These data indicate that IDO gene expression is a feature of aggressive NMIBC, suggesting a potential immunosuppressive role of IDO.

Bone morphogenetic proteins (BMPs) are members of the transforming growth factor-β (TGF-β) family and may play an important role in the regulation of malignant cells in bladder cancer. The aim of the present study was to investigate BMP expression in non-muscle invasive bladder cancer. Tumor tissue samples from 71 patients treated with transurethral resection and 10 samples of normal bladder tissue were stained using immunohistochemistry for BMP-2, -4, -6 and -7. The levels of BMP were correlated with the number and size of tumors in the bladder, the pathohistological findings as well as with tumor recurrence and progression. The results of the present study demonstrated that BMP-2 and -7 are highly expressed in normal bladder tissue, but significantly downregulated in cancer samples. This reduction correlates with a faster rate of tumor recurrence as well as with an increase in the number of recurrent tumors. There was no evident interrelation between BMP-2 and -7 reduction and changes in tumor grade and stage. In conclusion, BMP-2 and -7 are potential prognostic factors for tumor recurrence and further studies on BMP and bladder cancer are needed to confirm these results.

Sažetak. Benigna hiperplazija prostate (BPH) karakterizirana je umnažanjem žljezdanih i/ili stromalnih elemenata prostate. Ona može dovesti do uvećanja prostate i uzrokovati smetnje mokrenja donjeg dijela mokraćnog sustava (LUTS). Rast prostate ovisan je o dobi i utjecaju spolnih hormona, prvenstveno dihidrotestosterona. Simptomi se dijele na iritativne, opstruktivne i postmikcijske. U osnovnu obradu pacijenata spada anamneza, korištenje upitnika o smetnjama mokrenja, dnevnik mokrenja, fizikalni pregled, analiza urina, serumska koncentracija kreatinina i prostata specifičnog antigena, mikciometrija i mjerenje rezidualnog urina. Terapiju se odabire na osnovi smetnji koje pacijent ima i rezultata dijagnostičke obrade. Prvi korak u liječenju predstavljaju određene promjene u ponašanju i prehrani. U pacijenata s blagim smetnjama preporučuje se aktivno praćenje. U ostalih pacijenata započinje se s medikamentoznom terapijom. Mogućnosti medikamentozne terapije su mnogobrojne: blokatori alfa adrenergičkih receptora, inhibitori 5-alfa-reduktaze, antagonisti muskarinskih receptora, analog vazopresina -dezmopresin, agonisti beta-3 adrenergičkih receptora, inhibitori 5-fosfodiesteraze, fitoterapija i kombinirana terapija. U slučaju neuspjeha medikamentozne terapije ili prisutnosti komplikacija BPH-a preporučuje se kirurško liječenje.Ključne riječi: benigna hiperplazija prostate; medikamentozna terapija; simptomi donjeg mokraćnog sustava Abstract. Benign prostatic hyperplasia (BPH) is characterized with proliferation of glandular and stromal components of the prostate. BPH can produce prostate enlargement and caused lower urinary tract symptoms (LUTS). The growth of the prostate depends on patient's age and influence of sexual hormones, specially dihydrotestosterone. Symptoms can be divided as irritative, obstructive and postmicturation symptoms. The basic evaluation included medical history, symptom score questionnaire, bladder diary, physical examination, urinalysis, creatinine and prostate specific antigen serum concentration, uroflowmetry and postvoid residual urine. The modality of treatment depends about patients symptoms and results of diagnostic evaluation. The initial step in the treatment are behavioural and dietary modifications. In the patients with mild symptoms watchful waiting is first line treatment. In the other patients medicamentous treatment is recommended. Pharmacological management included: alpha adrenoreceptor antagonists, 5-alpha-reductase inhibitors, muscarin receptors antagonists, vasopressin analoguedesmopressin, beta-3 agonists, phosphodiesterase 5 inhibitors, phytotherapy and combination therapy. If the medicamentous therapy failed or the complications of BPH are present surgical treatment is recommended.

Sažetak. Nekada smo benignu hiperplaziju prostate smatrali glavnim uzrokom problema s mokrenjem kod muškaraca. Danas koristimo naziv simptomi donjeg urinarnog trakta jer se pokazalo kako je benigna hiperplazija prostate samo jedan od etioloških čimbenika. Kvalitetna dijagnostička obrada simptoma uputit će nas u pravom smjeru kako bismo mogli individualizirati terapiju. Za pacijente koji imaju indikaciju za kirurško liječenje danas postoji nekoliko operativnih tehnika. Otvorena jednostavna prostatektomija najstariji je i dokazano učinkoviti zahvat. Transuretralna resekcija prostate je zlatni standard liječenja. Laserska tehnologija danas stoji uz bok zlatnom standardu, a pojavile su se i tehnike minimalno invazivne kirurgije koje pružaju prednosti niskog morbiditeta i kratkotrajne hospitalizacije.Ključne riječi: minimalno invazivna kirurgija; povećanje prostate; prostatektomija; transuretralna resekcija prostate Abstract. Benign prostatic hyperplasia was once considered the main reason for urinary symptoms in male patients. Today we are aware that many etiological factors cause these symptoms so a new term was coined: lower urinary tract symptoms. An adequate diagnostic work up will lead us onto the right path of individualized treatment for each patient. Those in need of surgery have various surgical procedures at their disposal. Open simple prostatectomy is the oldest procedure that has proven its efficacy. Transurethral resection of prostate is the current gold standard. Laser techniques are challenging the gold standard while minimally invasive surgical procedures offer all the benefits of low morbidity and short hospital stay.

Patients with non-metastatic, stage T3 clear-cell renal cell cancer present a clinical challenge for urologists. The extent of tumor thrombus in inferior vena cava is the primary determinant of surgical procedure complexity. Level III and IV thrombi require the use of cardiopulmonary bypass and hypothermic arrest. Careful preoperative planning and a multidisciplinary approach are mandatory. In this paper, we report outcomes of 12 patients who were surgically treated in our center. The 29 months overall survival for all patients was 69%, while three patients died during follow-up. Of nine surviving patients, six are currently disease-free, whereas three had disease progression. Our study showed that carefully selected patients with clear-cell renal cell carcinoma with inferior vena cava tumor thrombus level III and IV could be successfully treated with an aggressive surgical approach.

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