r=0.33, r=0.29; respectively, p<0.005) and with Pdetmax (r=0.26, p<0.01), PdetQmax (r=0.24, p<0.05), Qmax and Qaver (r=0.31, p<0.005). DCD does not have individual correlations with patients' age, prostate volume and with cystometric capacity. CONCLUSION DCD is rather independent urodynamical variable, which does not correlate with I-PSS. Generally, DCD is prolonged during obstruction, while extension of DCD only partially depends on detrusor contraction strength. Practically, individual correlations of DCD with the urodynamic factors, which characterize obstructions, are modest.

The inverted papilloma is relatively rare urothelial benign tumor. In 1980 was described only 108 cases of this benign proliferative lesions of bladder. Papillary fronds project into the fibrovascular stroma of the bladder rather than into the bladder lumen. The lesion is usually covered by a thin layer of normal urothelium. In Our case, tumor was found during the open adenomectomy, although patient was examined by ultrasound, before surgical treatment. One year after surgical treatment, control cystoscopic examine shows no recidive benign lesion.

OBJECTIVE Determine sensitivity and specificity of uroflowmetry in the diagnosis of clear defined outlet obstruction in the patients with benign prostatic enlargement (BPE). MATERIALS AND METHODS 102 patients with proved BPE, after fulfilling International Prostatic Symptom Score (I-PSS), underwent complete urodynamic measurements (uroflowmetry, cystometry and pressure/flow studies). The patients were dichotomized in obstruction zone or out of obstruction, according to the models presented in the literature, but also with combination of Schafer and URA nomograms. Then sensitivity and specificity of uroflowmetry (with cut-off point of Qmax < 10 ml/sec) to the obstruction were determined, as well as to the level of I-PSS. RESULTS 52 patients (51%) had Qmax < 10 ml/sec. T-test has shown that noninvasive variables (age, level of I-PSS, volume of prostate, volume of post void residual or voided volume) differ among the patients of two observed groups (p < 0.05). Discriminant validity of Qmax < 10 ml/sec for diagnosis of clear defined urodynamic obstruction (combination of URA and Schafer nomograms) is calculated by ROC curve, with excellent area of 0.92 (p < 0,00001). According to the levels of I-PSS, the patients were trichotomized. Increase of uroflowmetry sensitivity and specificity to the obstruction by increment of symptoms is noticed. Post-test probability (accuracy) for Qmax < 10 ml/sec to the obstruction for the patients with mild symptoms was 84%, while the same test in the groups of the patients with moderate and severe symptoms were 93% and 95%, respectively. CONCLUSION Value of uroflowmetry, as non-invasive tool in the diagnosis of outlet obstruction is enhanced by accurate defining of obstruction, but also with increase of the lower urinary tract symptoms. By this mean, clinical decision making in the treatment for the individual BPE patient is easier.

Erectile dysfunction (ED)--the consistent or recurrent inability of a man to attain and/or maintain, a penile erection sufficient for sexual performance--is a common health condition among men that is largely untreated. It is estimated that some degree of ED affects more than one half of all men over the age of 40--152 million men worldwide. That is a big problem, that needs appropriate treatment. After diagnostic evaluation of the patient, doctor decides what is the best treatment option for the patient, following his health condition. Choice of treatment options: physio-sexual therapy, oral drug therapy, topical drug therapy, transurethral drug therapy, intracavernosal therapy, hormonal treatment, vacuum devices and surgery. Nowadays the most important contemporary treatments of ED are peroral sildenafil and intracavernosal pharmacotherapy using vasoactive medicines. However, these drugs are not suitable to every patient. More noninvasive methods to treat ED, such as oral medication or locally applicable preparations are needed.

