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FINAL PROGRAMME
AND ABSTRACT BOOK
SUBOTA 06.04.2013. / SATURDAY 06th April 2013
14:00 - 22:00 DOLAZAK I REGISTRACIJA
/ ARRIVAL AND REGISTRATION
19:30 - 20:00 KOKTEL DOBRODOŠLICE
/ WELCOME COCKTAIL
20:00 - 20:30 SVEČANO OTVARANJE
/ OPENING CEREMONY
Hotel Olympia Hall
20:30 - 23:00 VEČERA / DINNER
Hotel Olympia Restaurant
22:00
AFTER PARTY - „Disco 80-ties
Hotel Olympia Tavern
________________________________________________________________
NEDJELJA 07.04.2013. / SUNDAY 07th April 2013
Kongresna dvorana Olympia - Olympia hall:
08:00
- uvodna riječ predsjednika Hrvatskog urološkog društva, prof. dr. Željko Kaštelan
- welcome speech president of the Croatian Society of Urology,
Zeljko Kaštelan, MD PhD
________________________________________________________________
BOARD 1: 08:15
Željko Kaštelan, MD, PhD, Croatia
Dimitar Mladenov, MD, PhD, Bulgaria
Milan Hora, MD, PhD, Czech Republic
Haluk Akpinar, MD, PhD, Turkey
- predviđen početak video prijenosa 1. operacijskog zahvata iz
bolnice Šibenik
- anticipated beginning of video transmission of surgery No.1
from Sibenik hospital
Lecture 1 - 20 min.
Peter Tenke, MD, PhD,
South-Pest Teaching Hospital, Dept. of Urology, Budapest, Hungary
„The role of intraoperative frozen section during laparoscopic radical
prostatectomy“
Lecture 2 - 20 min.
Dimitar Mladenov, MD, PhD
Clinic of Urology, Medical University, Sofia, Bulgaria
„Minimally invasive treatment of BPH“
Lecture 3 - 20 min.
Milan Hora, MD, PhD,
Department of Urology, University Hospital Pilsen, Czech Republic
„LESS (laparoendoscopic single site surgery) nephrectomy – A technique for
everyday clinical practise? „
Lecture 4 - 15 min.
Haluk AKPINAR, PhD, MD,
Associate Professor of Urology, Departments of Endourology & Robotic
Surgery Group Florence Nightingale Hospitals, Istanbul, Turkey
„Current place of Flexible Ureteroscopy and Laser Lithotripsy for Stones
≥ 2 cm“
Lecture 5 - 15 min.
Haluk AKPINAR, MD,
Associate Professor of Urology
Departments of Endourology & Robotic Surgery, Group Florence Nightingale
Hospitals, Istanbul, Turkey
„Robotic partial nephrectomy with segmental ischemia“
Lecture 6 - 15 min.
Mario Šunjara, MD
Clinic of Urology , Clinical Hospital Center Zagreb, Croatia
„Minimally invasive treatment of upper urinary tract lesions“
10:30
- predviđen početak video prijenosa 2. operacijskog zahvata iz
bolnice Šibenik
- anticipated beginning of video transmission of surgery No.2 from Sibenik hospital
________________________________________________________________
BOARD 2:
Ivan Gilja, MD, PhD, Croatia
Ioan Coman, MD, PhD, Romania
Vinka Vukotić, MD, PhD, Serbia
Sandi Poteko, MD, Slovenia
Lecture 7 - 20 min.
Sandi Poteko, MD,
Department of Urology, General Hospital Celje, Slovenia
„Robotic assisted radical prostatectomia and large prostate“
Lecture 8 - 20 min.
Vinka Vukotić, MD, PhD,
Department of Urology, Clinical Hospital “Dr Dragiša Mišović- Dedinje ”, Belgrade, Serbia
„Ureteral stump in the treatment of upper urothelial tumors, is it so important?“
11:00 „Eli Lilly“ simposium:
“Proaktivni pristup dijagnostici i liječenju erektilne disfunkcije”
“Proactive approach to ED diagnose and treatment”
Voditelj simpozija / Simposium leader: Željko Kaštelan MD, PhD
Dinko Hauptman, MD - 20 min.
“Cialis- liječenje bolesnika s erektilnom disfunkcijom prilagođeno njihovim
potrebama”
“Cialis - ED patients treatment with intent to adopt to their profile”
Željko Kaštelan, MD, PhD - 20.min.
“Ažurirane smjernice o dijagnostici i liječenju erektilne disfunkcije”
“Update on the Diagnosis and Management of ED - Recent Guidelines”
Diskusija i zaključak / Discusion and conclusion - 5 min.
Lecture 9 - 20 min.
Ioan Coman, MD, PhD,
Clinical Department of Urology, Cluj-Napoca Municipal Hospital, Romania
“Robot-assisted radical cystectomy with intracorporeal ileal neobladder - initial
experience”
Lecture 10 - 15 min.
Dan Vasile Stanca, MD,
EndoPlus Urological Clinic Cluj-Napoca, Romania
„Transurethral Resection in Saline and Plasma Vaporization of the Prostate:
Clinical Evaluation of Safety and Short-term Results.“
________________________________________________________________
BOARD 3:
12:40
Davor Trnski, MD, PhD, Croatia
Hrvoje Kuveždić, MD, Croatia
Nado Vodopija, MD, Slovenia
Damir Šimunović, MD, Croatia
- predviđen početak video prijenosa 3. operacijskog zahvata iz
bolnice Šibenik
- anticipated beginning of video transmission of surgery No.3
from Sibenik hospital
Lecture 11 - 20 min.
Nado Vodopija, MD, Slovenia
„ The management of rising PSA after curative therapy“
Lecture 12 - 15 min.
Ivan Ćosić, MD,
Klinika za urologiju, Klinički bolnički centar Osijek, Osijek, Hrvatska
“KBC Osijek: experiences with percutaneus nephrolithotomy “
Lecture 13 - 15 min.
Dean Markić, MD,
Klinika za urologiju, Klinički bolnički centar Rijeka, Hrvatska
„Transuretralna incizija kod opstrukcije vrata mokraćnoga mjehura u žena“
„Transurethral incision in bladder neck opstruction in women“
Lecture 14 - 15 min.
Tomislav Dominis, MD
Odjel urologije, Opća bolnica Zadar
„Prikaz slucaja: Pracenje i lijecenje radioloski benignog tumora bubrega“
“Case report: radiological monitoring and treatment of benign tumors of the
kidney”
Lecture 15 - 15 min.
Jakov Škugor, MD
Department of Radiology, General Hospital Šibenik, Croatia
„ MR Urography: Techniques and Clinical Applications“
Lecture16 - 15 min.
Dejan Bratuš, MD
Department of Urology, University Clinical Centre Maribor, Slovenia
„Male LUTS“
________________________________________________________________
Dvorana Astellas - Astellas Hall:
Astellas Urology Academy
Evidence based medicine
10:00 - 10:45 Workshop 1
„Challenges in male LUTS“
Željko Kaštelan, MD, PhD
Davor Trnski, MD, PhD
11:15 - 12:00 Workshop 2
„It is time to think of something else - OAB“
Ivan Gilja, MD, PhD
Davor Librenjak, MD, PhD
12:30 - 13:15
Workshop 3
„New options for advance PCa“
Mladen Solarić, MD
Marijan Šitum, MD, PhD
________________________________________________________________
Dvorana Artemis - Artemis hall:
„Richard Wolf“
17:00 - 20:00 Workshop „Richard Wolf“
_______________________________________________________________
Napomene - remarks:
- Kava i osvježavajuća pića služiti će se ispred Kongresne dvorane
Olympia od 09:30 do 11:30 sati
- Coffee and refreshments will be served in front of the Olympia Hall
from 09:30 to 11:30 hrs
- RUČAK će se služiti u restoranu hotela od 14:30 do 15:30 sati
- Lunch will be served in the hotel restaurant 14:30 to 15:30 hours
- Molimo sve sudionike kongresa da prilikom dolaska na ručak sa sobom
imaju akreditaciju!
- Please bring your acreditation with you when you are going to lunch!
________________________________________________________________
17:00
IZLET NA OTOK PRVIĆ
/ BOAT EXCURSION TO THE ISLAND OF PRVIĆ
-posjet Memorijalnom muzeju Fausta Vrančića -polazak broda u 17:00 sati
-visiting Faust Vrančić Memorial Centre
-boat departure at 17:00 hours.
________________________________________________________________
20:30
VEČERA / DINNER
-planira se ribarska večera na plaži ispred hotela
-fisherman’s dinner on the beach in front of hotel is planned
-u slučaju nepogodnog vremena večera se može premjestiti u
restoran hotela
-In case of bad weather, dinner will be served in hotel restaurant
-Molimo sve sudionike kongresa da prilikom dolaska na večeru
sa sobom imaju akreditaciju!
-Please bring your acreditation with you when you go to dinner! ________________________________________________________________
22:30 AFTER PARTY - „Studio 54“
Hotela Olympia Tavern
________________________________________________________________
PONEDJELJAK 08.04.2013. / MONDAY 08th April 2013.
Kongresna dvorana Olympia - Olympia hall:
BOARD 4:
08:15
Peter Tenke, MD, PhD, Hungary
Krzysztof Szkarłat, MD, PhD, Poland
Cane Tulić, MD, PhD, Serbia
Boris Ružić, MD, PhD, Croatia
- predviđen početak video prijenosa 1.operacijskog zahvata iz
bolnice Šibenik
- anticipated beginning of video transmission of surgery No.4
from Sibenik hospital
Lecture 17 - 10 min.
Krzysztof Szkarłat , MD, PhD,
Department of Urology and Oncologic Urology, Szpital Specjalistyczny w
Kościerzynie, Poland
„Bipolar TURP - is it a mile stone in the treatment of bladder outlet
obstruction?“
Lecture 18 - 10 min.
Krzysztof Szkarłat , MD, PhD,
Department of Urology and Oncologic Urology, Szpital Specjalistyczny w
Kościerzynie, Poland
„Laparoscopic Nephrouterectomy for Upper Urinary Tract Transitional Cell
Carcinoma. Is it a standard of care?“
Lecture 19 - 20 min.
Cane Tulic, MD, PhD,
Klinika za urologiju KCS, Beograd, Srbija
„Can we safely reduce the fluoroscopic time during PCNL?“
Lecture 20 - 15 min.
Jablan Stanković, MD, PhD,
Department of Urology, Clinical Center Niš, Serbia
„Holmium Laser Enucleacion of the Prostate HoLEP: Results of the first 50
operations“
Lecture 21 - 15 min.
Mario Kordic, MD,
Clinic of urology, University Clinical Hospital Mostar, F Bosnia and
Herzegovina
„Transurethral laser vaporisation of the prostate – our early experience“
Lecture 22 - 25 min.
Zeljko Kastelan, MD, PhD
Clinic of Urology, Clinical Hospital Centre Zagreb, Croatia
„Kombinirana terapija u liječenju bolesnika s umjerenim i teškim simptomima
benigne hiperplazije prostate“ – GlaxoSmithKline predavanje
“Combination therapy in the treatment of patients with moderate to severe
symptoms of benign prostatic hyperplasia” – GlaxoSmithKline lecture
________________________________________________________________
BOARD 5: 10:30
Maksim Valenčić, MD, PhD, Croatia
Klaudio Grdović, MD, PhD, Croatia
Davor Librenjak, MD, PhD, Croatia
Sotir Stavridis, MD, PhD, Macedonia
- predviđen početak video prijenosa 2. operacijskog zahvata iz bolnice Šibenik
- anticipated beginning of video transmission of surgery No.5
from Sibenik hospital
Lecture 23 - 20 min.
Maksim Valenčić, MD, PhD,
Klinika za urologiju, KBC Rijeka, Hrvatska
„Endoskopsko liječenje kamenca u kontinentnom spremniku mokraće po tipu
Mainz-pouch I – prikaz slučaja“
“Endoscopic treatment of stones in the Mainz-pouch I continent container –
case report”
Lecture 24 - 20 min.
Sotir Stavridis, MD,
Medical Faculty Skopje, University Clinic of Urology Skopje, Macedonia
„ Correlation of laparoscopic versus open radical nephrectomy in patients with
T1-T3 tumors: personal experience and literature review“
Lecture 25 - 15 min.
Ivan Radoja, MD,
Klinika za urologiju, Klinički bolnički centar Osijek, Osijek, Hrvatska
„Liječenje ureteralnih kamenaca ureterorenoskopijom: iskustvo Referentnog
centra za urolitijazu Ministarstva zdravstva i socijalne skrbi Republike
Hrvatske“
„Ureterorenoscopy in treating ureteral calculi: experience of Croatian Reference
Center for Urolithiasis“
Lecture 26 - 15 min.
Tomislav Kuliš, MD
University Hospital Center Zagreb and University of Zagreb, School of
Medicine, Department of Urology, Zagreb, Croatia
„The application of lasers in the treatment of urological patients at University
department of Urology, University hospital center Zagreb“
Lecture 27 - 15 min.
Ante Reljic, MD, PhD
Department of urology, University Hospital Center „Sestre milosrdnice“ Zagreb,
Croatia
„TURBT – Can we do it better? Yes, WE can!“
Lecture 28 - 15 min.
Ljubomir Dinić, MD
Medical Faculty University of Nis, Department of Urology, Clinical Center Nis
“Ureteroscopic treatment of ureteral calculi using the holmium laser
(our first experience)”
________________________________________________________________
BOARD 6:
12:30 Mustafa Hiroš, MD, PhD, Bosnia and Herzegovina
Vahudin Zugor, MD, Germany
Christoph Lang, MD, Germany
Zoran Peršec, MD, PhD, Croatia
- predviđen početak video prijenosa 3. operacijskog zahvata iz
bolnice Šibenik
- anticipated beginning of video transmission of surgery No.6
from Sibenik hospital
Lecture 29 - 20 min.
Mustafa Hiroš, MD, PhD
Urology Clinic, University Clinical Centre Sarajevo, Bosna ad Herzegovina
„The management of small renal masses ( SRM )“
Lecture 30 - 10 min.
Vahudin Zugor, MD
Department of Urology and Pediatric Urology – Prostate Center Northwest, St.
Antonius Medical Center, Gronau, Germany.
„Potency outcomes of patients without preoperative erectile dysfunction
undergoing unilateral intrafacial nerve sparing robot-assisted laparoscopic
radical prostatectomy.“
Lecture 31 - 10 min.
Vahudin Zugor, MD
Department of Urology and Pediatric Urology – Prostate Center Northwest, St.
