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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

: 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.