BACKGROUND AND PURPOSE The present study was carried out to compare the efficacy of ESWL treating radiolucent ureteric calculi visible in the ureter after application of contrast media. MATERIAL AND METHODS Medical records of 47 patients who had verified ureteric calculi by intravenous urography and retrograde pyelography were included in this study. Patients had undergone ESWL treatment after application of contrast media. Patients were divided in two groups, different in focusing the shock waves either at the end and below contrast shadows of the column of contrast medium visible in the ureter. 23 patients from group 1 were treated with shock waves focused on the end of contrast medium column and 24 patients from group 2 were treated with shock waves focused below contrast shadow of the contrast column. RESULTS The stone free rate after 1 month were 9% and after 3 months were 14% greater in group 2 (89%) than in group 1 (75%). There were no allergic reactions to the contrast medium. Distributions of age, gender, treatment and diagnostic methods had been in both groups compared. CONCLUSION ESWL of radiolucent ureteric calculi with application of contrast media is effective and safe. Shock waves focused below contrast shadow of the contrast column had better stone free rate than focusing at the end of the column.

We have evaluated objectively pain tolerance in transrectal ultrasound-guided prostate biopsy (TRUS) using local periprostatic per rectal anesthesia as compared to the conventional method. From November 2008 to May 2009, 90 patients underwent transrectal ultrasound-guided prostate biopsy at Department of Urology, Clinical Center University Sarajevo. 90 patients who fulfilled the inclusion criteria were randomized into 3 groups of 30 patients each. Group 1 received periprostatic local anesthesia with 2% lidocaine, group 2 received Voltaren supp placed in rectum an hour before biopsy while group 3 received no local anesthesia. Pain scale responses were analyzed for each aspect of the biopsy procedure with a visual analog scale of 0-none to 10-maximal. There was no difference between the 3 groups in pain scores during digital rectal examination, intrarectal injection and probe insertion. The mean pain scores during needle insertion in group 1 receiving periprostatic nerve block and in group 2 receiving Voltaren supp were 3,10 +/- 2,32 and 5,15 +/- 2,01 respectively. In group 3 (no local anesthesia), mean pain scores were 6,06 +/- 2,95 which was found to be significantly different (p < 0,001). However, morbidity after the biopsy was not statistically different between all 3 groups. TRUS-guided prostate biopsy is a traumatic and painful experience, but the periprostatic blockage use is clearly associated with more tolerance and patient comfort during the exam. It is an easy, safe, acceptable and reproducible technique and should be considered for all patients undergoing TRUS biopsy regardless of age or number of biopsies.

OBJECTIVE It is known that ESWL can promote acute renal injuries and long-term complications of renal vasculature. Effects on renal vasculature can be evaluated by color Doppler ultrasonography measuring renal resistive index (RI). This prospective study aimed to determine the influence of number of delivered SW-s, used kV and changes in renal resistive index. PATIENTS AND METHODS Total of 60 normotensive patients, 38 males (63%) and 22 females (37%), with renal stones 6-18 mm in size were included in this study. Median age was 42.3 years (range 22-55). RI was measured at interlobar artery before, 1, 3, 5 and 30 days after treatment on treated and contra lateral non-treated kidney. Patients were divided in two groups: Group I (N=25) received 2000 SWs; 0-2 units; (0.5 unit each 500 SWs) Group II (N=35) received 4000 SWs, 0-4 units; (0.5 unit each 500 SWs). RESULTS In treated kidneys RI significantly increased first and second day after treatment from 0.62 +/- 0.05 at baseline to 0.67 +/- 0.05, p < 0.001 at first and 0.66 +/- 0.05, p < 0.007 on the second day after treatment. Increase of RI seven days after treatment is not significant (0.62 +/- 0.05). The contra lateral, non-treated kidney showed significant changes in RI only first day after treatment (0.64 +/- 0.05), p < 0.01. One month after the treatment RI is on normal values in both kidneys. CONCLUSIONS Resistive index-RI is important parameter in evaluation of renal vasculature. Patients treated by ESWL showed a temporary increase in RI two days after the treatment and only first day in contra lateral non-treated kidney--probably caused by release of substance with vasoconstriction properties (need further investigations).