Antonius Medical Center, Gronau, Germany.
„Intraoperative and postoperative complications as well as functional outcomes in
diabetic patients undergoing robotic-assisted laparoscopic radical prostatectomy.“
Lecture 32 - 10 min.
Vahudin Zugor, MD
Department of Urology and Pediatric Urology – Prostate Center Northwest, St.
Antonius Medical Center, Gronau, Germany.
„Outcomes after Botulinum toxin type A -Injection in detrusor vesica in patients
undergoing robot-assisted radikale Prostatectomy( RARP).“
Lecture 33 - 10 min.
Krzysztof Szkarłat , MD, PhD,
Department of Urology and Oncologic Urology, Szpital Specjalistyczny w
Kościerzynie, Poland
„Minimally invasive surgery, can we make it less invasive ?”
Lecture 34 - 10 min.
Krzysztof Szkarłat , MD, PhD,
Department of Urology and Oncologic Urology, Szpital Specjalistyczny w
Kościerzynie, Poland
„Transurethral prostate incision – a forgotten procedure?”
Lecture 35 - 20 min.
Christoph Lang,MD,
Department of Urology, Knappschaftskrankenhaus Sulzbach, Germany
„Ejaculation preserving Laservaporesection of the Prostate using a 2μm Thulium
Laser in endoscopic surgery – Outcome and demonstration of a new surgical
technique“
________________________________________________________________
Napomene - remarks:
-
-
Kava i osvježavajuća pića služiti će se ispred Kongresne dvorane Olympia od
09:30 do 11:30 sati
Coffee and refreshments will be served in front of the Olympia Hall from 09:30 to 11:30 hrs
- RUČAK će se služiti u restoranu hotela od 14:30 do 15:30 sati
- Lunch will be served in the hotel restaurant 14:30 to 15:30 hours
- Molimo sve sudionike kongresa da prilikom dolaska na ručak sa sobom imaju
akreditaciju!
- Please bring your accreditation with you when you go to lunch!
________________________________________________________________
Dvorana Artemis - Artemis hall:
„Richard Wolf“
17:00 - 20:00 -Workshop „Richard Wolf“
________________________________________________________________
17:00-
IZLET U ŠIBENIK / VISIT TO THE CITY OF ŠIBENIK
-razgledavanje stare gradske jezgre i katedrale sv. Jakova,
glazbeni program u katedrali - nastup poznate šibenske
sopranistice Nere Gojanović uz klavirsku pratnju prof. Gordane Pavić, degustacija srednje dalmatinskih vina
-polazak autobusa ispred hotela u 17:00 sati
-visiting old town centre and St. Jacobs Cathedral, music
program at the Cathedral
-a performance by the famous soprano mrs. Nera Gojanovic
with piano accompaniment by prof. Gordana Pavic, tasting of choicest Dalmatian wines
-bus departure in front of Hotel in 17:00 hours
________________________________________________________________
20:30
GALLA VEČERA / GALLA DINNER
- zabavni program - entertainment program
- sudionike zabavlja grupa „Orange“
- performing group “Orange”
- Molimo sve sudionike kongresa da prilikom dolaska na gala večeru sa
sobom imaju akreditaciju!
- Please bring your accreditation with you when you go to gala dinner!
________________________________________________________________
23:00 AFTER PARTY - „Oproštajna noć- Farewell Night“
Hotel Olympia Tavern
________________________________________________________________
UTORAK 09.04.2013. - TUESDAY 09th April 2013.
- IZLET u Nacionalni park Kornati
- BOAT EXCURSION to the Kornati National Park
- Polazak autobusa ispred hotela u 08:00 sati,
- Bus departure in front of Hotel Olympia at 08:00 hours
-
-
Dolazak u Pakoštane oko 09:00 sati i polazak brodom prema Kornatskim
otocima
Arrival in Pakoštane arround 09:00 hours and boat departure toward Kornati
islands
- Ručak i zabavni program na brodu
- Lunch and entertaiment at boat
-
-
Preporučamo sportsku i slojevitu odjeću i sportsku i udobnu obuću
We recommend several layers of warm, sporty clothes as the sensation of
warm or cold at sea and on the boat during sailing can considerably differ
from those on the mainland.
- Povratak u Pakoštane predviđen između 13:00 i 14:00 sati,
- Return in Pakoštane around 13:00 to 14:00 hours
- Organizirani transfer sudionika u hotel ili prema zračnoj luci već prema
ranijem dogovoru s tehničkim organizatorom BE-tours
- Organized transfer to the hotel or to the airport, according to an earlier agreement with the technical organizer of the BE-tours
- U slučaju lošeg vremena izlet brodom na Kornate može biti zamijenjen
nekim drugim izletom
- In case of bad weather boat excursion at Kornati islands could be replaced
with some other ecursion
PROGRAM SIMPOZIJA ZA MEDICINSKE SESTRE I TEHNIČARE
„ENDOUROLOGIJA DANAS“
________________________________________________________________
NEDJELJA 07.04.2013.
16:00 - 22:00 DOLAZAK I PRIJAVA SUDIONIKA SIMPOZIJA
17:00 - 20:00 IZLET NA OTOK PRVIĆ
- posjet Memorijalnom muzeju Fausta Vrančića
- polazak broda u 17:00 sati
20:30
VEČERA
- planira se ribarska večera na plaži ispred hotela
- u slučaju nepogodnog vremena večera se može premjestiti u
restoran hotela
- Molimo sve sudionike kongresa da prilikom dolaska na
večeru sa sobom imaju akreditaciju!
22:30
AFTER PARTY - „Studio 54“
Konoba Hotela Olympia
________________________________________________________________
PONEDJELJAK 08.04.2013.
Dvorana Atena - Atena hall:
Simpozij za medicinske sestre i medicinske tehničare „Endourologija danas“
Simposium for nurses and tehnicians „Endourology today“
08:00 - Svečano otvorenje
- voditelj - Zoran Parancin, med.teh, član Organizacijskog odbora simpozija
- pozdravna riječ predsjednika Hrvatskog urološkog društva Prof.dr. Željko Kaštelan,
- pozdravna riječ predsjednika Organizacijskog odbora međunarodnog
kongresa „Endourology today 2013.“ Mr.sc. Daniel Reljić
- pozdravna riječ glavne sestre Opće bolnice Šibenik bacc.med.tech.Dragica
Branica
________________________________________________________________
BOARD:
Ivanka Gelo, bacc.med.tech.
Marija Malek, prvostupnica sestrinstva
Zoran Parancin, med. teh.
08:30 - 11:00 sati
- 1. predavanje 20 min.
Ivanka Gelo, bacc.med.tech.
Klinika za urologiju KBC Zagreb, Zagreb
„Emocionalna inteligencija“
- 2. predavanje 20 min.
Marija Malek, prvostupnica sestrinstva
Glavna sestra Klinike za urologije, KBC Sestre milosrdnice, Zagreb „Uloga instrumentarke u endoskopskim zahvatima“
- 3. predavanje 20 min.
Astellas – sponzorirano predavanje
Irena Plaznik, dipl.m.s., Klinika za kirurgiju, odjel za urologiju, Univerzitetni
klinični centar Maribor, Maribor, Slovenia
Zoran Parancin, medicinski tehničar , Odjel kirurgije i urologije, Opća bolnica
Šibenik, Šibenik, Hrvatska
„Iskustva s lijekom Eligard®“
- 4. predavanje 20 min.
Ivana Lovrić, bacc.med.tech.
Klinička bolnica Split, Odjel za urologiju, Split
„Zdravstvena njega bolesnika nakon radikalne prostatektomije“
- 5. predavanje 20 min.
Marija Tkalac, bacc.med.tech.
Klinika za urologiju, KBC Rijeka
„Vanjske drenaže urina“
- 6. predavanje 20 min.
Ana Brežnij, bacc.med.teh.
Klinički bolnički centar Osijek, klinika za urologiju
„Tehnika instrumentiranja kod operacije radikalne prostatektomije“
- 7. predavanje 20 min.
Božena Kopjar, dipl.med.techn
Opća bolnica Varaždin, Odjel urologije, Varaždin
„TURP-prevencija i liječenje krvarenja“
- 8. predavanje 20 min.
Darija Vidović, ms
Klinika za urologiju KBC Zagreb, Zagreb
„Laserska uretrotomija“
________________________________________________________________
11:10 - 11:30 - Pauza za kavu
________________________________________________________________
BOARD: Ana Brežnij, bacc.med.teh.
Lidija Vitas, bacc.med.teh.
Danica Mladin, bacc.med.teh.
- 9. predavanje 20 min.
Kristina Prelas, bacc. med.teh.
Opća bolnica Šibenik, Odjel kirurgije i urologije
„Zdravstvena njega pacijenta s mokraćnim kamencima (urolitijazom)“
- 10. predavanje 20 min.
Strčić Nada, bacc. med.teh.
Klinika za urologiju, KBC Rijeka, Rijeka
„Transuretralna resekcija prostate u liječenju bolesnika sa benignom
hiperplazijom prostate“
- 11. predavanje 20 min.
Antonija Garai Jakovljević, bacc.med.techn.
KBC Osijek, Klinika za urologiju, Osijek
„ Zdravstvena njega bolesnika nakon operacije tumora testisa“
- 12. predavanje 20 min.
Karmen Kelam, prvostupnica sestrinstva
KBC Split, Odjel urologije, Split
„Sestrinska skrb za bolesnika s urinarnim kateterom“
- 13. predavač 20 min.
Draženka Rob, ms
Odjel kirugije i urologije, Opća bolnica Čakovec
“Kvaliteta života bolesnika s nefrostomom”
- 14. predavač 20 min.
Ivica Ražnjević, med.teh.
Odjel urologije, Opća bolnica Zadar
„E SWL“
- 15. predavanje 20 min.
Suzana Klasić, bacc.med.techn.,
Klinika za urologiju, Klinički bolnički centar Zagreb
„Transuretralna laserska incizija prostate“
- 16. predavanje 20 min.
Frau Helmi Henn,
„Aufbereitung und Werterhalt von starren und flexiblen Endoskopen“
„Obrada i odrzavanje krutih i fleksibilnih endoskopa“
________________________________________________________________
14:30 - 15:30 RUČAK - hotelski restoran
- Molimo sve sudionike kongresa da prilikom dolaska u hotelski restoran radi
ručka i večere sa sobom imaju akreditaciju!
________________________________________________________________
16:00 - 17:00 sati AKTUALNA TEMA: Diskusija u svezi osnivanja Udruge
uroloških medicinskih sestara i tehničara
________________________________________________________________
17:00 -IZLET U ŠIBENIK
- razgledavanje stare gradske jezgre i katedrale sv.Jakova, glazbeni program u katedrali - nastup poznate šibenske
sopranistice Nere Gojanović uz klavirsku pratnju prof. Gordane Pavić, degustacija srednje - dalmatinskih vina
- polazak autobusa ispred hotela u 17.00 sati
________________________________________________________________
20:30
GALLA VEČERA
-zabavni program
-sudionike zabavlja grupa „Orange“
- Molimo sve sudionike kongresa da prilikom dolaska na gala večeru sa sobom
imaju akreditaciju!
23:00
AFTER PARTY - „Oproštajna noć“
Konoba Hotela Olympia
________________________________________________________________
UTORAK 09.04.2013. – TUESDAY 9th April 2013
- IZLET u Nacionalni park Kornati
- BOAT EXCURSION to the Kornati National Park
- Polazak autobusa ispred hotela u 8.00 sati,
- Bus departure in front of Hotel Olympia at 08.00 hrs.
- Dolazak u Pakoštane oko 9.00 sati i polazak brodom prema Kornatskim otocima
- Arrival in Pakoštane around 09.00 hrs. and boat departure for Kornati islands
- Ručak i zabavni program na brodu
- Lunch and entertainment on boat
-
-
Preporučamo sportsku i slojevitu odjeću i sportsku i udobnu obuću
We recommend several layers of warm, sporty clothes as the sensations of
warm or cold at sea and on the boat during sailing can considerably differ
from those on the mainland.
- Povratak u Pakoštane predviđen između 13 i 14 sati,
- Return to Pakoštane between 13.00 and 14.00 hrs.
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Oganizirani transfer sudionika u hotel ili prema zračnoj luci, prema ranijem dogovoru s tehničkim organizatorom BE-tours
Organised transfer to the hotel or to the airport, according to earlier agreement with the technical organiser BE-tours
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U slučaju lošeg vremena izlet brodom na Kornate može biti zamijenjen
nekim drugim izletom
In case of bad weather, boat excursion to Kornati islands may be replaced
by some other excursion
Abstract lecture 1
Prof. Peter Tenke
South-Pest Teaching Hospital, Dept. of Urology, Budapest, Hungary
„The role of intraoperative frozen section during laparoscopic radical
prostatectomy”
The oncological safety of the patient is the number one priority during laparoscopic
radical prostatectomies. With the continous improvement in the surgical techniques
and correct indications excellent oncological outcomes can be achieved, and the
functional results become more and more important. The different nerve-sparing
techniques offer good functional outcomes regarding continence and potency, but
theoreticaly increase the risk of margin positivity. Therefore the EAU Guideline
for prostate cancer do not recommend the use of nerve sparing technique in case
of high risk tumors.
The use of intraoperative frozen section during laparoscopic radical prostatectomy
increases the oncological safety and creates a possibility to correct positive margins
during the surgery. Also, using intraoperative frozen section makes it possible to
aim for nerve-sparing even in case of high risk patients. In this presentation the
author presents the available data on intraoperative frozen section in the literature
and the results of his department as well.
Abstract lecture 2
D. Mladenov, Clinic of Urology, Medical University, Sofia, Bulgaria
“Minimally invasive treatment of BPF”
The urological practice has greatly changed during the last decades. There is no
part of the urogenital system, which could not be reached endoscopically. That’s
why today the urologists perform new, less invasive procedures, which were not
applied up to now.
The future of urology is to change from conventional to minimally invasive
surgery. One of the most often application of these less invasive endoscopic
methods is for treatment of BPH.
We present different modalities for minimally invasive treatment of BPH - TURP,
types of lasers – Holmium, Thulium, KTP etc. They discuss the major concerns
and needs for less invasive surgical options such as safety, efficacy and costs.
Indications, advantages, disadvantages and complications of these techniques are
compared, discussed and recommended.
In conclusion we consider that:
1. Laser vaporization resection or enucleation are alternative treatment options
for BPH.
4. None of these minimally invasive techniques achieved the definition of
“gold standard”.
