INTRODUCTION Antimicrobials are widely used in infectious diseases. Only the timely intervention will contribute to the positive outcome of the disease. Unjustified use of antimicrobial prophylaxis may have adverse effects, i.e., result in bacterial resistance to existing antimicrobials, as well as toxic effects on leukocyte lineage and other parameters of the blood. GOAL The goal of this study was to confirm that the antimicrobial therapy of urinary, gynecological and respiratory infections has a toxic effect on leukocyte lineage. Followed by lowered immunity and the emergence of risk for health complications especially in oncology and other immunodeficient patients for whom to apply pharmacotherapy it is necessary to have adequate immunity, or white blood cell count that is greater than 4.0 x 10(9)/L. MATERIAL AND METHODS A prospective-retrospective study was conducted on a sample of 30 patients in a Primary Health Care Center in Gracanica during the period from March 01, 2013 until April 01, 2014. Testing of this sample was conducted by survey on health status and treatment, or on taking of antimicrobial therapy and other treatment regimens, with the referral diagnosis and determination of leukocytes count in by hematology counter SYSMEX. Results of leukocytes below and close to the lower reference values were statistically analyzed by Students t-test. RESULTS Mean WBC count in the group treated with antimicrobial therapy was 3.687 +/- 0.83 x 10(9)/L, in the group which during repeated infection did not use the antimicrobial therapy 5.09 +/- 1.04 x 10(9)/L, and in the control group of healthy subjects 7.178 +/- 1.038 x 10(9)/L. Statistical analysis with Student's t test indicate highly significant differences between group of patients that used antimicrobial therapy with the group of patient that did not used antimicrobial during repeated infection (t = 6.091; p = 0.0001), as well as significant differences in mean WBC count of both of these groups and the controls (t = 4.984; p = 0.0001, and t = 8.402, p = 0.0001). CONCLUSION Use of antimicrobial drugs leads to serious toxic reactions, or leukopenia. Indications for the use of antimicrobial therapy must be strictly followed, because banal, frequent infections are not indication for antimicrobial therapy. It is necessary to know the types of infection causes. Important is the proper and timely selection of antimicrobial therapy. When selecting the drug we should bear in mind its antimicrobial activity, pharmacokinetic and toxic properties, as well as patient health status. Possible is also the application of preventive medicine as well as other manner of solving infection.

Introduction: Elimination of stone is determined by size and its localization. Stone from the ureter in 80% of cases can be eliminated spontaneously. If the stone by its characteristics is not spontaneously eliminated, taken are further steps and therapeutic protocols to solve this problem. Material and methods: The study was prospective, open and comparative. It was conducted at the Urology Clinic Clinical Center of Sarajevo University in the period from 2007 to 2013. The study included 404 patients with urinary tract lithiasis treated by ESWL. ESWL treatment is performed on the machine Siemens Model Lithostar Multiline, which has a combined ultrasonographic and fluoroscopic display, large energy density in order to obtain optimum focus (without damaging surrounding tissue) and minimal pain that on rare occasions requires for mild sedation-sedation. Results: From a total of 404 patients included in the study there were 234 (57.92%) male and 170 (42.08%) female patients. The most common type of stone both in female and male patients was calcium type. From a total of 262 calcium stones, 105 of them (40.07%) was present in female patients and 157 (59.92%) in male. Share of infectious type of stone in female patients was 63 (49.60%) and 64 among males (50.39%). Other stones were less abundant in both the gender groups and their total number was only 17. In women their frequency was 2 (13.33%) and 13 among males (86.67%). There was a significant difference in the frequency of different types of stones by gender (χ2 = 11.47, p = 0.009). Conclusion: There was no statistically significant correlation between the number of treatments and localization of stones in the ureter, as well as a statistically significant correlation between the size of the stone and the localization of calculus in the ureter.