: Harmonious physical and mental development of children and youngsters depend on the proper diet as one of the basic conditions of growth and development. Feeding to a great extent effects children's health and their future working capability. Feeding process can be perceived through nutritive status whose most valuable and accessive data are on body mass, height and thickness of skin wrinkles. On the basis of BMI, i.e. its centile values, critical values of overweight and obesity can be easily determined. The research aim was to see nutritional status and habits in the secondary school children in Tuzla Canton, then to analyze anthropometric parameters (body weight, body height); to determine BMI values, to standardize curves, to establish obesity frequency in children. The research was performed on the sample of 1544 children both sexes, in the first, third and seventh class involving four Tuzla-Canton municipalities: Tuzla, Lukavac, Gracanica and Kladanj. The research was performed by a questionnaire and anthropometric measurements in respect to IBP (International Biological Programme). Presence of brown bread in the primary school pupils' food is insufficient (5.8-10.7%). They consume fruit and vegetables mostly two times a day, milk is not consumed by 7.5-12.3% of boys and 8.4-28.4% of girls. As for meat, chicken is mostly consumed, fish a little and insufficient. Period between the third and seventh class is characterized by expressive increase in height and weight, what is the outcome of the adolescent jump. BMI value increases with age and exceeds limits of normal weight, thus obesity increases with age. In the seventh class obesity is present in 48.35% of boys and in 30.77% of girls. The above discussed trends in nutrition and obesity presence as the risk factors, require an urgent pass of the Action Programme for food and feeding on the state level, which would give a special importance to health promotion from this point of view.

OBJECTIVE to analyze doxazosin efficacy in the treatment of patients with proved benign prostatic enlargement (BPE), according to the reduction of the level of symptoms and urodynamic obstruction as well as reduction in detrusor contraction duration (DCD). SAMPLE AND METHODOLOGY 31 BPE patients after fulfilling International Prostatic Symptom score, undergone complete urodynamic measurement (uroflowmetry, cystometry and pressure/flow studies). All methodology of urodynamic measurement and definitions were based on the definitions of the International Continence Society. Three months therapy with doxazosin (4 mg daily) was prescribed to each patient, and the same control examinations were done after the treatment with analysis of all relevant data. RESULTS A reduction of the symptoms (T-paired test) (I-PSS from average of 12.6 decreased to 6.2; p < 0.0001), has been noticed, improvement of quality of life (from average 2.5 decreased to 1.5; p < 0.0001), as well as increasing of the maximal flow (average Q(max) grew for 1.9 ml/sec; p < 0.05). URA dropped from 39,6 cmH2O to 34,1 cmH2O (p < 0.01), remaining in the obstructive region, although 32% of the patients experienced absolute reduction of obstruction (URA < 29 cmH2O). The most prominent result was a drastic reduction in the duration of the detrusor contraction (average DCD from 105 sec. dropped to average 73.4 sec. with p < 0.0001). Other urodynamic parameters, as well as post void residual urine, were not changed significantly. Than patients were allocated in the two groups based on the pre treatment detrusor contraction duration with cut-off point of 90 sec. and the post treatment characteristics were examined (Wilcoxon test). Both groups were shown reduction regarding I-PSS, (its irritative and obstructive domain), but reduction of 54% for DCD > 90 sec group is better than for the 46% for the other group. Further, there is a difference among groups regarding several important characteristics. DCD > 90 sec. group showed increasing in urinary flow for 21% (p < 0.05), decreasing of URA for 13% (p < 0.05), improvement in the quality of life for the 46% (p < 0.001) as well as reduction in DCD for 32% (p < 0.001), what was not shown in the pretreatment DCD < 90 sec. group. CONCLUSION Doxazosin is a potent reducer of the symptoms in the treatment of the BPE, enhancing urinary flow and reducing DCD in the first place. Albeit, possibility of urodynamic obstruction reduction and influence to the volume of post void residual urine is limited, thus doxazosin is recommended to the patient with moderate obstruction, prolonged detrusor contraction duration and moderate levels of the symptoms. Patients with pretreatment prolonged DCD will be better responders to the therapy. This finding implicates necessity ofurodynamic measurements before treatment in order to optimize therapeutic effect of drug for individual patient.