2. TUR-P is a standard procedure for small and medium prostates.
3. Open prostatectomy remains standard procedure for large prostates.
5. Aggressive marketing obscures reality.
Abstract lecture 3
Milan Hora1, Viktor Eret1, Tomáš Ürge1, Ivan Trávníček1, Ondřej Hes2, Fredrik
Petersson 2,3, Petr Stránský1
Charles University Hospital, Pilsen, Czech Republic, Department of 1Urology
and 2 Pathology 3 Department of Pathology, NationalUniversity Health System,
Singapore
Correspondence:Prof. Milan Hora, MD, PhD
Department of Urology, UniversityHospital
E. Beneše 13
305 99 Plzeň
CzechRepublic
Phone/fax: ++420-377402171
E-mail: [email protected]
„LESS (laparoendoscopic single site surgery) nephrectomy - A technique for
everyday clinical practise?“
Introduction: A pertinent question is the potential benefit(s) of LESS nephrectomy
(NE) in comparison to standard laparoscopic NE (LNE). We herein report our
institutional experience with LESS and give our opinion regarding this technique/
procedure.
Materials: Since 8/2011 to 2/2013 we have performed 129 LNE. LESS technique
was used in 22.3 % (n=29) of them. The decision on what procedure to perform
did not follow any standardized approach.
Results: LESSNE was performed on the right side in 17 patients and on the left
side in 12 patients, respectively. The mean age was 59.9±15.0 years (25.9-87.4).
The mean BMI was 27.2±4.1 (16-33). Seven patients (24%) were obese (BMI
> 30). The mean operation time was 94.7±44.2 minutes (37-230), blood loss
was 69.0±164.1 (0-800) ml, weight of specimen 392.8±164.4 (190-750) g. The
patients were discharged from the hospital on 4.9±1.2 (3-8) postoperative day.
Used devices were Quadport+®, one special pre-bent grasper and any sealing
system (harmonic scalpel of different brands 7x, Ligasure® blunt tip 35 mm
15,7x harmonic scalpel and 7x Thunderbeat®). The hilar vessels were divided by
stapler en bloc in 22 patients (76%) and with lockable clips in 7 patients (24%). In
9 patients (31%), one 3 mm auxiliary instrument was introduced directly through
the abdominal wall to elevate the liver and/or spleen. In three of these cases (10%),
a 12 mm port had to be added in order to introduce a stapler (i.e. conversion to
standard laparoscopy). In no case was there conversion to open surgery. There
was only one complication Clavien II (light cerebral stroke).The time of surgery
was 73.8±18.9 (37-100) minutes for the more experienced surgeons (history of
hundreds laparoscopic renal surgeries) and 128.4±49.0 (85-230) minutes for the
three less experienced surgeons. In neoplasm aetiology (n=20), size of tumour
was 51.0±16.7 (20-80 mm, histology were 17clear RCCs and 3 oncocytomas.
Conclusion: LESS NEis indicated at our institution in only easier cases (i.e.
mainly BMI mostly less than 30 and smaller/less advanced kidney tumours). It
is safe and relatively fast method. LESS NE performed by a less experienced
surgeon extends the time of surgery.
Supported by the project Ministry of Health, Czech Republic, for conceptual
development of research organization 00669806 - FacultyHospital in Pilsen,
Czech Republic
Abstract lecture 4
Haluk AKPINAR, MD, Associate Professor of Urology, Departments of
Endourology& Robotic Surgery Group Florence Nightingale Hospitals, Istanbul,
Turkey
“Current place of Flexible Ureteroscopy and Laser Lithotripsy for Stones ≥
2 cm”
Traditionally large renal stones have been treated with PNL, shockwave lithotripsy
(SWL), or a combination of both and, and sometimes by an open procedure.
Currently, guidelines on urolithiasis recommend percutaneous nephrolithotomy
(PCNL) as the first-line therapy for the treatment of kidney stones > 20 mm in
diameter and can be considered as a gold standard. Stone-free rate following
PNL is between 78% and 95%. However there are significant complications
associated with this procedure, including urinary extravasation, bleeding requiring
transfusion, postoperative fever, septicemia, colonic injury or pleural injury.
Due to these potential complications PNL alternative treatment modalities have
driven interest. ESWL monotherapy has an overall stone-free rate (SFR) of 23%
to 57%, and the rate decreases with increasing stone size. Therefore, it is not an
ideal modality. Ureteroscopy in combination with ESWL has shown relatively
better results with a stone-free rate of 77%, but at least after 2 sessions.
Open surgery has been almost abandoned,even for themanagement of very large
stones. The most traditional of all these alternative modalities, has very limited
indication, suchas in patients with excessive morbid obesity or complex collecting
systems.
Since the introduction of modern flexible ureteroscopes two decades ago, there
have been remarkable technological improvements in their design. The size of
scopes decreased, greater resolution obtained, field of vision extended, light
transmission improved and deflection ranges increased. The smaller size of
accessory instruments and very effective lithotriptors like nickel-titanium baskets
and Holmium laser together with an increase in experience using them has
broadened the indications for using flexible ureteroscopes.
Recently f-URS and Holmium laser lithotripsy, in other words retrograde intrarenal
surgery (RIRS) started to be considered as an alternative to gold standart PCNL.
Safety and efficacy of flexible ureteroscopy and laser lithotripsy in thetreatment
of patients with renal stones equal to or larger than 2 cm. will be reviewed in this
presentation.
Abstract lecture 5
Haluk AKPINAR, MD, Associate Professor of Urology
Departments of Endourology & Robotic Surgery, Group Florence Nightingale
Hospitals, Istanbul, Turkey
ROBOTIC PARTIAL NEPHRECTOMY WITH SEGMENTAL ISCHEMIA
Although active surveillance and ablative technologies like cryotherapy and
radiofrequency have emerged over last decade, partial nephrectomy is the treatment
of choice for organ confined small renal masses. Open partial nephrectomy (PN)
continues to be the reference nephron-sparing surgery procedure. Over the last
two decades laparoscopic techniques developed to reproduce the open PN in
minimally invasive fashion. However due to technical difficulties laparoscopic
PN has been mainly limited to experienced laparoscopic surgeons.
Robotic technology is being increasingly used in urologic surgery. The current
robotic system has facilitated performing complex procedures like radical
prostatectomy and PN.
Recently some new techniques have been developed to avoid total renal ischemia
during laparoscopic and robotic PN. Selective occlusion of renal arterial branches
supplying only the tumor and close vicinity is possiblethrough micro dissection
and using small bulldog clamps,. The main renal artery and vein stays open
during the entire procedure, reducing ischemic damage. Also early unclamping
just before parenchymal renorraphy, after completion of tumor resection and base
sutures shortens the warm ischemia time. Because of 3D vision and 6 degrees of
intuitive movements, which are unique to robotic technology, may allow faster
resections and reconstruction, thereby reducing warm ischemia time.
Gettman at al were the first, reporting the feasibility of robotic PN in 2004. Now
increasing number of series from many centers has been reported. At our center
robotic PN program was started in 2008. In this presentation our current technique
of segmental ischemic robotic PN with the accompanying video clips is described.
Abstract lecture 6
Šunjara Mario, Ferenčak Vladimir, Krhen Ivan, Grković Marija, Kaštelan Željko
Clinic of urology, Clinical Hospital Center Zagreb, Croatia
MINIMALLY INVASIVE TREATMENT OF UPPER URINARY TRACT
LESIONS
Introduction: With advances in endourologic equipment no part of urinary tract
is left inaccessible to endoscopic diagnosis and treatment. Lesions that previously
required open exploration and often nephroureterectomy can nowadays be treated
endoscopically in selected patients.
Patients and methods:
From January of 2011. to March of 2013. 24 patients underwent ureterorenoscopy
for suspicious upper urinary tract lesions other then urinary stones.
In 7 patients we also acted therapeutically - in 5 patients biopsies of suspicious
tissue were taken and subsequently lesions were ablated using laser, in one
patient upper urinary tract bleeding was stopped using laser and one patient had
subepithelial collection of pus perforated using biopsy forceps.
Results: 13 patients were discharged for further follow up with no pathology
found.
4 patients were found to have significant tumor mass in renal pelvis and calices
and were treated with nephroureterectomy.
All procedures were completed without complications. There was no need for
conversion to open surgery and no need for blood transfusion, recovery in all
patients was swift.
Biopsy samples revealed following: 3 patients had urothelial cancer, 2 patients
had nephrogenic metaplasia. Follow up is too short to give final conclusion in
patients with upper urinary tract tumors.
Conclusion: Endoscopic treatment of upper urinary tract lesions, combining
semirigid ureteroscope, flexible ureterorenoscope, biopsy forceps and laser is safe
and effective procedure. It aids greatly in diagnostic algorithm when it comes to
upper urinary tract tumours and provides treatment for selected patients.
Abstract lecture 7
Sandi Poteko, Nado Vodopija, Klemen Jagodič
Department of Urology, General Hospital Celje, Slovenia
»Robotic assisted radical prostatectomia and large prostate«
Objective: Radical prostatectomy is common surgical treatment of localized
prostate cancer. Robotic assisted radical prostatectomia (RARP) offers advantages
compared with other treatments. Large prostate (prostate volume >70 g) are
challenging cases for experienced surgeons. Pasadena Consensus Panel did not
reach any consesnsus about the defiition of experienced surgeon. Data from the literature classifies surgeons as high volume (>40 procedures per year) or low
volume (<40 procedures per year). We analyzed the perioperative and recovery
outcomes of first 400 cases of RARP performed at our department from May 2010
and January 2013.There were 14 patients with prostate volume > 70 g.
Materials and methods: Operative and recovery data for 14 men with localised
prostate cancer and average prostate volume 86g (70g-107g) were reviewed. Half
of patients were treated for BPH with 5 alfa-reductase inhibitors before RARP.
Data include age, medical treatment of BPH, PSA level, Gleason score, console
time, estimated blood loss, time of catheterisation, complication sand continence
recovery.
Results: The age of patients varied from 60 - 74 years and PSA from 4,0 to 12,2
ng/ml. Preoperative biopsy GS 6 had 9 patients, GS 7 had 5 patients, all with
cT1-2. The mean consola time was 160 min. (70-220min.). Estimated blood loss
was 155 ml (50-450ml) with no need for transfusion. In a subgroup of RARP
number 150-300 the mean consola time was 145 min, and estimated blood loss
was 150 ml. There was one rectal injury, recognised intraoperatively and treated
with sutures in twolayers. Hospital stay for 13 patients was 3 days and catheter
was removed after 7 days. A patient with rectal injury had a catheter inserted
for 15 days. Histological report was pT2a, GS 6 for 6 patients and pT2c, GS 7
for 6 patients. Two patients were pT0. Both were preoperatively treated with 5
alfa-reductase inhibitors for many years. All reports were without positive
surgical margins (R0 resection). The biochemical reccurence rate is zero, till now.
Continence rate after 3 months is 9/14, ( 60%).
Conclusion:RARP for a patient with a large prostate is a challenging procedure
also for experienced surgeon. Our results are comparable with our subgroup of RARP number 150-300 and results in literature.
Abstract lecture 8
Vukotić V., Lazić M., Kojić D., Savić S., Babić U.
Department of Urology, KBC “Dr Dragiša Mišović- Dedinje ”, Belgrade, Serbia
“Ureteral stump in the treatment of upper urothelial tumors, is it so
important?”
The most common tumors of the urinary tract are Transitional Cell Carcinomas
(TCC), one of their important feature being the tendency of formation tumors either synchronously and/or metachronously in multiple foci throughout the
urinary tract. Urothelial tumors of the upper urinary tract (renal pelvis and
ureters- UUT) are rare, accounting for about 5% of all urothelial tumors. The
natural history of these tumors shows that 60% of UUT-UCCs are found to be
invasive at the time of diagnosis compared with only 15% of bladder tumors ;
60% of UUT-UCCs are invasive at diagnosis compared with only 15% of bladder
tumors There are almost no tumors of low malignant potential in the upper urinary
tract. Transitional cell carcinoma of the renal collecting system is traditionally
managed by open nephroureterectomy with en bloc resection of a bladder cuff.
Since lapaparoscopic nephroureterectomy (NUT) has recently emerged as a
safe, minimally invasive approach to upper tract urothelial cancers, the most
controversial and challenging feature is the oncologically correct management of
the distal ureter and ureterl stump.
Own results: We have performed our own study in order to find out risk factors
influencing prognosis in term of survival in our patients treated with different
types of open surgery for UUT TCC . In the 9 year period 124 patient were
surgically treated for suspicious UUT TCC, which was histologically confirmed in 113 patients. 87 patient were followed , while 26 pts were lost for control. Statistical analysis was performed using SPSS for descriptive statists, life table
and log rank tests for analysis of prognostic factors. Mean age of our patients
was 67.32 years ( 42- 82), both sexes were equally distributed, left side being
mostly affected ( 63:50). Bilateral tumors were present in 9 patients. Tumor was
located only in pyelon in 31 pts, in ureter in 56, while pyelon and ureter were
involved in 26 pts. The localisation of the tumor in ureter was lumbal (25 pts), illiac (15), pelvic (21), intramural (19). The most frequent grade of the tumor
was Gr 2 (63 pts), Gr 1 was found in 27 pts, while gr 3 was found in 23 pts.
The pT stage of the disease was 1 in 21 pts, 2 in 45, 3 in 37 and 4 in 10 pts.
Open nefroureterectomy (ONU) was performed in 54 pts, through two incisions
while only one pararectal incision was used in 30 pts. Subtotal nephrectomy was
done in 33 pts, with later ureterectomy in 3. Tumor ablation was performed in 12
pts. In 6 pts partial cystectomy was performed along with NUT for intramural
ureteral tumor. Lymophadenectomy was nor routinely performed. Of 87 patients who were evaluable for further assesment 43 died, 38 related to the UUT. Mean
survival was 2.63 godine, 11 patients died in the first postoperative year. Grade
was not associated with survival, while stage of the disease significantly influnced
survival ( p<0.05). The type of any surgical procedure did not influence the
survival . Diferent types of ONU ( one or two incisions) also did not made a
difference in prognosis and survival, mean expected survival for two incisions
being 4.99 years, for one incision 6.4 years .