INTRODUCTION A kidney tumor is an abnormal growth within the kidney that usually occurs over a period of a time. Each tumor has its own characteristics and it is important to know what tumor the patient has so that the proper treatment can be administered. Kidney tumors can be benign or malignant. Symptoms of all types of kidney tumors are very similar and unspecific. The aims of study: a) To determine how many patients, who were clinically and radiologically diagnosed with kidney tumor, after surgical intervention, have histopathologicaly confirmed renal cell carcinoma; b) To compare number of female and male patients have histopathologicaly confirmed renal cell carcinoma; c) To compare numbers of patients with renal cell carcinoma who are older than 50 years with the ones who are younger than 50 years; d) To determine the most common risk factors for renal cell carcinoma; e) To determine the most common symptoms of renal cell carcinoma; f) To determine what was the most common stage of kidney cancer in the time when it was histopathologicaly confirmed. MATERIAL AND METHODS This study was observational, descriptive, retrospective study of renal cell carcinoma. The study consisted of 28 patients who were clinically and radiologically diagnosed with kidney tumor, which was surgically removed and histopathologicaly tested. All patients were surgically treated at the Urological Clinic of Clinical Centre University of Sarajevo from 1/1/2012 to 06/30/.2012. RESULTS from 28 patients with a kidney tumor 26 had RCC, the most of patients with RCC were older than 50 years (22 patients), there was 7 female and 19 male patients, the most common symptom was pain (10 patients), the most common risk factor, excluding age, was hypertension (11 patients), patients with RCC was usually diagnosed stage 4 Fuhrman (11 patients). CONCLUSION Doctors should give their intention to discover early symptoms of renal cell carcinoma and to do preventive exams and tests in the population of patients who have one or more risk factors for developing this disease. Early diagnose and appropriate therapy could reduce mortality and morbidity of the patients with renal cell carcinoma, and could also reduce costs of treatment.

Goal: To investigate the correlation between TSH and HbA1c in the treatment of L-thyroxine in the process of glycemic control in patients with subclinical hypothyroidism. Patients and methods: The sample consisted of 100 patients, mean age 51.75±3.23 years, BMI=27.97±4.52 kg/m2, with SH (TSH>4.2 mU/L and normal serum T3 and T4). Laboratory diagnosis included the determination of free T3, free T4, thyroid antibodies, Tg, insulin, C-peptide and glucose during the OGTT, HbA1c, CRP and lipid levels. 20 patients with SH had prediabetes and 38 patients had DM. All patients were treated with low doses of L-thyroxine (25-50ug) and all were physically active. Results: After 6 months of treatment with L-thyroxine, the patients had normal or decreased TSH (5.85±0.92 vs. 3.54±0.55 mU/L), insulin levels (114.64±24.11 vs. 96.44±17.26 pmol/L) significantly reduced HbA1c (6.74±1.01 vs. 6.26±1.12) is reduced. Conclusion: The correlation between TSH and HbA1c was positive and significant (r=0.46). This indicates a significant effect of treatment with L-thyroxine on glycemic control in patients with subclinical hypothyroidism.

AIMS We examined effects of treatment with 1-thyroxin on glucose regulation in patients with subclinical hypothyroidism. METHODS The study included 100 patients, ages 51.75 +/- 13.23 years, BMI = 27.97 +/- 4.52 kg/m2, with SH (TSH > 4.2 mU/L and with normal level of T3 and T4). Laboratory evaluation included serum free T3, free T4, TSH, thyroid antibodies, TGL, insulin, C-peptide and glucose during OGTT, HbA1c, CRP and level of lipids. Percentile, average and correlation analysis have been utilized in statistical analysis. Twelve patients with SH had GI and 38 patients had DM. All patients were treated with low dose of 1-thyroxin (25-50 ug) and high physical activity. RESULTS After 6 months treatment with 1-thyroxin, patients had normal or limited TSH (5.85 +/- 0.92 vs. 3.54 +/- 0.55 mU/L), level of fasting insulin (114.64 +/- 24.11 vs. 96.44 +/- 17.26 pmol/l) significantly decreased, HbA1c (6.74 +/- 1.01 vs. 6.26 +/- 1.12) decreased as well. The level of CRP significantly decreased as well (2.27 +/- 0.8 vs. 3.32 +/- 1.1 mg/l). The changes were and in level of total cholesterol (5.39 +/- 0.57 vs. 6.10 +/- 0.67 mmol/l), triglyceride levels (1.69 +/- 0.37 vs. 2.22 +/- 0.49 mmol/l), HDL cholesterol (1.16 +/- 0.14 vs. 1.03 +/- 0.15 mmol/l) and LDL cholesterol (3.79 +/- 0.64 vs. 4.37 +/- 0.77 mmol/l). The correlation between TSH and HbA1c was positive and significant (r = 0.46). CONCLUSION The normalization of TSH resulted in decrease of level of fasting insulin, fasting and postprandial glucose, CRP and lipids. Higher CRP associated with fasting hyperinsulinemia before insulin resistance has been evidenced in most patients with SH. These data support an important role of treatment of SH in support of glucose regulation.

