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.

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.

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.

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.

GOAL To evaluate risk factors of erective dysfunction (ED) and find out incidence in patients with newly diagnosed diabetes mellitus. MATERIAL AND METHODS All patients from Centre for Diabetes with newly diagnosed diabetes mellitus type 2 are involved in study. We have done interview using questionnaire-International Index of Erectile Function (IIEF)-5. Result of IIEF-5 less than 21 was used as bottom line for identification of patients with ED. RESULTS Newly diagnosed diabetes mellitus type 2 was a case in 243 patients from which 37% of them had ED. Comparing potent man with those with ED there are statistically significant difference according to smoking, duration of smoking, hypertension, body mass index and serum level of glycozated hemoglobin HbA1c. Using multivariate logistic regression model, age was identified as the most significant risk factor. CONCLUSION Patients with newly diagnosed diabetes mellitus have high prevalence of ED which can be related with other risk factors such as age of diabetes onset, hypertension, smoking and body mass index.

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.