Discussion: Although the golden standard for the treatment of UUT is
nephroureterctomy with bladder cuff excision, the result from diffferent studies
are conflicting. Kwak et al did not found bladder cuff reccurences in patients who
underwent nephroureterectomy without bladder cuff excision1. Ku concluded
that most cancers that subsequently developed in the bladder were not muscle
invasive, and, thus, the association of bladder cancer was not a poor prognostic
factor 2. Lughezzani after the analysis analyses of 2299 patients treated with
nephroureterectomy (NU) or segmental ureterectomy (SU) for UUT TCC within Surveillance, Epidemiology and End Results registries found that the surgery type
(NU with bladder cuff removal versus NU without bladder cuff removal ) did
not affect the CSM -free rate3. Quite contrary to previous findings, Lughezzani
analyzing 4210 patient with UUT from SEER database stress the importance of
bladder cuff removal, unexpectadly especialy in patients with pT3/4 stage4.In a
Canadian study involving 680 surgicaly treated patients about 25 % of them had
incomplete ureteral resection, complete ureteral resection defined as pathologically
measured ureteral length of 10 cm. According to their results patients with
incomplete resection of ureter had worse survival5. Different approaches to the
bladder cuff had comparable oncologic outcomes, with transurethral incision
giving the same results as intra or extravesical incision in patients with primary
UUT-UC without coexistent bladder tumors 6
Conclusion: Since UUT TCC is rare but aggressive urologic cancer with a
propensity for multifocality, it is questionable why just the ureteral stump should
be of special interest. According to our results , as well as those of some other
authors, complete NUT is not always necessary. Since it is clear that any kind of surgery alone is not curable for patients with advanced stage of disease effective
adjuvant systemic therapy would be beneficial in order to improve the outcome
of some patients. The major drawback is the small number of patients, so more multicentric studies or meta analysis should performed in order to bypass this
limitation.
(Endnotes)
1 Kwak C., Lee SE., Jeong IG. ,. KU JH., Adjuvant systemis chemotherapy
in the treatment of patients with invasive transitional cell carcinoma of the upper
urinary tract. Urol 2006: 68: 53–57,
2 Ku JH, M.D., Choi WS, Kwak C Kim HH. Bladder cancer after
nephroureterectomy in patients with urothelial carcinoma of the upper urinary
trac tUrol Oncol: Seminars and Original Investigations 29 (2011) 383–387
3 Lughezzani G., Jeldres C, Isbarn H , Sun M.,. Shariat S, Alasker A, Pharand
D., , Widmer H., , Arjane P, Graefen M., c, Montorsi F , Perrotte P., Karakiewicz
. Nephroureterectomy and segmental ureterectomy in the treatment of invasive
upper tract urothelial carcinoma: Apopulation-based study of 2299 patients. EJC , 4 5 , 2 0 0 9 ; 3 2 9 1 –3 2 9 7
4 Lughezzani G., Sun M., Perrotte P., Shariat S, Jeldres C., Budaus L.,
Alasker A., Duclos A., Widmer H., Latour M. Guazzoni G., Montorsi F.,
Karakiewicz P. ,Should Bladder Cuff Excision Remain the Standard of Care at Nephroureterectomy in Patients with Urothelial Carcinoma of the Renal Pelvis?
A Population-based Study. Eur Urol 2 0 1 0; 5 : 9 5 6 – 9 6 2
5 Abouassaly R, Shabbir M,. Alibhai H., Shah N, Timilshina N., Fleshner N.,
Finelli A.. Troubling Outcomes From Population-level Analysis of Surgery for
Upper Tract Urothelial Carcinoma. Urology,2010; 76: 895–901.
6 Li WM, Shen JT , Li CC , Ke HK a, Wei YC , Wua WJ, et al . Oncologic outcomes Following Three Different Approaches to the Distal Ureter and
Bladder Cuff in Nephroureterectomy for Primary Upper Urinary Tract Urothelial
Carcinoma. Eur Urol 5 7 ( 2 0 1 0 ) 9 6 3 – 9 6 9
Abstract lecture 9
I.Coman, N. Crisan, C.Manea, A. Boc, Cristina Ivan, Z. Mihaly
Clinical Department of Urology, Cluj-Napoca Municipal Hospital, Romania
Robot-assisted radical cystectomy with intracorporeal ileal neobladder initial experience
Introduction and Objectives. Radical cystectomy is the standard treatment for
infiltrating bladder cancer. The interest in minimally invasive techniques and
robot-assisted radical cystectomy is growing in medical centers worldwide. In the
video footage we are presenting the initial experience and the surgical technique
used in robot-assisted radical cystectomy.
Material and Methods. Between January 2010 and November 2012, we
performed 10 robotic radical cystectomies for infiltrating bladder tumour (9 men
and 1 woman), out of which 3 patients had intracorporeal ileal neobladder. We
assessed the perioperative parameters (operating time, blood loss, complications),
oncological results (positive margins, number of lymph nodes) and functional
results (continence, erection, kidney function) at 6 months postoperatively.
Results. The duration of surgical procedures for the 3 intracorporeal ileal
neobladder procedures amounted to 725 minutes, 550 minutes and 490 minutes
respectively, while blood loss added up to 450 ml, 600 ml and 350 ml respectively.
There were no positive margins. We performed extended pelvic lymphadenectomy,
along with the excision of 16, 19, and 23 lymph nodes, all of them being negative.
Daytime and night-time continence was partially preserved, as patients used one
pad / day and one pad / night. Nerve sparing technique was used for patients 2
and 3, as they presented erections under PDE 5 inhibitors. Postoperative imaging
evaluation at 6 months showed normal appearance of the pyelocaliceal system
without local or distant recurrence.
Conclusions. Robot-assisted radical cystectomy with with intracorporeal ileal
neobladder is a feasible and safe technique for the treatment of infiltrating bladder
cancer, with minimal morbidity and comparable oncological and functional
results.
Abstract lecture 10
Dan Vasile Stanca, Mihaly Zoltan Attila, Andrei Boc, Ionut Juravle, Sergiu
Nicolescu, Ioan Coman
EndoPlus Urological Clinic Cluj-Napoca, Romania
Transurethral Resection in Saline and Plasma Vaporization of the Prostate:
Clinical Evaluation of Safety and Short-term Results.
Introduction and Objective: The morbidity of transurethral resection of the
prostate necessitates constant attempts at modifications of the standard equipment
and technique. We evaluated our results with transurethral resection in saline and
bipolar plasma electro vaporization of the prostate (TURIS-PVP) for treatment
of bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH).
Material and Methods:Between January and December 2012 TURIS-PVP was
performed in 123 men with BOO due to BPH. The preoperative investigation
protocol included digital rectal examination (DRE), prostatic specific antigen
(PSA), International Prostate Symptom Score (IPSS), quality of life (QoL) score
and abdominal ultrasonography assessing prostate volume and post-voiding
residual urinary volume (PVR). The patients were evaluated 6 weeks after surgery
using IPSS, QoL and PVR. We recorded the necessity of blood transfusion and
early complications.
Results:The median age of the patients was 65.5 years (51-82 years, SD 7.28).
The average BPH size was 62 ml, the mean operating time was 75 minutes (35150 minutes, SD 23.2). The majority of the patients were discharged after 24
hours (34%) or 36 hours (56%). The rest were discharged at 3 or four days (6 and
4% respectively). The catheterization time was 7 days (the catheter was removed
at the same visit when the pathological result of the resected tissue was obtained
and communicated to the patient). Preoperatively, the mean value of IPSS was
19, the mean QoL score was 4, the mean RV was 80 ml. Twenty patients were
on chronic bladder catheterization. During the interventions 5 patients required
blood transfusions; there were no other significant intraoperative complications.
Postoperatively one patient required re-catheterization for 7 days. We recorded
15 patients with mild early postoperative urinary incontinence (4 patients still
incontinent at 6 weeks). The mean postoperative IPSS score was 7 and the mean
PVR 10 ml.
Conclusions:The transurethral resection in saline and bipolar plasma electro
vaporization of the prostate is a safe and effective treatment for BOO due to BPH.
The intraoperative and early postoperative complications rate is very low. The
procedure has a fast postoperative recovery time, good short-term functional
outcome and good haemostatic efficiency. The main postoperative complication
was early urinary incontinence, with a tendency to spontaneous cure in the
following weeks.
Abstract lecture 12
Ćosić I, Šimunović D, Koprolčec D, Kuveždić H.
Klinika za urologiju, Klinički bolnički centar Osijek, Osijek, Coatia
“KBC Osijek: experiences with percutaneus nephrolithotomy “
Introduction: Percutaneus nephrolihotomy (PCNL) is recognized as treatment
option for staghorn stones, large stones (>2cm) , multiple stones, stones in inferior
calyx or after failed ESWL therapy.
Methods:First PCNL was performed at our department in 1986 and so far 239
patients were treated with PCNL, within that number are 22 cases of patients with
multiple PCNL. Single channel PCNL, with rigid instruments and electrokinetic
probe, rarely ultrasound probe was regularly performed. Average age of our
patients was 53,9 years (min:23, max:78). Males were slightly predominant
(53/47%), and left side was affected in 52,4%, with one case of bilateral PCNL.
Average diameter of stones was 3.48 cm, 51 stones were staghorn stones affecting
at least 2/3 of collecting system.
Results:Overall stone free rate was 73.8% (modified 83,1% in those in with a
bimodal therapy). JJ stent was placed in 40.5% of patients. ESWL prior to PCNL
was done in 50.6% and in 45.7% of patients after PCNL. Complications were
noted in 31,7% cases: fever (more than 1 day) in 52 (32.1%), transfusion in 11
(6.8%), stein-strasse (treated with URS) in 4 and conversion to open-procedure
in 3 patients. We had one nephrectomy (due to AV fistula). No injury to adherent
organs or mortality was recorded.
Conclusion: Although our SFR is slightly lower, one must bear in mind a large
number of staghorn stones. Also as our resources are limited, laser or flexible
instruments are not used, but we tend to bimodal-therapy.
Abstract lecture 13
Markić D, Maričić A, Oguić R, Sotošek S, Španjol J, Rahelić D, Rubinić N,
Valenčić M
Klinika za urologiju, Klinički bolnički centar Rijeka, Hrvatska
„Transuretralna incizija kod opstrukcije vrata mokraćnog mjehura u žena“
Opstrukcijske smetnje mokrenja u žena su rijetka pojava, a jedan od mogućih
uzroka je opstrukcija na razini vrata mokraćnoga mjehura. Prikazati ćemo naše
iskustvo u endoskopskom liječenju tih bolesnica.
Na Klinici za urologiju Kliničkoga bolničkoga centra u Rijeci tijekom 12
godina, od 2000.-2012., zbog subvezikalne opstrukcije 47 bolesnica je liječeno
transuretralnom incizijom vrata mokraćnoga mjehura. Dijagnoza se je temeljila
na nalazu urodinamskoga pregleda i isključivanju drugih mogućih uzroka opstrukcije. U svih bolesnica učinjena je transuretralna incizija vrata mokraćnoga
mjehura na dva mjesta, na 5 i 7 sati.
Od 47 bolesnica u dobi od 21 do 78 godina (prosječna dob 44 godine), u njih
42 (89,3%) transuretralna incizija učinjena je zbog primarne opstrukcije vrata
mokraćnoga mjehura. Ostale su pacijentice imale sekundarnu opstrukciju,
najčešće kao posljedicu neurogenoga mjehura. Bolesnice su praćene od 3-288
mjeseci. Povoljan ishod operacijskoga liječenja zabilježen je u 35/47 bolesnica
(74,5%) te u 6/12 bolesnica koje su ponovno operirane. Kompletna retencija
urina bila je vodeći simptom u 10/47 bolesnica (21,2%), a nakon operacije 6/10
bolesnica više nije trebalo kateterizaciju. Komplikacije u svezi s postupkom nisu
zabilježene.
Transuretralna incizija vrata mokraćnoga mjehura je minimalno invazivni način
liječenja opstrukcije na razini vrata mokraćnoga mjehura u žena s visokom stopom
uspješnosti.
Abstract lecture 14
Tomislav Dominis
Odjel urologije, Opća bolnica Zadar
Prikaz slučaja:
Praćenje i liječenje radiološki benignog tumora bubrega
Bolesnica u dobi od 55 godina više godina se prati u nekoliko uroloških odjela i
klinika zbog R-om verificiranog tumora lijevog bubrega. Unatrag dvije godine
bilježi se porast tumora sa 4 na 6 cm, te je indicirana operacija- laparoskopska
ekscizija tumora. Učini se navedeni zahvat koji prolazi bez komplikacija i
bolesnica je 5. postoperativni dan otpuštena kući. Definitivni nalaz patohistologije
ukazuje da se radi o papilarnom tipu karcinoma bubreznih stanica sa pozitivnim
kirurškim rubom na jednom mjestu.
S obzirom na navedeno, učini se radikalna nefrektomija koja protiče bez
komplikacija; na nalazu PHD-a nema znakova tumora.
Bolesnica nakon 1 godine praćenja nema znakova metastaza i/ili recidiva.
Rasprava: specifičnost i senzitivnost radioloških tehnika u detekciji AML bubrega
.
Abstract lecture 15
1Škugor J, Berović Š, Guberina P, Perković B, Zorić-Burić V
1Department of Radiology General Hospital Šibenik
Address correspondence to: [email protected]
MR Urography: Techniques and Clinical Applications
Abstract
Magnetic resonance urography (MRU) is clinically useful in the evaluation
of suspected urinary tract obstruction, hematuria, congenital anomalies and
surgically altered anatomy, also it can be particularly beneficial in cases when
ionizing radiation is necessary to be avoided. A complete MRU protocol can be
used for imaging all components of the kidneys and the urinary collecting system
in a single imaging session. MRU has better contrast resolution than CT urography
without exposure to ionizing radiation and does not require intravenous contrast
administration.
The most common MR urographic techniques for displaying the urinary tract
can be divided into two categories: static-fluid MR urography and excretory MR
urography.
Static-fluid MR urography is used to demonstrate the ureters in their entirety and
to confirm the presence of fixed stenoses and is most successful in patients with
dilated or obstructed collecting systems.
Excretory MR urography is performed during the excretory phase of enhancement
after the intravenous administration of contrast material.
The role of MRU in renal and urothelial imaging continues to evolve. MRU is a
useful one-stop imaging technique for pregnant and pediatric patients, for patients
with impaired renal function and for patients with congenital abnormalities, but
the spatial resolution of MRU may be inferior to that of CT urography, so the role
of MRU in the evaluation of hematuria is less clearly defined, as is reflected in the
limited use of MRU in comparison with CT urography in routine clinical practice.
Abstract lecture 17
Krzysztof Szkarłat
Department of Urology and Oncologic Urology Szpital Specjalistyczny w
Kościerzynie
„Bipolar TURP - is it a mile stone in the treatment of bladder outlet
obstruction?”