Introduction: Surgical intervention and anesthesia procedure lead to a series of hormonal changes in the organism, which is mainly attributed to catecholamine response to stress. Surgical intervention is resulting in significant changes in neuroendocrine regulation, metabolism and physiological functions, as part of the overall response to stress. Research aim: The aim of this study was to determine and evaluate the levels of hormones in patients undergoing transvesical prostatectomy under general or local anesthesia. Material and methods: The study included a total of 100 patients from the Clinic of Urology, Clinical Center of Sarajevo who underwent surgery by technique of transvesical prostatectomy (BPH) in which the indicators were set:: a) repeated urinary retention; b) calculosis and diverticulosis of the urinary bladder; c) urinary infection, d) repeated massive hamaturia and e) the distal obstruction that can lead to uremia. Results: General anesthesia may limit the perception of stimuli from injury, but does not eliminate the full response to noxious stimuli, even with deep anesthesia. All intravenous agents andvolatile anesthetics in normal doses have little effect on the endocrine and physiological functions. Neural blockade induced by regional anesthesia or local anesthetics have a direct impact on endocrine and metabolic response. Regional anesthesia with the present consciousness, but with sympathetic blockade caused a greater suppression of hormonal responses than the general balanced anesthesia. In our research we obtained: a) a significant increase in prolactin intraoperatively, for respondents under general anesthesia; b) a significant increase in TSH values intraoperatively for respondents under general anesthesia; c) a significant drop in T4 intraoperatively in patients with regional anesthetic technique; d) a significant increase in cortisol values 24 hours postoperatively in patients with regional anesthetic technique.

Ultrasound device, essentially, consists of a transducer, transmitter pulse generator, compensating amplifiers, the control unit for focusing, digital processors and systems for display. It is used in cases of: abdominal, cardiac, maternity, gynecological, urological and cerebrovascular examination, breast examination, and small pieces of tissue as well as in pediatric and operational review.

INTRODUCTION Radical retropubic prostatectomy is a therapeutic option for treatment of localized prostate cancer. The goal of radical prostatectomy is to completely remove the tumor while preserving erectile function and urinary continence as well as factors that determine the postoperative quality of life. There are many factors influencing sexual function after radical prostatectomy of localized prostate cancer. All factors can be divided into the preoperative, postoperative and intraoperative. In this paper we examine the significance of individual factors affecting erectile dysfunction following surgical treatment. MATERIAL AND METHODS The study included 36 patients who underwent nerve sparing radical prostatectomy at the Urology Clinic, Clinical Center of Sarajevo University in period from January 2009 until December 2010. RESULTS Out of 84 patients tested, radical retropubic prostatectomy with the reservation of neurovascular bundles was performed in 36 patients (42.8%). Of this number, both of the neurovascular bundles were preserved in 28 patients (77.7%) and one in 8 patients (22.2%). CONCLUSION The positive predictive factor for erectile function after radical retropubic prostatectomy is the preoperative sexual function, younger age, preservation of both neurovascular bundles and early rehabilitation therapy.