OBJECTIVE In order to define clear urodynamic obstruction, all patients from unclassified zone of the nomograms are to be allocated in the zone of obstruction or out of obstruction combining the parameters of different nomograms. Then, to analyze difference of the physical and radiological variables between obstructed and unobstructed groups. Finally, to determine the percentage of the patients with additional urinary bladder co morbidities in clear obstruction zone. SAMPLE AND METHODOLOGY 102 patients with proved BPE underwent complete urodynamic investigations, (uroflowmetry, cystometry and pressure/flow studies). All methodology of measurement and definitions were based on the definitions of the International Continence Society. Basic urodynamical data were manually plotted on the Abrams-Griffiths, URA, ICS and Schafer nomograms; A/G number was calculated as well. Then, patients were allocated in the region of clear obstruction from II region of Schafer nomogram by the several models (URA number of > or = 29 cmH20, according to the strength of detrusor contraction, opening detrusor pressure > or = 40 cmH2O, PdetQmax > 50 cmH2O with Qmax < 15 ml/s), comparing matching degree to the ICS nomogram. RESULTS Combining URA > or = 29 cmH2O (group-specific urethral resistence) and II zone of the Schafer nomogram the best allocation of the patients and best fitting to the ICS nomogram was achieved (99.1% of the cases). 65 patients (63.7%) went in the clear obstruction zone and 35 patients (36.3%) in the unobstructed zone. Student test, with 2-tail level of significance showed difference in the detrusor opening pressure (p < 0.01) among groups, although there is no difference in the premicturation detrusor pressure (p > 0.05), but there is clear difference in the duration of the detrusor contraction between obstructed and unobstructed groups (DCD; p < 0.005), independently of the grade of the detrusor contraction (GDC; p > 0.05). Obstructed group has a smaller cystometric capacity (p < 0.05), although there is no difference in the volume of voided urine (p > 0.05). Noticed is increased incidence of the detrusor instability in the obstructed group (42% versus 22%, p < 0.0005). Analyze of physical variables has shown that there is a difference in the prostate volume among the groups (p < 0.05), and the patients age (p < 0.05), albeit there is no difference in the level of I-PSS, QOL scores (p > 0.05) and post void residual urine volume (p > 0.05), as well. Out of the 65 obstructed patients, only 23 patients (35.3%) have uncomplicated urodynamical obstruction, while other 42 patients (64.7%) have additional detrusor instability or hypocontractility, or combination of both (10.7%). 8 patients (25%) from unobstructed group have detrusor instability (presumable idiopathic instability), and for the 14 patients (38%) detrusor hypocontractility was detected. CONCLUSION Combination of the II zone of the Schafer nomogram and URA > or = 29 cmH2O increases accuracy of defining clear urodynamic obstruction, achieving better accordance with ICS nomogram, as well. It has been shown that almost two third of obstructed patients have a bladder comorbidities (detrusor instability and hypocontractility), while more than half of unobstructed patient have similar problems as a cause of the lower urinary tract symptoms.

AIM To determine matching degrees of urodynamic obstruction among available nomograms in patients with confirmed benign prostatic enlargement (BPE). SAMPLE AND METHODOLOGY 102 patients with confirmed BPE underwent a complete urodynamic investigation (uroflowmetry, cystometry and pressure/flow study). All the measurements were based on definitions adopted by the International Continence Society. Basic urodynamic data were then manually plotted on the Abrams-Griffiths, URA, ICS and Schafer (LinPURR) nomograms; A/G number was calculated as well. RESULTS Patients were allocated in the three levels of obstruction by Schafer's nomogram; 24 patients (23.5%) had no obstruction, 28 patients (27.4%) had equivocal or non-defined obstruction, while 50 patients (49.1%) had a significant level of obstruction. Spearman rank correlation coefficient has shown a rather uniform correlation of all nomograms. The correlation between Shafer's nomogram and ICS nomogram is the best one, with rho = 0.89 (p < 0.00001), which is followed by correlations between ICS and A/G nomograms with rho = 0.88 (p < 0.00001) and Schafer and A/G with rho = 0.87 (p < 0.00001). URA nomogram and A/G number have a similar correlation of r = 0.87 (p < 0.00001). According to the levels of obstruction, there is a good correlation in the zone of clear obstruction, as well in the zone out of obstruction among available nomograms (chi 2 test, p > 0.05) (URA has not been subject to this process). However, the above nomograms have shown a significant difference in figures relating to the unclassified zone of obstruction (chi 2 test; p < 0.05). CONCLUSION Despite a very high degree of correlation among individual nomograms, there are considerable differences in figures relating to the unclassified zone of obstruction. This zone should, therefore, be avoided by establishing an optimum model of clear obstruction defining.