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. - - 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 - - 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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