Transurethral Prostate Resection (TURP) is considered „golden standard” for
the surgical treatment of BPH. In 1909 Young modified his urethroscope into
a prostatic punch thus starting minimally invasive surgery under direct vision.
In 1926 Stern performed first electro resection of the prostate. Since then
introduction of Hopkins lenses, light fibers and continuous flow resectoscope
made TURP the first choice in the surgical treatment of bladder outlet obstruction.
The appearance of bipolar technology is the most significant TURP modification
of the last decades, with apparently no change in the surgical technique. Authors
present bipolar technique with the systems of various companies. They review
the literature comparing mono and bipolar TURP in terms of efficacy, safety and
long term results.
Abstract lecture 18
K. Szkarłat, P. Jarecki, T. Wandzilak, A. Nieradka
Department of Urology and Oncologic Urology Szpital Specjalistyczny w
Kościerzynie
„Laparoscopic Nephrouterectomy for Upper Urinary Tract Transitional Cell
Carcinoma. Is it a standard of care?”
Upper tract urothelial carcinoma (UTUC) accounts for 5% of all urothelial
carcinomas. 605 of these tumors are invasive at the time of diagnosis. In these
instances open radical nephroureterectomy (ORN) with excision of the distal
ureter and bladder cuff is considered the current standard of care. However,
ORN has been associated with significant morbidity. In 1991, Clayman et al first
described the technique of laparoscopic nephroureterectomy (LRN), and since
then it has emerged as an accepted minimally invasive treatment alternative to
ORN.
With the careful review of the literature and with our own experience, we analyze
if LNR can be the “gold standard” of the treatment of UTUC.
Between 2000 and 2012 we performed 52 nephroureterectomies. 31 (60%) with
the minimally invasive surgery technique (LNU). We discuss different techniques
of management of distal ureter cuff. With the review of the literature we compared
oncologic effectiveness of these procedures.
LNU in organ confined disease offers comparable oncologic efficacy and reliable
perioperative safety to ONR
Well-designed randomized clinical trials with extensive follow-up are needed to
confirm if it is also safe and reliable in more advanced stages.
Abstract lecture 19
C. Tulic, O. Durutovic,
Klinika za urologiju KCS, Beograd, Serbia
„Can we safely reduce the fluoroscopic time during PCNL?“
Objective: Percutaneous nephrolthotomy (PCNL) represents today a standard
procedure in treatment of large kidney stones. In time of development of
PCNL renal access was mainly performed by radiologists, but during the time
became a routine procedure for urologist in many departments. The technique of
access to the renal collecting system (appropriate, mainly inferior calyx) differs
between centers. Ultrasound guidance became an attractive opportunity in aim of
decreasing the fluoroscopic time (FT), for both, patient and urologist.
Methods: We have compared our results with published data concerning
FT reached to successfully performing of PCNL. In our department we use a
combination of fluoroscopic and ultrasound guidance to puncture the appropriate
calyx and achieve the optimal and safe access to the stone.
Results: Compared to the studies which evaluated FT during PCNL our results
showed significantly lower exposure. Mean FT was 2.6 min, compared to 8.9
in study investigating learning curve in PCNL, achieved at level of surgical
competence.
Conclusions: Routine use of ultrasound by urologists for performing pecutaneous
nephrostomy, supported by adequate equipment, in aim of precision, opens a
window of opportunity to introduce a combined fluoroscopic and ultrasound
guidance for access during PCNL. This approach may protect patients and
especially urologists, if few of them are performing the procedure, of overexposure
to radiation during the procedure.
Keywords: PCNL, fluoroscopic time, renal access
Abstract lecture 20
J.Stanković, M.Stanković, Lj.Dinić,
Department of Urology, Clinical Center Niš, Serbia
“Holmium Laser Enucleacion of the Prostate HoLEP: Results of the first 50
operations.”
Introduction & objectives: Holmium Laser Enucleation of the Prostate (HoLEP)
in combination with mechanical morcellation represents new, minimal invasive,
surgical procedure in benign hyperplasia of prostate (BPH) treatment. Using this
technique, even large prostate can be treated successfully with minimal morbidity.
HoLEP technique requires several steps: from acknowledgment of the surgical
capsule, enucleation of median and lateral lobes of the prostate and the process
of morcellation.
Materials & methods: During one year (October 1st 2011 – September 30th 2012),
50 patients, mean age 69,3 years (58-72) were surgically treated. The mean IPSS
value was 24 (Range 16-28). The mean PSA value was 2,32 (0,73-3,60). The
prostate volume ranged from 40 to 75 ml, (mean 58,8 ml). Postmictional volume
of residual urine ranged from 70 to 180 ml, with a mean value of 163 ml. We
used the Laser produced by Lumenis Surgical, VersaPulse with a 550µ fiber, 2,7F.
The prostate size should not represent a contraindication. Enucleated lobes were
morcellated using a Richard Wolf Morcellator.
Results: Mean enucleation time of the prostate was 68 minutes. Foley catheter
removal was after 24 – 48 hours and the mean hospitalization time was 2,5 days.
Control examinations were done after 3 and 6 months. Control mean IPSS value
was 9,5, Qmax 22ml/sec (11 – 33 ml/sec), PVR with a mean value of 35ml (1055ml.)
Conclusion: HoLEP is a minimally invasive surgical procedure for BPH treatment
that enables the complete removal of the prostate lobes. HoLEP is a procedure
with no risk of TUR syndrome, which enables exact hemostasis and short hospital
stay. The results are comparable to TURP. Contraindications for HoLEP are:
active infection, abnormal homeostasis and unstable cardio-respiratory diseases. Abstract lecture 21
Mario Kordic,dr.med.mr.sc.; Davor V.Tomic,dr.med.prim.; Clinic of urology,
University Clinical Hospital Mostar, F Bosnia and Herzegovina
Transurethral laser vaporisation of the prostate – our early experience
ABSTRACT
Introduction: The LIFE (Laser induced Flow Enhancement) laser is an
alternative to TURP. The LIFE system is guided by a side-firing optic fiber,
vaporizing the prostate tissue very precisely and selectively while preserving the
surrounding structures. LIFE laser system offers critical advantage: vaporisation
and coagulation are both possible.
Objectives: The LIFE procedure uses Selective Light Vaporisation - SLV (Diode
Laser, wavelength 980 nm, output power 180 Watt) to eliminate unwanted soft
tissue using the EVOLVE Laser System and Twister fiber
Materials and methods: In the period of 6 months (01.05.-01.11.2012.) we treated
20 patients, age between 57-80 with BPH. IPSS was 25-35,QOL 4-5,Uroflow
6-11 ml/sec, RU 100-150ml. Eight patients had a complete urinary retention with
the catheter. Prostatic volume was 40-60 ml. Operation has lasted 25-45 min.
Results: All patients had catheter up to 72 hours. There were follow up after one,
two and three months.After the three months IPSS was 15-18,QOL 2-3, uroflow
15-20 ml/sec, RU <30 ml. Minimal post-treatment discomfort or side effects. All
patients had quick recovery. The levels of sodium and hemoglobin were stable.
Conclusion: LIFE laser is an effective, gentle and minimally invasive procedure.
It is an outpatients procedure, with no blood transfusion necessary, short time
for post-op catheterisation and option of short intravenous or spinal anesthesia.
Compared to traditional surgery, SLV is a low trauma, low-pain and comfortable
alternative.
Abstract lecture 23
Valenčić M, Krpina K, Rubinić N
Klinika za urologiju, KBC Rijeka
„Endoskopsko liječenje kamenca u kontinentnom spremniku mokraće po
tipu Mainz-pouch I - prikaz slučaja“
Zdjelična egzenteracija je složen operacijski postupak liječenja lokalno
rekurirajućih ginekoloških zloćudnih tumora u pacijentica, u kojih još postoji
mogućnost izlječenja. Ponekad se primjenjuje kao palijativni postupak u
pacijentica s teškim komplikacijama lokalne bolesti za koje ne postoji drugi način
lječenja.
Postupak se sastoji od istovremene resekcije svih zdjeličnih struktura, uključujući
maternicu, rodnicu, mokraćni mjehur i rektum. Jednu od mogućnosti za derivaciju
mokraće predstavlja kontinentni spremnik po tipu Mainz-pouch I. Ovo je prikaz
slučaja 60-godišnje pacijentice kod koje je u kolovozu 2012. učinjena djelomična,
prednja egzenteracija zdjelice s derivacijom mokraće spremnikom po tipu Mainzpouch I. Kod kontrolnoga pregleda nakon 6 mjeseci bolesnici je CT-pregledom
dijagnosticiran kamenac najdužega promjera 24 mm u spremniku mokraće. U
veljači 2013. bolesnici je učinjena endoskopska litotripsija kamenca s ekstrakcijom
fragmenata. Za operaciju upotrijebljen je rigidni ureteroskop promjera 9 Charr.
Kamenac je smrvljen elektrokinetičkim litotriptorom, a fragmenti su u potpunosti
izvađeni van. Poslijeoperacijski tijek kod bolesnice bio je uredan
Abstract lecture 24
S. Stavridis, O. Stankov.
Medical Faculty Skopje, University Clinic of Urology Skopje, Macedonia
“Correlation of laparoscopic versus open radical nephrectomy in patients
with T1-T3 renal tumors: personal experience and literature review”
ABSTRACT
Aims: To evaluate and compare laparoscopic radical nephrectomy (LRN) with
open radical nephrectomy (ORN) in patients with T1-T3 renal tumors.
Materials and Methods: The study consisted of 43 patients who underwent
LRN between January 2011 and January 2012. The patients were compared with
selected 43 patients who had undergone ORN between January 2010 and January
2011. The two groups were comparable in terms of age, body mass index (BMI)
and tumor size. We compared operative room time, blood loss, complications,
analgesic requirement, hospital stay and initiation of oral intake. The oncologic
outcome was also evaluated. We also performed a computerized MEDLINE search
followed by a manual bibliographic review of cross-references. The reports were
analyzed and the important findings summarized.
Results: The laparoscopy group had a significantly shorter hospital stay, analgesia
requirement and hemoglobin decline. All of the pathology specimens showed renal
cell carcinoma with majority of T1 stage in both groups. The cancer-free survival
rate at 12 months for ORN and LRN in T1, T2 and T3 lesions was 97.1%/97.1%,
100% and 97.1% and 100% and 94.1%, respectively. The patient survival rate
was 100% in both groups. There were neither port sites nor distant metastasis in
the LRN group. In the ORN group we found local metastasis in one patient and
distant metastasis in two patients.
Conclusion: Laparoscopic radical nephrectomy has advantages in terms of
shorter hospitalization and a lower analgesia requirement. It is feasible and
produces effective cancer control in T1 and T2 lesions. The T3 lesions could be
also manageable but it is mostly dependent on the tumors size and the surgeon’s
experience.
Keywords: renal cell carcinoma, laparoscopy, nephrectomy
Abstract lecture 25
Radoja I, Sudarević B, Šimunović D, Kuveždić H.
Department of Urology, University Hospital Center Osijek, Osijek, Croatia
Ureterorenoscopy in treating ureteral calculi: experience of Croatian
Reference Center for Urolithiasis
Introduction: Initial treatment for patients with ureteral stones are extracorporeal
shock-wave lithotripsy (SWL) and ureterorenoscopy (URS). The aim of this study
was to present our results of URS in treating ureteral calculi and to analyze stonefree rate (SFR) and complications.
Patients and Methods: We have analyzed 210 out of 777 patients who had URS
at our Department from 1987 to 2013. URS was performed with Storz semirigid
ureterorenoscope, using electrokinetic and rarely ultrasonic lithotripsy. Mean age
of the patients was 54 years (12-82 years). Male to female ratio was 0.93. Stones
were located proximally in 21.9%, mid-ureteral in 29.5% and distally in 48.6%.
Median stone size was 10 mm (2-90 mm). Comorbidities were present in 58%
patients (arterial hypertension 74.6%). 51% of the patients had previous SWL
treatment. SFR was determined as complete abscence of stone fragments on plain
abdominal film and ultrasonography after URS treatment.
Results: Overall SFR was 77.14%, with 58.7% for proximal, 79% for mid-ureteric
and 84.3% for distal calculi. 41% of the patients required JJ stent. In 58.3% of
non stone-free patients additional SWL session was sufficient for complete stone
clearance (modified overall SFR was 90.5%). The rest had clinically insignificant
residual fragments and were monitored or they had several SWL sessions.
Complications were noted in 23 patients: 13 had fever, 6 required percutaneous
nephrostomy and 4 open surgery.
Discussion: URS is initial treatment option for younger patients and it is safe and
effective in removing ureteral stones, because of low retreatment and complication
rate.
Abstract lecture 26
Tomislav Kuliš, Željko Kaštelan, Nikola Knežević, Mario Šunjara, Mirko Bakula,
Marija Topalović Grković
University Hospital Center Zagreb and University of Zagreb, School of Medicine,
Department of Urology, Zagreb, Croatia
The application of lasers in the treatment of urological patients at University
department of Urology, University hospital center Zagreb
The application of lasers in treatment of urological patients is rapidly developing
and has an increasing acceptance. In some therapeutic areas lasers have already
become part of standard treatment. Diode lasers provide good haemostatic ability
with adequate tissue vaporization while Holmium lasers have proven effective
in treatment of urolithiasis. Aim of this study is to present our experience and
innovations in the application of lasers.
In order to enhance endoscopic procedures in our department since 2009 we
have used several different lasers. Diode laser 980 nm and Dual diode laser
980 and 1470 nm (Ceralas® HPD DUAL, Biolitec AG, Jena, Germany) were
used in combination with various fibers, depending on the operation type. In
treatment of urolithiasis we have used HoYAG AURIGA laser. Diode lasers have
been applied for operations of prostate, urethral strictures, renal tumors, urinary
bladder and renal pelvis tumors. Holmium laser was primarily used for treatment
of urolithiasis.
Lasers represent useful, minimally invasive method with effective tissue
coagulation and haemostasis, in spite of increased operative costs. Further studies
and technical advances will provide wider adoption of laser techniques.
Abstract lecture 27
Reljić A¹, Tomić M¹, Tomašković I¹, Ulamec M², Krušlin B², Trnski D¹
Department of urology¹ and Department for clinical pathology², University
Hospital Center „Sestre milosrdnice“, Zagreb, Croatia
„TURBT – Can we do it better? Yes, WE can!“
Purpose: 43% of invasive bladder cancers (T≥2) arose by means of progression
from non-muscle invasive carcinomas (NMIBC) and their prognosis is worse in
comparison with primary T≥2 cancers. Since prognosis depends on the quality of initial resection we evaluate the features of TURBT for NMIBC at our institution.