Introduction: Treatment of localized prostate cancer refers to two basic modes which are the radical retro pubic prostatectomy and external radiotherapy. However, according to most authors, radical prostatectomy is the gold standard for long-term survival. Objective: To determine the occurrence of erectile dysfunction after radical operative treatment and irradiation therapy. Material and methods: In this paper we have examined the occurrence of erectile dysfunction after conducted treatment for localized prostate cancer. In this paper we have examined 84 of 138 patients who underwent radical retro pubic prostatectomy at the Urology Clinic in the period from January 2009 to December 2010 and 26 patients who underwent radical external radiotherapy in the same period, because of localized prostate cancer. Results: The average age of surgical patients was 65 years, the youngest patient was 49 years and the oldest 81 years. From the 84 patients which underwent surgery, neurovascular preservation of nerve bundles was done in 36 (42.8%) patients from which bilateral in 28 patients (77.7%) and unilateral in 8 patients (22.2%). Average age of patients who underwent irradiation therapy was 68 years. Conclusion: Erectile dysfunction occurs in greater proportion after radical retro pubic prostatectomy compared to radiation treatment, and the preservation of both neurovascular bundles reduces this difference.

Introduction: Transurethral resection (TUR) of bladder tumors is surgical treatment for visible tumors of the urinary bladder and is performed to remove the tumor and take samples for histopathological examination in order to determine the stage and tumor grade. Transurethral resection of prostate tumors (TURBT) is a surgical procedure that is performed daily at the Clinic for Urology, Clinical Center University of Sarajevo (CCUS). As for all other endoscopic urology procedure, typically urine must be sterile preoperatively. Patients with preoperative asymptomatic bacteriuria have a high risk of bacteremia and sepsis. In urological guidelines, antibiotic prophylaxis in TURBT is only given in cases of high risk patients, and necrotic tumors. Methodology: The study was conducted as a retrospective study which included patients underwent surgical treatment–TURBT and who underwent preoperative urine tests and postoperatively the clinical manifestation of UTI, urine cultures were isolated, and in case of the clinical indications also the blood culture. Included are only patients with preoperative sterile urine findings. The source of data was history of the disease. Results: From the 512 patients which underwent TURBT in 159 cases (31.0%) patients did not receive antibiotic prophylaxis and 353 (68.9%) patients received antibiotic prophylaxis. The first group of patients which did not receive antibiotic prophylaxis in 22 cases (14%) patients developed symptomatic urinary tract infection confirmed by urine culture and in 5 (3.1%) patient with blood culture was proven bacteraemia. In the second group of patients who received prophylactic antibiotic therapy in 78 cases (22%) patients developed a urinary infection and in 2 cases (0.57%) patients bacteremia was detected in blood culture. Conclusion: With regard to the set goals we have prove the incidence of urinary infection after performing TUR of bladder tumors in our Clinic.

OBJECTIVE This study aimed to demonstrate incidence, symptoms and therapy management of testicular cancer patients. Also we had evaluated significance of testicular tumor markers. PATIENTS AND METHODS The study was retrospective, clinical and manipulative, analytical and descriptive and covers the period from 01.01.2000 to 31.12. 2008 with 58 male patients from 16 years upwards. For each patient, the data were analyzed from ambulance and hospital protocol on the Urology Clinic Sarajevo. RESULTS Incidence of testicular cancer among patients at the Urology Clinic clinical center Sarajevo is on the rise for the last three years (about 20%). Of the 58 patients with testicular cancer, 70% of patients were in age 20-39 years. 47% were patients with right side testicular cancer and 53% were left sided. Walter Reed Hospital tumor classification showed I 50%, IIa 10%, IIb 19% and III 21% of patients. The highest incidence of pathohistological reports showed mixed tumors 46%, seminoma 26%, yolk sack 2%, teratoma 2%, carcinoma embrionale 16%, dysgerminoma 5% and Laydig cell carcinoma 3%. Mixed, seminoma and carcinoma embirionale represents 90% of testicular tumors. betaHCG marker was positive in 53% of patients with seminoma and non seminoma 80%. CEA marker was positive only in 9% of all testicular cancer, LDH showed higher incidence with metastatic seminoma tumor. 27,5% of patients undergone retroperitoneal lymphadenectomy treatment, all patients had radical orchiectomy. CONCLUSION The common therapeutic procedure in the treatment of testicular tumors are surgical methods radical inguinal orchiectomy, chemotherapy (advanced stages of seminoma and all stages of non seminoma tumor and radiotherapy (early stage seminoma). AFP and betaHCG are excellent markers in the evaluation of surgical and oncology treatment of testicular tumor.