Methods: 356 TURBT (259 primary and 97 second-look procedures) was
undertaken in 12-months period. The stage, grade, size and focality of the tumors,
surgeons age and frequency of video equipment use were evaluated. The presence
of the muscularis propria in the specimens was used as quality-marker for surgical
skills but hystological expertise also.
Results: Muscularis propria were present in 75,6% of specimens (71,3% in
primary vs. 87,9% of second-look procedures, p=0,001). In 32/356 (8,98%)
hystological findings the presence (nor absence) of muscularis propria was not
reported. 35 out of 97 second-look TUR were tumor-positive and 5/35 (14,2%)
discovered T≥2 cancer.The stage (Ta vs. T1, p=0,173), size (<3≤cm, p=0,394)
nor focality (solitary vs. multifocal, p=0,484) were predictive for residual cancer.
Grade 3 of the initial tumor was strong predictor for residual disease (G3 vs.
G<3, p=0,005).We have not done second-look TUR in165 patients and 36 of them
(21,8%) had the G3 cancer. Although younger collagues performed both primary
and second-look resection considerably fewer than older urologists, muscularis
propria was present in equal proportion in two groups of surgeons (79,4%
vs.78,0%, p=0,769). Video TURBT was performed in minority of procedures
(23,7%) mainly by younger surgeons.
Conclusions: We can be satisfied with overall TURBT performance. Closer
cooperation with pathologist, more consistency in indications for secondlook TUR, more younger surgeons with video equipment and supervision by
experienced urologists are just a few recommendations for further improvements. Abstract lecture 28
Dinić Lj., Ignjatović I., Stanković J.
Medical Faculty University of Nis, Department of Urology, Clinical Center Nis
“Ureteroscopic treatment of ureteral calculi using the holmium laser
(our first experience)”
Introduction & objectives: Ureteroscopy is a minimally invasive method for the
ureteral stone treatment and one of the most demanding procedure in endourology.
We analyzed our first experience with ureteroscopic treatment of ureteral calculi
using the holmium laser (Lumenis).
Material & methods: We analyzed the success rate, duration time of procedure and complications of ureteroscopic holmium laser lithotripsy in twenty one
patients retrospectively.
Results: Mean age was 54,67 years. Male to female ratio was: 1 to 1,3. In 66,6%
(14) patients stones were located in the distal ureter and 33,4% (7) in proximal
(lumbar) ureter. Average stone diameter was 8,75 mm. Intraoperative complications
were not registered. The success rate of ureteroscopic lithotripsy was 95,23%
(20/21). Average duration time of procedure was about 25min. Postoperative
minor complications were recorded in 4 (19%) cases and included prolonged
hematuria 2 (9,5%), urinary tract infections in 1 (4,75%) and pyelonephritis in 1
(4,75%).
Conclusion: Ureteroscopic treatment of ureteral calculi using the holmium laser
is a safe and less invasive method with a short time of duration and success rate
more then 95% in a single treatment. Abstract lecture 29
Ass. Profesor dr Mustafa Hiroš,
Urology Clinic, University Clinical Centre Sarajevo, Bosna ad Herzegovina
The management of small renal masses ( SRM )
Introduction: Renal cell carcinoma (RCC), which represents 2% of all adult
cancers, is the most lethal of all urologic cancers, with approximatelly 35% of
lethal outcome in 5-years follow-up. Incidence rate of RCC have risen unalteredly
each year during the last 20-30 years, with an average increase of 2% to 3% per
year. Most renal masses, particulary clinical stage 1, are discovered incidentally,
mainly by US examination. Small renal masses (SRM) defined as mass maximally
4 cm in diameter. At least 20% of SRM are benign and less than 2% of them
progressed to metastasis.
Matherial and methods: We have analyzed 174 patients who were underwent
radical or partial nephrectomy, with proved cancer of renal parenchyma, surgically
treated during the period between 2008 and 2012, at the Urological Clinic of the
Clinical Center in Sarajevo.
Results: We have evaluated the tumor size and T stage. 58 (33,1%) patients
were pT1a, tumor smaller than 4cm, 65 (37,6%) patients were pT1b with tumor
between 4-7cm. 51 (29,3%) with tumor pT2-4, bigger than 7cm. In group of
SRM 58 patients, 47 patients were operative treated. Radical nephrectomy were
preformed in 32 (69,7%) patients, and partial nephrectomy in 9 (17,4%). Also
by interventional radiologist, radiofreqvency ablation were done in 6 (12,9%).
11 patients were not operated, 6 underwent arterial embolisation and active
survivelence in 5 patients. Pathohystological reports of 47 patients were as follow,
42 patients were renal carcinoma and 5 patients were benigne (3 angiomyolipoma
and 2 oncocytoma).
Conclusion: Incidentally discovered small renal masses are being diagnosed
with greater frequency and they now account for 58% of renal cell carcinoma
(RCC) diagnosis. Nephron-sparing surgery should be considered in all patients
with SRM as gold standard, while thermal ablation (cryoablation or RFA), , is
an available treatment option for the patient who wants active treatment, and are at high surgical risk. Active surveillance should be a primary consideration for
patients with extensive comorbidities and high risk for intervention.
Abstract lecture 30
Vahudin Zugor, Apostolos P. Labanaris1-2, Jorn H. Witt1.
Department of Urology and Pediatric Urology – Prostate Center Northwest, St.
Antonius Medical Center, Gronau, Germany.
Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece.
Potency outcomes of patients without preoperative erectile dysfunction
undergoing unilateral intrafacial nerve sparing robot-assisted laparoscopic
radical prostatectomy.
Introduction & objectives: The aim of this study is to evaluate the potency
outcomes of patients without preoperative erectile dysfunction undergoing
unilateral intrafacial nerve sparing robot-assisted laparoscopic radical
prostatectomy (RARP).
Material & Methods: The records of 4000 men who underwent RARP from
February 2006 to August 2012 were retrospectively reviewed. N=69 patients
without preoperative erectile dysfunction (IIEF ≥22) who underwent unilateral
intrafacial nerve sparing RARP were indentified. None of the patients underwent
any kind of previous prior prostate surgery, hormonal therapy or 5-alpha-reductase
inhibitors therapy. Furthermore none of the patients exhibited biochemical
progression (defined as PSA ≥0.2 mg/dl after nadir or never reached nadir) or
underwent any type of adjuvant therapy. Potency status was defined as erections
sufficient for penetration with or without phosphodiesterase inhibitors. The
potency status was evaluated during at 3, 6, 12 and 24.
Results: The median age of the patients was 63.5 years old (47-74), the median
PSA was 8.1 mg/dl (2.6 -14 mg/dl) and the median prostate volume 39.6 ml.
(19-101 ml.). The clinical stage was thought to be confined in all 69 cases. The
Gleason biopsy score was Gleason 6 in N=23 patients (33.3%), Gleason 7 in
N=31 (44.9%) and Gleason 8 in N=15 patients (21.7%). All patients underwent
lymph node dissection with none of them exhibiting metastasis. After a median
follow-up period of 36.9 months (7-60 months), N=45 (65.2%) were potent. At 3
months, N=30 patients from 69 (43.4%) were potent. At 6 months, N=40 patients
from 69 (57.9%) were potent. At 12 months, N=20 patients from 31 (64.5%) were
potent. At 24 months, N=16 from 24 (66.6%) were potent.
Conclusions: Patients without preoperative erectile dysfunction undergoing
unilateral intrafacial nerve sparing RARP and without any kind of adjuvant
therapy exhibit very satisfying potency outcomes.
Abstract lecture 31
Vahudin Zugor, Apostolos P. Labanaris1-2, Jorn H. Witt1.
Department of Urology and Pediatric Urology – Prostate Center Northwest, St.
Antonius Medical Center, Gronau, Germany.
Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece.
Intraoperative and postoperative complications as well as functional
outcomes in diabetic patients undergoing robotic-assisted laparoscopic
radical prostatectomy.
Objectives: To assess the intraoperative and postoperative complications as
well as functional outcomes in diabetic patients undergoing robotic-assisted
laparoscopic radical prostatectomy (RARP).
Material & Methods: The records of 4000 men who underwent RARP from
February 2006 to August 2012 were retrospectively reviewed. N=146 patients
were indentified as having a clinical diagnosis of diabetes mellitus treated
with biguanide or/and insulin prior to RARP. All patients were assessed for
intraoperative as well as postoperative complications. Postoperative complications
and re-interventions encountered up to 30 days postoperatively stratified by the
Clavien classification and were characterized as minor (Clavien’s grade I–IIIa)
and major postoperative complications (Clavien’s grade IIIb-IVa). Hemorrhage
was defined as greater than 500 ml blood loss during the operation. Furthermore
the functional outcomes were evaluated as well. Continence status was defined as
no pad use and potency status was defined as erections sufficient for penetration
with or without phosphodiesterase inhibitors. Postoperative potency analysis
was limited to patients who were potent preoperatively and who had undergone
bilateral intrafacial nerve sparing.
Results: The time between the clinical diagnosis of diabetes was made and RARP
was performed was unknown. Intraoperative complications observed were only
hemorrhage and was encountered in N=1 case (0.6%). The Minor and major
postoperative complications are listed in the Tables. N=36 (24.6%) cases had
diabetes mellitus Type I and N=110 (75.4%) diabetes mellitus Type II. Patients
under biguanide stopped treatment 3 days prior to surgery. The median age of the
patients was 65.8 years (42-76), median prostate volume was 46.1 ml (18-142
ml) and median PSA value was 10.8 ng/ml (2.5-49.2 ng/ml). The Gleason biopsy
score was Gleason 6 in N=81 cases (55.4%), Gleason 7 in 46 cases (31.5%),
Gleason 8 in 11 cases (7.5%) and Gleason 9 in N=8 cases (5.6%). The clinical
stage was thought to be confined in N=144 patients (98.6%) and locally extended
in N=2 cases (1.4%). Lymph node dissection was performed in N=118 cases
(80.8%). A bilateral intrafacial nerve sparing procedure was performed in N=37
cases (25.3%), the median operative time was 152 min (50-280 min) and the
median blood loss was 151 ml (50-500-ml). The overall minor postoperative
complication rate was 19.1% (N=28 cases) and overall major was 5.4% (N=8
cases). According to their preoperative IIEF score, N=74 of the patients (50.6%)
had no signs of erectile dysfunction (IIEF ≥22) and only N=12 of these patients
underwent nerve sparing. After a median follow-up period of 27.3 months (7-75
months), N=113 (77.3%) were continent and N=9 (75%) were potent.
Conclusions: Although RARP in this cohort of patients it is not free of
complications and the functional outcomes are not optimal, taking into account
the complications of diabetes itself, such as diabetic neuropathy and angiopathy,
one would have expect worse outcomes.
Minor postoperative complications
Urinary track infection
N=10 (6.8%)
Re-cystogram (extravasation)
N=8 (5.4%)
Angina pectoris
N=4 (2.7%)
Shoulder pain
Scrotal edema
N=4 (2.7%)
N=2 (1.3%)
Major postoperative complications
Re-operations (Overall)
• Hematoma
• Windowing of lymphocele
• Wound dehiscence
N=8 (5.4%)
N=5 (3.4%)
N=2 (1.3%)
N=1 (0.6%)
Abstract lecture 32
Vahudin Zugor, Alayham Abdulhak, Mustapha Addali, Jörn Witt
Outcomes after Botulinum toxin type A -Injection in detrusor vesica in
patients undergoing robot-assisted radikale Prostatectomy( RARP).
Introduction & objective: To evaluate symptomatic effects of intraoperative
botulinum toxin type A (BTX-A) – injection in patient underwent robot-assisted
radikale Prostatectomy (RARP) for treating idiopathic detrusor overactivity
(IDO) including those with abnormally low bladder compliance.
Methods: From March 2011 to December 2012, N=14 patients with a
histological conformation of PCa, an urodynamic diagnosis of IDO with or
without incontinence , absence of hormonal or infective Pathology, no associated
or contributing neurological in 12 patients (2 patient with Parkinson´s disease),
obstructive Pathology was in only one patient, underwent RARP. N=13 patients
were urodynamic assessed with cystometry using a filling rate of 50 ml/min.
Before the operation took place, all patients were injected 100 units of (BTX-A) with 10 ml of normal saline, intradetrusally at the rate of 0,5 ml at each site for
20 sites of the posterior wall, lateral wall and the dome of the bladder sparing the
trigone and ureteric orifices. After discharge, all patients underwent rehabilitation
for 3-4 weeks. All 14 patients were evaluated in terms of urgency, frequency,
nocturia, incontinence and functional bladder capacity (FBC) preoperative and in
period from 4-6 weeks.
Results: The median age of the patients was 60 years (58-77) N=13 patients (93,75),
had preoperative an IDO with incontinence, exhibited exceptional improvements
in frequency, urgency and nocturia. Furthermore, they demonstrated an absence
of urge incontinence and a 36,36% mean increase of their FBC (mean 253,8 ml to
mean 345,8 ml). N=1 patient (6,25), exhibited with no improvement of the urge
symptoms .
Conclusions: The results of this study indicate that the simultaneous use of
BTX-A in such patients could normalise micturition frequency, diminish urge
incontinence. However, due to the small amount of patients involved in this study
a prospective trial with more patients is warranted to assess the impact of these
results on clinical practice.
Abstract lecture 33
Krzysztof Szkarłat, Piotr Adamkiewicz, Radosław Flisikowski
Department of Urology and Oncologic Urology Szpital Specjalistyczny w
Kościerzynie
„Minimally invasive surgery, can we make it less invasive ?”
PCNL (percutaneus nephrolithotomy) is most widely used procedure for treatment
of large renal stones. A most common complication in PCNL is bleeding.
Decreasing the size of the percutaneus tract can reduce morbidity.
We present our initial experience with PCNL performed through 4,85 FR needle
with 0,9 mm optic and 200 micrometers laser fiber in 3 cases. One more case was
performed with 8 FR shaft and ultrasonic probe. Stone size varied from 8 to 15
mm. All 4 patients were successfully treated with no morbidity.
Micro PCNL is efficacious for small volume renal stones. It may be alternative for
flexible uereteroscopy for difficult cases previously treated by SWL.
Abstract lecture 34
Krzysztof Szkarłat, Radosław Flisikowski, Agnieszka Nieradka
Department of Urology and Oncologic Urology Szpital Specjalistyczny w
Kościerzynie
„Transurethral prostate incision – a forgotten procedure?”
Transurethral prostate incision (TUIP) is advocated for patients with bladder
outlet obstruction and relatively small gland (< 30 cc) without median lobe.
This is nearly 50% of patients undergoing TURP. Short and long-term results of
TUIP are quite favorable when compared with those of TURP (also in regard of
retrograde ejaculation); however no tissue for pathologic examination is obtained.
Thus, all patients undergoing TUIP should be evaluated preoperatively with
serum prostate-specific antigen determination, TRUS and a meticulous digital
rectal examination. Authors present their technique of prostate incision and with
careful review of the literature show advantages and drawbacks of this procedure.
Abstract lecture 35
Christoph Lang, Department of Urology, Knappschaftskrankenhaus Sulzbach,
Germany, Younis Al Bulushi, Department of Urology, Städtisches Klinikum
Neunkirchen, Germany Robert Eichel, Urological Outpatient Clinic, Neunkirchen,
Germany, Saladin Alloussi, Department of Urology, Städtisches Klinikum
Neunkirchen, Germany, Schahnaz Alloussi, Department of Urology, Städtisches
Klinikum Neunkirchen, Germany
„Ejaculation preserving Laservaporesection of the Prostate using a 2μm
Thulium Laser in endoscopic surgery - Outcome and demonstration of a new
surgical technique“
Introduction and Objectives: To evaluate the feasibility and outcome of ejaculation
preserving Laservaporesection of the Prostate (epLaVaRP) using continuous-wave
2μm Thulium Laser in patients suffering from Lower urinary tract symptoms (LUTS)
caused by bladder outlet obstruction (BOO) with a wish of preserving ejaculation.
Methods: We prospectively evaluated the results of epLaVaRP in 53 consecutive
patients, aged 25 to 75years, medium 59y, with ability of ejaculation and wishing
to preserve it, suffering from surgically indicated treatment of BOO from 2.2008 to
2.2010 with a maximal long term follow up of 24 months. The surgical procedure
is performed by retrograde Vaporesection of middle lobe finishing 1 cm proximal
of verum montanum and followed by a latero-apical incision and semilunar laser
cuttings of the lateral lobes with preserving the paracollicular tissue.
The study terms included Prostate size by transrectal ultrasound, Urodynamic study,
duration of hospitalization, postoperative catheterization and the registration of laser
energy application.
The postoperative results are controlled by resected prostate weight, change of
maximum flow rate, post void residual volume, IPSS and LQI, the ejaculation is
evaluated by a questionnaire using Q 9 and 10 of the IEEF 15. Complications and
re-intervention rate are recorded.
Results: All patients were hospitalized for 4 days, catheterization time was 3 days.
The mean prostate volume preoperatively was 32ml [minimum: 10; maximum: 85],
the resected prostate weight without calculation of vaporized tissue (+ 1/3 of weight)
was 8,45g [2; 37]. Energy application per treatment was evaluated with 69542 J
[15320; 189369]. Urodynamic parameter showed clinically significant improvement:
Mean flow rate (ml/s) increased from 7,31 to 24,87 and 30,7 (16,6; 47,4) in the long
time follow up. Mean post void residual (ml) decreased from 183,73 to 10,91, IPSS
and LQI improved from 20,74 to 5,60 and 4,56 to 1,70 respectively. Ejaculation
was preserved in 82%. There was no stress urinary incontinence detected. A reintervention was necessary in 2 cases (bladder neck sclerosis). Our diagnostic
approach revealed detrusor overactivity in 6 patients preoperatively.
Conclusions: The presented technique of Laservaporesection of the Prostate by using
2μm Thulium Laser is an effective and successful procedure to preserve ejaculation in
endoscopic Prostate surgery. By appreciation of the ejaculation preserving technique
comes to mind the accuracy of the old concept of ejaculation physiology.
Sažetak 1.
Ivanka Gelo, bacc.med.tech.
Klinika za urologiju, Klinički bolnički centar Zagreb
EMOCIONALNA INTELIGENCIJA
Sažetak: Emocionalna inteligencija - produkt količine komunikacije između
racionalnog i emocionalnog moždanog centra.
Samosvijest, samoupravljanje, društvena svjesnosti i snalaženje u međuljudskim
odnosima su četiri vještine koje sačinjavaju emocionalnu inteligenciju.
Ljudi koji oštre svoju inteligenciju imaju jedinstvenu priliku da napreduju tamo
gdje ostali posrću. IQ nije promjenljiv za razliku od emocionalne inteligencije
koja je promjenljiva vještina i koja se lako može naučiti. Ona predstavlja nešto u
svakom od nas što je pomalo nedodirljivo.
Inteligencija, osobnost i emocionalna inteligencija su različite kvalitete koje svi
posjedujemo.
Ljudi mogu biti inteligentni ali ne i emocionalno inteligentni isto kao što svi tipovi
osobnosti mogu imati visoku EQ i/ili IQ.
Od svih triju kvaliteta emocionalna inteligencija je jedina fleksibilna i može se
mijenjati.
Emocionalna inteligencija je produkt vašeg razumijevanja sebe i drugih tj. kako
prepoznati i nositi se s osjećajima drugih. Povećanje emocionalne inteligencije je
stvar reagiranja na emocije koje vas pomiču. Moć emocionalne inteligencije je
uvijek na vašoj stani.
Ključne riječi: emocionalna inteligencija, osobnost, inteligencija.
Sažetak 2.
Marija Malek, prvostupnica sestrinstva
Glavna sestra Klinike za urologiju, KBC Sestre milosrdnice, Zagreb
ULOGA INSTRUMENTARKE U ENDOSKOPSKIM ZAHVATIMA
Sažetak: Bitna razlika između endoskopskog i klasičnog, otvorenog načina
operiranja sastoji se u činjenici da u endoskopskom pristupu svi članovi
operacijskoga tima u potpunosti mogu pratiti operacijski zahvat na ekranu.
Medicinske sestre i tehničari prestaju time biti sudionici procesa koji samo
naslućuju, već istovremeno i vide cijeli proces. Ta činjenica koja predstavlja
neupitnu prednost pri izvođenju endoskopskih operacija u odnosu na klasične,
omogućuje da medicinska sestra može unaprijed predvidjeti i pripremiti instrument
koji će urolog trebati, a i brže će reagirati u slučaju komplikacija npr. krvarenja.
U endoskopskom postupku se koriste već svi od prije poznati instrumenti, ali
naravno preuređeni novim tehnologijama. Jedino je kukasta elektroda instrument
koji se nije upotrebljavao u klasičnim operacijama, a danas je nezamjenjiv u
laparoskopiji. Jedna od prednosti endoskopskih zahvata nad klasičnima je i manji
broj instrumenata.
Pojednostavljivanje i tehnička opremljenost prilikom endoskopskih zahvata
medicinskim sestrama i tehničarima uvelike olakšavaju postupak kod navlačenja
konaca i dodavanja tupfera, ali je koncentracija instrumentarke na ekranu kako
bi pripremila ili dodala odgovarajući instument, pridržala laparoskop ili neku
hvatalicu. Instrumentarka pomaže kirurgu pri uvlačenju instrumenata u troakar,
kontrolira ventile i prati tlak zraka u trbušnoj šupljini. Isto tako prati ono što liječnik
ne može, zaokupljen slikom na ekranu, primjerice ispadanje troakara, položaj
kablova i vodiča svjetlosti te cijevi za CO2, količinu CO2 u boci i fiziološke
otopine za ispiranje. O svemu tome mora imati stalni uvid kako bi mogla brzo
reagirati u slučaju komplikacija.
Iz svega navedenog, razvidno je da je konstantno osposobljavanje i praćenje
medicinske tehnike izrazito potrebno medicinskim sestrama i tehničarima kako bi
što uspješnije pridonijeli uspjehu endoskopskih operacija.
Sažetak 4.
Ivana Lovrić, Gorana Dujić
Klinička bolnica Split, Odjel za urologiju
“Zdravstvena njega bolesnika nakon radikalne prostatektomije”
Sažetak:
Cilj / svrha: Cilj istraživanja je analiza ranih poslijeoperacijskih komplikacija
nakon radikalne prostatektomije, te provođenje sestrinskih intervencija u
prijeoperacijskoj i poslijeoperacijskoj njezi bolesnika, u svrhu prepoznavanja i
smanjivanja ranih komplikacija.
Metoda: Analizirano je 114 povijesti bolesti bolesnika operiranih retropubičnom
radikalnom prostatektomijom na Odjelu za urologiju KBC- a Split, u razdoblju od
01.01.2010.-31.12.2011. godine.
Rezultati: Od ukupno 114 operiranih bolesnika, kod 5 je bila potrebna revizija
zbog krvarenja. Na dan operacije, 11 bolesnika je bilo sufebrilno, 49 ih je primalo
krv i 29 krvnu plazmu.
Zaključak: Nužno je na vrijeme prepoznati znakove ranih poslijeoperacijskih
komplikacija, kao visoki rizik za krvarenje i infekciju, te pravilno provođenje
sestrinskih intervencija. Potrebno je provoditi psihološku pripremu bolesnika i
metode edukacije.
Sažetak 5.
Marija Tkalac, Nada Strčić, Lidija Vitas
Klinika za urologiju, Klinički bolnički centar Rijeka
“Vanjske drenaže urina”
Uvod i cilj rada: Posljedica nekih uroloških bolesti je zastoj mokraće koji
može dovesti do proširenja kanalnog sustava bubrega, bubrežne nakapnice,
mokraćovoda, mokraćnog mjehura te oštećenja ili čak prestanka rada bubrega.
Uzroci opstrukcijske uropatije najčešće su kamenci, novotvorine, hipertrofija
prostate, suženja mokraćovoda i mokraćne cijevi te ozljede i infekcije uropoetskog
sustava. Cilj rada je uočiti potrebu i učestalost postupaka vanjske drenaže urina.
Pacijenti i metode rada: Analizirali smo sve postupke vanjske drenaže urina
tijekom 2012. godine. Prikazali smo mogućnosti drenaže na Klinici za urologiju,
KBC Rijeka, s obzirom na izbor potrošnog medicinskog materijala i naglasili
specifičnosti pri pojedinim drenažama s obzirom na kritične točke za razvoj
infekcije.
Rezultati: Tijekom 2012. godine na našoj Klinici učinjeno je 1.470 postupaka
kateterizacije mokraćnog mjehura trajnim kateterima, najčešće radi opstrukcijske
uropatije. Kateterizacija mokraćnog mjehura najčešći je oblik derivacije urina.
Suprapubična derivacija urina, postavljanjem perkutane cistostomije, provedena
je 20 puta i to uglavnom u bolesnika sa suženjem mokraćne cijevi, koja je kasnije
rješavana endoskopskom operacijom. Učinjeno je i 150 postupaka postavljanja
perkutane nefrostomije, najčešće u bolesnika s proširenjem kanalnog sustava
bubrega kao posljedice opstrukcije kamencem ili nešto rjeđe zbog opstrukcije
uzrokovane malignom bolešću. Kateterizacija mokraćnog mjehura je postupak
koji uobičajeno radimo u urološkoj ambulanti dok se postavljanje perkutane
nefrostomije i suprapubične cistostomije većinom provodi u hitnoći. Najčešća
komplikacija ovih postupaka je bila hematurija. Kod svih bolesnika poduzete su
adekvatne mjere kako bi se spriječio ulazak infekcije u mokraćni sustav. Posebna
pažnja u sprečavanju infekcije je usmjerena na sva konekcijska mjesta kao i na
mjesto ulaska drenaže u mokraćni sustav.
Zaključak: Vanjske derivacije urina su česti postupci u urologiji. Najčešće
se provode u terapijske svrhe radi rješavanja opstrukcije, a kako bi se stvorili
uvjeti za konačni oblik liječenja bolesnika. U određenog broja bolesnika, onima
s uznapredovalom malignom bolešću ili značajnim komorbiditetom, vanjska
drenaža urina predstavlja trajno rješenje.
Sažetak 6.
Ana Brežnij
Klinika za urologiju, Klinički bolnički centar Osijek
TEHNIKA INSTRUMENTIRANJA KOD OPERACIJE RADIKALNA
PROSTATEKTOMIJA
Sažetak:
Karcinom prostate je maligni tumor koji je relativno čest kod muškaraca starije
životne dobi. Često ostaje ograničen na prostatu, ali se može proširiti na limfne
čvorove i kosti. Najčešće nastaje tiho, bez simptoma. Kada se poteškoće pojave,
nalikuju dobroćudnom povećanju prostate.
Redovitim godišnjim skriningom muškaraca u dobi od 40 – 50 godina,
digitorektalnim pregledom i određivanjem vrijednosti PSA u krvi, moguće je rano
otkrivanje karcinoma prostate. Dodatno se može učiniti transrektalni ultrazvuk s
biopsijom oba režnja prostate.
Radikalna prostatektomija, metoda je liječenja bolesnika, kod kojih se odstranjuje
prostata, vezikule seminales i obturatorni limfni čvorovi.
Sažetak 7.
Božena Kopjar, dipl.med.techn.
Odjel urologije, Opća bolnica Varaždin
“TURP-prevencija i liječenje krvarenja”
Sažetak:
TURP je najčešća kirurško endoskopska metoda liječenja BHP. Ovim radom
želimo prikazati važnost pravovremenog reagiranja medicinske sestre kod peri i
postoperativnog krvarenja nakon TURP-a.
Sažetak 8.
Darija Vidović, ms
Klinika za urologiju, Klinički bolnički centar Zagreb
LASERSKA URETROTOMIJA
Sažetak: Laserska uretrotomija je endoskopsko liječenje strikture uretre pomoću
lasera, predstavlja veliki izazov urološkoj praksi. Nekoliko autora je prikazalo
obećavajuće rezultate liječenja uretrotomije pomoću lasera (Holmium laser).
Cilj ovog rada je prikazati naša iskustva o uretrotomijama pomoću diodnog HPD
lasera. Diodni laser ima prodor u tkivo između 1-4 mm, a za razliku od Holmium
lasera, ima stalan rad i apsorbira se na hemoglobinu, pa je manja mogućnost krvarenja.
Trajanje operativnog zahvata je 18 min., a prosječno vrijeme hospitalizacije 2 dana
(1-4 dana). Svi pacijenti imaju perioperativnu antibiotsku profilaxu (Ciprinol 200mg)
Postoperativna njega pacijenta sastoji se od pomoći pri obavljanju osobne higijene,
kontrole vitalnih znakova, boje i konzistencije urina i primjene analgetika, te
antibiotika. Nisu zabilježene intraoperativne i postoperativne komplikacije. Kateter se
vadi 3 tjedna nakon operacije.
Endoskopska laserska uretrotomija je siguran minimalno invazivan operativni zahvat.
Laserska uretrotomija radi se kod nas od listopada 2011. godine.
Sažetak 9.
Kristina Prelas, bacc. med.teh.; Slavka Vrbat, ms
Odjel kirurgije i urologije, Opća bolnica Šibenik
ZDRAVSTVENA NJEGA PACIJENTA S MOKRAĆNIM KAMENCIMA
(UROLITIJAZOM)
Sažetak: Tema ovog rada je jedna od najčešćih uroloških dijagnoza. Urolitijaza (stvaranje kamenaca u mokraćnom sustavu) češće pogađa muškarce nego žene, a sam
uzrok joj još uvijek nije do kraja razjašnjen. Dijagnoza se postavlja na temelju kliničke
slike, lab. nalaza i određenih dijagnostičkih pretraga (UZV, Rtg, IVU…). Ovisno
o smještaju i veličini kamenca, liječenje može biti konzervativno ili operativno.
Konzervativno liječenje je opravdano kod sitnih kamenaca u mokraćovodu (3-4
mm) kod kojih se očekuje spontano izbacivanje, dok se kod većih kamenaca pristupa
op. zahvatu - ureterorenoskopiji (URS). Kod većih kamenaca mokraćnog mjehura
radi se TUR litotripsija. Kod kamenaca bubrega do 2 cm veličine koristi se metoda
izvantjelesnog razbijanja kamenca (ESWL- Extracorporeal Shock Wave Lithotripsy),
a kod većih kamenaca bubrega radi se perkutana nefrolitotripsija. Iz gore navedenog
vidljivo je da je pristup odgovarajućoj metodi liječenja pojedinačan. Stoga je i
provođenje zdravstvene njege prilagođeno pojedincu. U ovom izlaganju cilj nam
je kroz pojedine primjere pokazati da je sestrinska skrb individualna, a sam proces
zdravstvene njege prilagođen bolesniku.
Sažetak 10.
Strčić Nada, Lukić Jelena, Vitas Lidija
Klinika za urologiju, Klinički bolnički centar Rijeka
“Transuretralna resekcija prostate u liječenju bolesnika sa benignom
hiperplazijom prostate”
Uvod i cilj rada: Benigna hiperplazija prostate (BPH) predstavlja stanje izazvano
umnažanjem žljezdanog tkiva prostate. Njezina učestalost raste s godinama.
Učestalo mokrenje, noćno mokrenje i nemogućnost mokrenja najčešći su simptomi
zbog kojih se bolesnici odlučuju za operaciju. Transuretralna resekcija prostate
(TURP) je minimalno invazivna operacija koja se savjetuje bolesnicima čiji je
volumen prostate do 80 ccm. Cilj rada je analiza uspješnosti TURP u bolesnika sa
BPH, uz poseban osvrt na ulogu sestre instrumentarke.
Pacijenti i metode rada: Analizirali smo sve bolesnike u kojih je tijekom
2012. godine učinjen TURP. Učinjena je statistička obrada dobivenih podataka
uz poseban naglasak na uočavanje specifičnosti rada sestre instrumentarke za
vrijeme TURP-a.
Rezultati: Tijekom 2012. godine u 86 bolesnika je učinjena resekcija prostate
zbog BPH. Kompletnu retenciju urina imalo je 57% bolesnika. Operirani su
bolesnici u dobi od 50 do 86 godina. Nakon operacije urinarni kateter je uspješno
odstranjen u 98% bolesnika. Poslijeoperacijski tijek bio je uredan u 84%
bolesnika. Najčešća poslijeoperacijska komplikacija je bila febrilitet (7 bolesnika
- 8%). U 4 bolesnika bilo je potrebno nadoknaditi krv, a 1 je bolesnik razvio
epididimitis. Operacijski, radi hematurije, revidiran je 1 bolesnik. U više od 50%
bolesnika duljina hospitalizacije bila je samo 5 dana. Uz BPH, 15 bolesnika imalo
je kamence u mokraćnom mjehuru. Komplikacija sa strane instrumentarija nije
bilo.
Zaključak: TURP je metoda liječenja bolesnika sa BPH sa visokim postotkom
uspješnosti. Komplikacije, koje nisu česte, ponekada su uzrokovane i
neodgovornim ponašanjem bolesnika. Angažiranost kompletnog tima djelatnika
kao i sam bolesnik bitno mogu doprinjeti smanjenju poslijeoperacijskih
Sažetak 11.
Antonija Garai Jakovljević, bacc.med.techn.,
Goran Valter, mt
Klinički bolnički centar Osijek, Klinika za urologiju
ZDRAVSTVENA NJEGA BOLESNIKA NAKON OPERACIJE TUMORA
TESTISA
Sažetak: Tumor testisa nastaje u spolnim žlijezdama muškaraca, sjemenicima
(testisima), koji se nalaze u mošnjama (skrotumu). Tumori testisa najčešće se
pojavljuju u mlađim dobnim skupinama, a uz pravodobnu dijagnostiku i adekvatnu
terapiju njihova izlječivost vrlo je visoka. Prema prikupljenim podatcima Klinike
za urologiju Osijek, broj mladih muškaraca oboljelih od tumora testisa posljednjih
se godina povećao za 100 posto. Prije rata godišnje je bilo do deset slučajeva
tumora testisa, a sada se penje i do 20 slučajeva.
U radu je prikazan sestrinski pristup u prepoznavanju i rješavanju problema iz
područja zdravstvene njege kod bolesnika nakon operacije tumora testisa.
Sažetak 12.
Karmen Kelam, prvostupnica sestrinstva
Klinički bolnički centar Split, Odjel za urologiju, Split
SESTRINSKA SKRB ZA BOLESNIKA S URINARNIM KATETEROM
Sažetak: Cilj rada je prikazati važnost i ulogu medicinske sestre u tretiranju i
skrbi bolesnika s urinarnim kateterom, kao i prikaz sestrinskih intervencija koje
se provode kako bi se prevenirale infekcije mokraćnog sustava.
Sestre uvode preko 50% svih katetera, te poslije provode zdravstvenu njegu i
skrbe o svemu što je vezano za kateter. Najveća pažnja se posvećuje prevenciji
urinarnih infekcija i od početka se stavlja naglasak na toaletu katetera i perianalne
regije. Veoma bitan je pristanak bolesnika kojega treba kateterizirati, a isto tako
se treba procijeniti potreba za kateterizacijom. Naime, kateteri se postavljaju
samo kada je to potrebno i klinički opravdano, a onda kada su neophodni, treba
provoditi pravovaljanu njegu, te voditi računa o vremenskom ograničenju za
promjenu katetera i drenažne opreme.
Sažetak 13.
Draženka Rob
Odsjek za urologiju, Županijska bolnica Čakovec
“Kvaliteta života bolesnika s nefrostomom”
Sažetak: Pacijenti kod koji postoji prepreka uretera ili uretre dolazi do narušavanja
otjecanja mokraće iz bubrega u mokraćni mjehur ali i iz mokraćnog mjehura zbog
različitih simptoma, te je jedno od rješenja postavljanje nefrostome ili drugih
urinskih drenaža, ovisno o mjestu zapreke i patologije. Postavljanje nefrostome
odnosno urinskih derivacija može biti privremeno ili trajno tj. doživotno. U radu
je predstavljena cjelokupna zdravstvena njega pacijenata kod derivacije urina i
nefrostome i pravilno postupanje s nefrostomom i urinskim vrećicama. Opisani
su najčešći zdravstveni postupci, intervencije medicinske sestre, edukacija
bolesnika i kućna njega kod derivacije urina, preoperativna i postoperativna
priprema i najčešće sestrinske dijagnoze, kao i postavljanje te priprema bolesnika
kod nefrostome u Županijskoj bolnici Čakovec te kvaliteta života bolesnika s
nefrostomom.
Ključne riječi: derivacija urina, nefrostoma, ileum conduit, ureterosigmoidostomija, kutana ureterostomija, cistostomija, kontinentni rezervoar ileuma
(Kock pouch), urinska vrećica, zdravstvena njega, edukacija, sestrinske
intervencije, sestrinske dijagnoze, kvaliteta života.
Sažetak 14.
Ivica Ražnjević, med.teh.
Odjel urologije, Opća bolnica Zadar
ESWL
E (extracorporeal) S (shock) W (wawe) L (lithotripsy) je neinvazivna metoda
liječenja bubrežnih i ureteralnih kamenaca kojom nastojimo razbiti bubrežne i
ureteralne kamence s učinkom minimalne kolateralne štete na pacijenta. Zahvat
se radi uz pomoć ultrazvučnih valova.
Aparat i metoda su razvijeni ranih 1980-ih godina u Njemačkoj.
Prvi ESWL aparat proizveo je «Dornier Medizintechnick GmBH» 1983. godine.
To je bio aparat HM3.
U roku od nekoliko godina, ESWL je postao standardni postupak za liječenje
bubrežnih kamenaca.
ESWL metoda je pokazala najbolje rezultate kod liječenja bubrežnih kamenaca i
kamenaca početnog dijela uretera veličine od 0.4-2.2 cm.
Postupak se smatra uspješnim ukoliko se kamenac uspije razbiti na manje
fragmente koje pacijent uz određenu tjelesnu aktivnost i obilnu hidraciju uspije
izmokriti kroz nekoliko dana.
ESWL je manje invazivna metoda liječenja bubrežnih i ureteralnih kamenaca
od ureterorenoskopije ili perkutane nephrolitotripsije, ali isto nije zahvat bez
rizika. Šok valovi svojim udarcem mogu izazvati oštećenja kapilara, bubrežnog
parenhima i subkapsularno krvarenje te nastanak hematoma koji za posljedicu
može imati i nastanak hipertenzije.
Komplikacije ESWL tretmana kreću se u rasponu od 5-20%.
Sažetak 15.
Suzana Klasić, bacc.med.techn., Ana Tomljanović, ms
Klinika za urologiju, Klinički bolnički centar Zagreb
TRANSURETRALNA LASERSKA INCIZIJA PROSTATE
Sažetak: TULIP je moderna, minimalno invazivna metoda liječenja BPH kod
koje se laserskom energijom uništava tj. vaporizira proširena prostata koja pritišće
uretru.
Lasersko zračenje je elektromagnetski val koji se širi brzinom svjetlosti u
zrakopraznom prostoru (vakumu).
Benigna hiperplazija prostate (BPH) dio je procesa starenja muškaraca i
hormonalno je ovisna o produkciji dihidrotestosterona.
Smatra se da 8% muškaraca oko 40-te godine ima BPH, 50% ih ima smetnje
mokrenja povezane uz BPH s 50 godina, a preko 80% muškaraca starijih od 80
godina imaju smetnje vezane uz BPH.
Cilj liječenja je olakšati simptome i poboljšati kvalitetu života bolesnika,
prevenirati komplikacije vezane uz BPH, smanjiti volumen povećane prostate i
relaksacija mišića.
Laser je jedan od temeljnih izuma koji obilježava doba moderne tehnologije,
međutim desetak puta je skuplji od opreme za TURP, koja je još uvijek “zlatna
standardna metoda” u kirurškom liječenju bolesnika sa adenomom prostate.
Sažetak 16.
Frau Helmi Henn,
Aufbereitung und Werterhalt von starren und flexiblen Endoskopen
Obrada i održavanje krutih i fleksibilnih endoskopa
Abstract:
Die korrekte hygienische Aufbereitung ist ein wichtiger Baustein im
Gesamtprozess des Operationsablaufes. Um eine Richtlinien konforme
Aufbereitung zu gewährleisten, müssen alle Hersteller von Medizinprodukten Instrumenten, Reinigungs - und Desinfektionsmittelhersteller sowie Hersteller
von Reinigungs - und Desinfektionsautomaten und Sterilisatoren-Hersteller - eng
zusammenarbeiten.
Eine grosse Herausforderung stellt auch die maschinelle Aufbereitbarkeit dar.
Dabei muss sichergestellt werden, dass die Medizinprodukte so an die Maschine
angeschlossen werden können, dass alle inneren und äusseren Flächen vom
Aufbereitungsmedium erreicht werden können. Ein weiterer wichtiger Faktor für die korrekte Aufbereitung ist eine sorgfältige
Einweisung des Aufbereitungspersonals, welche auch in Form einer
aussagekräftigen Gebrauchsanweisung durchgeführt werden kann. Schlussendlich spielt der Werterhalt im Aufbereitungsprozess eine wichtige
Rolle. Auch deshalb ist es wichtig, die Gebrauchsanweisung der MP-Hersteller
genauestens zu beachten, nur so können evtl. hohe Reparaturkosten, die durch
falsches Handling verursacht werden, vermieden.
Ispravna higijenska obrada je bitan element u kompletnom procesu operativnih
odvijanja / procedura.
Da bih se moglo garantirati konformnu higijensku obradu po smjernicama, moraju
svi proizvođači medicinskih proizvoda - proizvođači instrumenata, sredstva za
čišćenje i dezinfekciju, kao i proizvođači strojeva za čišćenje i dezinfekciju i
sterilizatora - surađivati.
Takoder je strojna obrada veliki zadatak. Treba biti osigurano da se medicinski
proizvodi mogu tako spojiti na stroj, da su sve unutrašnje i vanjske površine
dohvatljive od medija obrade.
Daljnji bitni faktor za ispravnu obradu je iscrpno educiranje osoblja koje vrši
procesuiranje, koje se također moze izvršiti u obliku detaljne i sadržajne upute za
upotrebu.
Napokon i održavanje (vrijednosti) igra veliku ulogu u procesu obrade.To je
daljnji razlog za precizno pridržavanje uputa za upotrebu proizvođača medicinskih
instrumenata.
Samo tako se mogu izbjeći eventualni visoki troškovi za reparaturu uzrokovani
pogrešnom upotrebom. Endourology today
INTERNATIONAL CONGRESS
HOTEL OLYMPIA / VODICE, ŠIBENIK, CROATIA
22-25 May 2014
www.endourology-today.com
Main topic:
LAPAROSCOPY IN UROLOGY
Live surgeries
Lectures by leading experts
Workshops
Symposium for nurses and technicians
HOTEL OLYMPIA
VODICE - CROATIA
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